Abstract
IntroductionDespite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This low uptake is puzzling in the context of high awareness of LARC methods and its availability through public sector facilities at subsidized costs. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan.MethodsIn-depth interviews were conducted with 27 women who were using a LARC method for contraception. Data was managed using NVivo 12 and themes were identified using a content analysis approach to analyze the transcripts.ResultsFour key themes, supported by sub-themes relating to a temporal model, were identified to explain women’s experiences with initiating and continuing use of a LARC. The themes were (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC. Results highlight the significant role of immediate social network of female family members in supporting the women in initiating LARCs and maintaining the method’s use.ConclusionThis study contributes to an in depth understanding of the decision-making process of women who adopted LARC and maintained its use. Women who proceeded to use an LARC and who persisted with its use despite the experience of side effects and social pressures, were able to do so with support from other female family members and spouse.
Highlights
The Department of Health (DoH) provides services through a network of Reproductive Health Services (RHS) clinics attached to hospitals and the Population Welfare Department (PWD) provide services through Family Welfare Centers (FWCs) in rural areas and Mobile Service Units (MSUs) for hardto-reach areas
In the six study areas identified for this research, five Basic Health Units (BHU), one Rural Health Center (RHC), and three Family Welfare Centers (FWC) were operational and providing family planning products and services through a medical doctor and licensed midwives (Table 1)
Qualitative study findings Women’s experiences with initiating and continuing use of an long acting reversible contraceptives (LARC) are explained under four themes, (i) Use of trusted networks for information on LARCs; (ii) Personal motivation and family support in decision to use LARC; (iii) Choice of LARC methods and access to providers; and (iv) Social and professional support instrumental in long term use of LARC, supported by sub-themes
Summary
Despite evidence from recent Demographic Health Surveys that show 98% of the adult Pakistani population have an awareness of at least one modern contraceptive method, only 25% of married couples in Pakistan used a modern method of contraception. Of the modern contraceptive methods, LARC usage has increased only from 2.1 to 3%. This study aimed to understand the social influences in initiating and continuing use of an LARC methods for contraception in a rural setting in Pakistan. Results: Four key themes, supported by sub-themes relating to a temporal model, were identified to explain women’s experiences with initiating and continuing use of a LARC. The prevalence of contraceptive use has increased worldwide [2], millions of women in low and middle income countries (LMIC) remain vulnerable to short spaced, unintended pregnancies due to limited access to suitable contraceptives. Barriers for uptake of LARC include issues of access, affordability and insufficient promotion and misconceptions about their effects [10, 11]
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