Unrestrained population expansion is a persistent global concern. The world's population was approximately 7.7 billion in 2019, and almost one-third were under the age of 15 years (1). The potential for further population growth will be increased as this segment of the population finally reaches reproductive age, with the world population expected to reach 9.7 billion by 2050 (1). India established the first National Family Planning Program in 1952 to limit the population's rapid growth and alleviate poverty (2). However, with a population growth rate of 1.64% and contributing to 18% of the global population, India is far behind the worldwide average of 1.2%. It was anticipated to surpass China as the world's most populous nation by 2027 (3, 4) but in early 2023 India overtook China's population and became the world's most-populated country (5).

The ability to foresee and have the intended family size, spacing between children and timing their births is known as family planning. With the complicated links between fertility, population growth, and poverty, the benefits of family planning for the survival and health of mothers and children are fairly straightforward. In 2000, about 90% of global abortion-related and 20% of obstetric-related mortality and morbidity could have been averted by use of effective contraception by women wishing to postpone or cease further childbearing. A total of 150,000 maternal deaths (representing 32% of all such deaths) could have been prevented with high cost-effectiveness, with much of this benefit reaped in Africa and Asia (6). A crucial part of managing family planning programmes is anticipating demand for contraceptive services (7). This is achieved through the utilization of contraception techniques and addressing unintentional infertility (8). As part of its ongoing effort to broaden the range and accessibility of contraceptive alternatives, India has introduced new contraceptives and provided a full array of family planning services to all segments of the population (9). There are numerous modern methods of contraception available which includes both temporary as well as permanent methods, including the pill, injectables, male and female condoms, emergency contraception, implants, intrauterine contraceptive devices (IUCD), female and male sterilization, and lactational amenorrhea (LAM). Still, various factors influence the decision of a method by an individual, couple, or healthcare professional (10). Traditional family planning approaches, such as the withdrawal method and resorting to abortion, have significant drawbacks. These conventional contraceptive practices often prove ineffective, leading to unintended pregnancies, unsafe abortion procedures, and increased risks to maternal health and wellbeing. Furthermore, they may cause psychological distress, sexual dissatisfaction, and heightened vulnerability to sexually transmitted infections in both women and men (11). Although modern methods have some positive outcomes, they can also have some negative impacts on women's health e.g., pills. Both contemporary and conventional methods of contraception play a role in the overall usage of contraceptives, yet their individual contributions are relatively modest (12).

Female sterilisation is currently the most extensively used method of birth control in India (13). Diminished ovarian function results in a higher incidence of various menstrual irregularities, including menorrhagia, dysmenorrhea, oligomenorrhea, and polymenorrhea. Additionally, women with this condition are more likely to undergo gynaecological surgeries or require a hysterectomy (14). Sterilization also has certain psychological drawbacks, including anxiety and depression symptoms in those with neutral personalities (15), offers no protection from sexually transmitted diseases (STDs), and is difficult and expensive to reverse (16). The average age for female sterilization has been consistent at 26 years, showing little change since the last NFHS survey. Most of the women opting for sterilization reside in rural areas of India and choose this permanent method at a relatively young age. However, the usage of temporary spacing methods is considerably lower in comparison (17). Lack of awareness and fewer opportunities to use modern temporary methods due to unaffordability influence women's decisions to undergo female sterilisation (18).

According to the National Family Health Survey (NFHS-4), approximately 7% of women regretted their choice to undergo sterilization (17). Therefore, the use of temporary contraceptives needs to be addressed, and as many people should appreciate their beneficial effects as possible. Some healthcare benefits of temporary contraceptives like condoms include the fact that they may offer protection from cervical cancer caused by HPV and STDs (14, 19). According to the World Health Organization (WHO), the condom is the only method of contraception that can avert both pregnancy and STDs (18).

Therefore, this study intended to estimate the utilization of temporary modern contraceptives among women of reproductive age in India, determine the associated factors, and assess the geographical distribution of different modern contraceptive utilization using data from the most recent and fifth National Family Health Survey (NFHS-5) 2019-2021.

The analysis included findings from 359,825 women aged 15–49 years who ever had sex and had not undergone female sterilisation. The socio-demographic characteristics of the surveyed women are shown in Table 1. The respondents' mean (SD) age was 31.58 ± 8.48 years. Most of them were unemployed (n = 37,728, 71.26%), and were rural residents (n = 270,311, 75.12%). Concerning educational status, 49.24% of the women (n = 177,165) and 54.31% of their husbands (n = 28,452) had completed their education up to secondary. The behavioural and family characteristics of the participants are shown in Table 2. Around 31.34% (n = 51,323) had had sexual intercourse, and 14.27% (n = 43,161) had their first childbirth before reaching 18 years of age. Of total, 30.44% (n = 109,531) and 86.23% (n = 310,278) did not watch TV and radio, respectively.

The overall utilization of temporary contraception among reproductive-aged (15–49 years) women in India based on secondary data analysis of NFHS-5 data (2019–21) was 66.1% [95%CI: 65.90–66.35, n = 237,953]. Multigravida (vs. nulligravida), higher education of husband (vs. not educated), urban residence (vs. rural), watching TV less than once a week (vs. not at all), unemployed (vs. employed), divorced (vs. married), and ST (vs. general and others) were significant independent determinants. The highest utilization of male condoms, IUCDs, pills and injections were in Himachal Pradesh (86%), Nagaland (64%), Tripura (85%), and Ladakh (20%), respectively.

