Wealth differentials and contraceptive choices among women in India: insights from NFHS-5 (2019-21).

INTRODUCTION: Wealth status plays a crucial role in shaping contraceptive choices among women in India. This study aims to investigate the impact of wealth quintiles on current contraceptive use and identify the factors contributing to differentials in contraceptive choices. METHODOLOGY: Using data from National Family Health Survey-5 (2019-2021), current contraceptive use was categorised into non-users, traditional method users, permanent method users, and reversible modern method users. Multinomial logistic regression analysis was applied to investigate the association between wealth status and contraceptive method use while controlling for potential socio-economic factors. In addition, Wagstaff's concentration index was used to assess wealth inequality in each contraceptive method. RESULTS: The results indicate that 37.8% of women from the poorest quintiles do not use contraceptives, compared to 30.6% in the richest quintile. The use of reversible modern methods increases from 15.9% among the poorest to 25.0% among the richest. Women in the richest wealth quintiles were significantly more likely to use reversible modern methods (RRR = 1.61; 95% CI: 1.55-1.68) than in the poorest quintiles. Permanent method uses peaks in the middle wealth quintile (42.6%) and decreases in the richest quintile (33.7%). Regional disparities also exist, with higher use of permanent methods in southern and western India, while reversible methods were more common in northeastern and northern regions. The concentration index revealed a pro-rich pattern for reversible methods (CI = 0.092), while traditional and non-use were concentrated among poorer women. DISCUSSIONS: The findings suggested that wealth status significantly influenced contraceptive method use among currently married women in India. Reversible modern methods were more commonly used by wealthier women, whereas poorer women were more likely to rely on permanent methods or remain non-users. These differentials indicated persistent inequities in access to a diverse contraceptive method mix. These findings highlighted the need for targeted policy measures to improve availability of reversible methods in underserved areas, strengthening provider training to support informed choice, and addressing demand-side barriers through community support were essential to advanced reproductive health equity and help to meet the SDG 3.7 target in India.