Identifying and prioritizing determinants of Intra-uterine contraceptive device (IUCD) use in India

Background

Contraceptive prevalence in India is mediocre, with only 56% of married women practicing any form of birth control. Barriers such as lack of knowledge and provider bias have been shown to be impediments in improving use. Since 2008, PSI-India has conducted an integrated behavior change program to improve the use of IUCDs.

Objectives

To determine contraceptive prevalence in study areas, identify determinants of use of IUCDs and to prioritize determinants for communication campaign.

Methods

6000 randomly selected women aged 20-34 residing in urban areas of 10 districts in Rajasthan, Delhi and Uttar Pradesh were interviewed. Determinants related to behaviour were classified according to opportunity, ability and motivation framework. Behavioral determinants were measured using multi-item scales. Step-wise multivariate logistic regression was used to identify the predictors of IUCD use.

Results

Overall current use of IUD was 3%. To identify the most likely segment, women with unmet need were further divided into those with intention to use any method in the future. On analysis, knowledge, beliefs, and perceived attributes were significantly associated with use. Of these, programme prioritized knowledge indicators based on Odds Ratio and SWOT analysis:

„X IUD is as effective as sterilization (OR = 2.31), and „X Side-effects subside within 3-4 months (OR = 2.63)

Programme Implications

Based on the results, the communication team used IUD as effective as sterilization as the key message for the behaviour change campaign that had a significant impact on women.