Decomposing wealth-based inequality in modern reversible contraceptive utilisation in India: evidence from national family health survey, 2019-21

Though modern contraceptive prevalence has increased significantly across all wealth quintiles, a substantial gap in the utilisation of modern reversible contraceptives persists among women in lower socioeconomic groups. Nevertheless, very few studies have explored the same. This study assesses the magnitude and underlying factors of wealth-based inequalities in the utilisation of MRC. The study included 202,954 currently married women who are not currently pregnant, are not sterilised, and need family planning, from the fifth round of the National Family Health Survey, 2019-21. To address the study objectives, descriptive statistics, bivariate chi-square significance test, and Erreygers concentration index were employed. The results demonstrate that the level of MRC use varies from 41.93% among the poorest to 56.86% among the richest. Particularly, a pro-rich inequality was found in the utilisation of MRC (CI = 0.113), with the pro-rich pattern being more pronounced for short-acting (CI = 0.093) than for long-acting (CI = 0.020) reversible contraceptives. Additionally, pro-rich inequality in MRC is attributed to no media exposure (31.80%), the east region (16.71%), urban residence (14.39%), higher education level (13.15%), ≥ 3 children (8.64%), and the ≥ 35 age group (3.50%). Hence, the study findings endorse scaling up media exposure and strengthening outreach programmes, as well as informed choices through community support in the eastern region, as pivotal for achieving equity in reproductive health.