Intergenerational patterns of contraception use during extended postpartum period among women in Haryana , India

Background and Objectives: Present study is an attempt to examine the generational patterns of adoption of family planning during extended postpartum period before and after adjusting for individual, household and contextual factors. The study was further extended by analysing timing and type of contraceptive methods used by generations. Methods: Primary survey data from Rohtak district of Haryana, India, was used, in which two successive generations were interviewed regarding family planning and contraception use. Results: Findings demonstrated the different patterns of family planning use across the generations after adjusting for other potential covariates. The early initiation of use of family planning and use of modern methods during postpartum period was higher among younger women. Conclusions: Though, by time and generations there has been a significant change in the extent and patterns of contraceptive adoption among postpartum women, still in few segments, younger generation women reported low use of family planning which calls for urgent policy attention.


Background
Extended postpartum period has been defined as the 12-month interval after a child birth.    We preferred to interview mothers-in-law (older generation) aged less than equal to 65 years in order to reduce the recall bias.  women. This may be because of family structure as in vertically joint family younger women as daughter-in-law usually live under the control of elder women, especially mother-in-law.  For instance, the adoption of family planning methods in extended postpartum period among highly educated women increased from 54% for older generation to 67% for younger generation.

Profile of the respondents:
Also, across the generations, the use of family planning during postpartum period was increased from 53% to 67% among working women.
There were 48% older women who were aware about family planning used contraceptives in      The differentials in uptake of family planning methods after the child birth across the generation have been depicted in Graph 1. Findings state that among those who used family planning during extended postpartum period, majority (43%) of younger generation women adopted contraceptive methods within 3 months after child birth, while only 11% women of older generation used any contraception during this period.
Majority (41%) of older generation women started using contraceptive methods after 7-9 months of child birth. Also, there were 20% and 28% older women who used any contraceptive methods after 4-6 months and 10-12 months respectively.

Graph-1: Uptake of family planning across the generations by time (in months) after child birth
Significant differences in type of contraceptive methods opted during extended postpartum period across the generations were also observed.  Though, compared with older generation, uptake of family planning methods has been increased among younger women, still, a substantial proportion did not use any contraceptives during extended postpartum period. Up to some extent, it could be linked with the lack of adequate knowledge and awareness about family planning.
Also, influence of husband or other family members may also be associated with the women's decision to use contraceptives soon after child birth as all the younger women in the study were residing in joint family or with mother-in-law at the time of interview.
Previous studies also highlighted the dominant influence of husband's views & decisions over women's reproductive behaviour [12,13,14].
Moreover, in typical patriarchal joint kinship structure (most common family structure in Indian society), older women especially mother-in-law control their roles, responsibilities and even their reproductive decisions [15,16].
In addition, timing of contraceptive use across the generations was also examined here. The early initiation of use of family planning and use of modern methods during the postpartum period was higher among younger generation women compared to older generation.
It is also important to note that adoption of traditional contraceptive methods in extended postpartum period has been reduced significantly from older generation to younger generation. Modern contraceptive methods were more among younger generation women and condoms followed by copper-T were the most popular method used by younger women during extended postpartum period.
The findings also demonstrate low use of oral contraceptive pills in the postpartum period among women of younger generation. It may be argued here that during postpartum period majority of women breastfeed their child and probably because of the side effects of oral pills on quantity of breast milk and baby, they did not preferred to use oral contraceptive pills.
Though, by time and generations there has been a significant change in the extent and patterns of contraceptive adoption among postpartum women, still in few segments, women in present generation also reported low use of family planning during postpartum period especially among those belonged to low socioeconomic profile, which calls for urgent policy attention.
Researchers also argued that younger generation women still face challenges in accessing reproductive health services as long as the level of stigma remains high in society. Thus, family planning programmes should be designed keeping in mind the socioeconomic characteristics of younger generation women in order to reach the most unobserved women. Also, service providers should tend to focus their counselling on spacing methods to young couples. The study had few limitations also. The surveyed data was self-reported and in an attempt of identifying the patterns of family planning use across the generations, both the generations were asked retrospectively about their reproductive history and family planning use, which introduces recall and social desirability biases.