Reducing Unmet Need and Unwanted Childbearing: Evidence from a Panel Survey in Pakistan

Jain, Anrudh K.; Mahmood, Arshad; Sathar, Zeba A.; Masood, Irfan

doi:10.1111/j.1728-4465.2014.00389.x

Cited by 30 publications

(34 citation statements)

References 23 publications

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“…Major demographic survey programmes (e.g., the Demographic and Health Surveys [DHS], the Multiple Indicator Cluster Surveys [MICS]) have relied on three items: an item asking for the woman’s ideal number of children (ideal family size); an item asking about her desire to have another child, and the desired timing of the next birth (prospective preferences); and an item asking whether current pregnancies or recent births were wanted, mistimed or unwanted (retrospective desires). Many studies have demonstrated the relatively high validity and reliability of the prospective preferences item, including its predictive validity [ 12 – 15 ], and therefore the now-standard survey-based indicator of unmet need for contraception relies on this item [ 16 ]. But the standard indicator of unmet need also relies on the retrospective report of whether current pregnancies and recent births were wanted and on time, and empirical evidence raises serious questions about the validity and reliability of this item [ 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Machiyama

Casterline²,

Mumah

et al. 2017

Reprod Health

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BackgroundUnmet need for family planning points to the gap between women’s reproductive desire to avoid pregnancy and contraceptive behaviour. An estimated 222 million women in low- and middle-income countries have unmet need for modern contraception. Despite its prevalence, there has been little rigorous research during the past fifteen years on reasons for this widespread failure to implement childbearing desires in contraceptive practice. There is demographic survey data on women’s self-reported reasons for non-use, but these data provide limited insight on the full set of possible obstacles to use, and one may doubt the meaningfulness of explanations provided by non-users alone. To rectify this evidence gap, this study will gather extensive information on women’s perceptions of contraception (generic and method-specific) and their past contraceptive experience, and it will allow for more complexity in fertility preferences than is standard in demographic surveys.MethodsA multi-site cohort study will be conducted in urban Kenya, rural Kenya, and rural Bangladesh. In each setting trained fieldworkers will recruit and interview 2600 women, with participants re-interviewed at 12 and 18 months. Data will be collected using a questionnaire whose development was informed by a review of existing literature and instruments from past studies in both developed and developing countries. Dozens of experts in the field were consulted as the instrument was developed. The questionnaire has three main components: a sub-set of Demographic and Health Survey items measuring socio-demographic characteristics, reproductive history, and sexual activity; additional questions on prospective and retrospective fertility preferences designed to capture ambivalence and uncertainty; and two large blocks of items on (i) generic concerns about contraception and (ii) method-specific attributes. The method-specific items encompass eight modern and traditional methods.DiscussionPolicy and programmes intended to reduce unmet need for contraception in developing countries should be informed by clear understanding of the causes of this phenomenon to better reflect the population needs and to more effectively target planning and investments. To this end, this study will field an innovative instrument in Kenya and Bangladesh. The information to be collected will support a rigorous assessment of reasons for unmet need for family planning.

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Section: Introductionmentioning

confidence: 99%

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Machiyama

Casterline²,

Mumah

et al. 2017

Reprod Health

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“…Population growth in Pakistan presents significant challenges. Contraceptive prevalence rates (CPR) and fertility rates have largely remained unchanged, or have shown slow and insufficient improvements, during the last two decades [ 1 ]. Currently Pakistan has an estimated population of over 190 million people [ 2 ] and is the sixth most populous country [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions

et al. 2016

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BackgroundFamily planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - ‘Evidence for Innovating to Save Lives’, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan.MethodsWe conducted a quasi-experimental (pre - and post-intervention with control arm) study to assess the effectiveness of each of the two intervention models, 1) Suraj model (meaning ‘Sun’ in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and 2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls.Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. We used Stata® version 8 to report the net effect of interventions on outcome indicators using difference-in-differences analysis. Multivariate Cox proportional hazard regression analysis was used to assess the net effect of the intervention on current contraceptive use, keeping time constant and adjusting for other variables in the model.ResultsThe Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14 % percentage points, current contraceptive use by 5 % percentage points and long term modern method - intrauterine device (IUD) use by 6 % percentage points. The CMW model significantly increased contraceptive awareness by 28 % percentage points, ever use of contraceptives by 7 % percentage points and, IUD use by 3 % percentage points. Additionally the Suraj intervention led to a 35 % greater prevalence (prevalence ratio: 1.35, 95 % CI: 1.22–1.50) of contraceptive use among MWRA.ConclusionSuraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.

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“…The current FP2020 Initiative focus on reducing unmet need and identifying 120 million new FP users by 2020 [24] may miss the mark by ignoring current users who are motivated to avoid a pregnancy and need a more effective method [17, 25]. These women may be the most likely to resort to abortion if they experience contraceptive failure and an unintended pregnancy [10].…”

Section: Introductionmentioning

confidence: 99%

Fertility desires, family planning use and pregnancy experience: longitudinal examination of urban areas in three African countries

Speizer

Lance

2015

BMC Pregnancy Childbirth

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BackgroundMany women have inconsistent fertility desires and contraceptive use behaviors. This increases their risk of unintended pregnancies. Inconsistencies may reflect barriers to family planning (FP) use but may also reflect ambivalence toward future childbearing. Using urban data from Kenya, Nigeria, and Senegal, this study examines the role of fertility desires and FP use behaviors on pregnancy experience over a 2-year follow-up period.MethodsData come from baseline and 2-year follow-up among urban women interviewed in Kenya, Nigeria, and Senegal. At baseline (2010/2011), women were asked about their future fertility desires (want child soon, want to delay >2 years, does not want) and current FP use. At midterm (2012/2013), women were asked if they were currently pregnant or had a birth in the 2-year period. We examine the association between baseline fertility desires and FP use with pregnancy experience and desirability of an experienced pregnancy.ResultsIn the 2-year follow-up period, 27–39 % of women in union experienced a pregnancy or birth. In Kenya and Nigeria, 30–35 % of women using a modern FP method experienced a pregnancy/birth; the percentage with a pregnancy/birth was slightly higher among women not using at baseline (41 % in both countries). In Senegal, the distinction between pregnancy experience between users and non-users was greater (16 % vs. 31 %, respectively). In all countries, pregnancy was less common among users of long-acting and permanent methods; only a small percentage of women use these methods. Women not wanting any(more) children were the least likely to experience a pregnancy in the 2-year follow-up period. No differences were observed between those who wanted to delay and those who wanted soon. Multivariate findings demonstrate distinctions in pregnancy experience by fertility desires among modern FP users. Non-users have similar pregnancy experience by fertility desires.ConclusionsFertility desires are not stable; providers need to consider the fluidity of fertility desires in counseling clients. Programs focusing on new FP users may miss women who are the most motivated to avoid a pregnancy and need to switch to a more effective method; this will result in less unintended pregnancies overall.

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Reducing Unmet Need and Unwanted Childbearing: Evidence from a Panel Survey in Pakistan

Cited by 30 publications

References 23 publications

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study

Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions

Fertility desires, family planning use and pregnancy experience: longitudinal examination of urban areas in three African countries

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