Traditional or Modern Contraception? Association Between Health Worker Contact and Contraceptive Choice in India:...

Despite greater availability and affordability of modern contraception, the use of traditional contraception is rising in India. We examined the relationship between Indian women's contact with a community health worker (CHW) and discussion of family planning (FP) with their contraceptive use. We analyzed data from 306,037 nonpregnant, non-sterilized married women in the 2019-2021 National Family Health Survey (NFHS). Multinomial regression models estimated the association between CHW contact and contraceptive use (consistent use, switching, and discontinuation) in the past three months. Nearly 22 percent of women reported current use of traditional contraception, with 18 percent reporting exclusive use and 4.1 percent concurrent method use. Traditional contraception was more common among older women, women with lower education, higher parity, and in nuclear households. CHW discussion on FP was associated with higher traditional contraceptive use [Adjusted Odds Ratio (AOR) = 1.11 (95 percent Confidence Interval (CI): 1.04, 1.19)], reversible modern method use [AOR = 1.92 (95 percent CI: 1.82, 2.02)], and concurrent use [AOR = 2.19 (95 percent CI: 1.95, 2.45)]. Recent CHW engagement was associated with consistent modern method use [Adjusted Relative Risk Ratio (ARRR) = 2.02 (95 percent CI: 1.91, 2.13)], switching from traditional to modern method [ARRR = 1.67 (95 percent CI: 1.14, 2.46)], and discontinuation of modern contraception [ARRR = 2.10 (95 percent CI: 1.81, 2.44)]. CHW engagement on FP may enable initiation and consistent use of traditional and modern methods, switching, and discontinuation of contraception.