Understanding NFHS-5: Analyzing Data on Modern Contraceptive Use among Married Tribal Women
Introduction:
In this detailed article, we will delve into the key findings and analysis of the National Family Health Survey-5 (NFHS-5) which provides valuable insights into modern contraceptive use among married tribal women in India. We will explore the methodology used in the survey, the study population and sample size, the outcome variables, explanatory variables, and the types of modern contraceptive methods used. Additionally, we will discuss the reasons for not using contraceptives, the statistical analysis conducted, and the ethical considerations involved in the study.
I. Data Summary:
The NFHS-5 survey, conducted between 2019 and 2021, is a comprehensive source of information on various health-related aspects. It covers data on household populations, housing characteristics, sociodemographic and economic characteristics of respondents, reproductive health, maternal and child health, nutrition, morbidity, and intrafamily violence at the national, state, and district levels. The survey was administered by the International Institute of Population Sciences (IIPS), Mumbai, under the Ministry of Health and Family Welfare (MoHFW). The fieldwork was conducted in two phases, covering a total of 28 states and union territories, resulting in a vast dataset collected from 636,699 households, 724,115 women, and 101,839 men.
II. Study Population and Sample Size:
For the purpose of this study, a total of 91,976 married tribal women aged 15-49 years were included for analysis. The selection criteria and a detailed derivation of the sample are illustrated in Figure 1. This subgroup of women provides valuable insights into the prevalence and determinants of modern contraceptive use specifically among tribal communities.
III. Outcome Variable:
The NFHS-5 survey collected individual-level data through questionnaires, capturing various personal details. For this study, participants were asked about the type of contraceptive method they used. The survey categorized contraceptive methods into “modern” and “non-modern” methods. The modern contraceptive methods included pills, injectables, intrauterine devices (IUDs), condoms, and male and female sterilization. By identifying the prevalence of modern contraceptive methods among different sociodemographic attributes, the study aimed to understand the factors influencing their use.
IV. Explanatory Variables:
To understand the factors associated with modern contraceptive use, the study incorporated a range of independent variables. These variables were derived from previous literature and included sociodemographic factors such as age, religion, place of residence, education, occupation, household wealth, age at menarche, media exposure, and parity. In addition, behavioral factors such as cigarette/tobacco smoking were also considered. The study analyzed the relationship between these variables and modern contraceptive use.
A. Individual Characteristics:
The study categorized women based on their sociodemographic attributes such as age, religion, place of residence, education, occupation, household wealth, age at menarche, media exposure, and parity. These variables were key determinants in understanding the patterns and factors influencing modern contraceptive use among tribal women.
B. Types of Modern Contraceptive Method and Sources of Information:
The study classified modern contraceptive methods into short-acting reversible contraception (pills, injectables, and condoms) and long-acting reversible contraception (IUDs). It also considered permanent methods of birth control, including female and male sterilization. Additionally, the sources of information on family planning were analyzed, including government health facilities/staff, private health facilities/individuals, partners, friends/relatives, and other sources.
C. Reasons for Not Using Contraceptives:
The study explored the reasons behind the non-use of contraceptives among married tribal women. The reasons were categorized into four groups: fertility-related, opposition to use, lack of knowledge, and method-related factors. Understanding these reasons would shed light on the barriers and challenges faced by women in accessing and utilizing modern contraceptive methods.
V. Statistical Analysis:
The data collected from the NFHS-5 survey was analyzed using STATA version 17.0, Microsoft Office, and Q GIS for heat maps. Descriptive statistics were employed to report the frequency and proportions of participants’ sociodemographic characteristics and modern contraceptive use. Binary logistic regression was conducted to examine the relationship between different participant characteristics and modern contraceptive use. Variables that showed statistical significance were included in the multivariate logistic regression model to determine the adjusted odds ratio (AOR) and 95% confidence interval (CI) of modern contraceptive use. The regression model also checked for multicollinearity using the Variation Inflation Factor (VIF), and sampling weights were applied to account for the survey’s design.
