Understanding District-Level Variation in Fertility Rates in High-Focus Indian States
Categories: Health Systems Research, Maternal, Neonatal and Child Health (MNCH), Publications, Where We Work
Resource Type: Publication
Authors: A.A. Jayachandran, Rahul Dutta, and Priya Emmart
Published: January 2018
Resource Description: The assessment is based on secondary analysis of data from the Annual Health Survey (2012-13), which provides the most recent available survey data for the high-focus states and districts in India. High-focus districts in four states, Bihar, MP, Rajasthan, and UP, were selected to understand which factors explain the observed differences in fertility and contraceptive outcomes at the district level. Data on individual and household characteristics from 182 districts provide the units of observation for this analysis, while the unit of analysis is the district, since this is the focus of NHM health programming. Districts were categorized into low- and high-fertility groups, based on the NHM programmatic guidelines of total fertility rates (TFRs) of less than 3 (<3) and equal to or more than 3 (≥3). Both descriptive and multiple regression analyses were undertaken to evaluate drivers of variance in fertility and contraceptive use at the district level. Standard predictors of fertility and contraceptive use were examined along with India-specific predictors including categories of socially excluded populations whose health outcomes are worse than those of the general population. The assessment found a lot of variation in levels of fertility and contraceptive use in the high-focus districts.