Page | 1 Evaluation of family planning services in Uttar Pradesh- findings from a recent household survey carried out under Track20 project By Jay PRAKASH Extended Abstract Over the years, fertility has been declining in India and across all the states along with increase in two of the proximate determinants - use of contraception and age at marriage. The states have shown mixed responses in both the two indicators. Recent surveys (DLHS4/AHS3) carried out in the country shows that CPR has declined in about 16 states at varying pace from 2007-08 (DLHS 3) to 2012-13 (DLHS4/ AHS3). This decline is seen mostly in some of the good performing states such as Chandigarh, AP, A&N Islands, Karnataka, Punjab, etc. Even low performing states like Manipur, Meghalaya and Goa have also shown decline in CPR. There is an urgent need to address these issues in states with low performing and declining CPR. The unmet need has also increased in such type of states. In addition, there is high proportion of women in almost all the states with two children who do not want any additional child (DLHS 4). Addressing the need of such women may lead to better coverage of the family planning performance and bring further decline in fertility of the country. With the increased number in institutional birth, there is an opportunity to motivate women to adopt post-partum spacing (PPIUCD) and limiting methods (PPS). Also with increased schooling and age at marriage, it is expected that more people will adopt family planning method and soon fertility may further decline in high fertility states. In order to track the progress made under the FP program initiatives, regular (periodical) data on FP indicators is necessary. Service statistics provide some, but not all, of the data needed to measure the priority FP2020 indicators. However, service statistics data need to be supplemented with other data. One particularly promising source of data is continuing surveys at some intervals. If relevant indicators are captured through some surveys at an acceptable cost, such surveys may provide an ideal source for many of the indicators for which service statistics are not a feasible option. Page | 1 The Present Study Keeping in view the data limitations for assessment of the current level of program performance, a study was designed in 10 districts of Uttar Pradesh with the view to have an estimate of key FP indicators at the state level. Also, it was decided to design the study in such a way so that reliable district level estimates can be obtained. The study was executed by Track20 project of Avenir Health, USA, funded by Bill & Melinda Gates Foundation for the execuition of study. The study has been carried out with the following objectives: 1. Assess the current use of contraceptives among the eligible population; 2. Level of reach for FP services under the new program initiatives; 3. Identification of barriers, which prevent the couples in adoption and continuation of methods; 4. Unmet need for modern contraceptive methods addressed. In addition, the study also makes comparison of results with other surveys such as AHS/ DLHS. Methodology The proposed rapid assessment study of FP program has been designed to provide estimate of CPR and other key indicators in Uttar Pradesh based on 10 selected districts of Uttar Pradesh spread across different zones in the state. For this purpose, a statistical household survey was carried out among the reproductive age couple. Sample size and sampling design To obtain minimum sample size for the rapid assessment survey, the information on level of indicator to be estimated, permissible error, confidence intervals and the design effect are required. The state level CPR was used for estimation of sample size. Considering a prevalence of 50 per cent for CPR (conservative estimate) with 5 per cent of tolerance limit and at 95 per cent of confidence interval, a sample of 384 households is needed. Using a design effect of 1.5, minimum sample required is estimated as 580 households with an eligible couple. Therefore, sample size of 600 (rounding up) currently married women was decided for each of the selected 10 districts. In each selected district, the entire sample was sub-divided into rural and urban household as per the proportion of population in two segments. From each selected district, a representative sample was obtained using probability proportionate to size (PPS) method. A two stage sampling procedure was adopted. At first stage, 30 clusters from rural and urban areas in the ratio of 21:9 were selected using Census of India 2011 data with probability proportionate to size (PPS) method from each district. Page | 2 At second stage, approximately 20 households with at least one eligible couple were selected