VI. Ethical Considerations:
The study utilized secondary data obtained from the NFHS-5 survey, ensuring the anonymity and privacy of participants. As no personal identifiers were used, the study presented no risks to the participants. Prior permission was obtained from the appropriate authorities, and proper recognition and referencing of the data sources were ensured.
An engaging additional piece:
Understanding and Addressing Barriers to Modern Contraceptive Use: Implications for Health Programs
Modern contraceptive use plays a crucial role in improving reproductive health outcomes and empowering women to make informed choices about their family planning needs. The NFHS-5 study provides valuable insights into the prevalence, determinants, and challenges associated with modern contraceptive use among married tribal women. By expanding our understanding of these factors, policymakers, health practitioners, and researchers can work towards designing targeted interventions and programs to promote and increase modern contraceptive use in tribal communities.
Tribal populations in India face unique sociocultural and geographical challenges that influence their access to and utilization of modern contraceptives. Factors such as limited education, socioeconomic disparities, cultural beliefs and practices, and inadequate healthcare infrastructure contribute to the low prevalence of modern contraceptive use in these communities. Understanding these barriers is essential for developing context-specific interventions that address the needs and preferences of tribal women.
To overcome these challenges, health programs should focus on the following strategies:
1. Community Engagement and Awareness: Collaborating with community leaders, tribal elders, and local influencers can help dispel myths and misconceptions surrounding modern contraceptives. Community-based programs that emphasize the benefits of family planning, address cultural concerns, and utilize local language and communication channels can effectively raise awareness and promote positive attitudes towards modern contraceptive use.
2. Strengthening Healthcare Infrastructure: Improving access to quality healthcare services, especially in remote and underserved tribal areas, is crucial. This includes establishing well-equipped health facilities and training healthcare providers to deliver comprehensive family planning services. Mobile health clinics can also be utilized to reach remote tribal communities and provide contraceptive counseling and services.
3. Tailored Information and Counseling: Recognizing the diverse needs and preferences of tribal women, information and counseling sessions should be tailored to address their specific sociocultural contexts. This can be achieved through culturally sensitive educational materials, community dialogues, and one-on-one counseling sessions that address concerns related to family planning, reproductive health, and contraceptive methods.
4. Men’s Involvement: Engaging men as active partners in family planning decisions is vital for creating a supportive environment. Men’s participation in educational sessions, couple counseling, and community discussions can help break down gender barriers and ensure shared decision-making regarding contraceptive use.
5. Empowerment and Education: Improving educational opportunities for tribal women can significantly impact their empowerment and decision-making abilities related to family planning. Providing functional literacy programs, vocational training, and economic empowerment initiatives can enhance women’s agency and create an enabling environment for modern contraceptive use.
6. Enhanced Service Delivery: Ensuring a reliable supply of quality contraceptives at affordable prices is essential. Health programs should work towards strengthening supply chains, reducing stockouts, and offering a wide range of contraceptive methods to cater to individual preferences and needs. Regular monitoring and evaluation
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data summary
We used the National Family Health Survey-5 (2019-2021) for analysis, which provides vital information and statistics on household populations, housing characteristics, basic sociodemographic and economic characteristics of respondents, reproductive mortality , maternal, child and children, nutrition, morbidity as well as adult health problems and intrafamily violence at the national, state and district level. NFHS was run by the Ministry of Health and Family Welfare (MoHFW) and administered by the International Institute of Population Sciences (IIPS), Mumbai. The NFHS-5 fieldwork for India has been carried out in two phases. Phase I from June 17, 2019 to January 30, 2020 covering 17 states and 5 UTs and Phase II from January 2, 2020 to April 30, 2021 covering 11 states and 3 UTs and data collected from 636,699 households , 724,115 women and 101,839 men [11].
Study population and sample size
In the present study, a total of 91,976 married tribal women aged 15-49 years who were interviewed on an individual schedule were included for analysis. [16]the detailed derivation of the sample has been given in Fig. 1.
