Struggling with long-time low uptake of modern contraceptives in Pakistan

Background: Efforts to expand access to reproductive health care in Pakistan date as far back as the early 1950s. Despite such efforts, the fertility rate has declined at a slower pace compared to that in neighbouring countries. Aims: To explore the underlying reasons and challenges for long-time low contraceptive use among female clients and key service providers of community-based family planning programmes in Pakistan. Methods: A qualitative study was carried out with a total of 10 focus group discussions and 7 in-depth interviews with female clients and key service providers. The data were analysed using qualitative content analysis. Results: The intra-family dynamics, that is, influence of husbands and mothers-in-law, were significant in shaping the decision-making and choice of family planning methods. In addition, inadequate counselling skills, insufficient training for service providers, weak supportive supervision, interrupted supply of contraceptives, and delays in salary disbursement were among the key family planning programme challenges. Conclusion: Despite a well-designed community-based FP programme, providers’ counselling skills need to be enhanced. However, this has to be combined with sufficient training, supportive supervision and contraceptive availability.