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Abstract
Pakistan, the sixth populous country in the world, lags behind its regional neighbours with a low contraceptive prevalence rate of 25% and high unmet contraceptive need of 17% among married women. Despite its efficacy and low-cost availability, less than 3% of women use LARCs in Pakistan. Following a cross-sectional survey, an explanatory mixed methods design was used to examine influence of social networks, spousal communication and social norms on use of LARC in rural Islamabad.
The first study used a cross sectional survey of 800 married women and men to examine influence of social networks and other explanatory variables of use of LARC. The multivariable models, by gender, show differences of the effects of kin and non-kin (including lady health workers) on the use of LARC methods. A sequential explanatory, qualitative study of all women using LARC in the cohort revealed the decision-making process for adoption and maintenance of LARC. The third study explored perspectives of family planning service providers, including skilled and community-based providers, their perception of the barriers and challenges to married women’s use of LARCs. Deficiencies in provider knowledge and misconceptions of methods of both groups affected their advice to women. In a fourth study, with married couples, not using any modern contraceptives, issues of spousal communication and religious norms were explored using qualitative methods. Findings show differences between concordant and discordant couples in desired family size, contraceptive communication and religious influences.
Triangulation of the findings of all the studies show that women face and overcome a variety of barriers in making the decision to adopt and maintain LARC contraceptives. Nonusers face barriers due to inaccurate information provided by community-based providers, discordant inter-spousal communication and strong religious beliefs on use of modern contraceptives. Current policies and practices of services for Family planning in rural Pakistan need to encourage dissemination of information on LARC through kin networks and community-based providers. Further research on seeking best methods to develop such interventions need to be planned.