Association between geographic access to working family planning centres an unintended pregnancies among married women in district Thatta : a nested case control study

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


Background One-third of all pregnancies are unintended in South Asia every year, ranging from 21% in India, to 46% in Japan. In Pakistan from 1991 to 2006, the proportion of unintended pregnancies has risen from one fifth to almost a quarter, despite decreasing unmet need for family planning (from 28% to 25%). Despite the activities of public and private providers of family planning services in Pakistan, lack of access to these services remains an important barrier, with only 10% of women in urban areas living within walking distance of public sector family planning facilities. Objective To measure the distance from women's houses to nearest working family planning centers with the help of GIS and to assess the availability of transport as independent risk factors for unintended pregnancies in District Thatta. Hypothesis Among unintended pregnancies, limited geographic access to workin,a, family planning centers is approximately two times than intended pregnancies. Methods A community-based nested case control study was conducted of pregnant women drawn from the Maternal-Newborn Health Registry of the Global Network for Women's and Children's Health Research in district Thatta, Pakistan. A sample of 800 study participants was identified from this registry. Women reporting unintended pregnancy were cases and those with intended pregnancy were controls. Logistic regression was used to assess the effect of several factors on unintended pregnancy. Results In the multivariate model neither distance [OR=1; 95% CI (0.95-1.05)] nor availability of personal means of transportation [OR = 1.14; 95% CI (0.78-1.67)] were significantly associated with unintended pregnancy. Interestingly, women with unintended pregnancies were more likely to report the use of a method of family planning than women who had intended pregnancies [011=3.59; 95% CI (1.83-7.06)]. Even among non-users of FP, women with unintended pregnancies were more likely to have knowledge of FP as compared to controls [OR= 2.21; 95%Cl (1.23-3.97)]. Other risk factors for having an unintended pregnancy included increasing maternal age [OR=1.13; 95% CI (1.08-1.17)], having at least one living son [OR=3.13; 95% CI (1.93-5.07)]; husband's opposition to family planning [OR=3.24; 95% CI (1.89-5.56)] and husband's educational attainment at primary level or less [OR=1.85; 95% CI (1.08-3.18)]. Conclusion Lack of geographic access to a working FP center is not a risk factor for unintended pregnancy in Thatta district. In fact 56% of all women in the study live within 1km of a working FP center. More than three times the number of women who reported their last pregnancy as unintended used a family planning method prior to the index pregnancy than women whose pregnancy was intended i.e. unintended pregnancies occurred as a result of method failure. The other factor related to unintended pregnancy was spousal opposition to the use of FP and poor spousal education. Our study suggests that unintended pregnancies are likely to occur when women have achieved their desiredfamily size as evidenced by the higher average age and the presence of at least one living son amongst women with unintended pregnancies. We recommend that women who have achieved their desired family size should be mainstreamed as a specific target group for family planning programs. The quality of care of FP services must be improved to deal with issues of method failure including the provision of emergency contraception.

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