{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T19:27:45Z","timestamp":1792092465051,"version":"4.4.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-002939"],"award-info":[{"award-number":["INV-002939"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000008","name":"David and Lucile Packard Foundation","doi-asserted-by":"publisher","award":["2019-69110"],"award-info":[{"award-number":["2019-69110"]}],"id":[{"id":"10.13039\/100000008","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>The transition to small family size is at an advanced phase in India, with a national TFR of 2.2 in 2015\u201316. This paper examines the roles of four key determinants of fertility\u2014marriage, contraception, abortion and postpartum infecundability\u2014for India, all 29 states and population subgroups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from the most recent available national survey, the National Family Health Survey, conducted in 2015\u201316, were used. The Bongaarts proximate determinants model was used to quantify the roles of the four key factors that largely determine fertility. Methodological contributions of this analysis are: adaptations of the model to the Indian context; measurement of the role of abortion; and provision of estimates for sub-groups nationally and by state: age, education, residence, wealth status and caste.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Nationally, marriage is the most important determinant of the reduction in fertility from the biological maximum, contributing 36%, followed by contraception and abortion, contributing 24% and 23% respectively, and post-partum infecundability contributed 16%. This national pattern of contributions characterizes most states and subgroups. Abortion makes a larger contribution than contraception among young women and better educated women. Findings suggest that sterility and infertility play a greater than average role in Southern states; marriage practices in some Northeastern states; and male migration for less-educated women. The absence of stronger relationships between the key proximate fertility determinants and geography or socio-economic status suggests that as family size declined, the role of these determinants is increasingly homogenous.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Findings argue for improvements across all states and subgroups, in provision of contraceptive care and safe abortion services, given the importance of these mechanisms for implementing fertility preferences. In-depth studies are needed to identify policy and program needs that depend on the barriers and vulnerabilities that exist in specific areas and population groups.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0263532","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T18:31:02Z","timestamp":1644258662000},"page":"e0263532","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Key drivers of fertility levels and differentials in India, at the national, state and population subgroup levels, 2015\u20132016: An application of Bongaarts\u2019 proximate determinants model"],"prefix":"10.1371","volume":"17","author":[{"given":"Susheela","family":"Singh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6090-8470","authenticated-orcid":true,"given":"Chander","family":"Shekhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinrinola","family":"Bankole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajib","family":"Acharya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzette","family":"Audam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temitope","family":"Akinade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"pone.0263532.ref001","volume-title":"National Population Policy 2000","author":"Government of India","year":"2000"},{"key":"pone.0263532.ref002","volume-title":"National Family Health Survey (NFHS-4), 2015\u201316: India.","author":"International Institute for Population Sciences (IIPS), ICF","year":"2017"},{"issue":"6\/7","key":"pone.0263532.ref003","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2307\/1965445","article-title":"The Fertility-Inhibiting Effects of the Intermediate Fertility Variables","volume":"13","author":"J. Bongaarts","year":"1982","journal-title":"Stud Fam Plann"},{"issue":"3","key":"pone.0263532.ref004","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1086\/449714","article-title":"Social Structure and Fertility: An Analytic Framework.","volume":"4","author":"K Davis","year":"1956","journal-title":"Econ Dev Cult Change"},{"issue":"1","key":"pone.0263532.ref005","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2307\/1972149","article-title":"A Framework for Analyzing the Proximate Determinants of Fertility.","volume":"4","author":"J. Bongaarts","year":"1978","journal-title":"Popul Dev Rev"},{"issue":"19","key":"pone.0263532.ref006","doi-asserted-by":"crossref","first-page":"535","DOI":"10.4054\/DemRes.2015.33.19","article-title":"Modeling the fertility impact of the proximate determinants: Time for a tune-up","volume":"33","author":"J. Bongaarts","year":"2015","journal-title":"Demogr Res."