BASELINE SURVEY REPORT

AGRA CITY

March, 2011

Chapter 1 INTRODUCTION

1.1 BACKGROUND

Family planning (FP) is essential to achieving the Millennium Development Goals

(Cleland et al., 2006; Potts and Fotso, 2007; Allen, 2007)1. While FP programs had

considerable impact on increasing voluntary FP use and reducing fertility in many parts

of the world in the 1970s-1990s, they have received less attention at the global level in

recent years even as contraceptive use remains low in much of Sub Saharan Africa (SSA)

and parts of South Asia despite high levels of unmet need (Cleland et al., 2006). The Bill

and Melinda Gates Foundation (BMGF, also referred to as the ―Foundation‖)

Reproductive Health (RH) Strategy aims to reduce maternal and infant mortality and

unintended pregnancy in the developing world by increasing access to high-quality,

voluntary FP services. The RH Strategy will be implemented at the country level through

the Urban RH Initiative (also referred to as the ―Initiative‖). The Initiative aims to

increase modern contraceptive use in selected urban areas of four countries in SSA and

South Asia, namely India, Kenya, Nigeria and Senegal. In India, this Initiative has begun

in select cities of Uttar Pradesh.

Key elements of the Initiative include 1) integrating high-quality FP services with

maternal and newborn health services — especially post-abortion, post-partum, and

antenatal care, and in HIV/AIDS services; 2) improving the overall quality of FP

services, particularly in high-volume settings; 3) increasing access to FP services for the

urban poor through public-private partnerships and other private sector approaches; and

4) creating sustained demand for FP services among the urban poor. By reaching urban

women with greatest need, this comprehensive strategy is expected to increase

contraceptive use among women in urban and peri-urban areas and potentially diffuse to

rural areas to which urban women are linked (Cleland, 2001; Lindstrom and Munoz-

Franco, 2005)2.

1 Cleland, J., Bernstein, S., Ezeh, A., Faundes, A., Glasier, A., Innis, J. (2006). Family planning: The

unfinished agenda. Lancet, 368: 1810–27.

Potts, M., Fotso, J.C. (2007). Population growth and the Millennium Development Goals. Lancet, 360:354-

5.

Allen, R. (2007). The role of family planning in poverty reduction. Obstetrics & Gynecology, 110(5):999-

1002. 2 Cleland, J. (2001). Potatoes and pills: An overview of innovation-diffusion contributions to explanations

of fertility decline. In J. Casterline, ed. Diffusion Processes and Fertility Transition: Selected Perspectives.

Washington D.C.: National Academies Press.

Lindstrom, D.P., Munoz-Franco, E. (2005). Migration and the diffusion of modern contraceptive

knowledge and use in rural Guatemala. Studies in Family Planning, 36(4):277-288.

1.2 NEED FOR THE BASELINE SURVEY

The Measurement, Learning & Evaluation (MLE) Project will evaluate the impact and

effectiveness of Urban Reproductive Health Initiative using rigorous impact evaluation

methods. The MLE will address the evaluation gap for urban FP initiatives by:

1) Explicitly examining intra-urban differences in program impacts through

comparison of slum and non-slum populations and of the wealthy and poor;

2) Using a strong program framework to examine steps along the causal pathway

and assessing the plausibility of program effects on outcomes;

3) Using a longitudinal design to ensure the highest possible standard of evidence

with minimal disruption to program implementation; and

4) Developing study tools and methods that permit generalization beyond the

particular intervention areas and countries under study

In short, the MLE project will use innovative methods to evaluate the impact of the

Initiative on modern contraceptive use in diverse urban populations.

In India, six cities - Agra, Allahabad, Aligarh, Gorakhpur, Moradabad, and Varanasi – from Uttar

Pradesh are included in this study. The first four cities, Agra, Aligarh, Allahabad, and Gorakhpur

are serving as the initial intervention cities while the remaining two cities, Moradabad and

Varanasi, are serving as delayed intervention cities. It has a longitudinal design with baseline,

midline and end line surveys at 2 year intervals. In order to establish the baseline

indicators against which the future impact of the project will be assessed, a baseline

survey has been carried out at the initial stage of the project.

1.3 THE PROJECT SETTING - UTTAR PRADESH AND THE FOCUS

CITIES FOR THE BASELINE

The state of Uttar Pradesh (UP) has a population of approximately 166.2 million, which

accounts for nearly 16 percent of India’s total population (2001 Census). Around 21

percent of the population (34 million) is living in urban areas and urban areas are

growing faster than rural areas. It is estimated that by 2016, almost 30 percent3 of the

population would be urban. Further, thirty-one percent, or 11 million people, are

estimated to be living in poverty in urban Uttar Pradesh, which is the largest number of

urban poor in a single state (Agarwal et al., 2006)4.

Demographically, UP is one of the least advanced states of the country. When comparing

health indicators in UP to national averages, UP is often much worse off; total fertility

rate (TFR) of 3.8 as compared to the country average of 2.7 (NFHS-3)5; birth rate of 30.1

3 National Institute of Urban Affairs, 2000. UrbanStatistics Handbook. New Delhi : National Institute of

Urban Affairs. 4 Agarwal S., Kaushik S., Srivasatav A. (2006). State of Urban Health in Uttar Pradesh, Urban Health

Resource Centre, Ministry of Health and Family Welfare, Government of India. 5National Family Health Survey-3 (2005-06). Ministry of Health and Family Welfare, Government of India

as against the national average of 23.5 (SRS 2007)6; infant mortality rate (SRS 2007) of

71 as compared to the nationwide 57. Though the urban average for these indicators

suggests that urban dwellers are better off than their rural counterparts, urban averages

often fail to elucidate differences that exist within the urban population, namely the

inequalities between the urban poor and non-poor. NFHS-3 indicates large disparity

between the urban poor and urban non-poor. With low contraceptive use (poor - 36

percent, non-poor - 56.5 percent) and high unmet need (poor – 19, non-poor – 6.7

percent), the urban poor of UP have high TFR (3.9) compared to non-poor (2.3).

In Uttar Pradesh six cities were selected for carrying out the baseline survey including

Agra, Aligarh, Allahabad, Gorakhpur, Moradabad and Varanasi. A brief profile of

each of the six cities is given below.

Agra City7

Agra city, one of the major cities of Uttar Pradesh, is located in the southwest corner of

UP. Agra is best known as the home of the Taj Mahal, and as an important tourist

destination, transport hub and commercial centre. The total population of the Agra urban

agglomeration is 1,331,339; whereas the city population is about 1,275,000. The

decennial growth rate of Agra city (1991-2001) is 40.7%, which is twice the national

decennial growth rate of 21.3%. As an indication of the overcrowded conditions in Agra,

the population density is 897 persons per square km. As per the 1991 census, the sex ratio

of the city is 846 females per 1000 males (Indian average is 933). Eighty-two percent of

the local population is of the Hindu religion, 15% are Muslims, 1% Jains and the

remaining 2% are Sikhs, Christians and Others. The overall literacy rate is high at 70%

and the work participation rate is at 27%. Caste wise majority is of Scheduled Caste (SC)

population, which is 21.5% of the total. The population of 0-6 years constitutes 13.53%

of the total and the sex ratio in this age group is around 900.

The vulnerability assessment of the city conducted by various agencies estimates that

over 50% of residents live in slums and squatter settlements. However, official figures

reported during the 1991 census indicate that only 9.67% of residents are considered as

slum population. Estimates of the total number of slums ranges from 215 official slums

(DUDA), 386 slums (OXFAM), to 393 slums (215 registered and 178 unrecognized)

(EHP).

Health services in Agra are provided from a variety of sources including the public sector

(Department of Medical, Health and Family Welfare (DoMHFW) the Agra Municipal

Corporation), the private sector (hospitals, nursing homes, and clinics), as well as a few

charitable hospitals that provide subsidized health services to the poor. Additionally,

there are Central Government health facilities, which include Railways hospitals, ESI and

Cantonment hospitals and dispensaries. Primary health care in the city is provided

6 Simple Registration System (2007). Registrar General of India, Government of India.

7 www.uhi-india.org - Agra City Profile

through 20 first tier centres including 15 D-Type health centres located in various parts of

the city.

As per the recent District Level Household and Facility Survey (DLHS-3) 2007 – 2008,

only 28.8% of currently married women are using a modern method of contraception.

The DLHS-3 estimates the unmet Family Planning need in Agra at 33.7%, which consists

of an 11.1% unmet need for spacing methods and 32.4% unmet need for limiting

methods. The percentage of birth of order 3 and above is quite high at 44.9%. The slum

women perceive pregnancy as a natural process associated with risks, which every

woman undergoes in her life. EHP reports state that most deliveries are conducted at

home by untrained dais, family members and relatives. A few women call a hospital

nurse for conducting delivery at home. Data for urban low SLI, Reanalysis of NFHS II,

EHP (2004) shows a similar picture, i.e. 85.3% of the deliveries take place at home, and

of all deliveries only 26.2% are either attended by trained health professional at home or

at a health facility.

Aligarh City8

Aligarh is located at 27.30 N latitude and 79.40 E longitude in the western part of U.P.

The total population of the city is 669,000 (53% males and 47% females) with literacy

rate of 63.9% (Census 2001). It is estimated that 69.10% of the urban population is below

the poverty line.

According to the District Urban Development Authority in Aligarh there are around 128

registered slums with a total population of 380,776. As per EHP report 52.4% of the

population reside in slums. Over a period of more than a decade some of the slums have

become developed colonies. Additionally, some of the new unregistered colonies have

mushroomed

Health services in Agra are provided by the Public sector, including the Department of

Medical, Health and Family Welfare, and by the Private sector (hospitals, nursing homes,

and clinics). In addition, as per the list compiled by UNICEF, there are approximately

587 non-registered private providers catering to a large slum population of the city.

Primary health care in the city is provided through 11 urban health posts and seven health

& family welfare subcentres, located in various parts of the city. In Aligarh there are

three Government–run secondary/ tertiary level hospitals. These three hospitals cater to

the secondary care needs of the entire district. Apart from J.N Medical College, which is

under the Central Government, the other health facilities are under the State Health

Department.

As per the recent District Level Household and Facility Survey (DLHS-3) 2007 – 2008,

only 28.4% of currently married women are using a modern method of contraception.

The DLHS-3 estimates the unmet Family Planning need in Aligarh is at 40.7%,

comprised of 12.1% unmet need for spacing methods and 28.6% unmet need for limiting

methods. The Ministry of Health and Family Welfare, Family Planning Division has

8 www.uhi-india.org - Aligarh City Profile

recognized Aligarh as a high priority district for family planning programs in Uttar

Pradesh. According to family planning statistics shared by the Chief Medical Officer, the

uptake of family planning methods is very low in Aligarh as compared to other districts

in Uttar Pradesh.

Allahabad City9

Allahabad is among the largest cities of Uttar Pradesh in terms of population and area.

The geographical area of Allahabad is about 62 sq km. Its spatial extension falls at 25°

28’ N latitude and 81°54’ E longitude. Census data classifies Allahabad city as the 32nd

most populous city in India with the population of 975,000. The city has a relatively poor

sex ratio at 807 females per 1000 males, with the number of males being 539,772 and

females 435,621. Approximately 10% of the total population falls between 0-6 years. The

literacy rate was recorded at 81%, which is slightly better than many other cities of U.P.

About 12.4% of the total population belongs to the Scheduled Caste (SC) category. The

city registered a population growth of about 23% during the last decade. According to the

2001 Census, the average population density is 16,559 persons per sq. km.

Allahabad has 185 slums spread all over the city. The total population living in slums is

318,000, which is about 30% of the entire city population. It is estimated that one-third of

the slum population can be categorized in the urban poor category.

Health services in Allahabad city are mainly provided by the Public sector, including the

Department of Medical, Health and Family Welfare, and the Private sector (hospitals,

nursing homes, and clinics). In addition, charitable hospitals provide subsidized health

services to the poor. Additionally, there are Central Government health facilities, which

include Railways hospital, ESI hospital/dispensaries and Cantonment

hospitals/dispensaries. Primary health care is provided by first tier centres including 12

urban health posts, 3 urban Family Welfare Centers, and 30 dispensaries Though public

health infrastructure is fairly extensive, the private sector is an important player in the

city. There are 1421 health practitioners, 272 Maternity /Nursing Homes, 6 Certified

Abortion Providers and 10 Certified NSV/DMPA Providers. Various indigenous systems

of medicine health facilities such as Ayurvedic, Unani and Homoeopathic are also

available. Allahabad city also has many charitable health care providers offering services.

Gorakhpur City10

Gorakhpur occupies the north eastern corner of the state of Uttar Pradesh, and is located

between Latitude 26º 13’ N and 27º 29' N and Longitude 83º 05' E and 83º 56’ E. It has a

population of 622,701 (males - 53% and females - 47%). Gorakhpur has an average

literacy rate of 78%, which is more than the state average (64.8%). About 13% of the

population is under six years of age. The sex ratio of the city is an alarming 888 females

per 1,000 males. In terms of religious composition, the majority of the population (70%)

is Hindu, followed by Muslim (21%). Approximately 12% population belongs to the SC

category.

9 www.uhi-india.org - Allahabad City Profile

10 www.uhi-india.org - Gorakhpur City Profile

Being a major transit point and a relatively developed among cities of eastern U.P.,

Gorakhpur attracts a large number of people from neighboring districts. One third of the

city population is living in slums.

Health services in Gorakhpur are provided by the Public sector (Department of Medical,

Health and Family Welfare) and the Private sector (hospitals, nursing homes, and

clinics). In addition, a couple of charitable hospitals provide subsidized health services to

the poor. Central Government health facilities, which include Railways hospitals, ESI

hospital and dispensaries and Cantonment hospitals and dispensaries, also provide health

care services. Primary health care is provided by 21 First Tier centres. City has

flourishing private health sector. According to information available at the CMO Office,

there are over 400 private doctors and 87 nursing homes / maternity homes in the city.

Moradabad City11

Moradabad city is situated in western U.P. between 28°21´ to 28°16´ Latitude North and

78° 4´ to 79 Longitude East. The total population of Moradabad city (Municipal

Corporation) in year 2001 stood at 641,538 persons, of which 340,314 were males and

301,269 were females. The decennial growth rate (1991-2001) of 44.5% was more than

double the national growth rate of 21.3%. The overall sex ratio was 885 females per

thousand males, which is quite low when compared with the state average of 898. It has a

literacy rate of 51.5%. Eleven percent of the city population resides in slum.

Moradabad has both public and private health services, including health centres by

religious and charitable institutions. There are several government as well as private

hospitals and nursing homes, besides individual private practitioners. At the first tier, the

city has 13 urban health posts. In addition there are 5 urban RCH health posts, focusing

on reproductive and child healthcare services. There are two Government–run secondary

/ tertiary level hospitals, including one exclusively for women. There are 40 Maternity

/Nursing Homes, 40 Abortion/NSV Providers and 34 DMPA providers.

Varanasi City12

Varanasi is a major religious, cultural and educational centre of India and it lies between

the 25o 15’N to 25o 22’ N latitudes and 82o 57’E to 83o 01’E longitudes. The total

population of Varanasi urban agglomeration is 1.2 million; whereas the city population is

about 1.09 million. The decennial growth rate of the city (1991-2001) is 17.6%.It’s sex

ratio is 891 females per 1000 males. The literacy rate of the city is 77.1%.

Varanasi has 227 slums spread all over the city, both on government and private lands.

Total population in slums is about 457,613, which is about 38% of the total population.

Slum locations are spread all over the city but major concentrations can be found in the

old city area near the ghats, areas near small scale industries as well as in the Rajghat

area.

11

www.uhi-india.org – Moradabad City Profile 12

www.uhi-india.org - Varanasi City Profile

Public sector health services in Varanasi include facilities of the state Department of

Medical, Health and Family Welfare and Varanasi Municipal Corporation, besides

Central Government, ESI, railway and Cantonment facilities. There are 21 Urban Health

Posts, 19 District / Joint Hospital, 6 ESI Dispensaries, 1 Medical College , 1 One Medical

Care Unit, 2 Railway Hospitals and I Defence Hospital. In Private sector there are 83

Maternity /Nursing Homes, 21 Private Health Posts/Clinics, 4 Abortion Clinics, 1077

Registered Providers and 56 NSV/DMPA Providers. In addition, there are few charitable

hospitals, which provide subsidized health services to the poor.

4.0 OBJECTIVES OF THE MLE BASELINE SURVEY

The major objective of the study is to collect baseline information at the household level

and at health facilities that will be used to evaluate the impact of the Initiative on modern

contraceptive use in diverse population groups. The baseline survey is a part of the

longitudinal study and the same cohort of the currently married women ages 15-49 years

and the facilities covered in the baseline survey will also be contacted for the mid-term

and endline surveys at an interval of two and four years respectively.

Chapter 2 Methodology

A key objective of the MLE project is to undertake a rigorous impact evaluation of the

URHI country programs. Specifically, the MLE project will evaluate the success of both

demand-side URHI interventions (those that increase the desire for family planning

services) and supply-side URHI interventions (those that increase the quality of and

access to family planning services). The MLE project evaluation comprises three design

elements that allow researchers to measure programmatic impact across cities, over time,

and among the urban poor and non-poor.

2.1 Three Evaluation Design Elements

Impact across Cities. The MLE project will take advantage of the delayed

implementation of programmatic activities in some cities to develop a quasi-experimental

study design. In each country, the MLE project will evaluate four URHI-targeted cities

that will receive immediate interventions and two cities that will receive URHI

interventions during the third or fourth year of the project. This latter group of cities with

delayed URHI interventions will serve as comparison cities. An assessment of these cities

with the original set of intervention cities will add variation that will provide more

precise measures of program impact.

Impact over Time. The MLE project will use a combination of repeated cross-sectional

data (surveying a new representative sample of respondents at multiple points in time)

and longitudinal data (surveying the same respondents at multiple points in time) in a

hybrid study design. This hybrid approach maximizes the strengths of both types of data;

rigorous cross-sectional surveys provide the attitudes and behaviors of a representative

sample of the cities’ population at a given point in time, while longitudinal data measure

the causal impact of program components on outcomes of interest. The project will also

collect longitudinal data from a sample of health and family planning facilities that

provide services to women and men – service delivery points (SDPs) – and examine

access to and quality of family planning services at these facilities over the study period.

Impact among the Urban Poor. To identify the impact of URHI interventions among

the urban poor, the MLE project will structure the sampling of respondents to identify

programmatic outcomes among both slum and non-slum populations.

2.2 Survey Components

The project will use a quasi-experimental design in which data collection will be carried

out in four intervention and two comparison cities (that is, cities where the introduction

of the interventions will be delayed). Two types of data will be collected in all cities:

individual-level data; and service delivery point data.

Individual Surveys. The MLE project carried out confidential surveys with women in all

6 cities, while with men in four intervention cities. Women of age 15-49 years and men

of age 18-54 years provided their basic demographic characteristics (such as age,

ethnicity, family structure, and migration practices), their experience with family

planning methods, their awareness of family planning messages, and their fertility

desires. In addition, respondents discussed their current health care experiences,

including how they pay for health care and when and where they seek care for themselves

and their children. At baseline, the contact information of women was also collected, so

as to locate them at mid-term and endline surveys. This will permit an examination of

how fertility desires and family planning behaviors change over time with increasing

program activities and exposure.

To ensure that the urban poor are fully represented in this study, Geographic Information

System (GIS) data was utilized to map the location of urban slums and non-slum areas

onto maps of the study cities using country-specific definitions of what constitutes a

slum. As the residents of urban slums are predominantly poor, this geographic data

served as an approximate measure of where poor populations live. From the GIS data,

researchers designed sampling frames that captured both urban poor and non-poor

populations, and systematically selected members from both groups as survey

respondents from these geographically-determined sampling frames.

SDP Surveys. The data from a wide range of public and private SDPs has been collected

under the MLE project. Facility audits and provider interviews were conducted at these

facilities. In addition, exit interviews with female clients using family planning and

maternal and child health client services were conducted at high volume public and

private health facilities. Since several contraceptive methods are available at pharmacies

and retail outlets, facility audits were conducted.

2.3 Sample design and implementation

The study has involved a multi-stage sampling design. In this section the sample size

determination for Agra as well as the sample implementation procedures have been

discussed.

2.3.1 Sample size determination

The overall target sample size for Agra was 3,000 completed interviews with eligible

women (currently married women 15-49). In order to attain this, a sample of

approximately 3,840 households was selected. Similarly for men, the overall target

sample size was 1,500 completed interviews with eligible men (currently married men

18-54). In order to attain this, a sample of approximately 2,250 households was selected.

For both the women’s and men’s sample, the sample size was equally divided between

slum and non-slum populations to get adequate sample for urban poor.

2.3.2 Sampling Techniques

Household Survey: Using the GIS map, sampling frame for slum and non-slum were

developed and 64 primary sampling units (PSUs) were selected from each domain. Then,

a mapping and household listing operation was carried out in each of the selected PSUs,

which provided the necessary frame for selecting households. The household mapping

and listing operation involved preparing up-to-date notional and layout sketch maps

assigning numbers to structures, recording addresses of these structures, identifying

residential structures and listing the names of heads of all the households in residential

structures in each of the selected PSU. The work was carried out by seven teams, each

comprising one lister and one mapper, under the supervision of three field supervisors,

and one field executive. The teams were trained from 27-30 January, 2010 in Lucknow.

The mapping and household listing operation was carried out from 27 February-16 May,

2010.

On average, 30 households for the women’s survey and 20 households for the men’s

survey were selected in each of the PSU. All the selected households were visited during

the main survey, and no replacement was made if a selected household was absent during

data collection. In the selected household, all eligible women/men were interviewed.

SDP Survey: In the SDP survey, all public health facilities, high volume private health

facilities and select non-high volume private facilities, pharmacies and retail outlets were

covered. For each PSU, most preferred13

private facility/provider and pharmacy were

selected from the list of facilities which women reported visiting for family planning or

maternal and child health services during the individual survey. At each of the selected

SDP, a geographic information system (GIS) point was recorded using a geographic

positioning system (GPS) device.