in each village or urban ward constituting the cluster. From each selected household, only one currently married woman in the age group 15-49 years was interviewed. Data collection Tools Keeping in view objectives of the assessment, a short interview format was developed which was administered among the eligible respondent. The key themes in the questionnaire include: a. Socio-demographic profile b. Awareness of FP schemes c. Past use of contraceptive methods, duration of use and reasons for discontinuation d. Current use of contraceptives – method wise, duration of use e. Knowledge about sources of availability of methods f. Interaction with peripferal level health workers g. Reasons of non-use of contraceptives h. Unmet need for family planning methods Coverage In order to obtain state level estimate, the study was conducted in following 10 districts: Sl. No. Name of District Sl. No. Name of District 1 Sitapur 6 Gorakhpur 2 Varanasi 7 Etah 3 Banda 8 Ghaziabad 4 Lalitpur 9 Bareilly 5 Bahraich 10 Kanpur Dehat I. Background Characteristics A total of 6012 households were sampled and one currently married woman in the reproductive age group was interviewed from each selected household. As per the sampling plan, approximately 600 households were selected from each district. Age distribution Page | 3 Age distribution data show that 73% women were below the age 35 years and remaining 27% were more than 35 years. Only 1.5% women were adolescents in the sample. The average age of respondents was 31.3 years. The age distribution of women across districts was almost similar which is good for comparison of results across the districts. Age at first marriage Generally the respondents were married when they were in the age group of 15-20 years (81%) but 9% were married before 15 years of age. Only 10% were married after 20 years of age. The average age at marriage in UP was 17.3 years. However, more women got married before 15 years of age in Sitapur (16%) and Bareilly (12%) whereas this proportion was lower in Ghaziabad (5.8%) and Banda (6.2%). Education Education level data show that 46% of women across 10 districts were illiterate with a higher proportion in the districts of Sitapur (57%), Bahraich (61%) and Bareilly (65%). Only 9% of respondents across the districts had studied upto graduate level and above. As per the Census 2011, the proportion of females who are illiterate in the age group of 15-49 years is 44 percent. This information matches with the sample of women in the present study. Thus the sample may be considered representative of the state. Residence Nearly 70% of respondents were from rural area and 30% from urban area across the districts. Caste Caste wise information show that 46% respondents belonged to OBC, 20% to Scheduled Caste, 18% to general category and 1% to Scheduled Tribe. OBC were less in Sitapur (22%) and higher in Etah (65%) whereas ST were higher in Varanasi (7%). General category was more in Lalitpur (22%) and Ghaziabad (26%). The proportion of Scheduled Caste population in the state of UP is 20.7 percent as per Census 2011 which matches with the proportion in the sample. However, the proportion of Scheduled Tribe population (1.4%) in the sample is slightly at higher side than the state average (0.6%). Religion The Hindu-Muslim proportion in the sample is slightly distorted as compared to the Census population figures. In the sample, most of the respondents belonged to Hindu religion (85%) and 15% were Muslim. However, as per the Census 2011, there are 80 percent Hindus and 19 percent Muslims. Occupation Nearly 96% of women were housewives whereas 1.6% were in farming or agriculture (higher in Sitapur-9%) and 1% each were doing Government /private job and daily wage labour. Page | 4 II. Pregay ad Child Birth Pregnancy Outcome Nearly 94% respondents reported to have given birth at the time of survey. The age at first pregnancy was 19-21 years for 49% of respondents, below 19 years for 31% and 22 years or more for 20% of the respondents. Number of boys born alive was reported as one by 43%, 2 by 35%, 3-4 by 19% and only 3% reported 5 or more boys. Number of girls born alive was reported as one by 44%, 2 by 29%, 3-4 by 23% and 4% reported 5 or more girls. Number of surviving boys was reported as one by 47%, 2 by 36%, 3-4 by 15% and only 2% reported 5 or more boys. Number of surviving girls was reported as one by 48%, 2 by 29%, 3-4 by 20% and 3% reported 5 or more surviving girls. The total number of surviving children was reported as one by 17%, 2 by 27%, 3-4 by 40% and 5 and above by 16% of respondents. Antenatal care and place of delivery The responses of currently married women by antenatal care received, outcome of last pregnancy and place of delivery, are presented in Table 3.2.