Family planning has widespread positive impacts for population health and well-being; contraceptive use not only decreases unintended pregnancies and reduces infant and maternal mortality and morbidity, but it is critical to the achievement of Millennium Development Goals. This study uses baseline, representative data from six cities in Uttar Pradesh, India to examine family planning use among the urban poor. Data were collected from about 3,000 currently married women in each city (Allahabad, Agra, Varanasi, Aligarh, Gorakhpur, and Moradabad) for a total sample size of 17,643 women. Participating women were asked about their fertility desires, family planning use, and reproductive health. The survey over-sampled slum residents; this permits in-depth analyses of the urban poor and their family planning use behaviors. Bivariate and multivariate analyses are used to examine the role of wealth and education on family planning use and unmet need for family planning. Across all of the cities, about 50% of women report modern method use. Women in slum areas generally report less family planning use and among those women who use, slum women are more likely to be sterilized than to use other methods, including condoms and hormonal methods. Across all cities, there is a higher unmet need for family planning to limit childbearing than for spacing births. Poorer women are more likely to have an unmet need than richer women in both the slum and non-slum samples; this effect is attenuated when education is included in the analysis. Programs seeking to target the urban poor in Uttar Pradesh and elsewhere in India may be better served to identify the less educated women and target these women with appropriate family planning messages and methods that meet their current and future fertility desire needs.
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While not all women (including currently pregnant women) with an unmet need will use family planning if available,19 unmet need serves as a programmatic indicator of who could be targeted with family planning methods and services.
In some calculations of unmet need, women who are not using FP and are unsure of future childbearing or unsure of the timing of future childbearing are considered to have an unmet need; in this analysis, these women are not considered to have an unmet need since their fertility intentions are not firm. In addition, some calculations consider amenorrhoeic women who report their last pregnancy as mistimed or unwanted and are not using FP to have an unmet need for FP; we examine these women’s current intentions and FP use and classify them accordingly rather than incorporating their last pregnancy intentions in the calculation. Differences in unmet need estimates including the above referenced women as having an unmet need would lead to greater unmet need by 0.0–0.4% across the cities.
In non-slum models that removed education in these two cities, wealth remained non-significant and likewise for models that removed wealth, education remained non-significant (not shown). Thus, it is not thought that multicollinearity is affecting these findings.
Montgomery MR. Urban poverty and health in developing countries. Popul Bull. 2009;64(2).
United Nations. 2009 Revision of World Urbanization Prospects. New York, NY: United Nations; 2010.
Panel on Urban Population Dynamics. In Montgomery MR, Stren R, Cohen B, Reed HE, eds. Cities Transformed: Demographic Change and its Implications in the Developing World. Washington, DC: National Academies Press; 2003.
Matthews Z, Channon A, Neal S, Osrin D, Madise N, Stones W. Examining the “urban advantage” in maternal health care in developing countries. PLoS Med. 2010;7(9).
Vlahov D, Galea S, Freudenberg N. The urban health “advantage.” J Urban Health. 2005;82(1):1-4.
Ezeh AC, Kodzi I, Emina J. Reaching the urban poor with family planning services. Stud Fam Plann. 2010;41(2):109-116.
Hogan MC, Foreman KJ, Naghavi M, et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet. 2010;375(9726):1609-1623.
Cates W Jr. Family planning: the essential link to achieving all eight Millennium Development Goals. Contraception. 2010;81(6):460-461.
Census of India 2001. Metadata and Brief Highlights on Slum Population. http://censusindia.gov.in/Data_Products/Data_Highlights/Data_Highlights_link/metadata_highlights.pdf. Accessed September 11, 2009.
Hazarika I. Women’s reproductive health in slum populations in India: evidence from NFHS-3. J Urban Health. 2010;87(2):264-277.
Office of the Registrar General and Census Commissioner (India). India Population and Housing Census 2001. New Delhi, India: Office of the Registrar General and Census Commissioner (India); 2006.
International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey (NFHS-3), 2005–06: India, Volume I. Mumbai, India: IIPS; 2007.
Ministry of Health and Family Welfare (Government of India). State of Urban Health in Uttar Pradesh. http://uhrc.in/module-ContentExpress-display-ceid-84.html. Accessed January 2, 2011.
Planning commission (Government of India). Poverty estimates for 2004–05. http://www.planningcommission.gov.in/news/prmar07.pdf. Accessed January 2, 2011.
Urban Health Resource Centre (UHRC). Key Indicators for Urban Poor in Uttar Pradesh from NFHS-3 and NFHS-2. http://uhrc.in/downloads/Factsheet-UP.pdf. Accessed November 15, 2011.
Census of India, 2001. Population by religious communities. Available at: http://www.censusindia.gov.in/Census_Data_2001/Census_data_finder/C_Series/Population_by_religious_communities.htm. Accessed November 15, 2011.
Nanda P, Achyut P, Mishra A, Calhoun L. Measurement, Learning and Evaluation of the Urban Health Initiative: Uttar Pradesh, India, Baseline Survey 2010 [TWP-3-2011]. Chapel Hill, NC: Measurement, Learning & Evaluation Project; 2011. http://www.urbanreproductivehealth.org/sites/default/files/MLE_TWP_%20INDIA_2011_7Oct_nh.pdf. Accessed November 15, 2011.
Agarwal S, Bhanot A, Goindi G. Understanding and addressing childhood immunization coverage in urban slums. Indian Pediatr. 2005;42:653-663.
Pritchett LH. Desired fertility and the impact of population policies. Popul Dev Rev. 1994;20(1):1-55.
Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115-132.
Montgomery MR, Hewett PC. Urban poverty and health in developing countries: Household and neighborhood effects. Demography. 2005;42(3):397-425.
National Institute of Population Research and Training (NIPORT) MaA, and Macro International. Bangladesh Demographic and Health Survey 2007. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and Training, Mitra and Associates, and Macro International; 2009.
This project was approved by the Futures Group India Institutional Review Board (in-country approval) as well as by the Institutional Review Boards at The University of North Carolina at Chapel Hill and the International Center for Research on Women (ICRW). Funding for this project comes from the Bill & Melinda Gates Foundation. The authors would like to thank Lisa Calhoun for her helpful insights into this paper.
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Speizer, I.S., Nanda, P., Achyut, P. et al. Family Planning Use among Urban Poor Women from Six Cities of Uttar Pradesh, India. J Urban Health 89, 639–658 (2012). https://doi.org/10.1007/s11524-011-9667-1
- Uttar Pradesh
- Family planning
- Unmet need
- Urban poor