Effect of family size and composition on fertility desires, contraceptive adoption, and method choice in South Asia

Using data from recent Demographic and Health Surveys, we analyze whether the choice of contraceptive method adopted (modern versus traditional; temporary versus permanent) and desire for another child differ by parity and sex composition of surviving children. In addition, for India we pool data for four northern states (Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh) and four southern states (Andhra Pradesh, Karnataka, Kerala, and Tamil Nadu) in order to capture the north-south variation within the country. We also compare West Bengal and Bangladesh to understand how son preference in these culturally similar regions affects fertility desires and contraceptive adoption. The effects of parity and sex composition on fertility desire and contraceptive use are estimated using binary and multinomial logistic regression after controlling for key socioeconomic factors, including education, work status, media exposure, household wealth status, woman"s participation in household decision-making, and urban/rural residence. We find that, independent of socioeconomic factors, women with more sons have a lower desire to have another child and are more likely to use contraception than those with more daughters. These effects are more prominent in Nepal and India than in Bangladesh. Within India, the effects are stronger in north India than in south India or West Bengal. However, considerable proportions of women also express a desire for at least one daughter, especially in Bangladesh after having a son. There is a clear shift towards permanent methods of contraception with an increase in the number of sons, but we find no systematic pattern in the use of traditional methods by parity or sex composition of children. We conclude that son preference remains widespread in all three countries, and it has a major influence on reproductive behavior. The preference for boys is embedded in the cultural and traditional beliefs of these countries. Reducing such preference would require a change in social norms and attitudes of the people and an improvement of the status of women within the household. (Author abstract, modified)