Reproductive health encompasses physical, mental, and social well-being and involves individuals’ ability to choose their family size and spacing [1]. Contraceptive use prevents unintended pregnancies, reduces maternal mortality by 30% and child mortality by 10% [2], and supports socioeconomic development. India’s family planning program, initiated in 1952, has led to significant demographic shifts. Contraceptive usage increased from 13% of married women in 1970 to 56% in 2006, with fertility halving from 5.7 to 2.7 births per woman [3]. West Bengal (WB), with a population density of 1029/km², faces growing population demands despite higher female literacy rates (71%) than the national average [4]. NFHS-3 reported a contraceptive prevalence rate (CPR) of 71% among currently married women aged 15–49 years in WB [5]. However, unmet need persists, particularly for spacing methods, due to socio-cultural barriers, misinformation, and limited male involvement [6,7]. Age, education, socioeconomic status, religion, and gender dynamics shape contraceptive choices [8–11]. Studies have shown that higher education correlates with lower fertility and greater method awareness [12], while decision-making power and spousal communication influence uptake [13,14]. Traditional methods remain common among lower socioeconomic strata [15]. This study was conducted to assess contraceptive prevalence, method mix, and associated determinants among women in Asansol, WB—a semi-urban population with diverse sociodemographic profiles.

Study design and setting: Cross-sectional study conducted at the Department of Obstetrics and Gynecology, Asansol District Hospital, WB. Study population: 330 married women aged 18–45 years, stratified equally into three categories (110 each): • Medical (including allopathic, ayurvedic, homeopathic practitioners) • Paramedical (ASHA, community health workers, etc.) • Non-medical women Study period: June 2016 to May 2017. Sampling: Sample size was calculated using the formula N = 4pq/L² with contraceptive prevalence (p) = 71.2% [5], q = 1–p, and L = 5%, giving N = 330. Data collection: Semi-structured questionnaires captured demographic, socioeconomic, reproductive, and contraceptive data. Awareness, perceptions, and decision-making were assessed through structured questions. Variables: • Independent: Age, education, occupation, religion, socioeconomic class (modified Kuppuswamy). • Dependent: Contraceptive use and method choice. Statistical analysis: Data were analyzed using Epi Info 3.5.3. Descriptive statistics were calculated. Z-tests assessed proportions; Chi-square tested associations between categorical variables; one-way ANOVA compared mean ages across groups. p<0.05 was considered significant. Ethical considerations: Institutional permission and informed consent were obtained. Data were anonymized.