2.3.3 Achieved Sample Sizes

Table 2.1 and 2.2 gives the sample size achieved in the household and SDP surveys

Table 2.1 Sample results for Household survey in Agra

Household Survey Achieved

Number

Achieved Percent

Household for women survey 3575 94.56

Women 3007 92.89

Household for men survey 2244 89.04

Men 1673 83.60

Table 2.2 Sample results for SDP survey in Agra

13

Preferred facility/provider – A facility/provider mentioned maximum by women in a PSU.

SDP Survey Achieved Number

No of health facilities

HV Public

HV Private

Other public

Other private

Total

2

14

20

91

127

No of providers

Doctor

Nurse

Midwife

Ayush

Traditional Birth Attendant

Lady Health Visitor/Public Health

Nurse/District Public Health Nurse

Other*

Total

104

96

14

36

9

29

6

294

No of pharmacies 104

RMP 12

Retail outlets 23

Exit interviews 683

* Other includes Health educators/social workers, administrators, and others

2.4 Survey Questionnaires

MLE Baseline survey used three types of questionnaires for the household survey:

Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire.

The questionnaires were in Hindi.

Household survey

The Household Questionnaire listed all usual residents in each sample household plus any

visitors who stayed in the household the night before interview. For each listed person the

basic information was collected on age, sex, marital status to the head of household head,

education and occupation. The information was also collected on household assets and

environmental circumstances.

The Women’s Questionnaire collected information from currently married women age

15-49 who were usual residents of the sample household or visitors who stayed in the

sample household the night before the interview. The questionnaire collected the

information on background characteristics, reproductive behavior, quality of care,

knowledge and use of contraception, source of family planning, antenatal care and

postpartum care, breastfeeding and health reproductive health, and gender violence.

The Men’s Questionnaire collected information from currently married men age 18-54

who were usual residents of the sample household or visitors who stayed in the sample

household the night before the interview. The questionnaire collected the information on

background characteristics, reproductive behavior, quality of care, knowledge and use of

contraception, source of family planning, antenatal care and postpartum care,

reproductive health, and gender violence.

Service Delivery Point Survey: The baseline data was collected from the selected

service delivery points (SDP). The SDPs survey included public and private health care

facilities, pharmacies and retail outlets which provide family planning services or

method(s). At health care facilities a facility audit, provider interviews and exit

interviews with women were conducted. The interviews were also conducted at

pharmacies and retail outlets which provide family planning services or method(s). The

questionnaires were bilingual, with questions in both English and Hindi.

Facility audit: A manager at each public and private service delivery point

included in the survey (including health care facilities, pharmacies, and retail

outlets) was interviewed to obtain general information about the site including the

number of family planning clients, quality of services, types of services provided,

types of providers, prescription requirements, and whether each family planning

method offered is in stock.

Exit interviews: At high volume service delivery points that provide family

planning (FP) and maternal, newborn and child health (MNCH) services, exit

interviews with women ages 18 and older visiting the facility for family planning,

child health and postpartum care. All women receiving the targeted type of

services were eligible for participation in the exit interviews.

Provider interviews: Provider interviews were conducted in both public and

private FP and MNCH facilities. The same facilities used for the exit interviews

were used for conducting provider interviews. A sample of providers was selected

from the facility list of all providers offering FP and/or MNCH services at the

selected service delivery points. Various types of providers were selected,

including physicians, nurses, auxiliary staff, and auxiliary nurse midwives. Two

providers from each type of larger service delivery points were selected for

interviews.

2.6 Recruitment, Training, and Fieldwork

Field staff for the main survey were trained by senior professionals of the FactIndepth in

Lucknow. The training consisted of classroom training, demonstration and practice

interviews, as well as actual field practice and additional training for field editors and

supervisors. The class room training included instructions on interviewing techniques and

survey field procedures, a detailed review of each item in the questionnaires, and

instruction and mock interviews between participants. Special guest lectures on family

planning and on reproductive and child health were also arranged.

Seven interviewing teams conducted the main fieldwork in Agra, each team consisting of

one field supervisor, one female field editor, three female interviewers and two male

interviewers. The fieldwork was carried out between 17 April and 04 June 2010. The

coordinators and senior staff of the FactIndepth carried out monitoring and supervision of

the data collection. ICRW also appointed one consultant to help with monitoring

throughout the training and fieldwork period in order to ensure that correct survey

procedures were followed and data quality was maintained. From time to time, ICRW

staff visited the field sites to monitor the data collection operation.

2.7 Data Entry and Processing

Completed questionnaires for MLE baseline survey in Agra were sent to the office of the

FactIndepth, Lucknow, for data processing, which consisted of office editing, coding,

data entry, and machine editing. CSPro data entry software was provided by UNC. Data

entry was done in Lucknow by 8 data entry operators under the supervision of a staff

member of the FactIndepth. The data entry operators and supervisor were trained by

senior staff of UNC. The data entry and editing operations were completed between 19

May 2010 and 20 July 2010.

Chapter 3 Household Profile

This Chapter presents the profile of the households covered in the survey in the city of Agra. In the present survey information was collected about all the usual residents as well as the visitors who had stayed in the selected households the night before the household interview. The survey also collected information on key household characteristics, such as type of house, availability of electricity, sources of drinking water, type of toilets used, and the main source of drinking water. 3.1 Household Population by Age and Sex A total of 19,781individuals including the usual residents and visitors who had stayed there the night before the day of survey were enumerated in the 3,539 households interviewed in Agra. Table 3.1 shows the distribution of the household population in five year age groups by age and sex. Nearly one-third of the population (32%) is below 15 years of age and six percent is 60 years or above, with the remaining 62 percent in the age group of 15-59 years. The age distribution of the male and female population is similar to that observed for the total population. The sex ratio of the population surveyed in Agra is 903 females per 1,000 males. The sex ratio for the population in the age group of 0-6 years is only 844 females for 1000 males. Household Population by Age, Residence and Sex, India, 2007-08 Percentage D

Table 3.1: Household Population by Age And Sex in Agra

Age Male Female Total

% Number % Number % Number

0-4 9.8 1014 9.6 900 1914 9.7

5 9 10.3 1069 9.7 913 1982 10.0

6 14 12.7 1316 12.7 1189 2505 12.7

15-19 13.4 1396 12.6 1180 2576 13.0

20-24 10.9 1131 10.9 1022 2153 10.9

25-29 7.9 824 8.0 753 1577 8.0

30-34 6.1 637 6.4 601 1238 6.3

35-39 5.6 580 6.7 627 1207 6.1

40-44 5.2 542 5.5 517 1059 5.4

45-49 4.9 508 3.9 370 878 4.4

50-54 3.6 371 3.8 361 732 3.7

55-59 3.2 333 3.8 358 691 3.5

60-64 2.7 278 2.5 233 511 2.6

65-69 1.5 157 1.5 144 301 1.5

70-74 1.2 120 1.1 104 224 1.1

75-79 0.6 58 0.5 51 109 0.6

80+ 0.6 62 0.7 62 124 0.6

Total 100.0 10396 100.0 9385 19781 100.0

Sex ratio for 0 – 6 years age group - 844

3.2 Housing Characteristics The MLE baseline survey collected information on several household characteristics that are related to the living conditions of the people. The data on household characteristics was based on questions answered by the respondents of the Household Questionnaire as well as the interviewer’s observation of the type of housing. In this Section, household access to water and sanitation facilities are discussed first, followed by a discussion of other household characteristics including type of housing and fuel used for cooking. Table 3.2 presents the percentage distribution of households by source of drinking water. Most of the households in Agra (97%) reported using an improved source of drinking water, which included water piped into the dwelling, yard or plot, water available from a public tap or standpipe, a tube well or borehole and bottled water. Among the improved sources of drinking water, public hand pump was reported by 27 percent of the households followed by tube well/borehole (21%) and bottled water (20%). With respect to the use of sanitation facilities, Table 3.2 shows that only 58 percent of households have a modern toilet facility, which empties into a sewer/pit/septic tank. Owning a pour/flush toilet that does not empty into a sewer/pit/septic tank was mentioned by twenty three percent of the households, while 17 percent of the households had no toilet facility and defecated in the open. Data on the type of cooking fuel shows that a majority of the households (72%) were primarily using LPG, while 17 and eight percent of the households were using wood and dung respectively. Table 3.2 also gives information about the type of house, availability of a separate kitchen in the household and availability of electricity. Among the households covered in the survey, 89 percent lived in pucca houses and 10 percent lived in semi-pucca houses. Less than one percent of the households lived in kuchha houses. Fifty eight percent of the households had a separate room for cooking. Electricity was available in 96 percent of the households.

Table 3.2: Housing Characteristics of the Households Surveyed in Agra

Characteristics % Number

Main source of drinking water

Piped water into dwelling 6.7 237

Piped water into yard/plot 8.7 309

Piped water to public tap/standpipe 4.2 150

Hand pump inside dwelling 9.2 326

Public hand pump 26.7 944

Tube well/borehole 21.1 746

Dug unprotected well 0.2 6

Tanker truck 1.2 44

Cart with small tank 0.1 5

Bottled water 19.9 704

Other 1.9 67

Total 100.0 3538

Toilet facility

Septic tank/modern toilet 58.0 2053

Pour/flush toilet that does not empty to 22.7 803

Table 3.2: Housing Characteristics of the Households Surveyed in Agra

Characteristics % Number

sewer/pit/septic tank

Water sealed/slab latrine 1.8 64

Pit latrine without slab 0.1 5

No facility/bush/field 17.2 607

Other 0.1 7

Total 100.0 3539 Type of Cooking fuel Electricity 0.5 18 LPG/natural gas 71.8 2541 Biogas 0.1 2 Kerosene 1.2 43 Coal/lignite 0.6 21 Charcoal 0.0 1 Wood 16.9 598 Straw/shrub/grass 0.3 9 Dung 8.4 296 Other 0.1 5 Total 100.0 3537

Type of house

Kachcha 0.9 32 Semi Pucca 9.8 347 Pucca 89.3 3158 Total 100.0 3537

Separate room for kitchen

Households with separate kitchen 58.0 2053 Households without separate kitchen 42.0 1486 Total 100.0 3539

Availability of electricity

Households with Electricity 96.4 3413 Households without Electricity 3.6 126 Total 100.0 3539

3.3 Possession of BPL Cards and Ration Cards The baseline survey collected information on the availability of Below Poverty Line (BPL) Cards and ration cards for all the households covered in the survey. As Table 3.3 shows, BPL cards were available in only two percent of the households while ration cards were available in around two-thirds of the households.

Table 3.3 : Possession of BPL Card and Ration Card in Agra

Possession Percentage Number

BPL Card

Households with BPL Card 1.9 67 Households without BPL card 98.1 3472 Total 100.0 3539

Ration Card

Households with Ration Card 66.9 2366 Households without Ration Card 33.1 1173 Total 100.0 3539

3.4 Coverage under Health Insurance Schemes All the households covered in the survey were asked whether any member in the household was covered under any health insurance scheme. Table 3.4 shows that only in four percent of the households was any member covered under some health insurance scheme.

Table 3.4 Coverage of Household Members Under Health Insurance Schemes in Agra

Health Insurance Coverage Percentage Number

HH member covered by health scheme 4.4 156 Households without health scheme coverage 94.9 3361 Don’t Know 0.6 23 Total 100.0 3540

Chapter 4 Profile of Respondents

The information on age, educational status, religion, caste, number of live births, work status was collected from all currently married men and women covered in the survey. Information on household assets was collected through the household questionnaire to construct the household wealth index, which serves as a proxy indicator of the household economic well being of the women and men covered in the survey. This Chapter presents the socio-economic and demographic profile of the women and men covered in the survey in Agra. Table 4.1 provides information on age, education, religion, caste, wealth index, number of live births, employment in the last one year, type of payment received, education of the spouse, type of payment received by the spouse and duration of residence in the current location. The age distribution of the women shows that nearly two-fifths belonged to the age group of 20 - 29 years and around one-fourth were in the age group of 40- 49 years. About four percent of the women were in the age group of 15-19 years. The education status of the women presented in Table 4.1 shows that approximately 38 percent of the women surveyed in Agra had no education. Twenty six percent of women had completed 12 or more classes, while 12 percent had completed 10 or 11 classes. The majority of women (86%) covered in the survey were Hindus, while 13 percent were Muslims. The caste wise distribution shows that the surveyed women in Agra were mostly from the three caste groups,-Other Backward Classes (32%), Scheduled Castes (30%), and others, which is a general caste category (37%). One of the background characteristics used throughout this report is an index of the economic status of households called the wealth index. It is an indicator of the level of wealth that is consistent with expenditure and income measures. The wealth index has been constructed using household asset data. Table 4.1 presents the distribution of women by five wealth quintiles. Approximately 21 percent of the women surveyed in Agra were in the highest two wealth quintiles, while 18-20 percent were in the other three quintiles. As regards the number of live births, half of the women hadthree or more live births, while 42 percent had one to two live births (Table 4.1). Nine percent of the women had no live birth.

Table 4.1: Background Characteristics of Currently Married Women from Agra

Number of Women

Characteristic: Percentage of

Women* Weighted (N=3007)

Unweighted (N=3007)

Age

15-19 3.5 106 108 20-24 17.2 516 503 25-29 21.6 649 627 30-34 18.0 542 543 35-39 16.3 489 520 40-44 14.5 436 443 45-49 9.0 269 263

Education

No education 38.0 1144 1279 <5 classes complete 3.1 92 92 5-7 classes complete 9.6 287 309 8-9 classes complete 11.1 334 353 10-11 classes complete 12.1 363 329 12 or more classes

complete 26.1 784 642 Missing 0.1 3 3

Religion

Hindu 85.8 2580 2462 Muslim 12.8 386 514 Other/None 1.4 41 31

Caste/Tribe

Scheduled caste 30.4 915 982 Scheduled tribe 0.4 13 13 Other backward class 32.2 967 1030 Other 36.8 1107 978 Don’t know 0.0 1 1 Missing 0.1 4 3

Wealth Index

Lowest 18.0 540 602 Second 19.5 588 619 Middle 19.9 599 621 Fourth 21.1 635 571 Highest 21.5 646 594

Number of live births

0 8.5 256 273 1 16.7 501 440

Table 4.1: Background Characteristics of Currently Married Women from Agra

2 25.0 752 682 3 18.7 561 568 4 12.7 382 418 5 8.4 254 271 6+ 10.0 302 355

*Percentages are weighted In the survey, all the women were asked about their employment status in the last one year. In response to the query, only one-tenth of the women affirmed that they were employed in the last one year and almost all of them (98%) were paid in cash. With regard to the education of the spouses of the women covered in the survey, around one-fifth of the women reported that their spouses had no education, while 36 percent reported that their spouses had completed 12 or more classes Further, 97 percent of the women reported that their spouses receive payment in cash for their employment. Data on the duration of residence in the current location indicated that 38 percent of the women had stayed there for 10 years or more. However, a substantial proportion (20%) has stayed at the current location for two years or less (Table 4.1).

Table 4.1: Background Characteristics of Currently Married Women from Agra cont.

Number of Women

Characteristic: Percentage of

Women* Weighted (N=3007)

Unweighted (N=3007)

Employment in the last year

Did not work in the last year 90.0 2706 2714

Worked in the last year 10.0 302 293

Type of payment (among employed) (n= 301) (n=293)

Cash only 98.2 296 286 Cash and kind 1.3 4 5 In kind only 0.0 0 0 Not paid 0.5 1 2

Spouse’s education level

No education 19.3 580 697 <5 classes complete 2.6 77 85 5-7 classes complete 10.5 317 371 8-9 classes complete 13.6 408 427 10-11 classes complete 16.5 497 492 12 or more classes complete 36.3 1091 904

Table 4.1: Background Characteristics of Currently Married Women from Agra cont.

Don’t know 1.1 32 25 Missing 0.2 6 6

Spouse’s form of payment for work in the last year

Cash only 96.6 2905 2915 Cash and kind 0.3 10 10 In kind only 0.1 4 2 Not paid 0.0 0 0 Not working/unemployed 2.8 85 78 Missing 0.1 3 2

Duration of residence in current location

< 1 year 7.5 226 201 1-2 years 12.6 379 354 3-4 years 11.2 337 321 5-6 years 10.8 323 291 7-8 years 6.8 204 205 9-10 years 8.1 242 237 >10 years 37.7 1133 1255 Visitor 4.5 136 114 Always 0.6 19 22 Missing 0.3 8 7

*Percentages are weighted Table 4.2 presents the background characteristics of the currently married men surveyed in Agra. The age distribution of the men shows 43 percent were in the age group of 18 - 34 years and 40 percent were in the age group of 40 - 54 years. Nearly half of the men surveyed had completed at least 10 classes whereas 15 percent had no education. As regards religion, 87 percent were Hindus and 12 percent were Muslims. Thirty-two and 30 percent of the men belonged to the OBCs and SCs respectively. Nearly two-fifths were from the other caste groups. Data on wealth quintiles indicates that 20 percent of the men surveyed in Agra belonged to the highest wealth quintile and 18 percent to the lowest wealth quintile. Nineteen, 21 and 23 percent of the men were from the second, middle and fourth wealth quintiles respectively. Nearly one-third of the men had four or more live births and 39 percent had one to two live births and 10 percent of the men had no live births.

Table 4.2: Background Characteristics of Currently Married Men from Agra

Number of Men

Characteristic: Percentage of

Men* Weighted (N= 1682)

Unweighted (N= 1682)

Age

18-24 9.7 164 146 25-29 16.7 280 281 30-34 16.1 270 282 35-39 17.7 298 312 40-44 15.9 268 281 45-49 15.1 253 241 50-54 8.9 150 139

Education

No education 15.1 253 298 <5 classes complete 6.7 112 128 5-7 classes complete 11.8 198 218 8-9 classes complete 17.6 295 311 10-11 classes complete 17.7 298 280 12 or more classes complete 30.7 516 436 Missing 0.6 10 11

Religion

Hindu 87.0 1462 1400 Muslim 12.3 206 270 Other/None 0.8 13 12

Caste/Tribe

Scheduled caste 29.5 497 571 Scheduled tribe 0.5 9 12 Other backward class 31.9 537 570 Other 38.0 639 528 Missing 0.0 1 1

Wealth Index**

Lowest 17.6 295 324 Second 19.1 321 347 Middle 20.8 349 338 Fourth 22.9 386 380 Highest 19.7 331 293

Number of live births

0 9.8 165 173 1 15.4 259 230 2 23.8 400 374 3 18.1 305 295

4 13.0 218 247 5–6 14.4 242 260 7+ 5.5 93 103

*Percentages are weighted Only three percent of the men covered in the survey reported that they had not worked in the last one year. Among the men who were employed in the last one year, 66 percent worked for someone else and 27 percent were self employed. Almost all the men who worked in the last one year said that they were paid in cash for their services. Only seven percent of the men reported that their wives were employed for cash. In response to the question on who decides how his earnings are used, 77 percent reported that they take the decision jointly with their wives. Only 16 percent reported that they decide independently about the use of their earnings. On the age at marriage, around one-fourth of the men reported that they got married before the age of 20 years, while 70 percent got married between 20 - 29 years. Table 4.2: Background Characteristics of Currently Married Men from Agra, cont.

Number of Men

Characteristic: Percentage of Men* Weighted (N=1682)

Unweighted (N=1682)

Employment status in the last year

Did not work in the last year 2.8 47 45 Worked in the last year 97.2 1635 1637

For whom do you work (among employed) (n= 1635) (n= 1637)

Self-employed 26.7 437 410 For family member 6.9 112 126 For someone else 66.3 1083 1100 Missing 0.2 2 1

Type of payment (among employed) (n= 1635) (n= 1637)

Cash only 99.2 1622 1620 Cash and kind 0.8 13 16 In kind only 0.0 0 1 Not paid 0.0 0 0

Age at marriage

<15 1.3 22 27 15-19 23.8 401 382 20-24 48.9 822 834 25-29 21.5 362 361 30-34 4.0 67 66 35+ 0.5 8 12

Wife employed for cash

Yes 6.9 116 109 No 93.1 1566 1572 Don't know 0.0 0 1

Who decides how your earnings are used? (n= 1635) (n= 1637)

Respondent 16.4 269 289 Wife 0.9 14 18 Respondent and wife 76.9 1257 1242 Other 5.7 94 87 Missing 0.1 1 1

*Percentages are weighted

Chapter V

Marriage, Fertility and Fertility Preferences

Information relating to marital experiences, fertility and fertility preferences was collected from

currently married women (15-49 years) and currently married men (18-54 years) in the survey.

This Chapter presents the findings relating to age at first marriage, age at first cohabitation,

fertility level, fertility preferences, age at first birth, the ideal number of children and planning

status of pregnancies.

5.1 Marital Experiences

The age at marriage among males and females, as well as the age at first cohabitation has direct

bearing on several social and demographic outcomes. In this context, the information on age at

first marriage and age at first cohabitation was ascertained from all the men and women covered

in the survey. Table 5.1 presents age at first marriage and age at first cohabitation as reported by

the currently married women. One-third of the women reported that they had been married by the

age of 17 years i.e. before the legal minimum marriage age of 18 years, while44 percent of the

women had been married between the ages of 18-20 years. Thus, by the age of 20 years, 77

percent of the women were married. A small proportion of women (5 %) got married at the age of

25 years or later.

As regards the age at first cohabitation, 30 percent of the women reported that they had started

living with their husbands before the age of 18 years. In the case of 46 percent of the women, the

age at first cohabitation was between the ages of 18- 20 years. The age at first cohabitation

exceeded 25 years in only five percent of the women.

Table 5.1 also shows the co-residence with the husband in the last six months of the women

covered in the survey. Almost all the women (98 %) contacted for the interviews were reportedly

living together with the husband during the last six months.