},{"key":"pone.0263532.ref007","volume-title":"Fertility, Biology, and Behavior: An Analysis of the Proximate Determinants","author":"J Bongaarts","year":"1983"},{"issue":"3","key":"pone.0263532.ref008","doi-asserted-by":"crossref","first-page":"255","DOI":"10.2307\/172272","article-title":"Revising the proximate determinants of fertility framework: what have we learned in the past 20 years?","volume":"29","author":"J. Stover","year":"1998","journal-title":"Stud Fam Plann"},{"key":"pone.0263532.ref009","volume-title":"What factors explain the fertility transition in India?","author":"AA Jayachandran","year":"2018"},{"issue":"7","key":"pone.0263532.ref010","doi-asserted-by":"crossref","first-page":"736","DOI":"10.2307\/2644186","article-title":"Thirty Years of Family Planning in India","volume":"24","author":"R. Ledbetter","year":"1984","journal-title":"Asian Surv"},{"key":"pone.0263532.ref011","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.2307\/2991871","article-title":"From Family Planning to Reproductive Health: Challenges Facing India.","volume":"25","author":"L Visaria","year":"1999","journal-title":"Int Fam Plan Perspect"},{"issue":"4","key":"pone.0263532.ref012","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1007\/BF01849328","article-title":"Reproductive health in India.","volume":"12","author":"BN Saxena","year":"1996","journal-title":"Adv Contracept."},{"key":"pone.0263532.ref013","volume-title":"National Family Health Survey (MCH and Family Planning), India (1992\u201393).","author":"International Institute for Population Sciences (IIPS)","year":"1995"},{"issue":"1","key":"pone.0263532.ref014","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.1016\/S2214-109X(17)30453-9","article-title":"The incidence of abortion and unintended pregnancy in India, 2015.","volume":"6","author":"S Singh","year":"2018","journal-title":"Lancet Glob Health."},{"key":"pone.0263532.ref015","author":"Government of India","year":"1971","journal-title":"The Medical Termination of Pregnancy Act"},{"key":"pone.0263532.ref016","author":"Government of India","year":"2002","journal-title":"Medical Termination of Pregnancy Amendment Act"},{"key":"pone.0263532.ref017","first-page":"99","volume-title":"Prevention of Unsafe Abortion in Asia Oceania Region","author":"SK Banerjee","year":"2009"},{"key":"pone.0263532.ref018","article-title":"Public health facilities and women\u2019s access to abortion: A situational analysis in Maharashtra and Rajasthan New Delhi.","author":"S Kalyanwala","year":"2010","journal-title":"Population Council;"},{"key":"pone.0263532.ref019","volume-title":"Abortion in India: A Literature Review","author":"M Stillman","year":"2014"},{"key":"pone.0263532.ref020","volume-title":"Expanding community-based access to medical abortion in Jharkhand: A pre-intervention baseline survey in selected two blocks of Ranchi and Khunti districts","author":"B Ganatra","year":"2010"},{"key":"pone.0263532.ref021","volume-title":"National Family Health Survey (NFHS-3), 2005\u201306: India: Volume I.","author":"International Institute for Population Sciences (IIPS), Macro International","year":"2007"},{"key":"pone.0263532.ref022","volume-title":"The DHS wealth index","author":"SO Rutstein","year":"2004"},{"key":"pone.0263532.ref023","volume-title":"Human Fertility: The Basic Components","author":"H. Leridon","year":"1977"},{"issue":"2","key":"pone.0263532.ref024","doi-asserted-by":"crossref","first-page":"e0115441","DOI":"10.1371\/journal.pone.0115441","article-title":"Explaining the Role of Proximate Determinants on Fertility Decline among Poor and Non-Poor in Asian Countries.","volume":"10","author":"N Majumder","year":"2015","journal-title":"PLOS ONE"},{"key":"pone.0263532.ref025","doi-asserted-by":"crossref","DOI":"10.1363\/2020.31637","volume-title":"Adding It Up: Investing in Sexual and Reproductive Health 2019\u2014Methodology Report","author":"T Riley","year":"2020"},{"issue":"4","key":"pone.0263532.ref026","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/0277-9536(94)90091-4","article-title":"The social construction of infertility: The case of the matrilineal N\u0101yars in South India","volume":"39","author":"DL Neff","year":"1994","journal-title":"Soc Sci Med"},{"key":"pone.0263532.ref027","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.cegh.2020.08.008","article-title":"Prevalence and potential determinants of primary infertility in India: Evidence from Indian demographic health survey.","volume":"9","author":"Purkayastha Naina","year":"2021","journal-title":"Clin Epidemiol Glob Health"},{"issue":"1","key":"pone.0263532.ref028","first-page":"27","article-title":"Risk Factors and Spatial Clustering of Primary Infertility in India.","volume":"9","author":"MR Pradhan","year":"2021","journal-title":"J Infertil Reprod Biol"},{"key":"pone.0263532.ref029","volume-title":"Infertility in India: Levels, trends, determinants and consequences","author":"TS Syamala","year":"2012"},{"issue":"4","key":"pone.0263532.ref030","first-page":"638","article-title":"Marriages in Tribal India","volume":"15","author":"K. Kumar","year":"1973","journal-title":"J Indian Law Inst"},{"key":"pone.0263532.ref031","first-page":"38","author":"T. Tombing","year":"2017","journal-title":"Title: Marriage and Divorce Law among Indigenous North East Tribes of India: Comparative Study of Mizoram and Meghalaya"},{"key":"pone.0263532.ref032","article-title":"Married in Meghalaya: Feminist dream or the iron fist of matriarchy?