Volume 47 - Article 4 | Pages 73–110  

Measuring contraceptive use in India: Implications of recent fieldwork design and implementation of the National Family Health Survey

By Kaushalendra Kumar, Abhishek Singh, Amy Tsui


Background: India’s National Family Health Surveys (NFHS) have provided critical population-level data to inform public policy and research. Although fertility declined, NFHS-4 (2015–2016) reported lower modern contraceptive and female sterilization use compared with NFHS-3 (2005–2006).

Objective: This study assesses selected survey design and interviewer factors’ influences on respondent reporting of modern contraceptive and female sterilization use.

Methods: With data on 582,144 married childbearing-aged females, the analysis pursues multivariable logistic models of both outcomes using survey covariates, assesses interviewer deviance residuals, and estimates multi-level cross-classified random intercept models for state, cluster and interviewer effects.

Results: Adjusted odds ratios (AORs) for reporting modern use in NFHS-4 versus NFHS-3 were 1.21 (1.17–1.26) and 1.66 (1.59–1.74) for sterilization. The AOR for each interview month after survey launch was 1.16 (1.15–1.17) for modern use and 1.18 (1.16–1.19) for sterilization. The AOR for respondents interviewed in the first versus second survey phase was 1.35 (1.30–1.40) for modern methods and 1.12 (1.07–1.17) for female sterilization. Interviewer deviance residuals for both contraceptive outcomes were larger in NFHS-4 than NFHS-3. Eliminating problematic interviews raised modern use 2.0% points and sterilization 1.3% points. Larger state, community cluster and interviewer effects were observed for NFHS-4 versus NFHS-3.

Conclusions: The five-fold expansion of NFHS-4’s sample likely challenged pre-existing survey protocols and may have lowered modern method use by up to 6% points and female sterilization by 2% points.

Contribution: The roles of survey fieldwork and interviewers, as sources of measurement error, are important to consider when interpreting change observed in cross-sectional estimates.

Author's Affiliation

Other articles by the same author/authors in Demographic Research

Spatial heterogeneity in son preference across India’s 640 districts: An application of small-area estimation
Volume 47 - Article 26

Explaining the rural-urban gap in infant mortality in India
Volume 29 - Article 18

Most recent similar articles in Demographic Research

A test of the predictive validity of relative versus absolute income for self-reported health and well-being in the United States
Volume 48 - Article 26    | Keywords: absolute income, health, inequality, measurement, relative income, well-being

Contraceptive use and fertility transitions: The distinctive experience of sub-Saharan Africa
Volume 46 - Article 4    | Keywords: contraceptive use, family planning, fertility, proximate determinants, sub-Saharan Africa

Food insecurity among homeless and precariously housed children in the United States: Lessons from the past
Volume 45 - Article 37    | Keywords: child food insecurity, homelessness, institutional context, National Survey of Homeless Assistance Providers and Clients, population survey, risk, risk factors

An investigation of Jordan’s fertility stall and resumed decline: The role of proximate determinants
Volume 45 - Article 19    | Keywords: contraceptive use, fertility, fertility stall, Jordan, marriage

Has contraceptive use at pregnancy an effect on the odds of spontaneous termination and induced abortion? Evidence from Demographic and Health Surveys
Volume 44 - Article 37    | Keywords: contraceptive calendar, contraceptive use, induced abortion, pregnancy termination, reproductive health