Table 5.1: Marital experience of currently married women

Percentage distribution of currently married women by age at first marriage and age at

cohabitation , Agra , MLE-2010

Number of Women

Background Characteristic:

Percentage of

Women*

Weighted

(N=3007)

Unweighted

(N=3007)

Age at marriage

<15 6.7 201 214

15-17 26.3 792 788

18-20 43.8 1317 1366

21-24 18.0 541 504

25-29 5.0 150 129

30-34 0.1 4 5

35+ 0.0 1 1

Age at first cohabitation

<15 3.9 116 127

15-17 26.3 790 809

18-20 45.9 1380 1412

21-24 18.5 556 518

25-29 5.1 153 131

30+ 0.2 6 6

Don't know 0.2 7 4

*Percentages are weighted

Table 5.2 presents the age at first marriage of the women by their background characteristics. The

analysis of age at first marriage by age of the women shows that there has been a steady rise in

the age at first marriage, which is reflected by the general trend of declining marriages before the

age of 15 years, from the oldest to the youngest age groups. A particularly notable decline is seen

in the age at first marriage by the age of 15 years and the ages of 15-17 years in the three age

groups of 20-24 years, 25-29 years and 30-34 years. The age at first marriage has strong positive

association with the women’s education. There is a sharp increase in the age at first marriage with

the increase in the women’s education level. For example, the mean age at first marriage

increases from 17 years for the women with no education to 21 years for the women with 12 or

more years of education. The proportion of women who got married before the age of 15 years

and between the ages of 15-17 years declines sharply with the increase in the women’s education.

There was not much variation in the mean age at marriage by the religion and caste of the

women. The women’s wealth is also strongly associated with their age at first marriage. The

mean age at first marriage is much higher for the women coming from the highest and the fourth

wealth quintiles compared to those coming from the lowest and the second wealth quintiles

(Table 5.2).

Table 5.2: Marital experience by background characteristics of currently married women

Percentage distribution of currently married women by age at first marriage, Agra , MLE-2010

Background

Characteristics

Age at first marriage

<15 15 - 17 18 - 20 21 - 24 25 - 29 30 - 34 Mean

Age in Years

15 - 19 6.3 49.8 43.9 0.0 0.0 0.0 17.1

20 - 24 3.7 21.8 58.2 16.3 0.0 0.0 18.5

25 - 29 3.1 21.4 43.3 23.9 8.3 0.0 19.5

30 - 34 5.4 24.1 41.4 20.1 8.5 0.4 19.3

35 - 39 10.7 31.8 36.1 17.8 3.2 0.4 18.2

40 - 44 10.3 26.3 41.5 15.5 6.3 0.0 18.5

45 - 49 10.9 32.3 40.0 14.1 2.7 0.0 18.1

Education

No education 11.8 38.7 44.0 4.6 0.7 0.1 17.2

<5 classes complete 7.9 41.7 38.3 9.2 2.9 0.0 17.7

5-7 classes complete 9.1 33.4 47.8 7.6 2.1 0.0 17.8

8-9 classes complete 3.2 26.9 52.2 14.4 3.3 0.0 18.5

10-11 classes

complete 3.7 23.5 51.4 17.8 3.6 0.0 18.9

Table 5.2: Marital experience by background characteristics of currently married women

Percentage distribution of currently married women by age at first marriage, Agra , MLE-2010

12 or more classes

complete 0.9 4.9 35.8 43.9 14.0 0.5 21.4

Religion

Hindu 6.9 26.8 43.4 18.2 4.6 0.2 18.7

Muslim 6.3 25.6 48.4 14.2 5.5 0.0 18.6

Others/None 0.0 4.0 28.4 40.4 27.2 0.0 22.1

Caste/Tribe

Scheduled caste 9.6 32.8 43.4 11.0 3.0 0.3 18.0

Scheduled tribe 7.3 21.5 63.8 7.3 0.0 0.0 17.4

Other backward

class 7.8 29.8 44.8 14.7 2.8 0.0 18.2

Others 3.4 17.9 43.0 26.9 8.7 0.2 19.8

Dont know 0.0 0.0 100.0 0.0 0.0 0.0 20.0

Wealth

Lowest 8.6 40.9 42.8 4.8 2.9 0.0 17.5

Second 9.8 31.1 48.3 8.7 2.0 0.1 17.8

Middle 8.9 28.1 44.3 15.2 3.5 0.0 18.2

Fourth 5.0 20.4 46.3 22.1 6.1 0.1 19.3

Highest 1.8 14.1 37.7 36.1 9.8 0.5 20.5

Total 6.7 26.3 43.8 18.0 5.0 0.1 18.7

The N's are slightly smaller due to missing data for some characteristics

The age at first cohabitation by the women’s background characteristics is presented in Table 5.3.

As observed in the age at first marriage of the women, the proportion of women reporting first

cohabitation by the age of 17 years also declines from the oldest age group of 45 -49 years to the

younger age group of 20-24 years. The above findings indicate an increase in the age at first

cohabitation over the years. Like the age at first marriage the age at first cohabitation also has a

strong positive association with the education and the wealth index of the women. The variations

in the mean age at first cohabitation of the women by education, wealth index, religion and caste

are more or less similar to that observed for the women’s age at first marriage.

Table 5.3: Age at cohabitation of currently married women

Percentage distribution of currently married women by age at cohabitation - Agra , MLE-2010

Background

Characteristics

Age in years

<15 15 - 17 18-20 21 - 24 25 - 29 30+ Mean

Total

N

Current Age

15 – 19 6.7 44.8 48.5 0.0 0.0 0.0 17.1 106

20 – 24 2.0 21.1 59.8 17.1 0.0 0.0 18.6 514

25 – 29 2.3 21.5 43.1 24.5 8.6 0.0 19.6 649

30 – 34 4.1 23.1 42.0 21.3 9.0 0.5 19.5 542

35 – 39 4.6 34.0 39.4 17.8 3.3 0.8 18.5 489

40 – 44 4.7 27.7 44.8 16.0 6.4 0.4 18.8 436

45 – 49 6.6 29.8 45.7 14.7 3.1 0.1 18.5 269

Education

No education 5.8 39.0 48.5 5.5 1.0 0.2 17.7 1,144

<5 classes

complete 3.3 43.2 38.9 11.6 2.9 0.0 17.9 92

5-7 classes

complete 7.9 33.4 48.0 8.3 2.3 0.1 17.9 287

8-9 classes

complete 3.1 24.3 54.5 14.2 3.3 0.5 18.7 331

10-11 classes

complete 2.3 22.5 51.9 19.4 3.9 0.0 19.0 363

12 or more classes

complete 0.6 5.3 35.7 43.7 14.2 0.6 21.4 784

Religion

Hindu 3.9 26.5 45.7 18.9 4.8 0.3 18.9 2,577

Muslim 4.1 27.0 48.6 14.1 6.0 0.3 18.8 386

Others/None 0.0 3.9 27.7 39.4 26.5 2.4 22.1 41

Caste/Tribe

Scheduled caste 5.0 33.2 46.7 11.7 3.1 0.3 18.3 915

Scheduled tribe 0.0 3.7 73.7 22.6 0.0 0.0 18.8 13

Other backward

class 4.8 29.9 46.4 15.5 3.0 0.4 18.5 967

Others 2.1 17.3 44.3 27.0 9.0 0.2 19.9 1,105

Don’t know 0.0 0.0 100.0 0.0 0.0 0.0 20.0 1

Wealth

Lowest 3.4 40.2 46.3 6.4 3.5 0.2 17.9 540

Second 6.6 30.5 50.9 9.4 2.0 0.5 18.1 585

Middle 4.4 29.1 47.1 15.9 3.5 0.1 18.5 599

Fourth 3.3 20.8 47.2 22.1 6.4 0.3 19.4 635

Highest 1.6 13.3 38.4 36.1 10.1 0.5 20.5 645

Total 3.8 26.2 45.8 18.6 5.2 0.3 18.9 3,004

* The N's are slightly smaller due to missing data for some characteristics

5.2 Fertility Levels

Table 5.4 presents the age-specific fertility rates (ASFR) and total fertility rates (TFR) for the

women covered in Agra. As the Table shows, the TFR is 3.8 births per woman in Agra. The

women belonging to the poorest wealth quintile have reported the highest TFR (4.8) and for the

other wealth quintiles it varies between 2.9 to 3.3. The data on ASFR shows that the peak child

bearing age is 20-24 years where the ASFR is 278.2 births per 1000 currently married woman.

There is also a considerable amount of early childbearing at the age of 15-19 years (221.3 births

per 1000 currently married woman). After the age of 39 years fertility is quite low.

Table 5.4: Current marital fertility

Age-specific and Total Marital Fertility Rates - Agra , MLE-2010

Age-specific fertility rates per 1000 women

15 -19 221.31

20-24 278.21

25-29 151.70

30-34 72.52

35-39 32.95

40-44 3.50

45-49 0.00

Total Fertility Rate by Wealth

Poorest 4.79

Poor 2.93

Middle 3.50

Rich 3.23

Richest 3.33

Total Fertility Rate 3.80

In order to assess the fertility levels in the past, data on the number of children ever born (CEB)

was collected from all the women covered in the survey. Table 5.5 presents the number of

children ever born to currently married women in the age group of 15-49 years by their

background characteristics.

The mean number of children ever born to women covered in Agra is 2.9. Over one-third of the

women in the age group of 15-19 years had at least one child, which indicates that early

childbearing is still common among the women. The mean number of children ever born is

highest for the women in the two oldest age groups of 45-49 years (4.3) and 40-44 years (4.2).

Among the women in the age group of 45-49years, 35 percent reported three to four children and

43 percent reported five or more children. The above findings suggest high fertility among the

women in the past.

The number of children ever borne by the women is strongly influenced by their education and

wealth index. The mean number of children ever born declines sharply with an increase in the

women’s education and wealth index. The proportion of women having one or two children

increases steadily with the increase in the education and wealth index of the women. The analysis

by religion of the women shows that the mean number of children ever born is higher for Muslim

women compared to women from other religions. Analysis by shows that the number of children

ever born is lower for women belonging to other/general castes than those belonging to SCs, STs

and OBCs.

Table 5.5 : Children ever born by background characteristics of women

Percentage distribution of currently married women by number of children ever born - Agra , MLE-2010

Background Characteristics: Number of children ever born

0 1 2 3 4 5 6 + Mean Total N

Age

15-19 65.4 29.2 5.3 0.0 0.0 0.0 0.0 0.4 106

20-24 19.0 38.8 29.8 9.7 2.4 0.2 0.0 1.4 516

25-29 9.8 24.2 28.8 20.4 11.1 4.1 1.6 2.2 649

30-34 2.5 11.5 32.5 18.8 18.8 8.4 7.4 3.0 542

35-39 1.5 6.3 19.6 25.0 17.0 13.7 16.9 3.7 489

40-44 0.8 3.5 18.3 22.7 16.8 15.6 22.2 4.2 436

45-49 0.3 1.6 19.8 20.4 14.4 16.9 26.7 4.3 269

Education

No education 5.7 10.0 15.2 14.8 17.4 15.3 21.6 3.8 1,144

<5 classes complete 2.5 16.9 13.0 30.1 16.4 6.4 14.7 3.3 92

5-7 classes complete 10.8 16.7 19.2 20.0 17.0 7.1 9.3 2.8 287

8-9 classes complete 11.7 19.4 24.5 21.7 14.0 5.8 2.9 2.4 334

10-11 classes complete 8.5 20.2 31.9 19.4 11.8 7.6 0.7 2.3 363

12 or more classes complete 11.2 23.7 39.9 20.6 3.7 0.7 0.3 1.9 784

Wealth Index

Lowest 7.6 13.1 17.0 16.6 16.6 11.2 17.9 3.5 540

Second 8.6 14.5 19.5 13.8 15.3 13.7 14.5 3.3 588

Middle 9.3 14.5 22.0 19.9 15.2 8.0 11.2 3.0 599

Fourth 7.5 21.6 27.1 21.0 10.0 7.2 5.7 2.5 635

Highest 9.5 18.9 37.3 21.5 7.3 2.9 2.6 2.2 646

Religion

Hindu 8.7 16.7 26.0 19.2 12.6 8.1 8.8 2.8 2,580

Muslim 8.2 16.1 16.8 13.7 14.0 11.7 19.5 3.5 386

Other 0.5 18.6 38.3 33.2 9.3 0.0 0.0 2.3 41

Caste

Scheduled caste 9.3 14.3 16.5 16.0 15.4 12.4 16.1 3.3 915

Scheduled tribe 7.6 26.4 25.3 3.5 12.0 3.5 21.5 3.3 13

Other backward class 7.3 17.0 21.9 19.2 13.5 9.3 11.8 3.0 967

Others 8.9 18.1 34.7 20.6 9.8 4.5 3.3 2.4 1,107

Don’t know 0.0 0.0 0.0 0.0 100.0 0.0 0.0 4.0 1

Total 8.5 16.7 25.0 18.7 12.7 8.4 10.0 2.9 3,007

* The N's are slightly smaller due to missing data for some characteristics

Table 5.6 shows the percentage of women who are currently pregnant and the mean number of

children ever born to women in the age group of 40-49 years. Among all the women covered in

Agra, seven percent were currently pregnant at the time of survey. The percentage of such women

was higher among the SCs, Muslims and in the poorest wealth quintiles. The percentage of

women currently pregnant was lower for the women having 12 or more years of education.

The mean number of children ever born to women age 40-49 years is 4.2. The mean number of

children ever born declines gradually with the increase in the education and wealth. The mean

number of children ever born is much higher for Muslim women (5.65) compared to Hindus

(4.1). It is also higher among the women belonging to SCs (5.2) and OBCs (4.7) as compared to

other castes (3.2).

Table 5. 6: Currently pregnant and children ever born to women aged 40 – 49 years

Percentage of currently married women age 15-49 who are currently pregnant and mean

number of children ever born to women age 40-49 by background characteristics, Agra,

MLE-2010

Background Characteristic:

Percentage of

Currently

Pregnant

Mean number of children

ever born to women 40-

49

Education

No education 7.4 5.35

<5 classes complete 9.2 4.74

5-7 classes complete 10.2 4.50

8-9 classes complete 9.6 3.56

10-11 classes complete 7.6 3.11

12 or more classes complete 4.1 2.58

Religion

Hindu 7.1 4.09

Muslim 7.9 5.65

Other/None 0.0 2.53

Caste/Tribe

Scheduled caste 10.1 5.23

Scheduled tribe 7.6 7.74

Other backward class 7.6 4.70

Other 4.3 3.22

Missing 0.0 1.43

Wealth Index

Lowest 10.7 5.48

Second 8.3 5.16

Middle 9.4 4.74

Fourth 3.7 3.84

Highest 4.2 3.18

Total 7.1 4.23

* The N's are slightly smaller due to missing data for some characteristics

Table 5.7 presents the percentage of women who gave birth by specified exact ages, the

percentage of women who have never given birth, and the median age at first birth by the age of

the women. The median age at first birth is 21 years for the women in the age group of 20-49

years as well as those in the age group of 25-49 years. The median age at first birth is almost

constant in all the five-year age groups starting from 25-29 years. In the city of Agra, 11 percent

of women aged 20-49 years had given birth by the age of 18 years. Thirty four percent of women

aged 20-49 years gave birth by the age of 20 years and 61 percent gave birth by the age of 22

years. By the age of 25 years, 81 percent of the women aged 20-49 years had given birth.

Table 5.7. Age at first birth

Percentage of currently married women who gave birth by exact age and who never gave birth and median

age at first birth -Agra , MLE-2010

Current Age

Percentage who gave birth by

exact age Percentage

who have

never

given birth

Number

of women

Median age

at first

birth 15 18 20 22 25

15-19 0.0 na na na na 65.4 106 nc

20-24 0.5 12.1 40.7 na na 19.0 516 nc

25-29 0.2 8.2 29.0 57.1 78.5 9.8 649 21.3

30-34 0.4 11.6 32.9 59.0 77.3 2.5 542 21.2

35-39 1.0 14.2 38.7 64.4 85.5 2.3 489 20.7

40-44 1.0 11.0 32.6 62.2 84.8 0.8 436 21.2

45-49 1.3 7.8 27.8 58.5 82.6 0.5 269 21.3

Age 20-49 0.6 10.9 33.9 60.9 81.2 6.6 2901 21.0

Age 25-49 0.7 10.7 32.4 60.1 81.2 3.9 2385 21.2

na - not applicable

nc - not calculated because less than 50% of women had a birth before reaching the beginning of

the age group

All the women and women in the survey were asked about the desire for a child or another child

and the timing. The information on the desire for another child helps program managers and

policy makers draw interventions and strengthen strategies of family planning and other health

services. It also helps understand prevailing fertility norms. Table 5.8 provides information

regarding the desire for a child or another child among the women by their background

characteristics.

The survey shows that 28 percent of the women expressed their desire to have another child; 13

percent said within the next two years and 15 percent said two years or later. Forty three percent

of women said they did not want any more children. Among all the women, 22 percent were

sterilized and seven percent were declared infecund.

Analysis by background characteristics indicates that the desire for more children declines

sharply with the increase in the number of living children. Ninety five percent of women with no

living children said they want a child, compared with only 18 percent of women with two living

children and seven percent of women with three living children. A similar relation is observed

with the age of the women. However, no consistent pattern emerged while analyzing the desire

for children by education, wealth index, religion and caste of the women (Table 5.8).

Table 5.8: Fertility preferences among women Percentage of currently married women age 15- 49 years by desire for children according to other background characteristics, Agra, MLE-2010 Background Characteristics:

Fertility Preferences Wants now (< 2 yrs)

Wants in (+ 2 yrs)

Wants but don’t know when

Does not want

Sterilized

Declared infecund

D/K Total N

Age 15-19 42.2 50.9 1.5 5.4 0.0 0.0 0.0 106

20-24 22.9 42.6 0.2 31.3 2.2 0.0 0.8 516

25-29 21.4 19.1 0.1 50.6 8.2 0.2 0.5 649

30-34 10.1 7.5 0.1 56.1 23.6 2.6 0.1 542

35-39 3.1 1.2 0.0 53.4 35.1 7.2 0.0 489

40-44 1.5 0.0 0.0 40.4 41.1 17.0 0.0 436 45-49 0.9 0.0 0.0 25.0 43.7 30.4 0.0 269 Education No education 9.5 10.8 0.0 43.0 28.3 8.0 0.4 1144

<5 classes complete 14.5 5.1 0.0 37.9 37.3 5.2 0.0 92

5-7 classes complete 13.2 17.4 0.7 39.4 21.0 8.2 0.0 287

8-9 classes complete 15.2 18.4 0.3 41.2 19.5 5.5 0.0 334 10-11 classes complete

13.3 18.0 0.1 41.0 20.1 7.3 0.2 363

12 or more classes complete

15.5 17.8 0.0 47.7 13.3 5.4 0.3 784

Missing 0.0 0.0 0.0 100.0 0.0 0.0 0.0 3 Wealth Index Lowest 14.0 12.4 0.1 43.9 24.1 4.7 0.8 540

Second 12.5 17.5 0.1 43.0 20.4 6.4 0.2 588

Middle 11.8 15.6 0.3 43.1 23.2 6.0 0.0 599

Fourth 12.7 12.9 0.0 45.3 20.0 9.1 0.1 635

Highest 12.5 15.3 0.1 41.6 22.5 7.9 0.2 646 Religion Hindu 12.6 14.6 0.1 42.6 23.1 6.8 0.2 2580

Muslim 14.3 17.2 0.2 47.0 13.6 7.1 0.6 386

Other 3.2 0.0 0.0 59.5 30.6 6.7 0.0 41 Caste Scheduled caste 12.5 15.2 0.2 41.5 25.1 5.3 0.3 915 Scheduled tribe 33.7 3.8 0.0 57.0 5.4 0.0 0.0 13

Other backward class 13.4 15.8 0.1 43.9 19.4 7.1 0.4 967

Other 11.9 13.8 0.1 44.2 21.8 8.1 0.1 1107

Don’nt know 0.0 0.0 0.0 100.0 0.0 0.0 0.0 1

Missing 0.0 0.0 0.0 61.6 38.4 0.0 0.0 4 No. of live births 0 63.1 31.5 0.2 0.5 0.0 4.7 0.0 256

1 26.4 49.7 0.6 18.1 0.4 4.7 0.3 501

2 7.2 10.9 0.0 65.1 11.8 4.4 0.6 752

3 2.5 3.9 0.0 52.5 35.6 5.5 0.0 561

4 2.9 1.5 0.0 46.0 40.9 8.4 0.4 382 5 2.7 0.8 0.0 46.2 35.9 14.1 0.3 254

6+ 0.2 0.8 0.0 44.9 41.0 13.0 0.2 302 Total 12.7 14.8 0.1 43.4 22.0 6.9 0.3 3007

* The N's are slightly smaller due to missing data for some characteristics

As presented in Table 5.9, 28 percent of the men reported that they would like to have another

child (10 %within 2 years, 17 % after 2 years, and 1 %were undecided). As observed in the

women, the desire for additional children declines rapidly with the increase in the number of

living children. Eighty nine percent of men with no living children said they want to have a child,

compared with 22 percent of men with two living children and 10 percent of men with three

living children.

Table 5.9: Fertility preferences among men

Percentage of currently married men age 18- 54 years by desire for children according to no. of live births,

Agra , MLE-2010

Desire for children

Number of living children (in percentage)

0 1 2 3 4 5-6 7+ Total

MEN

Wants another soon (<2 years) 49.1 19.4 5.9 3.0 2.2 0.8 1.2 10.2

Wants another later (2+ years) 38.5 49.2 15.3 7.1 2.7 1.8 0.4 16.9

Wants another, undecided when 1.3 3.0 0.6 0.0 0.2 0.0 0.0 0.8

Want no more 6.8 23.6 60.2 58.7 45.2 50.5 71.8 46.3

Wife or husband sterilized or

infecund 4.4 2.4 15.2 29.0 46.8 46.1 23.7 23.7

Don't Know/Missing 0.0 2.4 2.7 2.2 2.9 0.8 3.0 2.1

Number of Men 165 259 400 305 218 242 93 1682

Each woman who had given birth since 2007 as well as the women who were pregnant at the time

of the survey were asked whether the pregnancy was wanted at that time (planned), wanted at a

later time (mistimed), or not wanted at all. Table 5.10 shows the percentage distribution of births

since 2007 and current pregnancies according to fertility planning status by birth order and the

mother’s age at birth. Nineteen percent of all pregnancies that resulted in live births since 2007

(including current pregnancies) were unplanned (that is, unwanted at the time the woman became

pregnant), nine percent were wanted later and 10 percent were not wanted at all. The proportion

of births that were not wanted at all increases sharply by birth order of children.