Selection criteria of the study population
outcome variable
The Individual questionnaire was administered by field staff to capture various personal data. Participants were asked what type of contraceptive method they use, participants who answered “Pill”, “Injectables”, “IUD”, “Condoms” and “sterilization (both male and female)” where it was defined as the “modern contraceptive method ” to find out the prevalence of the modern contraceptive method in different sociodemographic attributes.
explanatory variables
individual characteristics
Independent variables were included by pooling previous pieces of literature. The independent variables included were sociodemographic factors (age, religion, place of residence, education, occupation, level of household wealth, age at menarche, media exposure, and parity); and behavioral factors (cigarette/tobacco smoking).
In this study, the self-reported age of the women was grouped into the following age groups: “15–19 years”, “20–24 years”, “25–29 years”, “30–34 years”, “35 – 39 years”, “40–44 years” and “45–49 years”. Religion was classified as “Hindu”, “Muslim”, “Christian” and Sikh, Buddhist/Neo-Buddhist, Jain, Jewish, Parsi/Zoroastrian, no religion was classified as “other”. The residence of the study participants was defined as “Rural” and “Urban”. The educational level was classified as “Without formal education” (those who never attended school), “Primary” (up to 5he grade), “Secondary” (up to grade 10), and “Superior” (above secondary level). The occupation was categorized as “Working” and “Not working”. In this study, household wealth status was grouped as “Poorest” and “Poorest”, “Medium” and “Richest” and “Richest”.
The participant’s parity was categorized according to the number of children she has and labeled as “nulliparity”, “Primiparity”, “Multiparity”, and “Great multiparity”. The frequency of media exposure variable was created using three variables such as “frequency of exposure to social networks”, “frequency of exposure to television”, and “frequency of exposure to radio” coded as “none”, “less at once”. a week” and “at least once a week”. Tobacco use was categorized as “Yes” and “No”.
Type of modern contraceptive method and source of information on family planning
“Short-acting reversible contraception” this includes Pill, injectables and condoms, “Long-acting reversible contraception”: IUD and permanent method of birth control includes female sterilization and male sterilization Family planning information sources are Govt. health facility/staff, private health facility/individuals, partner, friend/relative, and other sources.
Reasons not to use contraceptives
In this study participants were asked why they are not using modern contraception, responses were categorized as (1) Fertility Related: This includes “Infrequent Sex, No Sex”, “Menopause, Hysterectomy”, “Subfertility”, “in -fertile”, “Lactation/postpartum amenorrhea”. (2) Opposition to use: Consisted of “Opposition of the defendant”, “Opposition of the husband”, “Opposition of others” and “Prohibited religion”. (3) Lack of knowledge: “Don’t know the method”, “Don’t know the source/lack of access” (4) Related to the method: “Health concerns”, “Fear of side effects”, “It costs too much” , “Interferes with body” “Inconvenient to use” and “I don’t like the existing method”.
statistic analysis
Data was analyzed using STATA version 17.0 (STATA Corp., Texas), Microsoft Office, and Q GIS for heat maps. Descriptive statistics were used to report the frequency and proportions of participants’ sociodemographic characteristics and modern contraceptive use. To examine the relationship between different participant characteristics and modern contraceptive use, binary logistic regression was performed. Statistically significant variables (p < 0.05) from the unadjusted model were used to run multivariate logistic regression to examine the association between modern contraceptive use and various correlates, which was expressed as an adjusted odds ratio (AOR) with a confidence interval of 95%. (CI). The Variation Inflation Factor (VIF) was verified in the regression model to detect multicollinearity between the explanatory variables. Sampling weights were taken into account during the analysis for both descriptive and regression models.
ethical considerations
This study is based on unnamed secondary data obtained from NFHS 5 with no personal identifiers and therefore no risk to participants. The data was requested from the DHS (Demographic Health Survey) through the appropriate channel and the corresponding permission was taken. They have been duly recognized and referenced where necessary.
https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-023-02454-5
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