The Association of Community Membership and Socioeconomic Status in India with Contraceptive Use

Examining the effect of various factors such as class, gender, and status on health inequalities in India is crucial for improving access to health services. However, most research on castes in India is done using broad, government-defined categories, including “Scheduled Castes,” “Scheduled Tribes,” “Forward Classes,” and “Other Backwards Classes.” These general categories erase the experiences that more specific caste groups have in their health and their livelihood. Using the 2015-2016 Demographic and Health Survey of India, this study analyzes data on 699,686 women aged 15-49 to investigate the association of socioeconomic status, assessed by wealth, education, and community status on two types of contraceptive use–sterilization and other modern methods. Those with secondary education or higher were much less likely to be sterilized and more likely to use non-sterilization forms of modern contraception. Interestingly, those with greater household wealth were more likely to be sterilized but had no different chance of using non-sterilization forms of modern contraception. After controlling for other socioeconomic factors, members of Scheduled Castes and Backward Classes are more likely to be sterilized. However, there was additional heterogeneity between groups, with Muslim groups and Northeastern tribes much less likely to be sterilized, and Southern tribes more likely to be sterilized. Moreover, Muslim groups as well as Northern and Northeastern tribes were more likely to use non-sterilizations forms of contraception, whereas Southern tribes were less likely to use non-sterilization forms of contraception. These findings illustrate that in addition to differences by major caste categories, there is still religious and regional variation in the likelihood of using different forms of contraception. Future research should examine how unique community factors erased within the already present government caste system can affect health. In addition, more research should be done on the various effects of discrimination faced by these communities and how this discrimination affects their health education, access, and autonomy.