Table 5.10. Fertility planning status among women

Percentage distribution of last birth since 2007 by birth order and mother's age at birth among currently

married women*, Agra , MLE-2010

Birth

order/mother's age

at birth

Planning status of birth (in percentage)

Number of

births

Wanted

then

Wanted

later

Wanted

no more Missing Total

Birth Order

1 95.3 4.1 0.0 0.6 100.0 321

2 85.5 13.4 0.5 0.6 100.0 367

3 82.2 6.5 10.9 0.3 100.0 205

4+ 51.9 10.2 35.3 2.6 100.0 253

Mother's age at birth**

<20 71.4 8.9 17.4 2.3 100.0 198

20-24 84.0 8.2 7.3 0.6 100.0 663

25-29 79.8 11.5 8.3 0.4 100.0 232

30-34 68.1 5.2 21.4 5.4 100.0 42

35-39 74.4 12.1 13.5 0.0 100.0 8

40-49 0.0 0.0 100.0 0.0 100.0 1

Total 80.2 8.9 9.9 1.0 100.0 1146

*including current pregnancies as last birth if currently pregnant

**for current pregnancy, used mother's current age; some women had missing data on age at birth

Table 5.11 shows the planning status of the last birth since 2007 by birth order and father's age at

birth among men. As reported by the men, 13 percent of births since 2007/current pregnancies of

the spouse were not wanted at the time the wife became pregnant, six percent wanted the child

later, while seven percent did not want the child at all.

Table 5.11. Fertility planning status among men

Percentage distribution of last birth since 2007 by birth order and father's age at birth among

currently married men *, Agra, MLE-2010

Birth

order/Father's

age at birth

Planning status of birth (in percentage)

Number of

births

Wanted

then

Wanted

later

Wanted

no more Total

Birth Order

1 96.6 2.8 0.7 100.0 157

2 86.6 12.2 1.2 100.0 118

3 78.7 5.7 15.6 100.0 80

4 89.8 6.2 4.0 100.0 35

5-6 64.7 4.0 31.3 100.0 35

7+ 94.1 0.0 5.9 100.0 17

Father's age at birth

<25 86.2 6.8 7.0 100.0 111

25-29 92.2 4.4 3.4 100.0 148

30-34 87.3 5.3 7.4 100.0 97

35-39 91.0 0.0 9.0 100.0 49

40+ 68.8 20.5 10.7 100.0 37

Total 87.5 6.1 6.4 100.0 442

*including current pregnancies as last birth if spouse is currently pregnant

5.3 Perception on Ideal Number of Children

Table 5.12 presents information on the ideal number of children for women. Overall, three-fifths

of the women perceived that two children was the ideal number of children. Around one-fifth

thought three was the ideal number and 11 percent considered four children the ideal number. The

proportion of women reporting one or two as the ideal number of children declines with the

increase in the number of living children. The proportion of women reporting the ideal number of

children as three or more increases with the increase in the number of living children. Among

women with four children, 74 percent perceived fewer than four children as ideal. Similarly,

among women with five living children, 95 percent perceived less than five children as ideal.

These findings indicate a huge mismatch in the ideal and actual number of children and also

indicate the potential for program intervention.

Table 5.12. Ideal number of children

Percent distribution of ideal number of children among currently married women of age 15 – 49 years by

number of living children-Agra, MLE-2010

Ideal

number of

children

Number of living children (in percentage)

0 1 2 3 4 5 6+ Total

0 1.5 0.5 2.1 2.7 1.1 4.3 9.3 2.7

1 5.1 8.7 1.0 1.4 0.3 0.0 0.0 2.4

2 80.7 77.6 83.0 53.3 45.1 30.5 16.3 60.4

3 6.4 10.8 11.1 36.8 27.8 33.9 26.0 21.0

4 2.7 2.2 1.9 4.6 23.3 25.9 34.8 10.6

5 0.0 0.1 0.0 0.1 0.5 1.4 4.0 0.6

6+ 0.0 0.0 0.0 0.0 0.0 0.3 0.8 0.1

Other 2.9 0.3 0.8 1.1 1.9 3.3 7.6 2.0

Don’t know 0.6 0.0 0.0 0.0 0.0 0.2 1.3 0.2

Missing 0.2 0.0 0.0 0.0 0.0 0.2 0.0 0.0

Number of

Women 256 501 752 561 382 254 302 3007

Fifty three percent of men perceived two children as the ideal number of children (Table 5.13), 23

percent perceived three children as ideal and 11 percent considered four to be ideal. The analysis

of the ideal number of children by number of living children for the men exhibits a similar pattern

as observed in the case of the women.

Table 5.13. Ideal number of children

Percent distribution of ideal number of children among currently married men of age 18 – 54 years by

number of living children-Agra, MLE-2010

Ideal

number of

children

Number of living children (in percentage)

0 1 2 3 4 5-6 7+ Total

0 3.1 0.3 3.1 4.0 5.1 14.4 13.3 5.3

1 7.3 12.5 3.1 0.0 0.3 0.1 0.0 3.4

2 76.5 75.1 73.9 48.1 34.4 12.8 16.2 52.6

3 8.6 9.6 15.6 40.5 25.9 37.1 22.2 23.3

4 4.5 1.6 3.2 5.7 27.3 22.9 34.1 11.2

5 0.0 0.0 0.1 0.3 4.3 5.9 2.0 1.6

6+/other* 0.0 0.9 1.1 1.4 2.9 6.8 12.3 2.7

Number of

Men 165 259 400 305 218 242 93 1682

*Other includes infrequent responses, such as God/other

Table 5.14 presents information on the ideal birth interval as perceived by men and women. Eight

percent of the women and 71 percent of the men consider a birth interval of at least three years as

ideal. Against 17 percent of women, 27 percent of the men considered two years as the ideal

birth interval.

Table 5.14. Birth intervals

Percent distribution of ideal birth intervals among currently married women and men -Agra , MLE-2010

Ideal birth interval % of women % of men

≤1 year 2.8 2.3

2 years 17.3 26.6

3 years 44.2 47.6

4 years 16.4 9.3

5 years 18.6 13.4

6+ years 0.6 0.8

Total 100 100.0

Chapter VI

Family Planning

This Chapter presents information on various aspects of family planning collected from women

and men. The issues covered in this Chapter include knowledge and use of various contraceptive

methods, sources of first knowledge, discussions and decision making regarding contraception,

future intention of using contraception and willingness to pay for contraceptive methods. This

Chapter also includes data about the men’s knowledge and the sources of first learning about

contraceptive methods.

6.1 KNOWLEDGE OF CONTRACEPTIVE METHODS

The study participants were questioned about their knowledge of various methods of family

planning, which included female and male sterilization, the pill, IUDs, injectables, implants, male

condoms, female condoms, diaphragms, foam or jelly, the lactational amenorrhea method (LAM),

emergency contraception and two traditional methods (rhythm and withdrawal). In addition, a

provision was made in the questionnaire to record any other methods named by the respondents.

Information on knowledge of contraception was collected in two ways. First, the respondents

were asked to spontaneously mention all the methods that they had heard of. For methods not

mentioned spontaneously, the interviewer described the method and probed to see whether the

respondent recognized it.

The information about the women’s knowledge of different contraceptive methods according to

their background characteristics has been presented in Table 6.1. Knowledge about any family

planning method among women is nearly universal. Ninety one percent of women spontaneously

mentioned at least one method of family planning. Overall, 95 - 100 percent of women were

aware of female sterilization, male sterilization, the pill, IUDs, condoms/Nirodh and injectables.

Nearly three-fourths of the women knew about emergency contraceptives. However, knowledge

about the female condom is quite limited (only 9%). Twenty nine percent of women were aware

of other modern methods, such as implants, diaphragms and foam or jelly. Although less than one

fifth of the women spontaneously mentioned the rhythm method (20 %) and withdrawal (13 %),

94 and 83 percent reported these methods respectively on probing.

Almost all of the men reported at least one contraceptive method spontaneously or after probing.

Similar to women, the knowledge of the two terminal methods (female and male sterilization) and

two of the most commonly promoted spacing methods (the pill, and condoms/Nirodh), is

universal. Four-fifths of the men were aware of IUDs, while nearly two-thirds were aware of

injectables. Awareness of emergency contraception and female condoms has been reported by 65

and 38 percent of the men respectively. Nearly three-fourths of the men reported knowledge of

the two traditional methods (rhythm-73 % and withdrawal-70 %) (Table 6.1). When comparing

knowledge of contraceptive methods by type of method, it appears that except for the female

condom, women are more informed about various contraceptive methods than men.

Table 6.1 Knowledge of contraceptive methods

Percentage of currently married women and men who know any contraceptive method by specific method,

Agra, 2010

Method

Women Men

Spontaneous or

probed knowledge

Spontaneous

knowledge

Spontaneous or

probed

knowledge

Spontaneous

knowledge

Any method 100.0 91.0 99.4 93.6

Modern methods

Female sterilization 100.0 69.4 97.7 78.5

Male sterilization 98.6 28.3 97.6 68.8

Pill 99.7 63.1 94.9 60.2

IUD 98.4 32.3 80.6 31.2

Injectables 94.6 16.9 65.0 23.4

Condom/Nirodh 99.4 59.8 99.1 86.7

Female condom 9.0 0.6 38.1 13.0

Emergency contraception 75.2 11.5 64.6 17.6

Other modern method 28.9 2.8 31.5 1.4

Traditional methods

Rhythm 94.3 19.8 73.1 9.3

Withdrawal 83.1 13.2 70.0 10.3

Table 6.2 presents data on women’s knowledge about contraceptive methods according to their

age and education. The data indicates that the women’s awareness about female sterilization,

male sterilization, pills, injectables, IUDs and male condoms does not vary by these background

characteristics. The knowledge about newer methods such as emergency contraceptives and

female condoms shows significant variation by education. As expected, women with 12 or more

years of education (95 %) are more informed about emergency contraceptives as compared to

women with no education (56 %). Among different age groups, women in the age group of 20-39

years are better informed about emergency contraceptives as compared to their younger and older

counterparts.

Table 6.2 Knowledge of contraceptive methods among women

Percentage of currently married women who know any contraceptive method by specific method, according to background characteristics, Agra, 2010

Female

Sterilization

Male

Sterilization

Pill IUD Injectables Condom /

Nirodh

Female

Condom

EC LAM Rhythm Withdrawal Others *

AGE

15 - 19 99.1 98.1 99.7 90.4 85.9 99.0 8.4 66.3 19.0 79.1 64.1 0.0

20 - 24 100.0 97.8 100.0 97.2 93.8 99.7 8.7 76.1 25.9 90.2 78.7 1.0

25 - 29 99.9 98.6 99.9 98.7 96.4 99.4 11.5 79.8 27.5 94.6 84.1 3.1

30 - 34 100.0 98.7 99.5 98.9 95.8 99.7 8.4 81.4 29.1 97.1 85.5 2.5

35 - 39 100.0 98.8 100.0 99.6 95.9 99.9 9.0 75.9 29.8 95.4 83.9 2.8

40 - 44 100.0 98.7 99.8 99.2 93.2 98.6 9.0 66.5 29.0 96.6 85.6 2.0

45 - 49 100.0 98.9 98.7 98.1 92.4 98.8 5.6 65.6 29.9 96.0 85.9 0.1

EDUCATION

No education 99.9 97.7 99.4 96.9 90.8 98.8 4.4 55.7 25.3 90.7 76.8 1.0

<5 classes complete 100.0 100.0 100.0 98.6 92.9 95.9 6.6 62.1 15.9 95.5 80.8 0.4

5-7 classes complete 100.0 98.7 99.8 98.8 95.4 99.8 4.9 75.2 35.2 95.7 85.4 0.7

8-9 classes complete 99.8 99.0 100.0 98.8 95.9 99.8 12.3 85.4 28.4 93.7 83.4 2.2

10-11 classes complete 100.0 98.8 99.9 98.7 94.8 100.0 12.3 88.2 25.4 96.8 83.6 3.6

12or more classes

complete 100.0 99.3 100.0 100.0 99.2 100.0 14.8 94.7 31.7 98.0 91.1 3.5

* Dermal patch, Diaphragm and Spermicide / Foam are included in others; * The N's are slightly smaller due to missing data for some characteristics

6.2 SOURCE OF FIRST LEARNING ABOUT CONTRACEPTIVE METHODS

The source of first knowledge about contraceptive methods among women has been presented in

Table 6.3 by their age. As the Table shows, television (TV) (74 %) followed by partner/spouse

(63 %) and family members/relatives (49 %) are the three commonly mentioned sources from

where women first learned about contraceptive methods. Doctors emerged as the first source of

information among 32 percent of the women. Health workers, newspapers/magazines and friends

have been mentioned as the sources of first learning by 13 - 15 percent of the women. There is

not much variation in the source of first learning by age, with the exception of women aged 15-19

years.

The data on source of first learning about contraceptive methods among the men has been

presented in Table 6.4. The two predominant sources from where the men first learned about

contraceptive methods are television (76 %) and friends (64 %). Doctors and newspapers

/magazines have been reported as the first source of information about contraception by 38 and

32 percent of the men respectively. Compared to women, a much lower proportion of men

reported family members/relatives (11 %) and partner/spouse (17 %) as the first source of

information about contraceptive methods. In general the source of first learning about

contraceptive methods does not vary much by the age of the men.

Table 6.3 Source of first learning about contraceptive methods among women

Percentage of currently married women who know any contraceptive method by source of first learning, MLE- Agra, 2010

Background

Characteristics

Doctor Health

Workers*

Friend Partner/

Spouse

Family

Members

/Relatives**

Peer

Educator

Radio TV Newspaper/

Magazine

Poster Other*** Don’t

know

Age 15-19 13.0 8.9 8.7 60.7 52.7 0.8 0.3 67.4 5.5 6.7 7.4 2.3

20-24 28.0 9.4 11.8 65.9 51.7 1.8 1.7 74.0 10.9 11.3 12.5 0.0

25-29 35.3 16.9 10.2 59.8 51.2 1.9 3.7 74.5 15.8 12.0 12.4 0.2

30-34 35.8 15.0 14.2 66.0 47.2 2.4 2.9 74.7 15.8 13.1 12.9 0.0

35-39 33.7 17.8 12.1 63.0 48.1 1.3 3.1 75.3 11.9 9.4 9.8 0.0

40-44 30.1 15.9 17.5 60.9 47.5 3.1 2.1 68.6 14.9 8.4 10.7 0.0

45-49 29.5 11.9 14.7 61.3 48.9 1.6 2.6 74.1 14.2 9.1 13.0 0.1

Total 31.8 14.6 12.9 62.8 49.3 2.0 2.7 73.5 13.7 10.7 11.7 0.1

* Includes ANM or Nurse, Comm Health worker/ASHA/USHA and AWW

** Includes Mother/M-in-Law, Father/F-in-Law, Sister/S-in-Law, Brother/B-in-Law and other relatives

*** Includes RMP, Unqualified Medical Provide, Leaflet/Broucher, Billboards, Community events, Live drama/theatre, School and Health center

Table 6.4 Source of first learning about contraceptive methods among men

Percentage of currently married men who know any contraceptive method by source of first learning, according to background characteristics, Agra, 2010

Background Characteristics: Doctor

or

Nurse

Health

Workers*

Friend Partner/

Spouse

Family

Members

/Relatives**

Peer

Educator

Radio TV Newspaper/

Magazines

Poster Other*** Don’t

know

Age

18-24 39.7 3.0 67.4 20.4 12.4 5.3 10.8 72.5 34.6 15.4 18.5 0.0

25-29 33.6 3.3 65.9 22.0 9.0 6.2 16.1 75.2 27.1 11.6 22.1 0.3

30-34 38.8 3.3 70.6 20.3 12.8 3.9 14.2 79.3 36.1 11.8 17.5 0.3

35-39 34.8 4.0 65.2 13.9 9.7 6.8 16.3 76.0 28.8 9.4 24.1 0.4

40-44 41.7 6.0 59.2 18.5 12.1 6.1 15.9 77.4 30.7 9.7 16.1 0.5

45-49 38.5 2.7 65.2 10.2 9.8 3.6 18.0 74.7 32.6 10.3 18.1 0.7

50-54 40.0 2.9 51.5 9.3 7.8 11.0 18.0 72.4 38.3 12.0 23.7 0.5

Total 37.8 3.7 64.2 16.7 10.6 5.9 15.7 75.8 32.0 11.1 19.9 0.4

* Includes ANM or Nurse, Comm Health worker/ASHA/USHA and AWW

** Includes Mother/M-in-Law, Father/F-in-Law, Sister/S-in-Law, Brother/B-in-Law and other relatives

*** Includes RMP, Unqualified Medical Provide, Leaflet/Brochure, Billboards, Community events, Live drama/theatre, School and Health center

6.3 DISCUSSIONS AND DECISION MAKING ON FAMILY PLANNING

The information relating to discussions with the spouse and others on family planning is

presented in Table 6.5. The majority of women (89 %) said that they have discussed family

planning with their spouse at some time. Among those women who have discussed family

planning with their spouses, 86 percent mentioned that these discussions were usually initiated by

both the spouse and herself.

The other persons with whom the women primarily discuss family planning are female relatives

(36 %), friends (27 %) and neighbors (25 %). Forty six percent of the women have never

discussed family planning with any other person.

Eighty six percent of the women said that they need the consent of their husband or family to use

family planning. Most of the women (92 %) reported that the decisions to use various methods of

family planning were taken jointly by the husband and the wife. Table 6.5 shows that most of the

women (88 %) have discussed the number of children they would like to have with their spouse,

and 38 percent of these women reported discussing this issue with the spouse in the last six

months.

Table 6.5 Discussion and decision making around family planning

Percentage of currently married women who discussed family planning and were involved in

decision making, Agra, 2010

Behavior Percentage

Ever discussed FP with spouse (n=3007)

Yes 88.8

No 11.2

Who initiates discussion among those who discuss (n=2669)

Self 6.1

Spouse 7.9

Both 86.0

Who else have you ever discussed FP with** (n=3007)

Female relatives 36.1

Male relatives 2.1

Friend 27.2

Neighbor 25.4

Others 7.5

No one 46.2

Do you need consent of your husband or family to use FP (n=3007)

Yes 85.6

No 4.1

Not applicable/never used or wanted to use 10.1

Don’t know 0.2

Who decides what type of method to use (n=3007)

Mainly you 1.6

Mainly husband 4.7

Jointly 92.1

Table 6.5 Discussion and decision making around family planning

Percentage of currently married women who discussed family planning and were involved in

decision making, Agra, 2010

Other 0.5

Missing 1.2

Have you discussed the number of children you would like to

have with your spouse (n=3007)

Yes 87.9

No 12.1

How often have you discussed the subject in the last 6 months (n=2643)

Not discussed in last 6 months 61.7

Once or twice 32.1

More than twice 6.1

* number of respondents vary by question

** percentages do not sum to 100 because women can give multiple responses.

6.4 EVER USE OF CONTRACEPTIVE METHODS

Contraception ever used, provides a measure of the cumulative experience of a population with

family planning. All currently married women who reported having heard about any method or

methods of family planning were asked whether they had ever used each method that they had

heard about. Table 6.6 presents the percentage of these women who had ever used any family

planning method by method and the age of the women.

Almost three-fourths of currently married women have used a family planning method at some

time in their lives. Women are much more likely to have used a modern method (60 %) than a

traditional method (28 %). Condoms/Nirodh (32 %) followed by female sterilization (22 %) are

the two most commonly used modern methods among currently married women. The pill and

IUDs have been used by 12 and six percent of the women respectively. The rhythm method has

been used by 26 percent of women, and 13 percent of women have used the withdrawal method.

The use of any method and any modern method increases with the woman’s age up to the age of

35-39 years and decreases subsequently. At the ages of 35-39 years, 85 percent of the currently

married women reported having used family planning and 70 percent reported using a modern

method. The extent of ever having used female sterilization and IUDs increases with the increase

in the women’s age. The use of condoms/Nirodh as well as the pill reaches a peak in the age

group of 30 - 34 years and thereafter the proportion of women reporting the use of these two

methods declines. Compared to all the age groups, the use of the two natural methods is lowest

for the youngest age group of 15-19 years.

