Title

Low uptake of modern contraceptives : perspectives of service providers and end users of lady health worker program in Karachi, Pakistan :

Date of Award

2013

Document Type

Thesis

Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)

Department

Community Health Sciences

Abstract

Low uptake of modern contraceptives: Perspectives of service providers and end users of Lady Health Worker Program (LHWP) in Karachi, Pakistan; a qualitative research Aim: The aim of the present study is to help identify areas that require strengthening in service delivery to increase the low uptake of modern contraceptives. Research Question: What are the underlying reasons for the low uptake of modern contraceptive methods among registered families under the LHWP in the urban squatters settlements of district Karachi (Korangi Town and Shah Faisal Town), Pakistan? Specific Objectives: To explore and understand perceptions and experiences of married women of registered families of LHWP regarding uptake of modern contraceptive methods To explore and understand perceptions and experiences of the LIAS, LHWs of LHWP regarding uptake of modern contraceptive methods To explore and understand the challenges and issues faced by the LHSs, LHWs and registered married women of LHWP regarding the uptake of modern contraceptive methods: Background: Pakistan is the sixth most populous country in the world and among one of the leading countries in South Asia where the initiative of Family Planning (FP) was started in late 1950s.The National Program for Family Planning and Primary Health Care (commonly referred to as Lady Health Worker Program LHWP), initiated in 1994 is one of the largest community based intervention for the provision of primary health care including family planning in Pakistan. Despite the efforts Pakistan still has one of the highest population growth rates in the world (2.07 in 2011) particularly among the South East Asian and Muslim countries. There has been little change in CPR since the new millennium. It has been stagnant for more than a decade now where it is 30 percent with the use of modern contraceptives only 21 percent and a high unmet need (25 percent) for contraceptives, perhaps owing to low performing FP programs. The fourth external evaluation of LHWP (OPM 2009) has identified a statistically insignificant improvement in CPR despite it covering more than 65 percent of target population. Methodology: A descriptive qualitative exploratory approach was carried out during July to September 2013 whereby, Focus Group Discussions (FGDs) and in-depth interviews were conducted with the registered married women, LHWs and LHSs of the LHWP respectively. The study participants were recruited through a purposive sampling technique with explicitly predefined inclusion and exclusion criteria. All LHSs who have been working for more than one year with in age categories 22-45 years were included, while LHSs who are working for less than one year were excluded. Similarly LHWs who have been working for more than one year, with age categories 18-45 were included while those who are working for less than a period of one year were excluded. The registered married female participants of the program, between the age category of 15-45 years, resident of area for more than a year and providing consent were selected, while those not registered under the program were excluded. The data was analyzed using Qualitative Content Analysis technique including both manifest and latent analysis. Findings: The analysis of data was done for both the tiers separately i-e registered married women, and LHWs & LHSs. The analysis of FGDs with community females revealed one major theme "Life experience of a community woman for using FP". This main theme included three main categories "comprehension about FP" "inspiration to use FP" and "challenges faced by the community female in using FP". The analysis of FGDs with LHWs revealed two main categories "Positive and negative aspects of LHWP" and "way forward for program improvement" and nine sub categories. The analysis of the in-depth interviews revealed the following five main categories; "Hindrances for use of FP" "Impetus for practicing FP" "Impact of LHWs on society" "Strengthening of accountability system for LHWs" and "next step towards improvement" and twenty sub categories. Conclusion: LHWP has been recognized as a remarkable initiative, the largest of its kind in the world by the Government of Pakistan. Besides its impact the current study has however identified certain key areas that require strengthening in service delivery to increase the low uptake of modern contraceptives. The demand side constraints include resistance from family members for practice of FP. The supply side constraints include counseling to male members of society, increased knowledge, technical and supervisory skills of LHSs for better performance of LHWs, uninterrupted supply of medicines, and salary for the LHSs and LHWs to maintain their level of motivation. Furthermore, it is recommended to address the constraints at both the sides in order to improve the service delivery for increase uptake of modem contraceptives.

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