Two new articles - A focus on contraception in Pakistan

Ados May

Dear colleagues

Hope you are staying well and keeping safe. Sharing two new articles that just got published.


The links are provided as under:  

Azmat SK, Lashari T, Ali M, Awan MA, Karim A. Contraceptive access, choices, and discontinuation among the urban users in Karachi, Pakistan: Findings from a comparative analysis of Pakistan demographic and health survey 2012-12 and 2017-18. J Pak Med Assoc. 2021 Nov;71(Suppl 7)(11):S38-S44. PMID: 34793427.



Introduction. To explore and assess the contraceptive access, choices, and discontinuation among the urban users in Karachi using the last two Demographic and Health Surveys in Pakistan.

Methods: A comparative analysis of the six districts of Karachi (Urban only) using Pakistan Demographic and Health Survey 2012-13 (sample size 2324) and 2017-18 (sample size 2896) of the currently married women of reproductive age 15-49 years was designed and conducted. For the current study, we used descriptive statistics on contraceptive use, method-mix, unmet need for family planning, method-specific discontinuation, sources of modern contraceptive use by channel (public and private), and exposure to family planning messaging. Results: The analysis of the PDHS indicated that the mCPR for Karachi Urban remained stagnant at 35%. However, CPR (all methods) improved from 48% to 52% mainly because of an increase in the traditional contraceptive methods. On the other hand, there was an increase in unmet need between the two DHS surveys from 13% to 16%. The possible explanation is inadequate resource allocations, affordability of the services, poor quality of care, and fear of side effects, among other factors. The supply-side situation indicates that the private sector holds a significant share of family planning service delivery. However, the decline of 15% in the current share of services from the private sector in Karachi's urban areas since 2012-13 PDHS data. The desire for pregnancy, method failure, and side effects remained three significant reasons for the method discontinuation.

Conclusion: The present study reports a high unmet need for family planning and a stagnant mCPR for urban Karachi between the two demographic surveys. In addition, the data reveals private sector taking over the public sector for the delivery of modern contraceptive methods while the major reasons for method-specific discontinuation illustrates a similar trend at national and urban Karachi level.


Azmat SK, Temmerman M, Ali M. Accessibility and uptake of modern contraceptive methods in Pakistan - a critical view on what works? J Pak Med Assoc. 2021 Nov;71(Suppl 7)(11):S20-S32. PMID: 34793425.



Background: In Pakistan, there is a clear imbalance between the population's needs and available resources to cater for spacing and limiting childbirth as desired by couples. More than two-thirds (70%) of the Pakistani population are now paying out-of-pocket for overall health costs. This critical review is guided by the aim to increase access and utilization of modern contraceptives in the underserved Pakistan. The research question explores the effects of multi-pronged health financing model "using vouchers" for increase in contraceptive access and uptake among married women in rural Pakistan. Methods: The review comprised studies that were published inclusive and after 2000 on implementation research on family planning. The international scientific databases searched included PubMed, SCOPUS, and MEDLINE until December 2016. Related articles were found using key terms and based on a review of the titles and abstracts of the published papers, a total of eight published studies met the criteria and were included for this review. Results: This critical review of key private sector intervention demonstrated that the use of multi-pronged health financing mechanisms targeting underserved communities such as 1) using demand-side free vouchers complemented by mid-level social franchise providers along with community health worker support to connect clients with facility and 2) using public sector trained community midwives and engaging a dedicated community health worker with them to generate demand and bridge the gap between clients with the local facility (financing CMW trainings and CHW salaries; and 3) expanding outreach services to reach out to underserved communities (financing free services) - has a positive and favorable impact. The findings show that free vouchers used alongside social franchising (multi-pronged health financing model) was able to increase the overall contraceptive uptake and also increased method specific uptake mainly for intrauterine device (IUD) and condoms in the intervention group in three different studies. Conclusions: The multi-pronged health financing mechanisms exclusive to FP not only were able to increase the uptake of modern FP services in underserved areas but also facilitated the long-term continuity of modern FP methods, while promoting method-specific switching behavior. The models, using voucher based social franchising, community midwives coupled by CHWs, and the outreach services have a tangible effect on modern family planning uptake within communities.


Thought these will be of interest to you. Feel free to share it among your networks.


Warm wishes for the New Year and Merry Christmas


Moazzam Ali MBBS, PhD, MPH, PG Diploma | Epidemiologist. Medical Officer | UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) | WHO Department of Sexual and Reproductive Health and Research | World Health Organization. Avenue Appia 20, Geneva 27, CH-1211 Switzerland | Tel: +41 (22) 791.3442  |  Mobile +41 (79) 477 0431 |  E-mail: alimoa@...   | Twitter: @Moazzam2000 | Personal profile | Moazzam’s ORCID |