Table 6.6 Ever use of contraceptive methods

Percentage of currently married women who ever used any contraceptive method by age, Agra, 2010

Age Any

method

Modern method Traditional method Number

of women Any

modern

method

Female

sterilization

Male

sterilization

Pill IUD Injectables Condom/

Nirodh

Other

modern

method

Any

traditional

method

Rhythm Withdra

wal

15-19 32.5 18.2 0.0 0.0 4.7 0.0 0.0 14.4 0.4 14.3 14.3 7.8 106

20-24 59.0 39.0 2.2 0.0 7.8 2.5 1.6 27.5 3.4 25.9 23.8 13.4 516

25-29 75.4 57.8 8.2 0.0 11.7 3.7 2.7 39.6 3.3 30.2 27.5 13.3 649

30-34 83.5 70.7 23.6 0.0 14.8 7.0 1.8 42.1 3.8 26.2 23.5 11.6 542

35-39 85.0 69.5 35.1 0.0 13.3 8.2 2.0 30.6 1.2 29.6 27.7 14.1 489

40-44 84.2 68.9 40.8 0.3 11.3 8.1 0.4 25.4 0.6 31.6 29.7 11.7 436

45-49 82.7 64.9 43.5 0.2 11.9 9.9 0.0 18.5 0.5 31.9 30.9 10.7 269

Total 76.0 59.7 21.9 0.1 11.5 5.9 1.5 31.7 2.3 28.4 26.3 12.5 3007

6.5 CURRENT USE OF CONTRACEPTIVE METHODS

The current level of contraceptive use, i.e., the contraceptive prevalence rate (CPR), is defined as

the percentage of currently married women aged 15-49 years who are currently using a

contraceptive method or whose husbands are currently using a contraceptive method. It is one of

the principal determinants of fertility. It is also an indicator of the success of family planning

programs. This Section focuses on the levels and differentials in the current use of contraceptive

methods in Agra. Current use of any contraceptive method, modern, traditional and method mix

among currently married women is presented by background characteristics in Table 6.7. The

contraceptive prevalence rate, of women using modern or traditional methods, in Agra is 63

percent, 48 percent are using modern methods and 15 percent are using traditional methods.

Similar to the age pattern of ever having used contraception, the current use of modern methods

also increases with age, peaks at 60 percent in the age group of 30-34 years and decreases

thereafter. The current use of any modern method of family planning increases sharply with the

increase in the wealth index of the women.

Data on method mix indicates a high preference for female sterilization (22 %) followed by

condoms (19 %). The use of IUDs, pills and injectables is limited. Only one to three percent

women reported using these methods. The current use of male sterilization is almost negligible.

The current use of female sterilization increases sharply with the increase in the age of women.

The use of four modern spacing methods namely the pill, IUDs, condoms and injectables

increases till the women reach the age of 25-29 years and starts declining thereafter. The current

use of all the above four modern spacing methods reaches a peak in the age group of 25-29 years.

In general, with increasing education and wealth of the women, the current use of female

sterilization declines where as the use of all the four modern spacing methods (the pill, IUDs,

condoms and injectables) increases steadily.

The use of traditional methods is higher among women in the lowest wealth quintile and women

with no education. Compared to Hindus (30 %), Muslim women (13.6 %) are less likely to use

female sterilization. However, condom use is high among Muslims. Analysis by caste shows that

the current use of female sterilization is higher among women belonging to the SCs. The

variations in the current use of various spacing methods by caste do not show any consistent

pattern. A higher proportion of women having three or more living children report the current use

of female sterilization, whereas current use of spacing methods is higher among low parity

women.

Table 6.7 Current use of contraceptive methods by background characteristics

Percent distribution of currently married women by contraceptive methods currently used, according to background characteristics, Agra, 2010

Background

Characteristic

Any

method

Any

modern

method

Modern method

Any

traditional

method Non-

users

Number

of

women

Female

sterili-

zation

Male

sterili-

zation Pill IUD

Inject-

ables

Condom/

Nirodh

Other

modern

method

Age

15-19 20.5 9.1 0.0 0.0 1.4 0.0 0.0 7.3 0.4 11.4 79.5 106

20-24 44.3 27.2 2.2 0.0 2.3 2.1 0.4 18.6 1.7 17.1 55.7 516

25-29 64.2 48.5 8.2 0.0 5.0 2.9 1.7 29.3 1.5 15.7 35.8 649

30-34 73.9 59.5 23.6 0.0 3.1 1.2 1.3 28.6 1.7 14.4 26.1 542

35-39 75.3 58.7 35.1 0.0 4.6 1.6 1.3 15.9 0.3 16.6 24.8 489

40-44 69.2 55.0 40.8 0.3 1.8 0.5 0.1 11.4 0.0 14.2 30.8 436

45-49 58.4 48.6 43.5 0.2 1.0 1.7 0.0 2.3 0.0 9.7 41.7 269

Education

No education 60.0 43.7 28.3 0.0 2.1 0.5 0.6 11.5 0.7 16.2 40.0 1144

<5 classes complete 65.6 52.4 37.3 0.0 0.7 0.4 0.0 12.9 1.1 13.2 34.4 92

5-7 classes complete 55.6 42.0 21.0 0.0 3.5 2.2 0.8 13.8 0.8 13.6 44.4 287

8-9 classes complete 59.3 45.7 19.5 0.0 3.2 0.2 0.7 21.7 0.5 13.5 40.7 334

10-11 classes complete 64.1 48.7 20.1 0.0 4.4 1.3 0.2 20.9 1.9 15.4 35.9 363

12 or more classes

complete 71.2 57.0 13.1 0.2 4.4 4.1 1.9 32.1 1.2 14.2 28.8 784

Wealth Index

Lowest 56.3 38.0 24.1 0.0 2.0 0.8 0.1 9.5 1.5 18.3 43.7 540

Second 60.3 43.4 20.4 0.0 2.6 0.6 0.7 18.2 0.9 16.8 39.7 588

Middle 60.1 46.8 23.2 0.0 2.5 1.5 1.3 18.0 0.3 13.3 39.9 599

Fourth 66.8 54.0 20.0 0.0 4.4 2.1 1.0 25.6 0.8 12.9 33.2 635

Highest 69.9 56.0 22.2 0.3 3.9 3.1 1.2 23.9 1.5 14.0 30.1 646

Table 6.7 Current use of contraceptive methods by background characteristics

Percent distribution of currently married women by contraceptive methods currently used, according to background characteristics, Agra, 2010

Background

Characteristic

Any

method

Any

modern

method

Modern method

Any

traditional

method Non-

users

Number

of

women

Female

sterili-

zation

Male

sterili-

zation Pill IUD

Inject-

ables

Condom/

Nirodh

Other

modern

method

Religion

Hindu 63.6 48.4 23.0 0.1 3.2 1.6 0.9 18.7 0.9 15.2 36.4 2580

Muslim 57.0 43.6 13.6 0.0 2.9 1.8 0.9 22.8 1.6 13.4 43.0 386

Other/None 78.5 67.0 30.6 0.0 5.7 3.7 0.0 27.1 0.0 11.5 21.5 41

Caste/Tribe

Scheduled caste 60.8 45.6 25.0 0.0 3.1 0.8 0.0 15.8 0.8 15.2 39.2 915

Scheduled tribe 36.8 33.3 5.4 0.0 0.0 8.2 0.0 19.6 0.0 3.5 63.2 13

Other backward

class 59.8 46.7 19.4 0.0 3.6 1.6 1.5 19.4 1.2 13.1 40.2 967

Other 67.7 51.4 21.7 0.1 2.9 2.3 1.1 22.3 1.0 16.3 32.3 1107

Don’t know 100.0 100.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 0.0 1

Missing 89.0 38.4 38.4 0.0 0.0 0.0 0.0 0.0 0.0 50.6 11.0 4

Number of live births

0 6.8 5.1 0.0 0.0 0.0 0.0 0.0 5.1 0.0 1.7 93.2 256

1 51.5 35.8 0.4 0.0 2.8 2.4 0.9 27.5 1.9 15.7 48.5 501

2 70.9 48.2 11.6 0.2 4.1 2.8 1.3 27.3 0.8 22.7 29.1 752

3 75.2 63.7 35.5 0.1 3.7 1.8 1.1 20.4 1.1 11.5 24.8 561

4 76.9 64.8 40.9 0.0 5.1 1.3 1.5 15.9 0.2 12.1 23.1 382

5 66.1 49.7 35.9 0.0 1.1 0.0 0.1 10.1 2.4 16.4 33.9 254

6+ 67.2 52.9 40.9 0.1 2.3 0.6 0.1 8.6 0.3 14.3 32.8 302

Total 63.0 48.1 21.9 0.1 3.2 1.7 0.9 19.4 1.0 14.9 37.0 3007

6.6 SOURCE OF CURRENT CONTRACEPTIVE METHODS

The source of the current method used was ascertained from the women who reported current use

of any modern method of family planning (Table 6.8). Fifty seven percent of women currently

using female sterilization reportedly accepted the method in a government/public sector facility

(govt./municipal hospital - 48 %, medical college hospitals 3 % and other public sector facilities -

6 %). Two-fifths of the women accepted female sterilization in a private hospital/clinic and 11 %

accepted it in a NGO/Trust hospital/clinic. Among the women currently using IUDs and

injectables, the majority received the method from a private hospital/clinic (IUDs- 76 % and

injectables - 87 %). Among the women currently using pills, 71 percent obtained it from a

pharmacy/drugstore. Condoms were mostly procured from a pharmacy/drug store (71 %). Nearly

one-fifth of the women reported that condoms were typically obtained by their husbands.

Condoms, pills and IUDs were infrequently obtained from government/public sector facilities.

Among all the current users of modern methods, 35 percent availed the method from a

pharmacy/drug store, 28 percent obtained them from government/public sector facilities and 23

percent received the method at a private hospital/clinic. Overall, the procurement of modern

methods by husbands has been reported by nine percent of the women.

Table 6.8 Source of modern contraceptive methods

Percent distribution of women modern contraceptive users by most recent source of the methods, Agra, 2010

Source

Female and

Male

sterilization Pill IUD Injectables

Condom/

Nirodh

All modern

methods

Govt/municipal hospital 48.4 3.9 11.3 2.6 1.3 23.7

Medical college hospitals 2.7 0.4 2.1 0.0 0.0 1.3

Other public sector facility 5.6 3.5 4.7 0.0 0.9 3.4

NGO/Trust hospital/clinic 3.6 0.0 0.9 0.0 0.0 1.7

Private hospital/clinic/doctor 39.7 6.3 75.9 86.6 0.2 23.3

Pharmacy/drugstore na 70.6 1.1 3.6 71.4 34.7

Husband na 7.8 0.0 0.0 21.1 9.3

Other private source na 0.8 0.0 0.0 0.8 0.4

Other 0.0 0.0 3.9 7.2 1.2 0.5

Don't know 0.0 6.8 0.0 0.0 3.0 1.7

6.7 REASON FOR DISCONTINUATION OF A FAMILY PLANNING METHOD

The reason for the discontinuation of family planning methods was ascertained from all the

women who had reported ever using any family planning method, but did not report the current

use of the method (Table 6.9). The most commonly mentioned reasons for discontinuation of

family planning methods are, wanted to get pregnant (48 %), method failed/got pregnant (18 %),

created health problems (14 %) and created menstruation problems (9%). Five percent of the

women had switched to other methods and four percent discontinued the method due to

menopause. Other reasons for discontinuing a family planning method were mentioned

infrequently, including that the method costs too much, suggesting that cost does not play a role

in why women stop using contraception.

Table 6.9 Reasons to discontinue a contraceptive method

Percent distribution of currently married women who are currently not using the same method as first

time by reasons to discontinue the method used first time, Agra, 2010

Reasons % of women

Wanted to get pregnant 47.8

Method failed/got pregnant 17.8

Lack of sexual satisfaction 2.1

Created menstruation problem 8.5

Created health problem 13.8

Inconvenient to use 1.1

Costs too much 0.2

Did not like method 1.6

Husband does not approve 2.1

Fear of side effects 0.8

Menopause 3.9

Switched method 5.1

Others 3.1

6.8 TIMING OF STERILIZATION

The timing of sterilization by age of the women at the time of sterilization has been presented in

Table 6.10. Eight percent of women reported that they did not know the year of sterilization.

Among sterilized women, 18 percent underwent sterilization when they were 20-24 years old, 38

percent when they were aged 25-29 years and 25 percent when they were aged 30-34 years.

Ninety two percent of sterilized women were sterilized before the age of 34 years.

Table 6.10 Timing of sterilization

Percent distribution of sterilized women by her age at sterilization, according to the number of years since

the sterilization, Agra, 2010

Years since

sterilization

Age of woman at time of sterilization Total

< 20

20 -

24

25 -

29

30 -

34

35 -

39

40 -

44

DK/CS

/NR N %

< 2 years 2.8 13.0 42.4 25.8 13.0 3.1 0.0 73 11.3

2 - 3 years 1.3 8.4 28.7 38.6 16.5 6.5 0.0 35 5.3

4 - 5 years 0.0 27.6 36.3 21.4 11.0 3.6 0.0 30 4.6

6 - 7 years 1.3 6.5 53.4 37.0 1.8 0.0 0.0 36 5.5

8 - 9 years 0.0 14.0 41.7 25.0 19.3 0.0 0.0 30 4.7

10+ years 1.8 22.4 41.7 26.7 7.4 0.0 0.0 397 60.9

DK/CS/NR 0.0 0.0 0.0 0.0 0.0 0.0 100.0 50 7.6

Total 1.5 17.8 38.3 25.4 8.4 0.9 7.6 652 100.0

6.9 REASONS FOR CURRENTLY NOT USING ANY FAMILY PLANNING METHOD

Table 6.11 shows the reasons for not using any family planning method among the women who

were currently not using any family planning method. The reasons more commonly mentioned

for not currently using any family method among the non users are currently pregnant (19 %),

wants to get/trying to get pregnant (19 %), attained menopausal/hysterectomy (15 %) and health

concerns (13 %) . Up to God, infrequent sex/no sex, wants as many children as possible,

postpartum amenorrhea and fear of side effects were mentioned as other reasons for not using any

family planning methods by six to 11 percent of the non users. Three to four percent of the

women cited opposition to using family planning (either by the husband, family members or

because of religious beliefs), currently breast feeding and cannot have children as some of the

other reasons for not using family planning methods. Interestingly, a very small percentage (0.1

%) of women cited the lack of access as their reason for currently not using contraception.

Table 6.11 Reasons for not currently using contraception among women

Percent distribution of currently married women age 15-49 who are not using

contraception by reasons for non-use, Agra, 2010

Reason * Percentage

Menopausal/hysterectomy 15.3

Trying to get pregnant 18.5

No sex/ infrequent sex 9.5

Husband away 1.4

Already pregnant 18.7

Breastfeeding 3.7

Wants as many children as possible 6.7

Postpartum amenorrhea 6.4

Has faced opposition to use 3.7

Lacks knowledge 0.5

Method-related reasons 16.8

Lack of access/too far 0.1

Costs too much 0.9

Others/ Don't know 12.2

*percentages do not sum to 100 because women could give multiple reasons

6.10 INTENTIONS TO USE CONTRACEPTION

The women who were not using contraceptive methods at the time of the survey were asked about

their intention to use contraceptives in the next 12 months. Table 6.12 shows the intention to use

family planning methods among the non users within 12 months. Nearly one-fourth of the non

users intend to use contraception, while 49 percent do not, and 28 percent were not sure about

their intentions.

The intention to use family planning in the next 12 months increases marginally with the increase

in the women’s age; it peaks in the age group of 25-29 years and declines thereafter. However, it

does not vary much with education or wealth. The intention to use family planning is relatively

lower among women belonging to other castes and Muslims. Analysis of intention with parity

indicates that it increases with the increase in the number of live births up to four live births and

declines thereafter.

Table 6.12 Future intention to use contraception

Percent distribution of currently married women who are currently not using any contraceptive method

by intention to use within 12 months, according to background characteristics, Agra, 2010

Characteristics

Whether intends to use within 12 months Total

N Yes No Don't know

Age

15 - 19 27.5 40.8 31.7 84

20 - 24 28.2 33.7 38.1 288

25 - 29 30.5 44.2 25.3 234

30 - 34 22.0 54.9 23.1 130

35 - 39 12.6 63.4 24.0 87

40 - 44 3.9 86.5 9.6 67

45 - 49 4.0 92.8 3.2 33

Education

No education 22.0 52.2 25.7 374

<5 classes complete 9.5 60.4 30.1 27

5-7 classes complete 21.6 45.7 32.7 107

8-9 classes complete 19.7 50.6 29.7 120

10-11 classes complete 34.7 35.9 29.4 104

12+ classes complete 26.8 47.8 25.3 190

Wealth

Lowest 24.0 48.2 27.8 213

Second 25.4 43.6 31.0 200

Middle 22.8 46.2 30.9 207

Fourth 20.6 52.6 26.8 158

Highest 25.8 55.9 18.2 145

Religion

Hindu 24.7 47.9 27.3 776

Muslim 19.2 51.2 29.6 141

Others/None .0 96.6 3.4 6

Caste/Tribe

Scheduled caste 24.4 44.6 31.0 314

Scheduled tribe 5.6 18.1 76.3 8

Other backward class 28.3 48.3 23.4 324

Other 18.3 54.7 27.0 276

Number of live births

0 21.1 41.0 37.9 226

1 26.3 41.8 31.9 224

2 25.7 57.5 16.8 188

3 25.6 52.1 22.4 109

4 27.6 46.7 25.7 59

5 10.8 56.1 33.1 56

6+ 22.8 65.2 11.9 61

Total 23.7 48.7 27.5 923

*Total number does not include women who, in a previous question, reported having a hysterectomy, being

menopausal, or being unable to have children

6.11 WILLINGNESS TO PAY FOR CONTRACEPTIVE METHODS

The willingness to pay for family planning methods was ascertained from all the women who

intended to use a family planning method within the next 12 months. Nearly one-fourth of all the

women intending to use a family planning method within the next 12 months were willing to pay

for them (Table 6.13). The willingness to pay for family planning methods increases with the age

of the women, though it peaks in the age group of 25-29 years and thereafter declines. The

women belonging to the highest wealth quintile and women having 10 or more years of schooling

are more likely to express their willingness to pay for contraceptives. A higher proportion of

Hindu women as compared to Muslim women have expressed willingness to pay for

contraceptives.

Table 6.13 Willingness to pay for contraceptive method

Percent distribution of currently married women who are currently not using any contraceptive method

but intent to use within 12 months by willingness to pay, according to background characteristics,

Agra, 2010

Willing to pay for FP

Yes No Don't know Total N

AGE

15 - 19 27.5 40.8 31.7 84

20 - 24 28.2 33.7 38.1 288

25 - 29 30.5 44.2 25.3 234

30 - 34 22.0 54.9 23.1 130

35 - 39 12.6 63.4 24.0 87

40 - 44 3.9 86.5 9.6 67

45 - 49 4.0 92.8 3.2 33

EDUCATION

No education 47.9 8.7 43.4 75

<5 classes complete 61.8 0.0 38.2 3

5-7 classes complete 61.1 18.7 20.2 19

8-9 classes complete 71.6 0.0 28.4 24

10-11 classes complete 58.6 6.5 34.9 36

12 or more classes complete 69.4 1.4 29.2 49

WEALTH INDEX

Lowest 24.0 48.2 27.8 213

Second 25.4 43.6 31.0 200

Middle 22.8 46.2 30.9 207

Fourth 20.6 52.6 26.8 158

Highest 25.8 55.9 18.2 145

RELIGION

Hindu 24.7 47.9 27.3 776

Muslim 19.2 51.2 29.6 141

Others/None 0.0 96.6 3.4 6

CASTE/ TRIBE

Scheduled caste 57.2 7.1 35.7 69

Scheduled tribe 100.0 0.0 0.0 0

Other backward class 54.2 9.2 36.6 89

Others 70.4 0.0 29.6 47

Total 23.7 48.7 27.5 923

6.12 ATTITUDE TOWARDS CONDOMS AND HORMONAL METHODS

Table 6.14 provides information regarding the women’s attitude towards condoms and hormonal

methods. Fifty four percent of women thought that if a condom is used correctly it protects

against pregnancy most of the time and 24 percent said it is effective only sometimes. Over one-

fifth of the women were not aware about how well a condom protects against pregnancy. Eleven

percent of the women said that condoms reduce sexual pleasure and six percent perceived the use

of condoms as a sign of infidelity. Sixty nine percent of the women had not recommend condoms

for family planning to their friends and relatives.

Forty two and 32 percent of the women said that if a woman uses a hormonal method as

instructed, it provides protection against pregnancy most of the time and sometimes respectively.

The percentage of women who have ever recommended the use of pills, IUDs and injectables to

their friends and relatives are 33, 28 and 25 percent respectively (Table 6.14).

Table 6.14 Attitude towards condoms and hormonal methods

Percent distribution of currently married women according to their attitude towards

condom and hormonal methods, Agra, 2010

Attitude Percentage

If a condom is used correctly how well does it protect against

pregnancy (n= 2989)

Most of the time 54.2

Sometimes 23.8

Not at all 0.8

Don’t know 21.2

Do you think condom reduces sexual pleasure (n= 2989)

Yes 11.0

No 59.0

Don’t know 30.0

Do you think using a condom is a sign of infidelity (n= 2989)

Yes 5.9

No 63.7

Don’t know 30.2

Missing 0.2

Have you recommended the condom for FP to friends and

relatives (n= 2989)

Yes 30.6

No 69.0

Missing 0.4

If a woman uses a hormonal method as instructed how well does it

protect against pregnancy (n= 3003)

Most of the time 41.8

Sometimes 32.2

Not at all 2.1

Don’t know 23.9

Missing 0.1

Have you recommended the pill for FP to friends and relatives (n=3003 )

Yes 32.7

No 67.2

Have you recommended the IUD for FP to friends and relatives (n= 3003)

Yes 28.3

No 71.6

Missing 0.1

Have you recommended injectables for FP to friends and relatives (n=3003 )

Yes 24.7

No 75.0

Missing 0.3

* number of respondents vary by question; * The N's are slightly

smaller due to missing data for some characteristics

6.13 UNMET NEED FOR FAMILY PLANNING

Unmet need is an important indicator representing the potential demand for family

planning. The data on unmet needs for the city of Agra, presented in Table 6.15, indicates

that five percent of the women have an unmet need for the spacing method, i.e., they

want to delay the next birth, but are not using any contraception. An additional 11 percent

women have an unmet need for the limiting method, i.e., they want to stop child bearing,

but are not using any method to do so. Thus, despite various efforts to ensure supply, 16

percent women have an unmet need for family planning.

Analysis by wealth indicates that poor women have a higher unmet need particularly for

the limiting method. Women in the first two quintiles have 19 - 21 percent unmet needs

for family planning. Even among the women from the richest quintile, the unmet need is

11 percent.

