JMIR Publications

ABSTRACT

Background:

Unmet need for Family Planning within Pakistan is high with 17% of all married women wanting to avoid or delay pregnancies. However, they cannot be due to a lack of access to modern contraception and socio-cultural hinderances. With the modern Contraceptive Prevalence Rate stagnant at approximately 25% over the last five years, it is important to explore barriers and enablers to modern contraception uptake, to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women.

Objective:

A formative research approach was taken to explore perspectives of community members and healthcare providers related to access and utilization of family planning methods in two rural districts of Sindh. The broader goals of this study were to provide evidence to design and implement a socio-culturally appropriate family planning interventions within the existing service delivery platforms to increase uptake of modern contraceptive methods in the context of rural Sindh, Pakistan.

Methods:

A qualitative exploratory design was used. Between October 2020 and December 2020, a total of 11 in-depth interviews and 11 focus group discussions were conducted. Focus group discussions were held with community males and females including adolescents to build an understanding of community beliefs and concepts regarding modern contraceptive methods use. The in-depth interviews took place with healthcare workers and explored multiple intersections between Family planning and reproductive health service delivery at the facility and outreach levels.

Results:

The findings revealed that limited financial autonomy, restricted female mobility, discriminatory gender norms, and cultural practices left women with little opportunities for independent decision making on use of modern contraceptive methods. Furthermore, facility level and supply-side barriers including frequent stock-outs of modern contraceptives combined with lack of capacity of providers and health workers to provide quality Family Planning services and counselling played an important role in demotivating women from accessing Family Planning services. Additionally, a lack of integration of Family Planning with Maternal and Child Health service delivery at the health systems level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to Family Planning uptake were also highlighted by participants. These included husbands and/or in-laws’ disapproval, social stigma and perceived fear of side effects regarding modern Family Planning method use. More importantly, the findings highlighted a lack of adolescent-friendly reproductive health services and spaces for counseling. This has been identified as a critical area for intervention.

Conclusions:

This study seeks to provide qualitative evidence on issues relating to the effectiveness of FP interventions and programs specifically in the context of rural Sindh. Findings emphasize the need to design socio-culturally appropriate and health system-relevant Family Planning interventions to be delivered to the community by a trained and skilled healthcare workforce in an integrated fashion. Clinical Trial: ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599