Out of the 330 respondents 110 respondents were from each category i.e. Medical, Paramedical, and Non-medical. The mean age was 31.7 ± 6.6 years (range 20–45). Most (82.7%) were aged 20–39. Each occupational category comprised 33.3% of participants. Graduates constituted 60.9%, followed by primary (15.8%), secondary (12.7%), and illiterate (10.6%). Hindus represented 46.7%, Muslims 27.0%, Christians 18.5%, and others 7.9%. Socioeconomic classes: upper (10%), upper middle (30.9%), lower middle (32.7%), upper lower (26.4%). Table 1. Age and Category of Respondents Age Group (years) Medical n (%) Paramedical n (%) Non-medical n (%) Total n (%) 20–29 40 (29.2) 45 (32.8) 52 (38.0) 137 (41.5) 30–39 53 (39.0) 42 (30.9) 41 (30.1) 136 (41.2) 40–45 17 (29.8) 23 (40.4) 17 (29.8) 57 (17.3) Total 110 (33.3) 110 (33.3) 110 (33.3) 330 (100) Age and literacy emerged as significant determinants of contraceptive use and method choice. The majority of contraceptive users belonged to the 21–29 years age group, while female sterilization was most commonly practiced among women aged 30–39 years. Traditional methods were predominantly used by couples aged 31–39 years, and the preference for terminal methods increased with age. Literacy level showed a positive correlation with contraceptive use; women with higher education levels demonstrated greater utilization of modern methods such as oral contraceptive pills, condoms, and female sterilization. Conversely, illiterate women most frequently used traditional methods, followed by permanent methods. Table 2. Influence of Age, Occupation, and Literacy on Contraceptive Method Use Variable OC Pills n (%) IUCD n (%) Female Sterilization n (%) Condom n (%) Male Sterilization n (%) Natural n (%) None n (%) Total n (%) Age (years) 20–29 (n=137) 32 (23.4) 10 (7.3) 12 (8.8) 35 (25.5) 0 (0.0) 26 (19.0) 22 (16.1) 137 (41.5) 30–39 (n=136) 16 (11.8) 17 (12.5) 42 (30.9) 7 (5.1) 3 (2.2) 38 (27.9) 13 (9.6) 136 (41.2) 40–45 (n=57) 6 (10.5) 4 (7.0) 23 (40.4) 3 (5.3) 0 (0.0) 12 (21.1) 9 (15.8) 57 (17.3) Occupation Medical (n=110) 18 (16.4) 13 (11.8) 25 (22.7) 21 (19.1) 2 (1.8) 20 (18.2) 11 (10.0) 110 (33.3) Paramedical (n=110) 25 (22.7) 8 (7.3) 30 (27.3) 15 (13.6) 0 (0.0) 27 (24.5) 5 (4.5) 110 (33.3) Non-medical (n=110) 12 (10.9) 9 (8.2) 23 (20.9) 9 (8.2) 1 (0.9) 28 (25.5) 28 (25.5) 110 (33.3) Literacy Graduate (n=201) 41 (20.4) 23 (11.4) 48 (23.9) 31 (15.4) 2 (1.0) 40 (19.9) 16 (8.0) 201 (60.9) Secondary (n=42) 5 (11.9) 0 (0.0) 12 (28.6) 6 (14.3) 0 (0.0) 10 (23.8) 9 (21.4) 42 (12.7) Primary (n=52) 5 (9.6) 2 (3.8) 9 (17.3) 6 (11.5) 0 (0.0) 15 (28.8) 15 (28.8) 52 (15.8) Illiterate (n=35) 4 (11.4) 5 (14.3) 9 (25.7) 2 (5.7) 1 (2.9) 10 (28.6) 4 (11.4) 35 (10.6) Total (n=330) 54 (16.4) 31 (9.4) 77 (23.3) 45 (13.6) 3 (0.9) 76 (23.0) 44 (13.3) 330 (100.0) Contraceptive method choice varied significantly across religious groups (χ² = 27.6, p < 0.001). Hindu women predominantly used female sterilization (23.4%), while Muslim women relied more on traditional methods (25.8%) and had the lowest IUCD use (4.5%). Socioeconomic status also significantly influenced method choice (χ² = 44.8, p < 0.0001). Women in the upper class preferred female sterilization and OCPs, whereas those in lower middle and upper lower classes relied more on traditional methods or reported non-use (Table 3). Table 3. Influence of Religion and Socioeconomic Status on Contraceptive Method Use Variable OC Pills n (%) IUCD n (%) Female Sterilization n (%) Condom n (%) Male Sterilization n (%) Natural n (%) None n (%) Total n (%) Religion Hindu (n=154) 30 (19.5) 15 (9.7) 36 (23.4) 17 (11.0) 2 (1.3) 35 (22.7) 19 (12.3) 154 (46.7) Muslim (n=89) 11 (12.4) 4 (4.5) 22 (24.7) 12 (13.5) 0 (0.0) 23 (25.8) 17 (19.1) 89 (27.0) Christian (n=61) 12 (19.7) 8 (13.1) 13 (21.3) 12 (19.7) 0 (0.0) 13 (21.3) 3 (4.9) 