Table 6.15 Unmet need for family planning

Percent distribution of currently married women with unmet need for family planning by

wealth index, Agra, 2010

Unmet Need*

Wealth For spacing For limiting No unmet need Total

Poorest 4.6 16.0 79.5 100.0

Poor 7.4 11.9 80.7 100.0

Middle 5.5 11.5 82.9 100.0

Rich 4.2 9.3 86.5 100.0

Richest 3.3 7.8 89.0 100.0

Overall 5.0 11.1 83.9 100.0 *Unmet need for spacing includes pregnant women whose pregnancy was mistimed; and fecund women who are non-

pregnant, who are not using any method of family planning, and say they want to wait 2 or more years for their next birth.

Unmet need for limiting refers to pregnant women whose pregnancy was unwanted; and fecund women who are non-pregnant,

who are not using any method of family planning, and who want no more children. Excluded from the unmet need category

are pregnant women who became pregnant while using a method (these women are in need of a better method of

contraception).

Chapter VII Maternal and Child Health

This Chapter presents information on some of the key maternal and child health indicators such as place of birth/delivery, reasons for non-institutional births, immunization of the children and contact with the health personnel for maternal and child health services. 7.1 Place of Delivery The women were asked about the place of delivery for the youngest child born since 2007. Table 7.1 presents the place of delivery according to the women’s background characteristics. Overall, 73 percent all the live births that had taken place since 2007 took place in some health institution, 57 percent in private hospitals/clinics and 16 percent at government health facilities. Over one-fourth (27%) of the deliveries took place at home. A higher percentage of women in the age group of 25-29 years (80 %) and 30-34 years (73%) reported institutional births. The proportion of home deliveries was considerably higher for women in the youngest age group of 15-19 years (46%) as well as the older age group of 40-44 years (47 %). The proportion of institutional births increases sharply with the increase in the women’s education and wealth (Table 7.1). Women having 12 or more years of schooling and the women belonging to the highest wealth quintile are more likely to deliver at private hospitals/clinics. A higher proportion of Hindu women (75 %) than Muslims (63 %) reported deliveries at health institutions. Across caste categories, the proportion of institutional deliveries was higher among women from other castes as compared to women from the SCs and OBCs. The results presented for the other religious groups and Scheduled Tribes (STs) should be viewed with caution because of low cell frequencies. Table 7.1: Place of delivery Percentage Distribution of last live births by the currently married women of age 15 – 49 years, who

have given birth in the past three years preceding the survey by place of delivery and percentage

delivered in a place by background characteristics- Agra, MLE 2010

Background Characteristics

Public facility NGO/Trust

Pvt facility

Any Facility Home Others

Total*

Age

15-19 15.2 0.0 39.4 54.5 45.5 0.0 33

20-24 16.5 0.8 52.8 70.1 29.9 0.0 381

25-29 13.2 0.3 66.4 79.8 20.2 0.0 372

30-34 18.3 0.6 53.8 72.8 27.2 0.0 169

35-39 14.5 1.8 52.7 69.1 30.9 0.0 55

40-44 35.3 0.0 17.6 52.9 47.1 0.0 17

Education

No education 17.8 0.5 35.4 53.7 46.0 0.3 387

<5 years complete 20.7 0.0 34.5 55.2 44.8 0.0 29

5-7 years completed 22.9 0.0 46.7 69.5 30.5 0.0 105

8-9 years complete 14.9 0.0 65.8 80.7 19.3 0.0 114

10-11 years complete 17.8 0.0 69.0 86.8 13.2 0.0 129

12+ complete 8.5 1.5 85.4 95.4 4.6 0.0 260

Wealth Index

Lowest 18.5 0.0 28.1 46.6 53.4 0.0 249

Second 24.8 0.0 42.2 67.0 33.0 0.0 230

Middle 10.5 1.1 68.4 80.0 20.0 0.0 190

Fourth 10.3 1.0 76.8 88.1 11.9 0.0 194

Highest 11.6 0.6 84.1 96.3 3.7 0.0 164

Caste

Scheduled Caste 20.1 0.6 47.6 68.3 31.7 0.0 328

Scheduled Tribe 0.0 0.0 12.5 12.5 87.5 0.0 8

Other backward class 15.6 0.0 55.5 71.0 28.7 0.3 366

None of the above 12.0 0.9 68.7 81.6 18.4 0.0 326

Religion

Hindu 17.2 0.5 57.1 74.8 25.2 0.0 858

Muslim 8.7 1.2 53.4 63.4 36.0 0.6 161

Other 0.0 0.0 100.0 100.0 0.0 0.0 8

Total 15.8 0.6 56.9 73.2 26.7 0.1 1027

* 12 missing cases are excluded

All the women who had delivered the child at home were asked to mention the reason for not delivering the child at a health institution. The responses presented in Table 7.2 show that the most commonly mentioned reasons for non-institutional deliveries are “it is not necessary to give birth at the health facilities” (37%), “Did not have time to go to the health facility” (28 %) and “expensive institutional deliveries” (25 %). “Poor quality of services at the health facilities and did not trust the staff” have been mentioned as reasons for non institutional deliveries by seven and four percent of the women respectively. Table 7.2: Reasons for not delivering in a health facility–

Percentage of currently married women of age 15 – 49 years, who had their last live birth in the

three years preceding the survey by reasons for not delivering the mist recent live birth in a health

facility, Agra, MLE 2010

Costs too much 25.4

Didn’t have time 28.4

Don’t trust the staff 4.4

Not necessary 36.6

Poor quality services 6.9

Other Reasons 44.6

Base 288

7.2 Vaccination Coverage Table 7.3 presents the immunization status of the youngest child born since 2007. Among them, 86 percent received the Polio vaccine and 83 percent received BCG. DPT and measles vaccines were administered to 62 and 42 percent of the children respectively. One-tenth of the children had not received any vaccination. Ninety eight percent of all the women who reported administration of any vaccine to their youngest child said that the child was given at least one dose of polio drops .Among these children, 83 percent had received the first dose within the first two weeks of birth.

Table 7.3: Vaccinations received by youngest child Percentage of children, who are most recent born in past three years preceding the survey to a

currently married women of age 15 – 49 years, who received different vaccinations, at any time

before the survey, Agra, MLE 2010

Vaccinations received

Polio 86.3

BCG 83.3

DPT 62.1

Measles 41.6

Others 0.3

None 10.2

Total N 1025 Ever received polio vaccine including the vaccine received in a Pulse Polio campaign

98.1 (N=871)

Receipt of polio drops within the two weeks after birth

Received in first two weeks 83.5

Received later than 2 weeks 16.5 Total N 871

7.3 Contacts with Health Personnel Table 7.4 shows the contact the women have had with health workers and visits to doctors or health workers because of illness. Nineteen percent of the women reported contact with an Auxiliary Nurse Midwife (ANM) or Lady Health Visitor (LHV) in the last three months. Women had primarily visited a private hospital/clinic/doctor (87 %) in the last one year in case of their illness or their children’s illness. Only 11 percent of the women reported visiting a government health facility in case of sickness in the last one year. The most commonly mentioned reason for visiting a particular doctor/health personnel is proximity to home (61 %) followed closely by high quality of services offered by the health provider (56 %). Good reputation, provision of multiple services at the same facility and affordability of services have been mentioned as other reasons for visiting the facility by 14 to 19 percent of the women.

Table 7.4: Contact with Health Personnel Percent of currently married women of age 15 – 49 years who contacted or were

contacted by any health personnel, type of facilities visited and reasons for visiting

the health facilities by these women, Agra, MLE 2010

Contact Percentage

Have you been contacted by a health worker in the last 3 months

Yes 18.6

No 81.1

Don't know 0.3

In the last year have you or your child been ill and visited a doctor or other health personnel

Yes 65.4

No 28.9

Did not fall ill 5.6

Don't Know 0.1

What type of health facility did you visit (n=1968)

Govt./municipal hospital 9.3

Medical college hospitals 0.9

Other public sector facility 0.4

NGO/Trust hospital/clinic 0.3

Private hospital/clinic/doctor 86.6

Pharmacy/drugstore 2.0

Other private source 0.0

Don't Know 0.1

Other 0.3

Why did you visit this facility *

Close to home 60.7 Has a good reputation 15.4 Provides multiple services 14.3 It is affordable 19.0 High quality services 55.6 Other reasons 23.0

* Percentages do not sum to 100 because women can give multiple responses.

Chapter VIII Media

This Chapter presents the main sources of information on birth spacing among currently

married women and men. The Chapter also discusses the exposure the women and men

have had to radio and television (TV), as well as the type of information on family

planning they received from these sources. 8.1 Sources of Information on Birth Spacing Table 8.1 presents the main sources of information about birth spacing among the currently married women and men. Television is citied as the main source of information on birth spacing for both women and men (women 91% and men 88 % respectively).This is followed by friends/relatives/neighbors (66% and 77% among women and men respectively). Newspapers are a major source of information for 55 percent of the men and 29 percent of the women. Compared to 62 percent of the men, only 12 percent of women mentioned other health sources (other than government and private hospital staff) as their main source of information on birth spacing. The women (63 percent) are more likely than the men (19 %) to report their spouse as the main source of information on birth spacing. A small proportion of women have reported radio, government health staff and private health staff as their main sources of information on birth spacing. Table 8.1. Source of information on birth spacing Percentage distribution of women and men by main source of information for birth

spacing - Agra, MLE 2010

Exposure Percentage of

Women Percentage of

Men

What are your main sources of information for birth spacing * (n=3007) (n= 1673)

Radio 4.5 16.0

TV 91.0 87.8

Newspapers 28.9 55.2

Other media sources 18.5 20.9

Govt. hospital staff 14.9 16.7

Pvt. hospital staff 14.5 16.0

Other health sources 12.2 61.6

Community sources 1.8 22.5

Spouse 62.9 18.8

Friends/relatives/neighbors 65.9 77.3

Other interpersonal sources 26.4 4.9

Other 0.2 0.1

None/Don't know 0.2 0.7

* percentages do not sum to 100 because multiple responses could be given

8.2 Exposure to Information on Family Planning Through Radio and TV An attempt has been made in the present study to assess the exposure of women and men to radio and television and the different types of family planning information that they received through these sources in the last three months. As Table 8.2 shows, only nine percent of the men and four percent of the women listen to the radio. Seventy four percent of the women and 63 percent of the men listening to the radio reported receiving some family planning information on the radio in the last three months. Among the women reporting exposure to family planning messages on the radio, information about condoms was the most mentioned (67 %) topic. The other methods on which a sizeable proportion of the women received information through the radio are emergency contraceptives (42 %), pills (39 %) and IUDs (31 %). Receiving information through the radio on female sterilization, spacing between births, limiting family size and delaying first birth has been reported by 13 to 20 percent of the women. Among the men receiving any family planning information on the radio in the last three months preceding the survey, 86 percent had reportedly heard about condoms and 58 percent about emergency contraceptives. Receiving information through the radio on pills, female sterilization, male sterilization and injectables has been mentioned by 25 to 39 percent of the men. Compared to women, a lower proportion of the men received information on spacing between births, limiting family size and delaying first birth (7-11%). The vast majority of women and men (over 90 %) have been exposed to television (Table 8.2). Seventy nine percent of the women and 65 percent of the men watching television have seen some family planning related information on television in the last three months preceding the survey. Women had primarily seen information related to condoms (74 %) and emergency contraceptives (59%) on television. Thirty eight percent of the women had seen information related to pills on television and 19 to 27 percent had been exposed to information on IUDs, spacing between births and limiting family size. The men had mostly received family planning information through television on condoms (86 %), pills (57 %) and emergency contraceptives (52 %).

Table 8.2: Exposure to family planning on radio and television Percent distribution of recent exposure to FP in the media among currently married women of

age 15- 49 years and currently married men of age 18 – 54 years- Agra, MLE 2010

Women Men

Do you listen to the radio (n=3007) (n= 1682)

Yes 3.5 8.6

No 96.6 91.4 Have you heard any family planning information on the radio in the past three months (n=104) (n= 145)

Yes 74.1 63.3

No 26.0 36.7

What information have you heard * (n=77) (n= 92)

Pills 38.8 38.7

IUD 31.3 7.7

Condom 67.4 86.2

Injectables 6.4 24.8

Emergency contraceptives 41.6 57.8

Female sterilization 16.0 37.0

Male sterilization 1.6 35.2

Standard days method (sdm) 3.7 2.2

Mtp/abortion 0.0 0.0

Age at marriage 5.1 4.0

Delaying first birth 13.1 5.1

Spacing between births 20.2 9.4

Limiting family size 16.8 9.4

Do you watch television (n=3007) (n=1682)

Yes 90.4 91.1

No 9.6 8.9

Have you seen any family planning related information on the TV in the past three months (n=2419) (n= 1533)

Yes 79.4 64.8

No 20.6 35.2

What information have you seen * (n=2157) (n= 994)

Pills 37.7 57.1

IUD 18.8 6.7

Condom 73.9 86.3

Injectables 8.3 4.6

Emergency contraceptives 58.9 51.6

Female sterilization 11.7 16.0

Male sterilization 1.9 14.6

Standard days method (SDM) 0.4 0.6

MTP/abortion 1.0 0.1

Age at marriage 7.6 9.5

Delaying first birth 10.7 7.3

Spacing between births 26.9 11.0

Limiting family size 22.4 11.2

* percentages do not sum to 100 because multiple responses could be given

Chapter IX Gender

The present Chapter deals with the issues relating to women’s participation in decision making, opinions regarding the mobility of the women, the perceptions of women and men regarding the justification for domestic violence and spousal control, spousal communication and gender attitudes among men. 9.1 Decision Making Table 9.1 shows women’s participation in decision making regarding the use of their cash earnings as well as their husband’s earnings. Eighty nine percent of the women earning cash reported that the decision regarding the use of their earnings was jointly taken by the wife and the husband. Seventeen percent of the women reported that they took the decision themselves. As for the decision making regarding the use of the husband’s cash earnings, 71 percent of the women reported that this decision was taken jointly, 13 percent said that this decision was taken mainly by the husband and 15 percent said that someone other than the husband decided how the husband’s income was to be used. Half of the women said that they had some money of their own that they alone could decide how to use it.

Table 9.1. Decision making regarding the women’s and men’s cash earnings in Agra

Decisions Percent N

Who decides how the money she earns will be used

Respondent 5.9 24

Husband 0.8 4

Respondent & husband 91.2 246

Other 2.1 7

Who decides how the money that husband earns will be used

Respondent 1.3 39

Husband 12.2 386

Respondent & husband 70.6 2109

Other 14.8 395

Do you have any money of your own that you alone can decide how to use

Yes 50.9 1439

No 49.2 1524

Table 9.2 provides information about the participation of women in decision making for four different types of decisions, including buying food for the week, their own health care, their children’s health care and visiting their natal homes. Joint decision making was most common for all the four decisions described above. Only four to seven percent of the women themselves took the decisions on the above issues.

Table 9.2 : Women’s participation in decision making on certain key issues

Decisions Percent N

Buying food for the week

Mainly you 5.2 179

Mainly husband 17.4 460

Jointly 56.6 1765

Others 20.9 601

About health care for yourself

Mainly you 7.2 222

Mainly husband 15.2 472

Jointly 66.7 1997

Others 11.0 313

About health care for your children

Mainly you 7.5 242

Mainly husband 10.0 312

Jointly 68.0 2023

Others 8.3 225

NA 6.2 203

About visits to your natal home

Mainly you 3.9 151

Mainly husband 15.0 565

Jointly 68.9 1963

Others 12.1 319

NA 0.2 7

Table 9.3 shows the men’s perspectives on women’s participation in household decision making on matters relating to the wife’s health care, the children’s health care, making major household purchases, making purchases for daily needs and the wife’s visit to her family or relatives. Fifty one to 71 percent of the men said that the decision regarding the above four issues was jointly taken with the wife. A small proportion of the men felt that these decisions should be mainly taken by the wife. Twenty two to 37 percent of the men said that the decision regarding their wife’s health care, major household purchases, purchases for daily needs and visits to the wife’s family or relatives should mainly be taken by themselves.

Table 9.3: Men’s perspecitives on women’s participation in decision making on certain key issues Decisions Mainly

you Mainly wife

Jointly Others NA

About health care for your wife 37.0 4.2 54.1 4.8 - About health care for your children 12.4 7.6 71.3 3.1 5.6 Making major household purchases

23.5 3.6 64.3 8.6 -

Making purchases for daily needs 21.9 20.4 50.8 6.9 - Deciding about visits to the wife’s family or relatives

23.8 5.9 64.6 5.7 -

Total N 1680 9.2 Women and Mobility

The women were asked if they were allowed to go alone, with the child, only with another adult or not allowed to go at all to different places like the health center, friends or relatives’ houses, to the market and religious events. As Table 9.4 shows, only seven and 15 percent of the women are allowed to go alone to visit the health center/clinic for their checkups or in the case of their children’s illness respectively. Thirty five and 32 percent of the women said that they could go alone to a friend or relative’s house located within a 5-10 minute walk and located in another neighborhood or place respectively. As regards visiting the market, 35 percent said that they were allowed to go alone to the market if it was located in the same neighborhood or area, whereas 24 percent said that could go alone to the market, which is located in a different neighborhood or area. Similarly, 19 and 10 percent of the women respectively said that they were allowed to attend a religious event in the same neighborhood or area and a religious event in another neighborhood or area alone. In a majority of the cases it was required that the women be accompanied by another adult to different places especially when the place was located in another neighborhood or place.

Table 9.4: Mobility of the Women in Agra Places Alone With

child Only with another adult

Not at all

Health centre or clinic for yourself for a check up like when you are pregnant

6.6 4.8 86.6 1.9

Health centre or clinic for yourself if you are sick

14.8 19.8 64.8 0.6

Friends or relatives house within a 5-10 minute walk

34.9 25.2 39.5 0.5

Friends or relatives house in another neighborhood or place

31.5 27.9 39.7 1.0

To the market in the same neighborhood or area

35.0 22.6 38.6 3.9

To the market in a different neighborhood or area

24.3 21.4 46.2 8.1

To a religious event in the same neighborhood or area

19.3 16.8 50.1 13.9

To a religious event in another neighborhood or area

9.7 10.3 53.6 26.5

Total N 3004 9.3 Justifications for Domestic Violence The women were asked whether, in their opinion, a husband is justified in hitting or beating his wife in the following seven situations: if she goes out without telling him, if she neglects the house or children, if she argues with him, if she refuses to have sex with him, if she does not cook food properly, if he suspects her of being unfaithful, and if she shows disrespect for her in-laws. Agreement with any of the reasons justifying wife beating indicates a low level of women’s empowerment, since it implies an acceptance of men’s exercise of power over women.

Table 9.5 shows the percentages of women who agree with the different reasons for hitting or beating the wife. Except for the reasons for hitting or beating a woman for suspecting her of being unfaithful (41%), five to 21 percent of the women agreed with the other reasons for beating the wife.

9.5 Attitude of the women towards hitting or beating the wife

Issues Percent

If she goes out without telling him 10.1

If she neglects the house or the children 4.7

If she argues with him 17.8

If she refuses to have sex with him 5.4

If she doesn’t cook the food properly 9.8

If he suspects her of being unfaithful 40.8

If she shows disrespect for her in-laws 20.8

The men respondents were asked as to whether they thought that a wife was justified in refusing to have sex with her husband when she knows her husband has a sexually transmitted disease, when she knows her husband has sex with other women, when she is tired or not in the mood and when the husband refuses to use contraception. As Table 9.6 shows, 69 - 79 percent of the men agree with the first three reasons that they were asked about and 62 percent agree with the fourth reason (refusing to have sex if the husband refuses to use contraception).

Table 9.6 Attitude of the men towards refusing sexual intercourse with husband

Whether wife should refuse sexual intercourse with husband if

Yes No Don’t know

She knows her husband has a sexually transmitted

79.3 18.5 2.3

She knows her husband has sex with other women

76.4 20.4 3.2

She is tired or not in the mood 69.3 27.6 3.1 Her husband refuses to use contraception 62.3 32.6 5.2 Total N 1680 The currently married men were also asked; “Do you think that if a woman refuses to have sex with her husband when he wants her to, he has the right to: 1) Get angry and reprimand her, 2) Refuse to give her money or other means of financial support, 3) Use force and have sex with her even if she doesn’t want to and 4) Go and have sex with another woman”. The responses of the currently married men on the above queries are presented in Table 9.7. Over one-fifth of the men said that if the wife refuses to have sexual intercourse with the husband, the husband has the right to get angry and reprimand her. Seven to 11 percent of the men agreed that if the woman refuses to have sex with her husband when he wants her to, the husband has the right to refuse to give her money or other means of financial support (11 %) and use force and have sex with her even if she doesn’t want to (8 %) and have sex with another woman (7 %).

Table 9.7 Attitude of the men towards rights of the men when the women refuses to have sex with the husband Rights of the men to Yes No Don’t

know Get angry and reprimand her 22.3 75.9 1.8 Refuse to give her money or other means of financial support

10.8 85.3 3.9

Use force and have sex with her even if she doesn’t want to

7.8 88.5 3.7

Go and have sex with another woman 6.5 89.9 3.6 Total N 1680 9.4 Spousal Control The study participants, including both women and men, were asked whether a husband should prohibit his wife from doing certain things such as working outside the home, receiving visits from people, visiting her friends, visiting her family and using contraceptives. As Table 9.8 shows, over one-third of the women perceived that a husband should prohibit the wife from working outside the home and 22 percent were in favor of the husband prohibiting the wife from receiving visits from people. Four to nine percent of the women felt that a husband should prohibit his wife from visiting her friends, visiting her family and using contraceptives. Compared to women, a considerably higher proportion of the men (75 %) think that a husband should prohibit his wife from working outside the home (Table 9.8). Further, the men are much more likely to be in favor of prohibiting the wife from receiving visits from people (59 %). A higher proportion of men than the women also think that a husband should prohibit his wife from visiting her friends (30 %), visiting her family (15 %) and using contraceptives (19 %).

