Department of Community Health Sciences, Public Health Physician RPHB (Ali) & Pacific Health and Development Sciences (White)

July 2005

Published in the Journal of the College of Physicians and Surgeons Pakistan 15(7), this 4-page article evaluates various strategies for reaching women with family planning messages and shaping their reproductive health attitudes and behaviour. The investigation was carried out to obtain information about factors affecting use of family planning methods in the rural area of Khairpur District, Sindh, Pakistan as the basis for future communication-centred initiatives designed to enhance reproductive health in that area. The research was motivated by data such as this: the contraceptive prevalence rate in Pakistan is only 24% in spite of the fact that 94% have heard of at least one method of family planning (Pakistan Fertility and Family Planning Survey 1997).

This study (conducted May-June 2000) assessed prevalence of, and sociodemographic factors associated with, family planning practices among currently married women in Khairpur District. A pre-tested structured questionnaire was used during interviews with 300 subjects from the study area. Stratified cluster sampling was also carried out. Among the findings:

• Regarding access to information, nearly 66% of women had seen family planning messages on television within the past month; exposure to family planning messages through this medium was greater than through radio (55%).
• Regarding knowledge, oral pills were the most widely known modern method (90%) followed by female sterilisation (88.3%) and injections (87.6%).
• Regarding attitudes, 91% of women and 78% of their husbands approved the use of family
  planning methods.
• Regarding practices, the prevalence of married women who used family planning methods was 27%, with oral pills being the predominant method (32%).
• Regarding sociodemographic factors, more than 4 living children, exposure to family planning messages on TV, and husband's approval were the main factors associated with the use of family planning methods.

In the Discussion section, the authors identify several key factors impacting women's access to information about family planning methods, and their attitudes toward and use of these methods:

• "Education is considered to improve the ability of women to resist subjugation and to
  acquire greater power in decision-making." However, the authors found no significant association with education when adjusted for other factors, probably due to the overall low education status in this community. Nonetheless, they suggest that greater investment in women's education is a key future strategy.

• Electronic media play an important role in a society where literacy levels are low; in this study, 62% of respondents were illiterate. "Keeping in mind our literacy level, television must continue to be utilized as a future effective way of dissemination of family planning messages." For this reason, they urge development of more effective use of electronic media.
• They stress that involvement of males should be incorporated in future family planning initiatives. Although the present study did not use the variable "husband's approval of
  family planning" as perceived by the wife as an independent variable, findings from other studies that have done so can be illuminating; for example, in Sri Lanka, where female literacy is high, women whose husbands disapproved of family planning had a 4 times higher risk of unwanted pregnancy compared with those whose husbands approved. Fostering men's participation could also have an impact on women’s mobility, which "can be a proxy indicator for women’s autonomy", and which has been shown to be associated with increased use of family planning. In this study, only 36% of the respondents were allowed to travel to a health facility alone.