A Study Of Contraceptive Use In Calcuttas Slums Statistics Essay

Calcutta is one of the largest metropolitan cities in India, with a population of 4.6 million, spread over an area of 1380 sq kms. About a third of the city's population, amounting to 1.5 million, live in slums.[1] Over 40 per cent of Calcutta's slum residents have been slum dwellers for two generations or longer, and more than half originate from the Calcutta hinterland. In addition, there are also migrants from neighboring states of Bihar, Jharkhand, Uttar Pradesh and Orissa. About 37 percent of the slum population is engaged in economic activities, of which as many as 86 percent are marginal workers. The proportion of female workers is even lower (12 percent).

An interesting finding is that the literacy level in Calcutta slums is 66 percent, while the corresponding figure for the female slum population is 60 percent. This is not markedly below the national urban average of 70 percent. Given the relatively high literacy levels, it is not surprising that researchers have generally found high contraceptive prevalence rate among slum-dwellers, with a preference for modern and irrerversible methods, like sterilization (Sen, 2001; Chattopadhyay et al., 2004). The only exception is Biswas et al. (1991). The latest wave of Demographic Health Survey data (2005-06) reports that contraceptive use in Calcutta (77 percent of currently married women) is higher than in other cities surveyed. This indicates analysis of contraceptive use patterns in Calcutta slums an interesting area of study.

This paper is an attempt to understand contraceptive use patterns and its determinants in Calcutta slums. We argue that given the economic vulnerability of the study group - Kundu (2003) estimates that about three quarters of the slum populationare below the pverty line while the low workforce participation levels have been noted earlier - economic considerations will be important in determining contraceptive use. In particular, in line with the microeconomic models of fertility (Becker 1977, Willis 1973), it is argued that slum-dwellers will try to limit their family (to prevent thin spreading of resources over a large family in the current period) but will try to have at least one son in order to ensure economic security in the long run. This implies that if a son is borne a typical slum couple will be more likely to adopt contraceptive than if a girl is borne.

2. Database and Methods

The paper is based on unit level Demographic Health Survey (DHS) data. This survey, undertaken in 2005-2006, is the third in a series of national surveys. In DHS-3, the initial target sample size was 8500 completed interviews with ever-married women. Applying city-level filters, the data on Calcutta's female population was extracted from the DHS-3 data set. It was found that a total of 1615 out of 2471 respondents were currently married; of them 789 resides in slum areas. The analysis is based on this sub-sample.

The function estimated will take the following form:

Contraceptive choice = F ( Socio-religious identity, culture, age of respondent and its square, education of respondent and her partner, log of wealth index score, place of last delivery, number of living sons, number of living daughters, participation in economic activities)

Most studies (D'Souza 2003, Kamaal 2000, 2007, Kamaal and Huda 2008, Stephenson 2004, Waiz 2000) use binary or multinomial logistic models to identify the determinants of contraceptive prevalence rates. Now, the choice variable analyzed is discrete but not binary - possible responses are not using any method, using folkloric method, using traditional method or using modern method. Given the low incidence of folkloric methods, traditional and folkloric methods can be clubbed together, so that the choice variable can assume three values (no method, traditional or folkloric, modern). In such cases a multinomial model is appropriate. Further, given that the options can be ordered ordinally in terms of reliability, the ordered logit model is appropriate (McCullagh 1980).

The ordered logit model is based on the proportional odds, or parallel lines, assumption. As this assumption is strong, Brant (1990) has suggested the use of a method to test the validity of this structure. If tests indicate that the assumption of proportional odds is violated, the question arises whether the coefficients vary for all explanatory variables, or only some (Williams 2006). In this context, the Likelihood Ratio test is used to select the parsimonious model.

3. Findings

Analysis of DHS-3 data indicates that contraceptive prevalence rates in Calcutta's slums (72 percent) are higher than those in the other 8 cities covered in the survey (64 percent) and also national levels (56 percent). Only 11 percent had never used contraceptives.

Analysis of the methods used indicates that the incidence of female sterilization is very high, followed by use of condoms and pills (Fig. 2). This corresponds to the preference for terminal methods observed in other Indian slums (Das and Shah 2001, Agarwal and Bharti 2006). Sen (2001) and Chattopadhyay et al. (2004), too, make a similar observation for Calcutta's slums. The reasons underlying preference for a method that allow less freedom than condoms pills, IUD, etc. in terms of birth spacing needs investigation. But what is interesting is that 60 percent of respondents who have sterilized had a boy child on their last delivery. This may be indicative of the desire to satisfy son preference while limiting family size.

Analysis of the reasons for not adopting any contraceptive shows that factors like religious strictures, opposition by partner or family members are unimportant. About 63 percent of the respondents were either infecund, sub-fecund or had undergone hysterectomy. This implies that contraceptives are viewed primarily as a method for family planning, rather than protection against STD or AIDS/HIV. A further 11 percent either do not have intercourse or do so infrequently. Thus about 73 percent of the non-users do not require family planning methods. Examination of future intentions of non-users reveals that about 53 percent are planning to use contraceptives in the future. Again, it is interesting to note that 58 percent of non-users who had a boy plan to use contraceptives in the future, while 43 percent of non-users who had a girl will use contraceptives in the future.

