Date of Award

12-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Shiyam Sunder Tikmani

Second Advisor

Dr. Sarah Saleem

Third Advisor

Dr. Muslima Ejaz

Department

Community Health Sciences

Comments

INTRODUCTION: Postpartum family planning (PPFP) is critical for preventing unintended pregnancies and promoting maternal and child health within the first two years after childbirth. However, in Pakistan, PPFP uptake remains low due to barriers such as low socioeconomic status, limited literacy, young maternal age, misconceptions, religious beliefs, husbands' opposition, and fear of side effects. While studies show that joint decision-making between couples can significantly improve family planning uptake, Pakistan’s predominantly patriarchal society often leaves reproductive decisions to men, which may limit PPFP use.
OBJECTIVES: This study aimed to assess the prevalence of PPFP uptake among married women in Thatta, Sindh, Pakistan, and assess its association with couples' joint decision-making, adjusting for factors such as sociodemographic characteristics, modern family planning knowledge, obstetric history, desire for more children, and women’s autonomy in household decision-making.
METHODS: A cross-sectional study was conducted in Thatta District from June to July 2024, involving 524 married women aged 18–49 who had given birth a year ago. Women who were pregnant again, critically ill, or faced cognitive barriers were excluded. Eligible participants provided written consent and were interviewed using EpiCollect 5 on mobile devices. Data were analysed using STATA 17; descriptive statistics summarized participants’ characteristics, with frequencies for qualitative variables and means, standard deviations, medians, and ranges for quantitative data. A stepwise multiple logistic regression model was applied and adjusted Odds Ratios with 95% confidence intervals were reported. Variables were considered statistically significant with p<0.05.
RESULTS: The mean age of the participants was 29.89 ( ± 4.95) years. The prevalence of PPFP uptake was 39.69% (95% CI: 35.58%-43.95%) (208 out of 524 participants) with injectables being the most used method (33.00%). Factors associated with PPFP uptake included couple’s joint decision-making aOR:1.71; 95% CI (1.06-2.76)], number of living children [aOR: 1.23; 95% CI (1.13-1.34)], wife’s formal education till primary grade [aOR:2.47; 95% CI (1.35- 4.55)] and secondary grade and higher [aOR:2.65; 95% CI (1.40- 5.04)], husband’s education with primary level of education [aOR:1.74; 95% CI (1.02- 2.95)] and women’s autonomy in decision-making at least one decision in household matters [aOR: 2.39;95% CI (1.22-4.67)].
CONCLUSION: Postpartum family planning use was 39.69% in our sampled population. The key facilitators being joint decision-making, number of living children, education level of both spouses, and women’s household autonomy. Addressing both individual and couple-based dynamics, promoting healthy timing and spacing of pregnancy, and empowering women in decision making are essential for enhancing maternal and child health outcomes in rural settings.

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