Aggressive and forceful male sterilisation campaigns during the seventeenth century stigmatized the method entirely and burdened female sterilisation (15). Family planning programs in India have been traditionally intended to promote permanent ways of preventing pregnancy with the concern of the need to restrict the rising population trajectory (2). This resulted in an invariably explicit promotion of sterilization, with the main focus exclusively on women. As of the current scenario, female sterilization, in particular, is the most commonly used method of contraception in India (16). As of 2011, statistics from the United Nations indicated that India was accountable for a significant 36% of all global female sterilization cases (22). A 2021 study by Singh et al. revealed variations in the reliance on female sterilization across India. In the southern region, over 80% of women have been choosing sterilization for more than two decades, possibly due to strong demand for family size limitation and better access to family planning services. High prevalence in the south also relates to societal taboos around temporary alternatives, lack of awareness, incentives for sterilization, and unequal male involvement in contraception (23). De Oliveira et al. suggested that women from disadvantaged and marginalized groups continue to have sterilisation as a preferred method of contraception compared with reversible methods (2). Since then, the government's policy has evolved, as shown by the Family Planning 2020 action plan, that continues to support sterilisation while simultaneously promoting modern reversible contraceptives (13).

Our study found a higher prevalence of temporary modern contraceptives than an earlier study conducted using NFHS-3 data (34%) and in Liberia (23.87%) (2, 24). Ejembi et al. suggested that the utilization of modern contraceptives in Nigeria (21.6%) was lower than that of the temporary methods in our study (25). However our result is lower than the findings of another study, which found that the reported use of temporary contraceptive methods was 78.8% (14). Bangladesh (62.4%) and Tanzania (34.3%) revealed a lower prevalence of overall modern contraceptive utilization than temporary modern contraceptive utilization in the current study (26, 27). Andia et al. conducted a study in Uganda and found that the prevalence of barrier methods was high (82%) (28). These differences could be because of sociodemographic and behavioural characteristics. Additionally, personal knowledge, awareness, information, understanding of modern contraceptives, and sociocultural differences between various countries could significantly impact contraceptive use, which could cause discrepancies. Furthermore, the time interval between earlier studies and this study differs.

Women residing in cities were more likely to use modern contraception than those living in rural areas. Such results align with the research conducted in Afghanistan, Nigeria, Bangladesh, and Ethiopia, which showed that urban resident women are more likely than rural women to utilize modern contraceptives (15, 16, 29, 30). This might be because urban individuals are more educated, earn relatively more money, and have easier access to medical facilities and mass media than rural women, all of which positively impact the use of modern contraceptives. Furthermore, rural women require more children to assist them with fieldwork, reducing the conviction to have smaller families and reducing the use of contraceptives (30, 31, 32, 33).

A previous study found a positive correlation between a husband's education and contraceptive use which is in line with our study findings, suggesting that modern contraceptive utilization is substantially proportional to the husband's educational status (29). A husband's education substantially impacted contraceptive use compared to a wife's, particularly for male-dominant methods such as condoms and male sterilization (34). Educated husbands directly influenced better contraceptive knowledge and were more willing to sacrifice their cultural beliefs, perception, and attitude toward temporary methods. Additionally, it also motivates their partner to use contraceptives. Indirectly it is associated with higher income, which has a synergistic effect with contraceptive use (31, 32, 35). Caste was significantly associated with the temporary modern contraceptives' utilization. Our study highlights that utilization was lesser among scheduled tribes (STs) than in the general category. The results are in harmony with the study conducted using NFHS-4 (36). This might be due to less awareness and knowledge of modern contraceptives among tribes because of socio-cultural barriers, including lower access to education and marginalization.

Preceding studies have highlighted that women with three children reported the highest use of modern contraceptives. The lowest utilization was found among women who have no children, which is again in harmony with our findings (37). This implies that women with no or fewer children will try to have more children to attain the intended family size, thus reducing contraceptive use (38). Our findings suggest that unemployed women were significantly associated with contraceptive use. Unemployed women spend most of their time at home, so they utilise more contraceptives to attain desired family size than employed individuals. However, our findings contradict other studies that reported employed women use more contraceptives (39). Contraception usage is lesser among divorced women as compared with married women. Further research is needed in this context to collect more evidence.

Mass media exposure, especially watching TV, is positively associated with using temporary contraceptives. Women who watched TV at least once a week used more contraceptives than those without exposure to mass media. The finding concurs with a study in Nepal and NFHS-4, which found that TV exposure strongly impacts contraceptive usage (36, 40). Ghosh et al. reported that women would become aware of various family planning methods if they access the information offered by different mass media platforms. TV is the most efficient medium for conveying family planning messages, followed by use in conjunction with other mass media formats (36).

Out of every ten reproductive-aged (15–49 years) women in India, six are using temporary modern contraceptive methods. More intervention strategies should be planned, considering factors like gravida, education, residence, health promotion and caste to attain replacement fertility level.