Validation of a family planning self-efficacy measure with married women in Bihar, India: Findings from the Bihar Integrated Family Planning Survey.

Objectives: Adapting and testing a novel measure of family planning self-efficacy (FPSE) and examining its association with fertility intention and contraceptive use in India. Study design: Data were analyzed from 13,901 non-sterilized, currently married women of reproductive age (15-49 years) in the Bihar Integrated Family Planning Survey (BIFS) 2021. We adapted an FP Self Efficacy measure comprising women's agency to overcome barriers to accessing, discussing and using contraception, regardless of family pressure and social judgment. We used factor analyses to assess reliability and validity, and regression analyses to examine the associations of FPSE with key family planning outcomes. Results: The study sample was relatively young (35% below 25 years of age), with 43% reporting no education and over half (52%) married before 18 years of age. The 9-item FPSE scale demonstrated high reliability (Cronbach's α=0.82) with two factors - self-efficacy to access and discuss contraception versus self-efficacy to use contraception in the face of resistance. Higher FPSE was associated with spousal communication [AOR: 2.35 (95% CI: 2.18, 2.54), traditional [AOR: 1.24 (95% CI: 1.12,1.36)] and reversible modern contraception [AOR: 1.58 (95% CI: 1.43,1.75)], and fertility intention [AOR: 1.13 (95% CI: 1.01,1.25)]. Conclusion: FP Self Efficacy was found to be a reliable and valid measure associated with spousal communication, reversible contraception use and fertility intention. Implications: Measures to capture reproductive agency, such as family planning self efficacy within FP programs, place women's choice as central goals of FP programming and can help in meeting community needs and the demand for contraceptive use.