Putting Unmet Need to the Test: Community-Based Distribution of Family Planning in Pakistan

Shelton, James D; Bradshaw, Lois E.; Hussein, Babar; Z, Zubair; Drexler, Tony; McKenna, Mark

doi:10.2307/2991884

Cited by 23 publications

(17 citation statements)

References 11 publications

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“…5 Recent studies offer strong evidence that increasing contraceptive usage can reduce induced abortion rates 30 and could prevent up to 35 per cent of maternal deaths. 3 Thus, increased access and use of contraceptives through community-based initiatives is a key strategy 31 and PMVs can play a significant role.…”

Section: Discussionmentioning

confidence: 99%

The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria

Fayemi

Oduola

Ogbuji

et al. 2010

J Public Health Pol

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Patent Medicine Vendors (PMVs) can play a critical role in increasing access to emergency contraceptive pills (ECPs) in developing countries, but few studies have examined their knowledge and dispensing practices. Using cluster sampling, the authors selected and interviewed 97 PMVs (60.8 per cent female) in Oyo and Ogun States of Nigeria to assess their knowledge, dispensing practices, and referral for ECPs. About one-third (27.8 per cent) of respondents were not aware of ECPs, and only half knew that ECPs could prevent pregnancy. Forty per cent had ever dispensed ECPs. Reasons proffered by those who do not dispense ECPs included barriers from the State Ministry of Health, police, other regulatory agencies, and religious beliefs. Only 50.5 per cent have referral arrangements for clients. Strategies to increase access to ECPs through PMVs include training on counseling techniques and referral, effective government regulation, and community involvement. Where unsafe abortion is a major cause of maternal mortality, these strategies offer protection for many women in the future.

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Section: Discussionmentioning

confidence: 99%

The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria

Fayemi

Oduola

Ogbuji

et al. 2010

J Public Health Pol

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“…Such informal means of receiving information are likely to have contributed to the significant rise in knowledge of contraception in the short period covered by this evaluation and to have influenced contraceptive adoption. Much has been written of the link between contraceptive use and contact with community-based workers in Pakistan (Razzaque-Rukanuddin and Hardee-Cleaveland 1992; Shelton et al 1999;Sultan et al 2002). One-third of b Net effect refers to the percentage of change in study site after accounting for the effect in the province control site.…”

Section: Discussionmentioning

confidence: 99%

“…This high level of unmet need has been attributed to a poor environment of service provision and to cultural norms that discourage contraceptive use (Mahmood and Ringheim 1997;Shelton et al 1999). An estimated 10 percent of the population live within easy walking distance of a government-operated family welfare clinic, and only half the population have adequate physical access to any type of family planning service (Sathar and Casterline 1998).…”

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confidence: 99%

The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan

Hennink¹,

Clements

2005

Studies in Family Planning

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This study uses a quasi‐experimental design to determine the impact of new family planning clinics on knowledge, contraceptive use, and unmet need for family planning among married women in poor urban areas of six secondary cities of Pakistan. Baseline (n = 5,338) and end line (n = 5,502) population surveys were conducted during 1999–2000 and 2001–02 in four study sites and two control sites. Exit interviews with clients identified the socio demographic and geographic characteristics of clinic users. The results show that the clinics contributed to a 5 percent increase in overall knowledge of family planning methods and an increase in knowledge of female sterilization and the IUD of 15 percent and 7 percent, respectively. Distinct effects were found on contraceptive uptake, including an 8 percent increase in female sterilization and a 7 percent decline in condom use. Unmet need for family planning declined in two sites, whereas impacts on the other sites were variable. Although the new clinics are located within poor urban communities, users of the services were not the urban poor, but rather were select subgroups of the local population.

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“…17 During the 1990s, community-based distribution programs in South Asia and Africa produced sharp increases in the knowledge and use of contraceptives. 18,19 A principal difference between community-based distribution programs and PRACHAR is that the latter does not provide services; rather, it generates demand for services and provides information on where services are available. In Uttar Pradesh, another disadvantaged state in India, providing carefully designed, community-oriented information through meetings, leaflets and posters has been shown to be a powerful means of generating demand for and utilization of health and social services.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Community-Based Reproductive Health Communication Interventions on Contraceptive Use Among Young Married Couples in Bihar, India

Daniel¹,

Masilamani²,

Rahman³

2008

IFPP

162

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having a demand for contraception; those who want to wait at least two years before having a child or do not want any more children but are not using a contraceptive method are considered to have an unmet need for contraception. 2 ) For example, in Bihar, where the mean age at cohabitation after marriage is just 17, more than a third of married women aged 15-19 (34%) and 20-24 (40%) have a demand for contraception, and similar proportions (31% and 33%, respectively) have an unmeet need for contraception (primarily for spacing). 4,5 The benefits of contraceptive use by young couples in India are many, especially in states where the age at marriage is very low, and levels of fertility, population growth, infant and child mortality, and abortion are high. 6 Delaying first births until age 21 and increasing the interval between the first and second births would help lower infant and child mortality, 2,7 increase the mean age of childbearing and reduce India's high momentum effect* on population growth. 8 Cultural barriers impede young women in rural India, especially northern India (including Bihar), from postponing childbearing. Parents and relatives are eager to see newly married women become pregnant and give birth soon after marriage and cohabitation. Many fear that the capacity for childbearing may decline with age, and there- times those in comparison areas.Women in intervention areas had elevated odds of knowing that fertility varies during the menstrual cycle,and of agreeing that early childbirth can be harmful and that contraceptive use is necessary and safe for delaying first births (odds ratios,1.6-3.0). CONCLUSION: Culturally appropriate,community-based communication programs that target youth and those who influence their decisions can create demand for contraception among young couples and lead to increased contraceptive use.International Family Planning Perspectives,2008,34(4):189-197 By India is home to one-sixth of the world's population, and to 30% of youth aged 10-24. 1 There are more than 211 million 15-24-year-olds in India, 2 and they account for 48% of the country's fertility. The total fertility rate in 2005-2006 was 2.7 children per woman, but there was much variation among states, from 2.0 (below replacement level) in Kerala to 4.0 in Bihar and 4.6 in Meghalaya. 3 Early marriage and childbearing are common in India: The median age at marriage for females is 16.7, well below the legal age of 18, and 28% of women aged 20-49 gave birth before age 18. 1 Contraceptive use by mothers younger than 25 is negligible, resulting in short interpregnancy intervals. Women usually achieve their desired fertility of 2-3 children by age 25 and then adopt a permanent method.Although contraceptive use among women younger than 25 is low, the demand for contraception in this population is high. (The National Family Health Survey classifies married women who want to wait at least two years before having a child or do not want any more children as *The momentum effect in India can be explained as follows: Bec...

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Putting Unmet Need to the Test: Community-Based Distribution of Family Planning in Pakistan

Cited by 23 publications

References 11 publications

The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria

The knowledge of emergency contraception and dispensing practices of Patent Medicine Vendors in South West Nigeria

The Impact of Franchised Family Planning Clinics in Poor Urban Areas of Pakistan

The Effect of Community-Based Reproductive Health Communication Interventions on Contraceptive Use Among Young Married Couples in Bihar, India

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