Use of a spacing method before sterilization among couples in Kerala, India

Context: Many couples in India never use a reversible method to delay or space births, and instead adopt sterilization as their first and only method. Little is known about the factors that distinguish sterilized couples who have used spacing methods from those who go directly to using a permanent method. Methods: Data on 2,029 ever-married women protected by sterilization are taken from the part of the 1992-1993 Indian National Family Health Survey that was conducted in the state of Kerala. Multivariate logistic regression techniques are used to assess the socioeconomic, demographic and behavioral characteristics that determine prior temporary method use among sterilized couples. Results: Once all significant variables are controlled for; higher educational attainment (of either partner) independently increases the likelihood that a couple will have used a method to delay or space births, as does middle socioeconomic status. That likelihood is also significantly higher among respondents who experienced an abortion, among Christian women and among those who were older than age 25 when either they or their partner were sterilized. However, the likelihood of temporary method use before sterilization is significantly reduced among respondents who preferred shorter birth intervals and among relatively older women (age 31 and older). The median interval between the first and second children born to sterilized couples who had ever used a reversible method was longer than that among children born to couples who had relied only on sterilization (32 months vs. 26 months). Conclusions: In Kerala, both small family size ideals and a desire to shorten the period of exposure to the risk of pregnancy might explain the tendency for couples to go directly to sterilization at a relatively young age and bypass temporary method use altogether. An approach that emphasizes clients' choice of methods and high-quality services that cater to their needs would enhance the use of methods to space births.