-Specials News, Firstpost","author":"S. Dowerah","year":"2015","journal-title":"Firstpost"},{"issue":"2","key":"pone.0263532.ref033","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1017\/S0021932020000115","article-title":"Increasing role of abstinence and infecundity in non-use of contraceptive methods in India.","volume":"53","author":"P Dhillon","year":"2021","journal-title":"J Biosoc Sci"},{"issue":"2","key":"pone.0263532.ref034","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1080\/17441730.2013.797294","article-title":"Socioeconomic Determinants of Temporary Labour Migration in India.","volume":"9","author":"K Keshri","year":"2013","journal-title":"Asian Popul Stud"},{"key":"pone.0263532.ref035","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-015-0281-3","article-title":"A scoping review on determinants of unmet need for family planning among women of reproductive age in low and middle income countries.","volume":"16","author":"JK Wulifan","year":"2016","journal-title":"BMC Womens Health"},{"issue":"Suppl","key":"pone.0263532.ref036","first-page":"S1","article-title":"Family planning in India: The way forward","volume":"148","author":"P Muttreja","year":"2018","journal-title":"Indian J Med Res"},{"issue":"3","key":"pone.0263532.ref037","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1080\/17441730500441178","article-title":"Ultramodern contraception","volume":"1","author":"AM Basu","year":"2005","journal-title":"Asian Popul Stud"},{"issue":"Suppl","key":"pone.0263532.ref038","first-page":"S17","article-title":"Use of traditional contraceptive methods in India & its socio-demographic determinants","volume":"140","author":"F Ram","year":"2014","journal-title":"Indian J Med Res"},{"issue":"1 & 2","key":"pone.0263532.ref039","first-page":"59","article-title":"Measuring Child Marriage from Census and Large Scale Data Systems in India","volume":"45","author":"S. Kumar","year":"2016","journal-title":"Demogr India"},{"issue":"6","key":"pone.0263532.ref040","first-page":"7","article-title":"Differentials and Determinants of Child Marriage in India: Evidences from Large-scale Surveys","volume":"55","author":"Kumar S. Trends","year":"2020","journal-title":"Econ Polit Wkly"},{"issue":"2","key":"pone.0263532.ref041","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1177\/0973703020950263","article-title":"Child Marriage Among Girls in India: Prevalence, Trends and Socio-Economic Correlates.","volume":"14","author":"P. Paul","year":"2020","journal-title":"Indian J Hum Dev"},{"issue":"Suppl","key":"pone.0263532.ref042","first-page":"S137","article-title":"Priority strategies for India\u2019s family planning programme","volume":"140","author":"S. Pachauri","year":"2014","journal-title":"Indian J Med Res"},{"key":"pone.0263532.ref043","article-title":"Sources of Family Planning: India","author":"SHOPS Plus","year":"2019","journal-title":"Internet]. USAID SHOPS Plus project led by Abt Associates"},{"issue":"1","key":"pone.0263532.ref044","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1186\/s12913-019-4249-0","article-title":"Choice of contraceptive methods in public and private facilities in rural India.","volume":"19","author":"A Mozumdar","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0263532.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-4778-6","article-title":"Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India.","volume":"20","author":"A Kumar","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"pone.0263532.ref046","doi-asserted-by":"crossref","first-page":"e002372","DOI":"10.1136\/bmjgh-2020-002372","article-title":"Incidence of treatment for postabortion complications in India, 2015","volume":"5","author":"S Singh","year":"2020","journal-title":"BMJ Glob Health"},{"issue":"3","key":"pone.0263532.ref047","doi-asserted-by":"crossref","first-page":"e001491","DOI":"10.1136\/bmjgh-2019-001491","article-title":"Unsafe abortion and abortion-related death among 1.8 million women in India","volume":"4","author":"R Yokoe","year":"2019","journal-title":"BMJ Glob Health"},{"issue":"1","key":"pone.0263532.ref048","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1186\/s12913-019-4318-4","article-title":"Knowledge, provision of information and barriers to high quality medication abortion provision by pharmacists in Uttar Pradesh, India.","volume":"19","author":"N Diamond-Smith","year":"2019","journal-title":"BMC Health Serv Res"},{"issue":"3","key":"pone.0263532.ref049","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0120637","article-title":"Delivering Medical Abortion at Scale: A Study of the Retail Market for Medical Abortion in Madhya Pradesh, India.","volume":"10","author":"T Powell-Jackson","year":"2015","journal-title":"PLoS ONE"},{"key":"pone.0263532.ref050","doi-asserted-by":"crossref","DOI":"10.31899\/pgy13.1004","volume-title":"Youth in India: Situation and Needs 2006\u20132007.","author":"International Institute for Population Sciences (IIPS), Population Council.","year":"2010"},{"key":"pone.0263532.ref051","volume-title":"SDG India Index & Dashboard 2020\u201321: Partnerships in the Decade of Action","year":"2021"},{"key":"pone.0263532.ref052","author":"Government of India Ministry of Statistics and Programme Implementation","year":"2021","journal-title":"National Indicator Framework on SDG (Version 3.0)."},{"issue":"1","key":"pone.0263532.ref053","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1186\/s12978-021-01220-w","article-title":"Modern contraceptive use among women in need of family planning in India: an analysis of the inequalities related to the mix of methods used.","volume":"18","author":"F Ewerling","year":"2021","journal-title":"Reprod Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263532","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T18:31:50Z","timestamp":1644258710000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0263532"}},"subtitle":[],"editor":[{"given":"Akanni Ibukun","family":"Akinyemi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,7]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0263532","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,7]]}}}