This discussion indicates a high awareness about family planning methods among slum dwellers and willingness to adopt such methods. However, we argue that while slum-dwellers realize the economic benefits of limiting family size, they are also motivated by the benefits of investing in male children as a means of assuring for the future. If our hypothesis is valid then the probability of using contraceptives will increase as number of sons and daughters increase, but the increase will be greater for additional sons. That is, if we run an econometric model, the odds ratio for boys will be greater than odds ratio for girls.

4. Econometric Analysis

As mentioned earlier, the econometric analysis is based on an ordered logit model with the respondent assumed to face three choices - no use, traditional/folkloric method and modern method. The result of the Brant test (the χ2 value, with 14 degrees of freedom, is 56.08, with a probability value < 0.00) indicates that the null hypothesis of proportional odds assumption is rejected. Allowing parameters to vary enables an examination of the variations in impact of each variable at different choice levels. This provides more sophisticated information set for policy making. Both the partial proportional odds model and the generalized ordered logit model - which may be interpreted as a set of logistic equations (Williams 2006) - are estimated, and the Likelihood Ratio (LR) test used to choose the most parsimonious (in the sense of least restrictive) model specification. The value of the LR ratio is 20.65 (with a probability value of 0.02), so that the null hypothesis (the partial proportional odds model is nested in the variable parameter model) may be accepted. This implies that the former model is not too restrictive and is appropriate in the present case.

Table 1: Results of Generalized Ordered Logit of Contraceptive Use by Slum-dwellers

The final model, therefore, is a generalized ordered logit where the coefficients of age, its square, the language dummy and number of living sons is allowed to vary.

It can be seen that coefficients of both number of living sons and daughters are significant and have high odd ratios. Comparison of the effects of birth of a boy and girl child reveals that number of living boys has a higher odd ratio, indicating that birth of a son has a greater impact on adoption of contraceptive than birth of a girl. This is consistent with the son preference observed in developing countries (Roy et al. 2008, Jayaraman et al. 2009, Saha and Bairagi 2007) and our research hypothesis.

Quite a few of the other control variables are significant. Muslims have a lower probability of using contraceptives than BCH (Iyer 2002, Bhatt and Xavier 2005, James and Nair 2005, Kulkarni and Alagarajan 2005), while UCH and All Others have the same levels of contraceptive use. Inter-state migrants from Bihar, Jharkhand, Uttar Pradesh are expected to be more conservative than the local population. Language (used as a proxy for their different cultures) exerts a significant effect on the decision to use a contraceptive, but not in choice of modern method. We had taken both age and its square to reflect the non-linear relation between contraceptive use and age. Both coefficients are significant in the first choice situation, but not when modern methods are considered. Increases in number of living children encourage respondents to adopt contraceptives and modern methods. Freedom of the women to go for health check-ups by herself also has a significant impact on adoption of contraceptive methods, including modern methods.

Education - neither of the partner nor the respondent - does not influence contraceptive use. This is contrary to the effect of education found in other studies (Gubhaju 2010, Kamal et al. 2007, Kamal and Huda 2008). Nor is the coefficient of wealth index score significant. This may be due to the presence of multi-collinearity (all three variables are highly correlated with each other).

We had also included the place of last delivery as an explanatory variable, motivated by anecdotal evidence that slum-dwellers having more than two or three children are persuaded to get sterilized if they deliver in public sector health units. However, this variable is not significant. The coefficient of participation in labor market is also not significant. This may be because of the lack of employment opportunities for women residents of Calcutta.[2]

5. Conclusion

To sum up, analysis of contraceptive use by slum-dwellers in Calcutta reveals the other importance of culture-related factors in influencing contraceptive use. Non-Bengali migrants and Muslims are reluctant to adopt contraceptives. The Government should therefore consider targeting these communities. Given the prevailing lack of confidence in the State among migrants and, particularly, the Muslims, such efforts should involve community-based organizations, rather than impose them from outside. This will reduce the probability of controversy emerging over issues like whether contraceptives are permissible in Islam.

Fertility preference, however, is still a major barrier to the adoption of contraceptives. Preference for more children, particularly boys, reduces demand for contraceptives. The birth of a an additional girl child will increase probability of using (modern) contraceptives by 50 percent; in case a boy child is borne, the effect is almost double (122 percent). This implies that patriarchal attitudes still persist within Calcutta slum population. Economic forces, too, plays an important role. Males constitute the majority of both workers and main workers in not only slum but also non-slum areas. Within the Calcutta Municipal Corporation, males comprise 84.5 percent of total workers and 85.5 percent of main workers. Therefore, the microeconomics of fertility decisions creates a son preference that has a major impact on contraceptive use. This can be tackled by reducing differential returns from having a boy and girl child. The role of employment-generation schemes like Swarna Jayanti Sahari Swarojar Yojana, Pradhan Mantri Rojgar Yojana, etc. is important in this context.

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[1] Slums have been defined in the 2001 Census as “A compact area of at least 300 population or about 60-70 households of poorly built congested tenements, in unhygienic environment usually with inadequate infrastructure and lacking in proper sanitary and drinking water facilities” (Office of Registrar General and Census Commissioner of India, 2005). In Calcutta there are 2,011 registered and 3,500 unregistered (occupied by squatters) slums.

[2] Census figures reported that only 12 percent of the female population in Calcutta slums is workers. DHS data shows that only 23 percent of slum-dwellers work throughout the year.