Understanding access and adoption of family planning measures among the urban disadvantaged: evidence from Indore city, India
Creators: name: Siddharth Agarwal
name: Shabnam Verma
name: Verma, Neeraj
name: Kanupriya Kothiwal
Publisher: name: Gates Open Research
Year: 2019

description: Background<br>India’s rapidly urbanising population is expected to be 590 million by 2030. Indore is one of the 53 million plus urban agglomerations in India.<br>Urban vulnerable population largely consisting of informal sector workers is the fastest growing segment of India’s population increasing at about 5% per annum. This growth is the result of natural increase in urban poor population and migration from villages and small cities to larger cities owing to greater availability of temporary and informal employment.<br>Using Indore as an example of many rapidly growing cities in India and the Global South with populations &gt; 1 million, this study seeks to capture the differences of access and adoption of FP methods and associated challenges of urban poor families while contributing to the growth of these cities and nearly 10 per cent of India’s GDP at low wages.<br>Most of this group comes from villages and smaller cities where space constraints are less and fertility is higher than larger cities.<br>Differential health vulnerability of different segments of the urban vulnerable has been relatively understudied. Usually the entire family including the adolescent and children work together and contribute to the family income which does not incentivise family planning<br> <br>Main Question<br>Our hypothesis is that differential vulnerabilities exist among the urban vulnerable in terms of certain segments having a lower access to healthcare services.<br>This study is an attempt to understand FP needs and adoption among three categories of urban disadvantaged – older settlers; seasonal migrants and recent migrants, factors contributing to level of FP adoption, access to services and possible strategies to improve implementation. <br> <br>Methodology<br>The study was conducted in 2015-16 in Indore, Madhya Pradesh, Urban Health Resource Centre’s program site. The sample was identified with the help of slum women’s groups included a) recent migrants &lt; one year; b)migrants living on temporary/seasonal basis; c) older settlers residing in the city for &gt; 5 years, the sample of each being 160.<br>Recent migrants comprised of informal daily-wage workers. Construction site workers, brick kiln workers, vendors, labourers comprised seasonal workers. Older settlers had more settled work though as informal sector workers.<br>Quantitative data was collected through structured questionnaires with respondent categories to understand the levels of access and adoption of FP services. Qualitative - Focused Group Discussions and Individual interviews using a checklist of open ended probes were conducted with the respondent categories to understand the associated factors of FP. Focused Group Discussions with slum women’s groups were conducted on possible solutions to overcome FP and health challenges.<br>Quantitative data was entered in MS Excel and analysed. Transcribed qualitative data was analyzed to understand levels of access and reasons for non-adoption of FP services. Transcripts of FGDs with slum women’s groups were analysed to infer possible approaches to improve access of services to vulnerable population.<br>Key findings<br>Seasonal migrant workers reported 23% knowledge, recent migrant workers reported 58% knowledge while older settlers reported nearly 72% knowledge. 3% seasonal migrants, 22% recent migrant and 28% older settlers reported use of temporary birth spacing methods.  39% seasonal migrants, 25% recent migrants, while 32% older settlers reported use of permanent family planning measures including NSV and female tubal ligation. In total 99% use of permanent family planning measures were adopted by females (across all categories) indicating that men contributed very less to permanent FP.   Considerably older settlers were sterilized in a public hospital or dispensary, accounting for 36 per cent of all migrants sterilized in such facilities.                                                                                                                                                                                      <br>Qualitative Data showed that temporary family planning users favoured natural child spacing to prolong the interval between pregnancies. Seasonal migrants favoured traditional healers and herbal medicines/potions believed to prevent pregnancies.<br>Many women across all categories felt that their inadequate diets decreased their ability to tolerate side effects of contraceptive pills. Others believed that oral contraceptive pills had a negative effect on their body.<br>Respondents reported infrequent availability of condoms in health centres. Most seasonal migrants were not willing to purchase condoms from medical shops owing to low wages. <br>Knowledge of FP measures and accessing appropriate materials (pills, condoms etc.) were higher among older settlers than recent and seasonal migrants, owing to their increased experience in the city.<br>Respondents reported the common belief that male sterilisation makes men engaged in heavy manual labour physically and sexually weak.<br> <br>Knowledge Contribution<br>There is need for more research on FP needs of different segments of urban vulnerable populations in developing countries since most existing literature has not explored differential heath and FP vulnerability among urban poor in cities.<br>This study emphasises the need for energetic implementation of policies with FP and related care provisions for the urban vulnerable including India’s National Urban Health Mission (NUHM), Integrated Child Development Services (ICDS) Scheme, Ladli Laxmi Yojana (families who have had permanent sterilisation after 2 children and have one girl are eligible).<br>Findings show that mapping of squatters, slums and similarly vulnerable habitations in cities mandated in the NUHM and ICDS Scheme is needed with urgency for expanding reach of FP and related services to left-out segments.<br>FGDs with slum women’s groups in Indore suggest that Government partnering with NGOs working with the urban vulnerable including informal workers mandated in NUHM, National Creche Scheme co-located with ICDS Centres will facilitate increase reach of FP services to left-out urban vulnerable populations.