61 (18.5) Others (n=26) 2 (7.7) 3 (11.5) 7 (26.9) 4 (15.4) 1 (3.8) 4 (15.4) 5 (19.2) 26 (7.9) Socioeconomic Status Upper (n=33) 8 (24.2) 4 (12.1) 13 (39.4) 1 (3.0) 1 (3.0) 3 (9.1) 3 (9.1) 33 (10.0) Upper middle (n=102) 13 (12.7) 13 (12.7) 22 (21.6) 21 (20.6) 1 (1.0) 24 (23.5) 8 (7.8) 102 (30.9) Lower middle (n=108) 24 (22.2) 8 (7.4) 24 (22.2) 15 (13.9) 0 (0.0) 29 (26.9) 8 (7.4) 108 (32.7) Upper lower (n=87) 9 (10.3) 5 (5.7) 19 (21.8) 8 (9.2) 1 (1.1) 24 (27.6) 21 (24.1) 87 (26.4) Total (n=330) 54 (16.4) 30 (9.1) 78 (23.6) 45 (13.6) 3 (0.9) 75 (22.7) 44 (13.3) 330 (100.0) Table 4. Influence of Decision-Making, Awareness, Source of Awareness, and Perception on Contraceptive Use Variable OC Pills IUCD Female Sterilization Condom Male Sterilization Natural None Total n Decision-Making Husband (n=37) 5 (13.5) 2 (5.4) 11 (29.7) 3 (8.1) 0 (0.0) 9 (24.3) 7 (18.9) 37 (11.2) Wife (n=53) 8 (15.1) 4 (7.5) 13 (24.5) 7 (13.2) 0 (0.0) 15 (28.3) 6 (11.3) 53 (16.1) Joint (n=133) 25 (18.8) 15 (11.3) 36 (27.1) 20 (15.0) 2 (1.5) 26 (19.5) 9 (6.8) 133 (40.3) Family/Others (n=107) 16 (15.0) 9 (8.4) 18 (16.8) 15 (14.0) 1 (0.9) 25 (23.4) 23 (21.5) 107 (32.4) Awareness and Practice Aware (n=282) 52 (18.4) 30 (10.6) 72 (25.5) 44 (15.6) 3 (1.1) 64 (22.7) 17 (6.0) 282 (85.5) Unaware (n=48) 2 (4.2) 0 (0.0) 6 (12.5) 1 (2.1) 0 (0.0) 11 (22.9) 28 (58.3) 48 (14.5) Source of Awareness Health Personnel (n=136) 29 (21.3) 15 (11.0) 34 (25.0) 20 (14.7) 1 (0.7) 30 (22.1) 7 (5.1) 136 (41.2) Mass Media (n=104) 16 (15.4) 9 (8.7) 26 (25.0) 14 (13.5) 1 (1.0) 24 (23.1) 14 (13.5) 104 (31.5) Peer/Family (n=62) 6 (9.7) 3 (4.8) 12 (19.4) 5 (8.1) 1 (1.6) 17 (27.4) 18 (29.0) 62 (18.8) Others (n=28) 3 (10.7) 3 (10.7) 6 (21.4) 4 (14.3) 0 (0.0) 4 (14.3) 8 (28.6) 28 (8.5) Perception Positive (n=268) 49 (18.3) 29 (10.8) 69 (25.7) 42 (15.7) 3 (1.1) 58 (21.6) 18 (6.7) 268 (81.2) Negative/Misconceptions (n=62) 5 (8.1) 1 (1.6) 9 (14.5) 3 (4.8) 0 (0.0) 17 (27.4) 27 (43.5) 62 (18.8) Total (n=330) 54 (16.4) 31 (9.4) 78 (23.6) 45 (13.6) 3 (0.9) 75 (22.7) 44 (13.3) 330 (100.0) Joint decision-making between spouses was the most common (40.3%), followed by wife-only (16.1%), husband-only (11.2%), and family-influenced decisions (32.4%). Occupational category showed a significant association with decision-making: medical women were more likely to decide independently. The association between occupational category and decision-making pattern was significant (χ² = 29.8, p < 0.0001). Awareness of contraceptive methods was high (85.5%), with corresponding high levels of contraceptive practice (86.7%). Modern methods were more commonly used among women with better awareness, whereas lower awareness correlated with reliance on traditional methods or non-use. Sources of contraceptive information included health personnel (41.2%), mass media (31.5%), peers/family (18.8%), and others (8.5%). Medical and paramedical women most frequently cited formal health channels, whereas non-medical women relied more on informal sources. Perceptions toward contraception were generally favorable, with most women acknowledging its role in family planning, maternal health, and economic well-being. However, misconceptions and fear of side effects persisted, particularly among less educated and non-medical women, influencing method choice and preference for traditional methods.