Table 9.8 Perception of women and men regarding prohibition by the husbands in doing certain things by the wife Things for prohibition % of women % of men Working outside the home 35.7 74.9 Having visits from people 21.8 58.5 Visiting your friends 9.3 30.1 Visiting your family 7.0 14.7 Using contraceptives 4.4 19.1 Total N 2999 1680 9.5 Spousal Communication All the currently married women were asked about the extent of spousal communication on things that happen at home, events in the community, events that happen at work and money matters. The women’s responses on the extent of spousal communications have been presented in Table 9.9. Among the women, 50 - 54 percent reported that they often spoke with the husbands on matters relating to things that happened at home,

events that happened at work and on money matters and another 19 - 25 percent reported that they only communicated with the husband on these matters some times. Nineteen to 30 percent said that the husband talked on these issues all the times. Half the women say that the husband speaks to them about events in the community only some times and 13 percent mention no spousal communication on this issue.

Table 9.9: Extent of Spousal Communication Issues on which the husband talk to the wife

All the time Often Sometimes Never

Things that happen at home

21.5 53.8 23.8 0.9

Events in the community 11.6 25.5 50.2 12.6 Events that happen at work 18.8 53.8 24.5 2.9 Money matters 29.7 50.0 18.8 1.6 Total N 3002 9.6: Gender Attitudes In order to assess the gender attitudes, a number of statements were read out to each of the currently married man covered in the survey one by one and thereafter the respondent was asked to mention whether they agree or partially agree or do not agree with the statement. The analysis of their responses has been presented in Table 9.10. The majority of the men (61-82 %) agreed with the statements such as “Changing diapers, giving the kids a bath, and feeding the kids are the mother’s responsibility”, “A man should have the final word about decisions in his home” “A couple should decide together if they want to have children”, “In my opinion, a woman can suggest using condoms just like a man can”, “If a man gets a woman pregnant, the child is the responsibility of both” , “A man and a woman should decide together what type of contraceptive to use” and “It is important that a father is present in the lives of his children, even if he is no longer with the mother”. A majority of the men either did not agree or partially agreed with the statements “You don’t talk about sex, you just do it” and “I would be outraged if my wife asked me to use a condom” respectively. It is not encouraging to note that over half of the men either agreed or partially agreed with the statement that “It is a woman’s responsibility to avoid getting pregnant” and “A woman should tolerate violence in order to keep her family together”.

Table 9.10: Gender Attitudes among Men in Agra Decisions Agree Partially

agree Do not agree

Missing

You don’t talk about sex, you just do it 32.7 27.7 39.4 .1 Women who carry condoms on them are “easy”

43.1 18.7 38.0 .2

Changing diapers, giving the kids a bath, and feeding the kids are the mothers responsibility

75.6 10.0 14.3 .1

It is a woman’s responsibility to avoid getting pregnant

39.6 14.6 45.6 .2

A man should have the final word about decisions in his home

61.4 22.1 16.4 .1

A woman should tolerate violence in order to keep her family together

39.2 18.9 41.6 .3

I would be outraged if my wife asked me to use a condom

29.9 25.6 44.2 .3

A couple should decide together if they want to have children

82.2 14.3 3.4 .1

In my opinion, a woman can suggest using condoms just like a man can

75.1 17.0 7.7 3

If a man gets a woman pregnant, the child is the responsibility of both

77.7 15.6 6.4 .3

It is important that a father is present in the lives of his children, even if he is no longer with the mother

60.1 20.4 19.5 .1

A man and a woman should decide together what type of contraceptive to use

80.2 14.3 5.2 .3

Total N 1680

Chapter X

SERVICE DELIVERY POINTS

The Service Delivery Points (SDP) survey in Agra included all public health facilities,

all high volume private sector health facilities, and a sample of other private sector health

facilities that were preferred by the women covered in the individual survey.

Additionally, the SDP survey covered a sample of pharmacies and retail outlets located in

the Public Sector Undertakings (PSUs) covered in the study. The details of the SDPs

included in the survey and the procedure followed for the selection of the SDPs have

been described in Chapter 2. The survey of SDPs involved facility audits, exit interviews

and provider interviews at the public and private sector health facilities located in Agra.

In addition to the above, a facility audit was also undertaken at pharmacies and retail

outlets selected for the study. The findings of the facility audit, exit interviews and

provider interviews are presented in this Chapter.

10.1 AVAILABILITY OF SERVICES AND INFRASTRUCTURE

Table 10.1 shows the types of services provided at the health facilities covered in the

survey. The majority of the health facilities covered in the survey provide family

planning and counseling services (97 %), counseling on initiating breastfeeding after

pregnancy (60 %) and ante-natal care services (55 %). The services on maternal

care/delivery, post-abortion care, post natal care, child immunization and child growth

monitoring are offered at 35-48 percent of the facilities. Only 20 percent of the facilities

offer services for the detection and treatment of Sexually Transmitted Infections (STIs).

All of the high volume public and high volume private health facilities provide services

on antenatal care, counseling on initiating breastfeeding after pregnancy, and family

planning and counseling services.

More than 97 percent of other public and other private health facilities provide family

planning and counseling services. A higher proportion of the other public health facilities

(95 %) than the other private health facilities (32 %) provide services on child

immunization. A higher proportion (39 %) of the other private health facilities provides

maternal care and delivery services as compared to other public health facilities (15 %).

Only 10 and 18 percent of the other public and other private health facilities respectively

provide services for the detection and treatment of STIs.

Table 10.1. Percent of facilities providing services by type of service in Agra

Type of Service

High

Volume

Public

High

Volume

Private

Other

Public

Other

Private Total

Maternal Care/Delivery

services 50.0 92.9 15.0 38.5 40.9

Post-abortion care 50.0 85.7 20.0 29.7 34.7

Ante-natal care 100.0 100.0 90.0 39.6 55.1

Post natal care 100.0 92.9 70.0 35.2 48.0

Counseling on initiating

breastfeeding after pregnancy 100.0 100.0 73.7 49.5 59.5

Child immunization 100.0 64.3 95.0 31.9 46.5

Child growth monitoring 50.0 42.9 50.0 35.2 38.6

Detection and treatment of

STIs 50.0 42.9 10.0 17.6 19.7

Family planning and

counseling services 100.0 100.0 100.0 96.7 97.6

Total number of

facilities* 2 14 20 91 127

* The N's are slightly smaller due to missing data for some services

Table 10.2 provides information on the health facilities with specific services by type of

facility in Agra. Seventy-nine percent of both the high volume private and the other

private health facilities open seven days in a week. However, only 50 percent of the high

volume public and 10 percent of the other public health facilities have reported that they

open seven days in a week. Among the facilities that provide family planning services, 28

percent of high volume private and none of the high volume public health facilities have

standard operating procedures. Twenty-one percent of the high volume private health

facilities are registered with an institution or program that provides/discounts family

planning methods. However, none of the public sector facilities are registered with an

institution or program that provides/discounts family planning methods. Eight-five

percent of the other public health facilities are registered with an institution or program

whereas six percent of the other private health facilities are registered with an institution

or program that provides/discounts family planning methods.

Further, while none of the high volume public sector facilities accept vouchers for family

planning services, 14 percent of the high volume private sector facilities accept vouchers

for family planning services. Against 83 percent of the high volume private health

facilities, none of the high volume public health facilities are willing to participate in a

voucher program for family planning methods. Fifty-seven percent and 53 percent of the

other private and other public health facilities respectively are willing to participate in a

voucher program.

Table 10.2. Percent of facilities with specific services by type of facility in Agra

Indicator

High

Volume

Public

High

Volume

Private

Other

Public

Other

Private Total

Percent of facilities open 7

days/week 50.0 78.6 10.0 78.7 67.2

Of facilities that provide FP

services, the percent of facilities

with standard operating procedures*

0.0 28.6 10.0 2.3 6.5

Percent of facilities registered

with an institution or program that

provides/discounts FP methods

0.0 21.4 85.0 5.5 19.7

Of facilities that provide FP

services, the percent of facilities that

accept vouchers for FP services*

0.0 14.3 5.0 0.0 2.4

Of facilities that provide FP

services and are not participating in

a voucher program, percent of

facilities that would be willing to

participate in a voucher program for

FP methods*

0.0 83.3 52.6 56.8 57.9

Total number of facilities** 2 14 20 91 127

*Number of facilities slightly smaller than full sample when services not provided; **The N's are slightly

smaller due to missing data for some services

Table 10.3 shows the health facilities that offer sterilization, IUDs, injections and

implants with specific conditions by type of facility in Agra.

Fifty two to 76 percent of the public sector facilities offering sterilization, IUDs,

injections and implants have reported that they have running water supply, availability of

sterile disposable gloves, availability of sharps container, availability of an examination

light and privacy for pelvic examination/IUD insertion and 81 percent have facilities with

a storage area for drugs and supplies. All high volume private facilities have mentioned

supplies/facilities except storage. Among 14, only one facility reported that it doesnot

have storage facility. Among, other private facilities, 80-87% have basic

supplies/facilities.

Table 10.3. Percent of facilities that offer sterilization, IUD, injections and

implants with specific conditions by type of facility in Agra*

Indicator

Public

facilities**

High

Volume

Private

Other

Private Total

Percent of facilities with running water

supply 52.4 100.0 84.1 78.5

Percent of facilities with storage area

for drugs and supplies 81.0 92.9 88.6 87.3

Percent of facilities with sterile

disposable gloves always available 57.1 100.0 79.6 77.2

Percent of facilities with a sharps

container 57.1 100.0 88.6 82.3

Percent of facilities that offer privacy

for pelvic exam/IUD insertion 57.1 100.0 79.6 77.2

Percent of facilities with an

examination light 76.2 100.0 79.6 82.3

Total number of facilities 21 14 44 79

*Includes only those facilities that provide these methods; **Two high volume public facilities included

Table 10.4 provides information on the availability of staff in the different categories of

health facilities. Fifty percent of the high volume public health facilities and 35 percent of

the other private facilities do not have a single doctor. The availability of two or more

doctors has been reported in 86 percent of the high volume private, five percent of the

public and 31 percent of the other private health facilities.

Ninety-six percent of the high volume public, 93 percent of the high volume private, and

57 percent of the other private health facilities do not have a single Ayush doctor. As

compared to 43 percent of the other private facilities, five percent and seven percent of

the high volume public and high volume private have one or more Ayush doctor

respectively. Eighty two percent of the high volume public facilities, 59 percent of the

other private facilities and seven percent of the high volume private facilities do not have

any nurse. Availability of five or more nurses has been reported in 29 percent of the high

volume private facilities and in less than 10 percent of the public and other private

facilities.

Ninety seven percent of the other private health facilities, 86 percent of the private health

facilities, and 77 percent of the high volume private facilities do not have any midwives.

A traditional birth attendant (TBA) is available in 43 percent of the high volume private

facilities and 27 percent and three percent of the public facilities and other private

facilities respectively. The other staff, which includes the health educators/social workers

and Lady Health Visitors/Public Health Nurse/District Public Health Nurse are available

in 73 percent of the public facilities and 21 percent of the high volume private facilities.

Table 10.4. Level and composition of facililty staff by type of

facility in Agra

Staff composition

Public

facilities**

High

Volume

Private

Other

Private

Physicians/Doctors

No doctors 50.0 0.0 35.2

One doctor 45.5 14.3 34.1

Two or more doctors 4.6 85.7 30.8

Physicians/Doctors (Ayush)

No doctors (Ayush) 95.5 92.9 57.1

One or more doctors

(Ayush) 4.6 7.1 42.9

Nurses

No nurses 81.8 7.1 59.3

1 - 2 nurses 9.1 28.6 20.9

3 - 4 nurses 4.6 35.7 9.9

5+ nurses 4.6 28.6 9.9

Midwife

No midwives 77.3 85.7 96.7

1+ midwives 22.7 14.3 3.3

Traditional Birth Attendant

No TBAs 72.7 57.1 96.7

1+ TBAs 27.3 42.9 3.3

Other*

None 27.3 78.6 94.5

1+ 72.7 21.4 5.5

Total number of facilities*** 22 14 91

*Other includes: health educators/social workers and Lady Health Visitors/Public Health

Nurse/District Public Health Nurse; **Two high volume public facilities included; ***

The N's are slightly smaller due to missing data for some types of providers

Table 10.5 provides information on the public facilities providing family planning

methods and services by type of method. Most of the public health facilities provide

IUDs, oral pills, and condoms (96% each). Female sterilization, male sterilization, and

MTP services (9% each) are available in a few public health facilities. Emergency

contraceptives and Progestin-only oral pill are provided at nine percent and five percent

of the public facilities respectively. None of the public health facilities provide implants,

dermal patches and female condoms and only two facilities offer the progestin-only oral

pill. Of facilities providing these services, 50 percent facilities are open seven days in a

week for female sterilization.

The partner’s consent is required in all the facilities for male sterilization. Seventy

percent of the facilities required the partner’s consent for IUDs, followed by oral pills

(55%), emergency contraceptives, female sterilization, MTPs (50% each), and male

condoms (40%). In general the public sector facilities require a prescription for

providing different family planning methods.

None of the public facilities providing injectables, progestin-only oral pills, and

emergency contraceptives reported current availability of the method at the facility. IUDs

was reported currently available in 95 percent of public facilities, followed by the

combined oral pill and male condom (86% each). Of the methods that they have currently

available, none of the public facilities reported stock-out in the last 30 days or in the last

one year except for male condoms (11%), IUDs (10%), and combined oral pills (6%).

Table 10.6 shows private facilities providing family planning methods and services by

type of method.

Thirteen of the 14 high volume private facilities provide female sterilization. Twelve high

volume private facilities provide MTP services and nine high volume facilities provide

IUDs and injectables. Seven high volume facilities provide combined oral pills and male

sterilization and six high volume private facilities provide emergency contraception and

male condoms. None of the high volume private facilities provide implants, dermal

patches and female condoms. Sixty-seven to 75 percent of the high volume facilities

providing different methods of family planning have reported that they provide these

services seven days a week, though all facilities provide the progestin-only pill seven

days a week.

Partner’s consent is required in all the facilities for male sterilization. Eighty nine percent

of facilities require the partner’s consent for IUDs, followed by injectables (88%), female

sterilization (85%), emergency contraceptives (50%), combined oral pill (43%),

progestin-only oral pill (33%), and male condoms (17%). In general, the high volume

private sector facilities require a prescription for providing different family planning

methods. None of the high volume private facilities reported stock-out of the methods

they have currently available in the last 30 days, though stock-outs of IUDs and

injectables were reported in the last one year.

Among the other private facilities, 48 percent and 44 percent of the facilities provide

male condoms and emergency contraceptive pills respectively and 40 percent each

provide both IUDs and the combined oral pill (Table 10.7). Twenty three to 31 percent of

other private facilities provide injectables, progestin-only oral pill, female sterilization,

and MTPs.

All of the other private facilities are open seven days a week for female sterilization, male

sterilization, and female condoms. Seventy eight to 88 percent of the other private

facilities reportedly provide various family planning methods seven days a week.

All the other private facilities providing implants, dermal patches, and female condoms,

and nearly all providing female sterilization (96%) and MTP (94%) require the partner’s

consent to provide the method Between 64 and 77 percent of facilities require the

partner’s consent to provide IUDs, male sterilization, and injectables. Almost all the other

private facilities require a prescription for providing different family planning methods.

All other private facilities have at least one method currently available. Stock-out of the

methods currently available at other private facilities were reported for IUDS,

injectables, progestin-only pill and the combined oral pill in the last 30 days as well as in

the last one year.

Table 10.8 shows the percentage of pharmacies that provide various family planning

services. Almost all the pharmacies (93 to 99%) contacted provide emergency

contraceptives, combined oral pills, and male condoms, and 37 percent of the pharmacies

provide injectables. Progestin-only oral pills are provided at 24 percent of the

pharmacies. A few pharmacies (1 %) provide female condoms. None of the pharmacies

stock dermal patches or implants. All the pharmacies providing family planning methods

report current availability of some method. Stock-outs of the methods currently available

at pharmacies were reported for all methods with the exception of the female condoms in

the last 30 days (1 to 12%), as well as in the last one year (2 to 12%).

,

Table 10.5 Percent of public facilities providing FP methods and services by type of method in Agra*

Method

Number

of

facilities

Percent of

facilities

that

provide

this

service

% (n)

Of facilities providing the service,

the percent of facilities that:

Stock-out situation

Method is

currently

available

% (n)

Of facilities with

method currently

available, percent of

facilities that:

Offer this

service 7

days/week

Require

partners

consent to

receive

the

method

Requires a

prescription

to receive

the method

Stock-out

in the last

30 days**

Stock-out

in the last

one

year**

IUD 22 95.5 (21) 4.8 70.0 60.0 95.2 (20) 10.0 10.0

Injectable 22 4.6 (1) 0.0 0.0 0.0 100.0 (1) 0.0 0.0

Implant 22 0.0 (0) 0.0 0.0 0.0 0.0 (0) 0.0 0.0

Combined oral pill 22 95.5 (21) 4.8 55.0 60.0 85.7 (18) 5.6 5.6

Progestin-only oral

pill 22 4.6 (1) 0.0 0.0 0.0 100.0 (1) 0.0 0.0

Emergency

contraceptive 22 9.1 (2) 0.0 50.0 50.0 100.0 (2) 0.0 0.0

Dermal patch 22 0.0 (0) 0.0 0.0 0.0 0.0 (0) 0.0 0.0

Male Condom 22 95.5 (21) 4.8 40.0 45.0 85.7 (18) 11.1 11.1

Female Condom 22 0.0 (0) 0.0 0.0 0.0 0.0 (0) 0.0 0.0

Male sterilization 22 9.1 (2) 0.0 100.0 NA 100.0 (2) NA NA

Female sterilization 22 9.1 (2) 50.0 50.0 100.0 100.0 (2) NA NA

MTP 22 9.1 (2) NA 50.0 100.0 100.0 (2) NA NA

* High volume public facilities are included in this table; **Only among those with method currently available; small number with missing information on stock;

NA - Not asked

Table 10.6 Percent of High Volume Private facilities providing FP methods and services by type of method in Agra

Method

Number

of

facilities

Percent of

facilities

that

provide

this

service

% (n)

Of facilities providing the service,

the percent of facilities that:

Stock-out situation

Method is

currently

available

% (n)

Of facilities with

method currently

available, percent of

facilities that:

Offer this

service 7

days/week

Require

partners

consent to

receive

the

method

Requires a

prescription

to receive

the method

Stock-out

in the last

30 days**

Stock-out

in the last

one

year**

IUD 14 64.3 (9) 66.7 88.9 88.9 77.8 (7) 0.0 14.3

Injectable 14 64.3 (9) 75 87.5 87.5 66.7 (6) 0.0 16.7

Implant 14 0.0 (0) 0 0.0 0.0 0.0 (0) 0.0 0.0

Combined oral pill 14 50.0 (7) 71.4 42.9 71.4 71.4 (5) 0.0 0.0

Progestin-only oral

pill 14 21.4 (3) 100 33.3 66.7 33.3 (1) 0.0 0.0

Emergency

contraceptive 14 42.9 (6) 66.7 50.0 66.7 66.7 (4) 0.0 0.0

Dermal patch 14 0.0 (0) 0 0.0 0.0 0.0 (0) 0.0 0.0

Male Condom 14 42.9 (6) 66.7 16.7 50.0 66.7 (4) 0.0 0.0

Female Condom 14 0.0 (0) 0 0.0 0.0 0.0 (0) 0.0 0.0

Male sterilization 14 50.0 (7) 100 85.7 NA 100.0 (7) NA NA

Female sterilization 14 92.9 (13) 84.6 83.3 83.3 92.3 (12) NA NA

MTP 14 85.7 (12) NA 81.8 81.8 91.7 (11) NA NA

*Only among those with method currently available; small number with missing information on stock; NA - Not asked

Table 10.7. Percent of other private facilities providing FP methods and services by type of method in Agra

Method

Number

of

facilities

Percent of

facilities

that

provide

this

service

% (n)

Of facilities providing the service,

the percent of facilities that:

Stock-out situation

Method is

currently

available

% (n)

Of facilities with

method currently

available, percent of

facilities that:

Offer this

service 7

days/week

Require

partners

consent to

receive

the

method

Requires a

prescription

to receive

the method

Stock-out

in the last

30 days*

Stock-out

in the last

one year*

IUD 91 39.6 (36) 85.7 77.1 85.7 91.7 (33) 6.1 6.1

Injectable 91 30.8 (28) 88.0 64.0 84.0 78.6 (22) 4.6 4.6

Implant 91 1.1 (1) 0.0 100.0 100.0 100.0 (1) 0.0 0.0

Combined oral pill 91 39.6 (36) 86.2 58.6 69.0 69.4 (25) 4.0 4.0

Progestin-only oral

pill 91 30.8 (28) 82.6 52.2 73.9 71.4 (20) 5.0 5.0

Emergency

contraceptive 91 44.0 (40) 78.4 51.4 62.2 65.0 (26) 0.0 0.0

Dermal patch 91 1.1 (1) 0.0 100.0 100.0 100.0 (1) 0.0 0.0

Male Condom 91 48.4 (44) 78.4 35.1 27.0 54.6 (24) 0.0 0.0

Female Condom 91 1.1 (1) 100.0 100.0 100.0 0.0 (0) 0.0 0.0

Male sterilization 91 5.5 (5) 100.0 75.0 NA 80.0 (4) NA NA

Female sterilization 91 26.4 (24) 100.0 95.7 82.6 91.7 (22) NA NA

MTP 91 23.1 (21) NA 94.4 88.9 81.0 (17) NA NA

*Only among those with method currently available; small number with missing information on stock; NA - Not asked

Table 10.8. Percent of pharmacies providing FP methods by type of method in Agra

Method

Number of

pharmacies

Percent of

facilities

that

provide

this

method

% (n)

Of facilities providing the service,

the percent of facilities where:

Method is

currently

available

% (n)

Stock-out

in the last

30 days*

Stock-out

in the last

one year*

Combined oral pill 104 96.2 (100) 100.0

(100) 4.0 (4) 4.0 (4)

Progestin-only oral

pill 104 24.0 (25) 100.0 (25) 12.0 (3) 12.0 (3)

Emergency

contraceptive 104 93.3 (97) 100.0 (97) 1.0 (1) 2.1 (2)

Dermal patch 104 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0)

Male Condom 104 99.0 (103) 98.1 (101) 2.0 (2) 2.9 (3)

Female Condom 104 1.0 (1) 100.0 (1) 0.0 (0) 0.0 (0)

Injectable 104 36.5 (38) 100.0 (38) 2.6 (1) 5.3 (2)

Implant 104 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0)

*Only among those with method currently available; small number with missing information on stock; NA - Not asked

Table 10.9 shows the proportion of different categories of health facilities, which are

currently providing some family planning method. All the high volume facilities (both

public and private) and all the pharmacies currently provide some family planning

method. Among the other public and other private facilities, 90 and 48 percent

respectively currently provide some family planning method. All the high volume public

facilities and 29 percent of the high volume private facilities are currently providing more

than four modern methods. Among other private facilities and pharmacies 66 and 46

percent, respectively, provide more than four modern family planning methods. Among

other public facilities and pharmacies, 78 and 53 percent respectively provide two to

three modern methods. All of the high volume public, 86 percent of the high volume

private, 52 percent of the other private, and six percent of the other public facilities are

offering at least two long-acting and permanent methods.

