Full text

Turn on search term navigation

© 2023 Fazal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

Population growth in Pakistan necessitates the implementation of comprehensive family planning (FP) initiatives. The adoption of modern contraceptives, especially long-acting reversible contraceptives (LARC), and permanent family planning methods in the country is challenging and has yet to reach an optimal level. These challenges are deeply rooted in the lack of informed decision-making, as well as demographic and maternal obstetric history. Interventions tailored according to women’s needs can address the challenges faced by FP programs. This paper presents the findings of the implementation of a client-centered counseling and facilitation approach in an urban slum in Karachi, Pakistan. Such an approach has the potential to inform women and help them make better decisions regarding their health.

Methods

In Rehri Goth, a slum located in Karachi, client-centered counseling along with facilitation at the facility was implemented to encourage the adoption of any modern contraceptive methods, with a specific emphasis on promoting the use of LARCs and permanent methods (where needed) among married women of reproductive age (MWRA). This approach was integrated into the existing Maternal, Neonatal, and Child Health (MNCH) services established in 2014. During the routine delivery of services, data were collected on various aspects including demographic characteristics, obstetric history, motivation to adopt LARCs, and reasons for refusal.

Results

A total of N = 3079 eligible MWRA received client-centered counseling, and 60.3% accepted modern contraceptive methods after counseling. Furthermore, 32.5% of these MWRA adopted LARCs or permanent methods. Factors explaining reluctance to adopt any method by MWRA despite specialized counselling were: age >25 years (AOR:1.28, 95% CI:1.08–1.51), no formal education (AOR:1.58, 95% CI:1.36–1.89), having no decision making role at household (AOR:1.60, 95% CI:1.36–1.89), the desire of female or male progeny (AOR:1.86, 95% CI:1.59–2.25) and age of youngest alive ≥3 years (AOR:1.50, 95% CI:1.22–1.84). Factors explaining adoption of short-term methods instead of LARCs or permanent method were: being resident in high under-five mortality clusters (AOR:1.56, 95% CI:1.14–2.14), maternal age > 25 years (AOR:1.88, 95% CI: 1.47–2.40), no decision-making role (AOR:11.19, 95% CI:8.74–14.34), no history of abortions (AOR:2.59, 95% CI:1.79–3.75), no female child (AOR:1.85, 95% CI:1.30–2.65) and ≤ 2 children (AOR:1.74, 95% CI:1.08–2.81).

Conclusion

Considering the obstacles mothers face when it comes to accessing extended contraception, public health officials can devise effective strategies that empower MWRA to make well-informed and empowered choices regarding their families and reproductive health.

Details

Title
Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan
Author
Zoha Zahid Fazal; Noor ul Huda Zeeshan; Ghazal Moin; Bachlany, Alishan; Shafiq, Yasir; Ameer Muhammad  VIAFID ORCID Logo 
First page
e0289107
Section
Research Article
Publication year
2023
Publication date
Jul 2023
Publisher
Public Library of Science
e-ISSN
19326203
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2844072919
Copyright
© 2023 Fazal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.