Quantitatively evaluating the effect of social barriers: a case–control study of family members’ opposition and women’s intention to use contraception in Pakistan

Abstract

BackgroundUptake of family planning services in Pakistan has remained slow over the past decade despite a rapid increase in availability and awareness, indicating that social barriers may be preventing uptake. Social barriers such as opposition by family members have largely been studied qualitatively; there is a lack of quantitative evidence about the effect of different family members’ opposition on women’s intention to use contraceptives. The objective of this study was to quantitatively evaluate the effect of family members’ opposition to family planning on intention to use contraception amongst poor women in Pakistan who have physical access to family planning services.MethodsAn unmatched case control study (nested within a larger cohort study) was conducted in two public hospitals in Karachi, Pakistan. Univariable and multivariable logistic regression analyses were conducted to compare risk factors between women that were not intending to use any contraceptive methods in the future (cases) and women that were planning to use contraceptive methods (controls).Results248 cases and 496 controls were included in the study. Negative contraceptive intent was associated with no knowledge of contraception (AOR = 3.79 [2.43-5.90]; p < 0.001), husband’s opposition (AOR = 21.87 [13.21-36.21]; p < 0.001) and mother-in-law’s opposition (AOR = 4.06 [1.77-9.30]; p < 0.001).ConclusionsThis study is the first to quantitatively assess the effect of opposition by different family members on women’s contraceptive intent in Pakistan. Our results indicate that of all family members, husband’s opposition has the strongest effect on women’s intention to use contraception, even when the women have knowledge of and physical access to family planning services.

Socio-Economic Disparities in Use of Family Planning Methods among Pakistani Women: Findings from Pakistan Demographic and Health Surveys

“…Almost half of all married women in reproductive age have never used any contraceptive methods and the prevalence estimates remain higher than many developing countries with similar or worse socio-demographic profiles [ 22 ]. Regionally, the proportion of women aged 15–49 reporting use of a modern contraceptive method in Asia is 62% (prevalence of non-use is 38%)[ 23 , 24 ].…”

Overcoming Barriers to Family Planning in Pakistan: Lessons from stories of change and a literature review

“…Second, a lack of general knowledge or misconceptions about contraceptive methods is another obstacle for couples to adopt family planning methods (Khan, 2015;Kiani, 2003). For example, one male storyteller of the Stories of Change recounted that he and his wife were in dire need to delay the conception of another child, but the fact that he and his wife didn't know any other way than to abstain from sex created a lot of frustration, and even caused difficulties in their relationship:…”

“…Lack of approval and support from family-in-laws forms in particular for women, but also in some cases for men, the strongest obstacle in adopting family planning methods (Agha, 2010). Intentions to start using contraceptives strongly depend on both the husband's (Stephenson, 2004;Zafar, et al, 2003) and mother-in-law's approval (Khan, 2015;WCP, 2016). The Stories of Change showed that defying or otherwise failing to fulfil the fertility wishes of her husband or relatives-in-law can have grave consequences for a woman, as her husband -sometimes pressured by his familymay decide to divorce her on account of it (WCP, 2016).…”

“…Instead, it is either the husband or the mother-in-law that decides. Even though women might hold different views on the use of contraceptives (Khan, 2015), many of them still believe family planning decisions should be made by their husbands (Agha, 2010). As described by a female story teller: It is also often perceived that women are not allowed to consult information about contraceptives without their husbands' knowing and approval (Zafar, et al, 2003).…”

Intimate partner violence and use of contraceptives in Bangladesh: Results from a national sample

“…As expected, women with children under the age of five were more likely to use contraceptives, which is perhaps an indication of the success of a national campaign to reduce the number children per family in an attempt to limit the population growth rate so that families with limited resources could invest more in a fewer number of children (Khan et al, ). This would suggest that women with greater wealth assets might be less likely to use contraceptives given that they have access to more resources they can use for raising children.…”