Date of Award

12-7-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Ms. Farina Abrejo

Second Advisor

Dr. Sarah Saleem

Third Advisor

Dr. Xaheer Gul

Department

Community Health Sciences

Abstract

Introduction: WHO defines Family planning as "the planning that allows individuals and couples to expect and attain their desired number of children and the spacing and timing of their births.” In light of this definition, health systems are responsible for providing family planning services per the population's needs. There has been no improvement in contraceptive utilization in Pakistan since the last decade, especially in male involvement in family planning programs and services, as the programs focus on women for contraception. Men have been excluded from family planning despite their involvement in decision-making in society. The exclusion of males from family planning may have been one factor in curbing the contraceptive prevalence rate in Pakistan.
Methodology: The study is a qualitative exploratory research design using a deductive approach. Data were collected through semi-structured interviews using a purposive sampling approach. The data collection technique included key-informant interviews and individual in-depth interviews. A total of 25 interviews were collected eight key informant interviews, eight service provider in-depth interviews, and nine in-depth interviews of married men. In-depth interviews were conducted with male and female FP service providers from the public and private sectors and married men residing in different parts of Karachi. The key-informant interviews were conducted with stakeholders working in family planning programs in Sindh.
Findings: Our result suggests poor efforts in involving males from the program's perspective. No male involvement is evident in the family planning service delivery and programs. The knowledge about the availability of couple counselling and other male services at public facilities is meager. In these centres, services are provided by women health care providers to women users only due to sociocultural norms, which act as a barrier. However, limited male service providers are only available in RHS” A centres. However, policies have been addressing men's involvement at the level of advocacy and availability of male service providers since 2002, but still, those policies lack male-specific roles and responsibilities of male family planning providers. The men living in communities are reluctant to discuss family planning with female providers due to their behaviour and hesitation to share information and knowledge regarding family planning methods. Men in the communities have several reservations about other family planning methods besides condoms. Female service providers are not trained to counsel males. No specific programs are running in Karachi to address male needs; however, one International NGO is running a small-scale vasectomy project in collaboration with Population Welfare Department. Men only know about social marketing NGOs due to their advertisements. However, the policy review revealed that multiple policies have been evident since 2002 involving males in family planning programs. To fill the gap of male involvement at the service delivery and the community level in family planning, it is crucial to take further actions such as; recruiting more male service providers and increasing the knowledge through training to this cadre to reduce the stigma related to family planning methods for male contraception. Further future research is needed to understand the best practices for including men at the communities and services delivery level.
Conclusion: Study findings suggest that the health system is working to involve men in FP; however, their initiatives are not implemented properly. Significant disparities in service delivery for men, such as gender-specific service delivery, limited vasectomy facilities, and no reliable information exchange regarding family planning, make men lose and feel ignorant. However, the men want to get involved in family planning programs and avail services with their partners. Involving men can increase the use of contraceptives in Pakistan.

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1

Last Page

152

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