Access to WASH and Economic Resources Associated with Women’s Family Planning Decision-Making

Overview: This study explores women’s education, resource ownership, access to water, sanitation, and hygiene (WASH), and their associations to family planning decision-making in India. We use the 2015-2016 India National Family Health Survey (NFHS-4), administered to women (Nf63,696) aged 15-49, to understand how these factors influence their reproductive health choices.Proposal text: Background
The World Health Organization [WHO] (2019) defines reproductive choice as the freedom to engage in safe sex and decide if, when, and how often to have children. Family planning (FP) has been recognized as one of the most cost-effective solutions to achieving better health and wellbeing outcomes for women and their agency to make sexual reproductive choices. (Starbird, Norton & Marcus, 2016). Many women still die from perinatal complications, every day; 94% of these deaths occur in developing countries (WHO, 2019). With over half of its population of reproductive age, India has significantly unmet contraceptive needs. Although there have been increased efforts to create awareness of FP, there’s little understanding of a woman's bargaining power regarding FP preferences and methods. An area that is least understood is the association between water, sanitation, and hygiene (WASH) and family planning. Millions, globally, do not have access to clean water and do not have a decent toilet of their own. This significantly impacts women's reproductive health experiences (Deliverforgood.org.nd.). The objective of this study is to examine the bargaining power of family planning among women in India, and whether education, WASH, and ownership of resources are associated factors.

Method:
This study used the 2015-2016 India National Family Health Survey (NFHS-4), administered to women (Nf63,696) aged 15-49. It is a population-based data set collected using stratified sampling at various levels (IIPS and ICF, 2017). We used ownership of the house and/or land, sources of drinking water, time to get to a water source, and type of toilet facility to examine women’s fertility preference and their current contraceptive method use. All variables were measured at ordinal levels. Data analysis included descriptive, exploratory factor analysis (EFA), and structural equational modeling (SEM), using STATA 15 to understand the associations of the variables discussed.
Results
EFA resulted in almost all communalities loaded higher than .327 loadings. The Kaiser-Meyer-Olkin measure of sampling adequacy was .57 and Bartlett’s Test of sphericity was significant χ2 (28) =106091.178, p