Demographic Research (Jul 2022)

Measuring contraceptive use in India: Implications of recent fieldwork design and implementation of the National Family Health Survey

  • Kaushalendra Kumar,
  • Abhishek Singh,
  • Amy Tsui

DOI
https://doi.org/10.4054/DemRes.2022.47.4
Journal volume & issue
Vol. 47
p. 4

Abstract

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Background: India's National Family Health Surveys (NFHS) have provided critical population-level data to inform public policy and research. Although fertility declined, NFHS-4 (2015-2016) reported lower modern contraceptive and female sterilization use compared with NFHS-3 (2005-2006). Objective: This study assesses selected survey design and interviewer factors' influences on respondent reporting of modern contraceptive and female sterilization use. Methods: With data on 582,144 married childbearing-aged females, the analysis pursues multivariable logistic models of both outcomes using survey covariates, assesses interviewer deviance residuals, and estimates multi-level cross-classified random intercept models for state, cluster and interviewer effects. Results: Adjusted odds ratios (AORs) for reporting modern use in NFHS-4 versus NFHS-3 were 1.21 (1.17-1.26) and 1.66 (1.59-1.74) for sterilization. The AOR for each interview month after survey launch was 1.16 (1.15-1.17) for modern use and 1.18 (1.16-1.19) for sterilization. The AOR for respondents interviewed in the first versus second survey phase was 1.35 (1.30-1.40) for modern methods and 1.12 (1.07-1.17) for female sterilization. Interviewer deviance residuals for both contraceptive outcomes were larger in NFHS-4 than NFHS-3. Eliminating problematic interviews raised modern use 2.0Š points and sterilization 1.3Š points. Larger state, community cluster and interviewer effects were observed for NFHS-4 versus NFHS-3. Conclusions: The five-fold expansion of NFHS-4's sample likely challenged pre-existing survey protocols and may have lowered modern method use by up to 6Š points and female sterilization by 2Š points. Contribution: The roles of survey fieldwork and interviewers, as sources of measurement error, are important to consider when interpreting change observed in cross-sectional estimates.

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