The present study examined multiple determinants influencing contraceptive use among married women, including age, literacy, religion, occupational category, decision-making, awareness and practice, sources of information, and perceptions. The aim was to assess variations in contraceptive use across different sociodemographic strata. While most findings are consistent with existing literature, some notable variations were observed, reflecting the distinct population composition of the study, which included a substantial proportion of medical and paramedical women. Age was a significant determinant of contraceptive use and method choice. The highest contraceptive use was observed among women aged 21–29 years, while female sterilization was most common among women aged 30–39 years (30.9%). About 27.9% of couples in the 31–39 years age group relied on traditional methods, and terminal methods increased with age, reaching 40.3% among women aged 40–45 years. These findings are consistent with Ram et al., who found that women aged 30–44 years were more likely to use traditional methods, while those below 30 years preferred sterilization [15]. Mohanan et al. also reported that most users were between 15 and 34 years [16], while Jahan et al. observed comparable prevalence among women aged 19–25 years [17]. NFHS-3 data similarly indicate that female sterilization remains the most widely used method nationally (37.8%), predominantly among women aged 35–49 years [18]. Literacy showed a clear positive gradient with contraceptive prevalence. The use of oral pills (20.4%), condoms (15.4%), and sterilization (23.9%) increased with education. Among illiterate women, traditional methods were most common (28.6%), followed by sterilization. Surprisingly, non-use among graduates remained relatively high (36.4%), suggesting that behavioral factors may influence uptake despite knowledge and access. NFHS-3 reported similar patterns, with condom use highest among educated women and sterilization highest among uneducated women [18]. Girdhar et al. found a positive relationship between education and contraceptive acceptance [19], while Chakraborty et al. showed that 88% of illiterate women never used contraception compared to 62% among those with some education [20]. Female literacy has been identified as an independent predictor of contraceptive use [21], and similar associations have been documented in rural populations [22,23]. Religion played a crucial role in shaping contraceptive behavior. Hindu women predominantly used female sterilization (23.4%), followed by traditional methods (22.7%) and oral pills (19.5%). Muslim women relied mostly on traditional methods (25.5%) and had the lowest IUCD use (4.5%), while Christian women primarily used sterilization followed by natural methods and OCPs (19.7%). These patterns are similar to findings from Muslim-predominant areas in Mewat, Haryana [24]. Donati et al. reported lower contraceptive use among Muslims (17%) compared to Hindus (62%), even after controlling for education [25]. NFHS-3 data show that 43% of Hindus use terminal methods compared to 21% of Muslims, with Muslim women having higher fertility (TFR 3.8) and pregnancy rates (6.8%) [18]. These findings highlight the impact of religious norms on contraceptive behavior. Occupational category influenced contraceptive patterns indirectly through education, autonomy, and health awareness. Medical and paramedical women adopted modern methods such as OCPs, IUCDs, and sterilization more frequently, and they exercised greater independence in decision-making. Non-medical women relied more on traditional methods and family influence, indicating the role of professional exposure in shaping reproductive health behavior. Decision-making dynamics significantly affected contraceptive behavior. Joint decision-making between spouses was most common (40.3%), followed by decisions made by wives (16.1%), husbands (11.2%), and family members (32.4%). Studies have shown that joint decision-making and female autonomy are associated with higher contraceptive use [26,27]. In this study, medical professionals were more likely to make independent decisions, suggesting that education and occupational status enhance reproductive autonomy. Awareness levels were high (85.5%), similar to national figures [18], and correlated with high contraceptive prevalence (86.7%), especially among educated women. However, awareness did not always lead to modern method use, indicating that other factors, such as attitudes and partner involvement, mediate contraceptive behavior. Health personnel (41.2%) and mass media (31.5%) were the main sources of information, followed by peers and family (18.8%) and other sources (8.5%). This highlights the importance of structured communication strategies. Previous studies have emphasized the effectiveness of community health workers and media in promoting contraceptive awareness [28,29]. Women relying on informal sources were more likely to use traditional methods or not use contraception. Perceptions and attitudes were key determinants of contraceptive behavior. Positive perceptions facilitated modern method use, while misconceptions about side effects, religious beliefs, and gender norms led to reliance on traditional methods or non-use. These misconceptions were particularly prevalent among less educated and socioeconomically disadvantaged groups. Similar findings have been reported in studies showing that behavioral factors often pose greater barriers than cost or accessibility [27,30,31]. Addressing these perceptual gaps through targeted counselling, male involvement, and culturally sensitive interventions is essential to improving contraceptive uptake and method diversity.

This study highlights key determinants influencing contraceptive use across different age groups, literacy levels, religions, occupations, and socioeconomic strata. Programmatic efforts should address health concerns and side effects associated with modern contraceptive methods while involving family members who often influence reproductive decisions. Socioeconomic variations strongly affect both contraceptive prevalence and method choice, with sterilization serving as both a practical and empowering option for many women. Strengthening family planning programs through culturally sensitive counseling, community involvement, and robust service delivery is essential. Further research using mixed methods and rigorous analytical approaches is needed to better understand the complex relationship between women’s autonomy, perceptions, and contraceptive behavior. A comprehensive and equitable contraceptive structure is vital to address population growth and reproductive health needs in India.

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