A district level investigation of family planning program in rural India: Stagnant or progressive?

Decentralized district-based health planning is essential in India because of large inter-district variations. Presently, there are 640 districts in India with an average population of two million per district. There is a need for studying the performance of family planning programs at district level. Current paper aims to explore the district-level differences in the use of modern family planning methods (mCPR) in rural areas, changes in contraceptive usage over time, and the association between changes and macro-level socio-demographic characteristics. Current paper uses data from the third round of District Level Household Survey conducted in 2007–08 (DLHS-3) and the latest round of National Family Health Survey conducted in 2015–16 (NFHS-4). The sample size for representing a district varies from 1000 to 1500 households in DLHS-3 and 836 to 1800 households in NFHS-4. Out of the total 640 districts as per Census 2011, the 506 districts which have common geographical boundary in DLHS-3 and NFHS-4 have been considered for analysis. Results show a wide variation in mCPR at district level in India. Only 91out of 506 districts have more than 64% mCPR, majority being from Andhra Pradesh, Haryana, Maharashtra, and Punjab. Six out of 10 districts have CPR below 50% and majority of them being from central, north-eastern, and eastern regions of India. Since 2007–08, there has been significant decline in them CPR among half of the districts (256/506), majority decline being in the southern and western regions of India. Only in 69 districts mCPR increased by more than 10 percentage points from 2007–08 to 2015–16. At the same time, it declined by more than 5 percentage points in onethird of the districts. Findings reveal that marginal changes in female literacy, child marriage, unmet need for spacing family planning methods, antenatal care and institutional delivery have no impact on mCPR over time, but significant changes in these contextual factors of more than 10 percentage points increase/decrease have greater impact on the mCPR decline/increase. Study suggests that policymakers and programme managers need to reconsider district specific strategies to address the barriers in the use of contraceptives in rural India to achieve family planning 2020 goals