Table 10.9. Percent of facilities currently offering modern methods by facility

type in Agra

Facility type

Percent

of

facilities

providing

any FP

method

% (n)

Percent of facilities currently

offering:

Percent of

facilities

offering 2+

long-acting

and

permanent

methods*

Only 1

modern

method

2-3

modern

methods

4+

modern

methods

High Volume

Public 100.0 (2) 0.0 0.0 100.0 100.0

High Volume

Private

100.0

(14) 0.0 71.4 28.6 85.7

Other Public 90.0 (18) 11.1 77.8 11.1 5.6

Other Private 48.4 (44) 15.9 18.2 65.9 52.3

Pharmacies 100.0

(104) 1.0 52.9 46.2 NA

* Long-acting and permanent methods includes male sterilization, female sterilization, and IUD

Table 10.10 shows that 60 percent of the providers at the high volume public 41 percent

providers at the high volume private, other public (18 %) and other private (11 %)

facilities have received pre-service training on family planning. A higher proportion of

the providers at the public and private facilities than those at the other public and other

private facilities had received in-service training on family planning. Sixty percent of the

providers at the other public facilities and half of those at the high volume public

facilities had received in-service training on family planning. None of the providers at the

high volume public facilities are members of an institution or program that provides

family planning methods at a discounted rate or free. However, 88 percent of providers

from high volume private facilities are members of an institution or program that

provides family planning methods at a discounted rate or free of charge.

Table 10.10. Provider training and participation in FP initiatives by facility type in

Agra

Characteristic

High

Volume

Public

High

Volume

Private

Other

Public

Other

Private

Received pre-service training on FP n = 10 n = 46 n = 50 n = 188

Yes 60.0 41.3 18.0 11.2

No 40.0 58.7 82.0 88.8

Received in-service training on FP

Yes 50.0 26.1 60.0 27.1

No 50.0 73.9 40.0 72.9

Received in-service training on FP in the last

year* n = 5 n = 10 n = 30 n = 47

Yes 20.0 20.0 23.3 19.2

No 80.0 80.0 76.7 80.9

Member of institution or program that provides

FP methods at a discounted rate or free n = 10 n = 45 n = 50 n = 186

Yes 0.0 24.4 88.0 6.5

No 100.0 75.6 12.0 93.6

*Only includes those providers who ever received in-service training

Table 10.11 shows the specific services provided by the pharmacies. Almost all the

pharmacies stock socially marketed contraceptive products (99 %). Among the

pharmacies not participating in a voucher program, 21 percent have shown willingness to

participate in a voucher program for family planning methods. A few pharmacies are

registered with an institution or program that provides family planning methods and

materials at a discounted rate or free of charge (2 %) and accept/redeem vouchers for

contraceptives (1 %).

Table 10.11. Percent of pharmacies with specific services in Agra

Indicator

Of pharmacies that provide FP

methods, percent

Registered with an institution or program that provides FP

methods and materials at a discounted rate or free 1.9

Accept/redeem vouchers for contraceptives 1.0

Of pharmacies not participating in a voucher program,

percent that would be willing to participate in a voucher

program for FP methods

21.4

With socially marketed contraceptive products in stock 99.0

Number of Pharmacies 104

Table 10.12 shows the type of services provided by the Registered Medical Providers

(RMP) and retail outlets. Ninety two percent of the RMPs provide family planning

counseling and 17 percent provide some family planning method. Eighty two percent of

retail outlets provide some family planning method and 22 percent provide family

planning counseling. Of the retail outlets who do not provide any family planning method

(n=4), half of them are willing to provide a family planning method. None of the RMPs

or the retail outlets accept/redeem vouchers for contraceptives.

Table 10.12. Percent of Registered Medical Providers and

Retail Outlets with specific services in Agra

Service

Registered

Medical

Provider

(RMP)

Retail

outlets

Percent that provide FP counseling 91.7 21.7

Percent that provide any FP method 16.7 82.6

Of those that do not provide any FP

method, the percent that would be

willing to provide FP

NA 50.0

Percent that accept/redeem vouchers

for contraceptives 0.0 0.0

Total Number of RMPs/Retail

Outlets* 12 23

*Number of RMPs/retail outlets included is small as only those in the localities of the

individual-level survey were identified and included

10.2 INTEGRATION OF FAMILY PLANNING WITH MATERNAL,

NEWBORN AND CHILD HEALTH (MNCH) PROGRAMS

Table 10.13 shows information on the integration of family planning with MNCH

programs across different types of health facilities. All of the high volume facilities (both

public and private) and 95 percent of the other public and 75 percent of other private

facilities offering MNCH services provide family planning information during MNCH

visits. Therefore, none of the high volume facilities require a return visit for family

planning information nor provide family planning referrals at MNCH visits.

Additionally, none of the other public facilities and only six percent of the other private

facilities require a return visit for family planning information at MNCH visits. However,

nine percent and five percent of other private and other public facilities, respectively

provide family planning referrals at MNCH visits. All of the public and private facilities

offering postnatal services provide family planning information at postnatal visits,

therefore none of them require a return visit for family planning information nor provide

family planning referrals at postnatal visits. Similarly, all the public facilities offering

post abortion services provide family planning information at post-abortion visits, and

therefore none of them require a return visit for family planning nor provide family

planning referrals at post-abortion visits. More than 90 percent of all private facilities

provide family planning information at post-abortion visits, and the majority of the

remaining private facilities therefore require a return visit for family planning

information, as no private facilities report providing referrals for family planning at post-

abortion visits.

Table 10.13 Integration of FP with MNCH services at facility Percent distribution of facilities where family planning services are integrated with maternal and child health services, according to facility type, Allahabad, 2010

MNCH visits* Postnatal visits* Post-abortion visits*

Facility type

Number

of

facilities

offering

child

health

services

Percent of

facilities

that

provide FP

information

at MNCH

visits

Percent

of

facilities

that

require a

return

visit for

FP at

MNCH

visits

Percent

of

facilities

that

provide

FP

referrals

at

MNCH

visits

Number

of

facilities

offering

postnatal

care

Percent of

facilities

that

provide FP

information

at postnatal

visits

Percent

of

facilities

that

require a

return

visit for

FP at

postnatal

visits

Percent

of

facilities

that

provide

FP

referrals

at

postnatal

visits

Number

of

facilities

offering

post-

abortion

care

Percent of

facilities

that

provide FP

information

at post-

abortion

visits

Percent

of

facilities

that

require a

return

visit for

FP at

post-

abortion

visits

Percent

of

facilities

that

provide

FP

referrals

at post-

abortion

visits

High Volume

Public 2 100.0 0.0 0.0 2 100.0 0.0 0.0 1 100.0 0.0 0.0

High Volume

Private 9 100.0 0.0 0.0 13 84.6 15.4 0.0 12 91.7 8.3 0.0

Other Public 20 95.0 0.0 5.0 14 100.0 0.0 0.0 4 100.0 0.0 0.0

Other Private 51 74.5 5.9 9.8 32 93.8 3.1 0.0 26 92.3 3.9 0.0

The providers offering antenatal care, postnatal care, post-abortion care, child health

services and curative services at the health facilities were asked about whether they

routinely provide family planning information to clients visiting for other services. Table

10.14 shows that 59 percent of the providers interviewed at different types of health

facilities provide antenatal care services. Among them, 91 percent are routinely providing

family planning advice to ANC clients. All the providers offering ANC services in other

public facilities and 92 percent of those in the other private facilities routinely provide

family planning to ANC clients.

Overall 51 percent of all the providers provide post natal care/delivery services. Ninety

percent of these providers routinely offer family planning information to delivery/

postnatal care clients.

Nearly half of the providers provide post-abortion care and out of these providers 89

percent routinely provide family planning information to post-abortion clients.

Nearly half of the providers offer child health services like immunization and growth

monitoring. Among them 89 percent are routinely providing family planning information

to child immunization/child growth monitoring clients.

Fifty nine percent of the providers offer curative services. Eighty seven percent of

providers providing curative services routinely offer family planning information to

curative services clients.

Table 10.15 shows that among all the women that participated in exit interviews at the

public and private high volume facilities, 60 percent were MNCH clients. Among these

MNCH clients, only three percent reported receiving any family planning related

information during their visit to the facility. The Table further shows that among the

MNCH clients, only a few (less than 1%) received either a prescription or a family

planning method and two percent were currently using a family planning method. Ninety

seven percent of the women did not receive any family planning services during their

MNCH visits to the facilities. Among the women who did not receive any family

planning service during their visit for MNCH services, 37 percent reported that they

would have been interested in family planning if the provider had offered any family

planning services.

Table 10.14. Percent of interviewed providers routinely providing family planning services to clients seeking other services by type of visit

in Agra

Number

of

providers

Antenatal care Postnatal care Post-abortion care Child Health

Services Curative Services

Type of Facility

Percent

of

providers

offering

ANC

% (n)

Percent

of

providers

routinely

providing

FP to

ANC

clients

Percent

of

providers

offering

postnatal

care

% (n)

Percent

of

providers

routinely

providing

FP to

delivery/

postnatal

care

clients

Percent

of

providers

offering

post-

abortion

care

% (n)

Percent

of

providers

routinely

providing

FP to

post-

abortion

clients

Percent

of

providers

offering

child

health

services

% (n)

Percent of

providers

routinely

providing

FP to child

immuni-

zation/child

growth

monitoring

clients

Percent

of

providers

offering

curative

services

% (n)

Percent

of

providers

routinely

providing

FP to

curative

services

clients

High Volume

Public 10 60.0 (6) 83.3 70.0 (7) 100.0 50.0 (5) 80.0 60.0 (6) 100.0 50.0 (5) 80.0

High Volume

Private 46

82.6

(38) 79.0 82.6 (38) 76.3 73.9 (34) 79.4 47.8 (22) 72.7 69.6 (32) 67.7

Other Public 50 80.0

(40) 100.0 38.0 (19) 100.0 50.0 (25) 100.0 82.0 (41) 97.6 60.0 (30) 100.0

Other Private 188 47.3

(89) 92.1 45.2 (85) 92.9 43.6 (82) 90.2 39.4 (74) 78.4 53.2 (100) 90.0

Total* 294 58.8

(173) 90.7 50.7 (149) 89.9 49.7 (146) 89.0 48.6 (143) 83.9 56.8 (167) 87.4

* The N's are slightly smaller due to missing data for some services

Table 10.15. Percent of women surveyed in exit interviews receiving MNCH services by whether they received FP information,

referrals, or methods at high volume facilities in Agra

Number

of

clients

Percent of

clients at

facility for

MNCH

services

% (n)

Of clients at

facility for

MNCH visit,

percent that

received any

FP

information

% (n)

Of clients at facility for MNCH services, percent of clients that

received: Of those that did

not receive

anything, if the

provider had

offered, percent

that would have

been interested in

FP

Type of Facility

Any

Method Referral Prescription

Already

using

Did not

receive

anything

% (n)

High Volume

Public 80 65.0 (52) 0.0 (0) 0 0 0 0 100.0 (52) 48.9

High Volume

Private 603 59.0 (356) 3.7 (13) 0.6 0.3 0.8 2 96.4 (343) 34.8

Total* 683 59.7 (408) 3.2 (13) 0.5 0.3 0.7 1.7 96.8 (395) 36.6

* The N's are slightly smaller due to missing data for some services

10.3 QUALITY OF FAMILY PLANNING SERVICES

Table 10.16 shows the percentage of family planning clients and providers at high

volume facilities who discussed topics related to contraception during counseling. At the

high volume public facilities, almost all the clients using family planning as well as the

clients not using or switching family planning at the time of the visit reported discussing

the purpose of visits and identification of reproductive goals at the facility. The majority

of both categories of clients reported discussions on different family planning methods,

client's family planning preferences, possible side effects of the methods, and specific

medical reasons to return and when to return for follow-up. All of the clients not using or

switching family planning methods at the time of visit reported discussing the client’s

family planning preferences, selection of a method, how to use the method, and possible

side effects of the method. Among the clients using family planning at time of visit, the

majority also reported that the problems encountered with the current method were

discussed and they were suggested some action(s) to resolve the problem.

Among the providers contacted at the high volume public facilities, 78 percent reported

discussing the possible side effects with the family planning clients and 67 percent

reported discussions about the identification of reproductive goals as well as information

given about different family planning methods. The discussions about the client's family

planning preferences, selection of a method, possible side effects of the methods, and

when to return for follow up were reported by 11 to 44 percent of the providers at the

high volume private facilities.

At the high volume private facilities, all of the clients reported that the reason for their

visit was discussed at the facility. Similar to that observed in case of public high volume

facilities, the majority of clients both using family planning as well as the clients not

using or switching family planning methods at the time of the visit, reported discussions

on identification of reproductive goals, different family planning methods, client's family

planning preferences, possible side effects of the methods, specific medical reasons to

return and when to return for follow-up at high volume private facilities. Further, the

majority of the clients not using or switching family planning methods at the time of the

visit reported discussions on the selection of a method and how to use a method. Among

the clients using family planning at time of visit, almost all of the clients reported

discussing the problems encountered with the current method and they were suggested

some action(s) to resolve the problem.

Among the providers contacted at the high volume private facilities, 67 percent reported

discussing the different family planning methods with the family planning clients as well

as how to select a method. Discussions about the identification of reproductive goals, the

client's family planning preferences, selection of a method, use of the method, possible

side effects of the methods was reported by 19 to 43 percent of the providers at the high

volume private facilities.

Table 10.16. Percent of FP clients (from exit interviews) and providers (provider surveys) at high volume facilities who

discuss(ed) topics related to contraception during counseling in Agra

At High Volume Public facilities, the

percent of clients/providers:

At High Volume Private facilities, the

percent of clients/providers:

Topics of discussion

Client:

Using FP at

time of visit

Client: Not

using or

switching

FP at time

of visit

Providers

Client:

Using FP at

time of visit

Client: Not

using or

switching

FP at time

of visit

Providers

Reason for visit 100.0 100.0 NA 100.0 100.0 NA

Identify reproductive goals 100.0 81.8 66.7 93.7 97.1 42.9

Information about different FP methods 100.0 90.9 66.7 98.2 99.3 66.7

About the client's FP preferences 94.1 100.0 33.3 97.3 98.5 42.9

Help client to select a method NA 100.0 44.4 NA 98.2 66.7

Explain how to use this method NA 100.0 0.0 NA 98.2 33.3

Talk about possible side effects 94.1 100.0 77.8 93.7 98.8 50.0

Explain specific medical reasons to

return 100.0 93.3 NA 98.2 97.5 NA

Tell client when to return for follow-up 92.9 93.3 11.1 90.1 93.3 19.1

Any problems had with current method 93.8 NA NA 99.1 NA NA

Suggest any action(s) to resolve the

problem 94.1 NA NA 100.0 NA NA

Total number of clients/providers* 17 11 (15)** 9 111 136

(162)** 42

NA - Not Asked; Not all questions were asked to all clients and/or providers; * The N's are slightly smaller due to missing data for some topics; **Note, n in

parentheses includes switchers; method switchers were only asked fewer questions including method selection, how to use the method, side effects, actions to resolve

the problem and return for follow-up

96

Table 10.17 shows the client’s level of satisfaction with the services at the high volume

public and private facilities. Almost all of the clients reported that the waiting time at the

high volume public and private facilities was reasonable. Almost all of the clients in both

categories of high volume facilities reportedly felt overall satisfaction with their visit.

Privacy during the examination was reported by a higher proportion of the clients at the

high volume private (93 %) than the public (69%) facilities. Forty six and 36 percent of

the clients at the high volume private and public facilities respectively believed that the

information they shared with the provider would be kept confidential. Almost all of the

clients at both categories of facilities reported that they felt comfortable asking questions

during their visit.

Table 10.17. Client satisfaction with services by facility type in

Agra

Type of Facility*

Indicator

High

Volume

Public

High

Volume

Private

Percent of clients reporting waiting

time is reasonable 100.0 (80) 98.8 (596)

Percent of clients reporting privacy

during their exam 68.75 (55) 93.4 (563)

Percent of clients who felt

comfortable asking questions during

their visit

95.0 (76) 98.0 (591)

Percent that believe the information

they shared with the provider will be

kept confidential

36.3 (29) 45.6 (275)

Percent of clients who reported

overall satisfaction with their visit 98.73 (78) 98.8 (596)

Total number of clients** 80 613

*Client exit interviews come from 2 high volume public facilities and 14 high volume

private facilities; ** The N's are slightly smaller due to missing data for some services

Table 10.18 shows the availability of information, education and communication (IEC)

material for family planning at different types of health facilities. All of the high volume

public facilities reported availability of a family planning sign or poster. The high volume

public facilities did not report having an IEC outreach program for family planning.

Among high volume private facilities, 86 percent have a family planning sign or poster,

97

64 percent have brochures/ handouts, 36 percent have job aids, and 21 percent have an

IEC outreach program for family planning. Only 14 percent of the high volume private

facilities give health talks about family planning to community members. Among the

other public facilities, 90 percent give health talks for community members, 70 percent

have an IEC outreach program for family planning, and 45 percent have a family

planning sign or poster. Only 10 percent of these facilities have brochures/ handouts and

job aids. Availability of family planning signs or posters has been reported by 39 percent

of the other private facilities. However, a few of these facilities (4 to 12%) have

brochures/ handouts, job aids, give health talks for community members and have an IEC

outreach program for family planning.

Table 10.18. Availability of information, education and communication materials for

family planning by facility type in Agra

Facility type

Number

of

facilities

Percent of facilities*

IEC

outreach

program

for FP

Brochures/

handouts

FP sign

or poster Job aids

Give

health

talks for

community

members

High Volume

Public 2 0.0 50.0 100.0 50.0 50.0

High Volume

Private 14 21.4 64.3 85.7 35.7 14.3

Other Public 20 70.0 10.0 45.0 10.0 90.0

Other Private 85 1.2 11.9 39.3 8.3 3.5

* Some data on IEC materials are missing; Those that respond "don't know" are recoded to "no" for relevant

IEC items

Table 10.19 presents the number of family planning providers who provide different

methods of family planning and the percentage of providers who restrict the clients'

eligibility to use a method for reasons of parity, marital status or spouse's consent.

The majority of doctors providing sterilization restrict clients' eligibility to use

sterilization for reasons of parity, marital status, and spousal consent. Among the doctors

providing injectables, 79, 76, and 57 percent consider marital status, spouse’s consent,

and parity respectively to screen women. Similarly, most of the doctors, nurses and

midwifes consider marital status and parity for IUD insertion.

98

Table 10.19. Number of family planning providers who provide each method and

who restrict clients' eligibility to use a method for reasons of parity, marital status

or spouse's consent, by method, according to type of provider in Agra

Barrier and

method

Doctors Nurses Midwife

Number

that

provide

method

Percent

that

restrict

Number

that

provide

method

Percent

that

restrict

Number

that

provide

method

Percent

that

restrict

Parity

Pill 46 47.8 24 79.2 8 75.0

Condom 43 14.0 25 24.0 8 12.5

Sterilization 26 88.5 NA NA NA NA

IUD 51 82.4 31 93.6 8 87.5

Injection 37 56.8 NA NA NA NA

Marital status

Pill 47 74.5 25 72.0 8 75.0

Condom 42 42.9 25 36.0 8 75.0

Sterilization 27 100.0 NA NA NA NA

IUD 51 98.0 33 84.9 8 100.0

Injection 34 79.4 NA NA NA NA

Spouse's consent

Pill 45 64.4 24 75.0 8 87.5

Condom 42 35.7 25 44.0 8 12.5

Sterilization 27 92.6 NA NA NA NA

IUD 51 76.5 33 93.9 8 95.5

Injection 34 76.5 NA NA NA NA

Table 10.20 shows the number of pharmacies who provide different methods of family

planning and the percentage who restrict the clients' eligibility to use a method for

reasons of parity, marital status or spouse's consent. As compared to providers at health

facilities, overall, pharmacies have fewer restrictions for client’s eligibility to use a

method based on parity, marital status, or spousal consent.

99

Table 10.20. Number of pharmacies that provide each method and restrict

clients' eligibility to use a method for reasons of parity, marital status or

spouse's consent, by method in Agra

Barrier and method

Number of

pharmacies Percent that restrict

Parity

Pill 98 7.1

Condom 102 1.0

Injection 37 5.4

Marital status

Pill 99 15.2

Condom 102 2.9

Injection 38 15.8

Spouse's consent

Pill 99 10.1

Condom 102 4.9

Injection 38 7.9