| Sumario: | Background Alcohol consumption among women of reproductive age is a growing concern in India, with significant implications for reproductive health. Despite evidence linking alcohol use to suboptimal contraceptive behaviors, research on the patterns and determinants of contraceptive use remains limited. Methods Data from 6626 married women aged 15–49 years who reported alcohol consumption and 468 142 who did not were drawn from the National Family Health Survey-5 (2019–2021). Contraceptive use was classified by the World Health Organization's effectiveness levels. Alcohol consumption was examined by type (homemade, country liquor, Indian Made Foreign Liquor), frequency (daily, weekly, less than weekly), and duration. Covariates included age, education, wealth, residence, parity, and tribal status. Ordinal logistic regression was used to identify predictors of contraceptive use. Results Alcohol use was associated with lower odds of effective contraceptive use (aOR = .86, 95% CI:.82–0.90)—31.18% reported no contraceptive use, while 75.09% used very effective or effective methods, primarily female sterilization (45.44%) and oral contraceptives (19.32%). Homemade alcohol users showed the highest prevalence of effective methods (82.76%), while IMFL consumers reported higher non-use (33.44%). Those who drink daily relied more on effective methods compared to less frequent drinkers. Education and wealth were significant predictors among all women but not in those who drink alcohol. State-wise variations were notable, with low rates of contraceptive use in Meghalaya (18.52%) and high rates in Sikkim (81.72%). Conclusion Integrated family planning and alcohol screening and brief intervention services are needed, especially in underserved regions.
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