Epidemiological models and related simulation results for understanding ofcontraceptive adoption in India

Background For the first time, models using multilevel analysis of Indian d ata and related simulation results are reported. They take hierarchical str ucture into account and incorporate variables from all levels to get correc t analysis and proper interpretation of data on current contraceptive use ( including sterilization and modern methods). Methods The data from an Indian State, Uttar Pradesh (UP), collected by the National Family Health Survey (NFHS) conducted during 10 October 1992 to 2 2 February 1993 was used. For model I, 7851 currently married women who wer e neither pregnant nor had continuing post-partum amenorrhoea (PPA) were co nsidered. For model II, these women with at least one child (n = 6748) were used. Two-level logistic regression analysis was carried out for which wom en's level (level 1) and PSU (Primary Sampling Unit) level (level 2) variab les were considered. The results were considered significant at the 5% leve l of significance. Simulation analysis using each model was also carried ou t. Results Model I reveals that those more likely to adopt contraception were women exposed to a TV message (odds ratio [OR] = 1.3; 95% CI : 1.1-1.6); wh ose houses were pucca (bricks and mortar) (OR = 1.3; 95% CI : 1.1-1.5); who were educated to high school level and above (OR = 2.9; 95% CI:2.2-3.7); w hose husbands were literate with schooling of greater than or equal to 11 y ears (OR = 1.7; 95% CI: 1.4-2.1); and who had greater than or equal to 2 li ving sons (OR = 2.2; 95% CI:1.1-4.4). Muslim and other religious women were less likely than Hindu women to adopt contraception (OR = 0.5; 95% CI:0.4- 0.6). Also, the PSU level availability of all weather road was positively a ssociated with contraceptive adoption (OR = 1.4: 95% CI:1.1-1.7). The PSU l evel variance, which is the unexplained PSU level variation after controlli ng for the considered characteristics, was significantly higher. The simula tion results revealed that public health education (a TV message) was found to be more effective among less educated women. The PSU level availability of all weather road was as effective as public health education. Similar r esults were evident from the analysis of second data set (model II) with th e noticeable finding that those whose last child is surviving are most like ly to adopt contraception (OR = 8.82; 95% CI: 1.01-77.38). Conclusions These results reveal that the survival status of the last child has a marked effect on the adoption of contraception in UP. They further s upport the idea that public health education (a TV message) is more effecti ve among less educated women. Also, the PSU level presence of all weather r oad is equally effective. Consideration of higher level variables provides not only more accurate results but also important public health clues to he lp the policy planners.