Use of a spacing method before sterilization amoung couples in Kerala, India

Context: Many couples in India never use a reversible method to delay or space births, and in-stead adopt sterilization as their first and only method. Little is known about the factors that dis-tinguish sterilized couples who have used spacing methods from those who go directly to usinga permanent method.Methods: Data on 2,029 ever-married women protected by sterilization are taken from the partof the 1992-1993 Indian National Family Health Survey that was conducted in the state of Ker-ala. Multivariate logistic regression techniques are used to assess the socioeconomic, demo-graphic and behavioral characteristics that determine prior temporary method use among ster-ilized couples.Results: Once all significant variables are controlled for, higher educational attainment (of ei-ther partner) independently increases the likelihood that a couple will have used a method todelay or space births, as does middle socioeconomic status. That likelihood is also significant-ly higher among respondents who experienced an abortion, among Christian women and amongthose who were older than age 25 when either they or their partner were sterilized. However,the likelihood of temporary method use before sterilization is significantly reduced among re-spondents who preferred shorter birth intervals and among relatively older women (age 31 andolder). The median interval between the first and second children born to sterilized couples whohad ever used a reversible method was longer than that among children born to couples whohad relied only on sterilization (32 months vs. 26 months).Conclusions: In Kerala, both small family size ideals and a desire to shorten the period of ex-posure to the risk of pregnancy might explain the tendency for couples to go directly to steril-ization at a relatively young age and bypass temporary method use altogether. An approachthat emphasizes clients' choice of methods and high-quality services that cater to their needswould enhance the use of methods to space birth