Effect of Contraceptive Method Use on Fertility among Currently Married Women in Rajasthan: Evidence from NFHS-5 Using Survey-Adjusted Count Regression Models

Fertility decline in India has been accompanied by substantial changes in contraceptive behaviour, although important regional and socioeconomic differences remain. Rajasthan has experienced considerable fertility decline, but its contraceptive method mix continues to be characterized by relatively high reliance on permanent contraception and comparatively limited use of reversible spacing methods. Understanding the relationship between contraceptive method choice and cumulative fertility is therefore important for family-planning policy and reproductive-health programming.
This study examines the association between current contraceptive method use and Children Ever Born (CEB) among currently married women aged 15–49 years in Rajasthan using data from the fifth round of the National Family Health Survey (NFHS-5), 2019–21. CEB was analysed as a count outcome. Contraceptive methods were classified into non-use, modern spacing methods, long-acting reversible contraception (LARC), traditional methods, and permanent methods. Poisson and Negative Binomial models were considered, and model adequacy was assessed using dispersion diagnostics, likelihood-based information criteria, and assessment of excess zeros. The revised analysis additionally accounts for the complex NFHS-5 sampling design through sampling weights, primary sampling units, and survey strata. Multivariable models control for current age, age at marriage, education, household wealth, religion, caste, rural–urban residence, son preference, and exposure to family-planning messages. Marriage duration is incorporated in a sensitivity analysis as an exposure term.
In the unadjusted analysis, permanent-method users had the highest mean CEB (3.120), followed by traditional-method users (2.425), LARC users (2.200), and short-acting modern-method users (1.887), compared with 0.775 among women reporting no current contraceptive use. The initial unadjusted Poisson model produced IRRs of 2.435 for short-acting methods, 2.840 for LARC, 3.130 for traditional methods, and 4.028 for permanent methods. However, these estimates represent crude associations and should not be interpreted causally. After adjusting for complex survey design and multivariable confounders, the survey-adjusted Incidence Rate Ratios for short-acting modern methods, LARC, traditional methods, and permanent methods were 1.142 (95% CI: 1.102–1.184, p < 0.001), 1.198 (95% CI: 1.115–1.287, p < 0.001), 1.254 (95% CI: 1.206–1.304, p < 0.001), and 1.382 (95% CI: 1.334–1.432, p < 0.001), respectively, relative to non-users.
The findings suggest that the higher cumulative fertility observed among permanent contraceptive users primarily reflects parity-dependent and timing-related contraceptive adoption rather than a fertility-increasing effect of contraception. The results support greater access to reversible modern spacing methods, informed counselling, and method choice throughout the reproductive life course. Because NFHS-5 is cross-sectional, longitudinal or panel studies are required to establish temporal relationships between contraceptive adoption, birth spacing, and subsequent fertility.

Fertility; Children Ever Born; Contraceptive Method; Family Planning; Poisson Regression; Negative Binomial Regression; NFHS-5; Rajasthan; Survey-Adjusted Analysis

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