Practice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling

Practice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Practice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling Dure Samin Akram, Farah Khalid, Yasmeen Hanif, Sobia Taj This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-111188/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND The means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). The successful implementation of Family Planning has remained a difficult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2). METHODOLOG This study is the analysis of retrospective secondary data from an NGO, HELP’s Family Planning clinics, to determine the trends and patterns of contraceptive methods used in two squatter settlements(Neelam Colony and KKB) in Karachi from 2010-2018. The data originated from Mother and Child centers of HELP. Records of the monthly data collected by CHWs from their catchments areas were obtained and it was cumulated annually. Variables studied included number of women of childbearing age (CBA), number of married women of childbearing age, information about number of family planning users, number of babies born. The data also included different types of FP methods used by married couples. For analysis, the data was entered in Microsoft Excel and then exported to SPSS version 19. Mean and percentages, graphs and other graphics for all the variables were calculated and created through SPSS 19 and Excel. RESULTS The Mean number of FP users were 43% in Neelum Colony and 48% at KKB. Similar data was reported in PDHS 2017-18 that 34% of married women in Pakistan were opting for methods of family planning (3). Use of Condoms was the most commonly used method of family planning in Neelum Colony and in KKB, recorded as being 36%, and 41% users respectively. The FP2020 reports that there are 34% condom users in Pakistan (4). Our study also found that that that the increase in use of FP was influenced by increased reminders and nudging techniques during counselling by CHWs. CONCLUSIONS To progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scientific information regarding FP methods be given frequently. Acceptance of using FP has to be developed primarily in the male counterpart and therefore, male social mobilisers should form part of a team. Sexual & Reproductive Medicine Family Planning Slum areas NGO Family planning users Condoms Pills IUCDs Injections Sterilization Child-bearing Age Karachi Figures Figure 1 Figure 2 Plain English Summary The methods and services used for the prevention of pregnancies are called Family Planning. In this study, the authors collected eight years of Family Planning trends in two urban slums of Karachi. The data collection was focused on the number of family planning users, common methods of family planning, and counseling sessions held by CHWs. Through analysis of the data, it was found that there were 40% to 50% FP users in both the urban slums. The condom was the popular choice for family planning, whereas IUCD was the least opted method. It was also seen that during the year when the maximum number of counseling sessions was held, the trend in the use of FP methods was also increasing. In relation to this, it can be concluded that the provision of scientific information regarding Family Planning can help to increase the use. CHWs can play a vital role in disseminating the anxiety and myths associated with FP. Empowerment of CHWs through ability and accessibility can be a good initiative. It is also emphasized that male counterparts should be targeted to increase the acceptance of FP methods. Introduction The means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). This method helps a couple or individuals to take informed decisions regarding the number of children they plan to have, when to start having children, to give space between the birth of their children by means of contraception or complete their family by sterilization (5, 6). Family Planning is of significant importance as it gives a couple the power to make decisions according to their preference of giving birth whenever they feel ready. It also empowers women to care for their own health (7). Contraceptive methods are also important for improved reproductive health due to its central role in preventing the transmission of Human Immunodeficiency viruses (HIV) and other sexually transmitted diseases (STDs) (8, 9). Maternal and infant mortality rates are reduced by increasing use of contraception and optimum birth spacing. It curtails the rate of population growth which in turn benefits the economy and environment of the country (10, 11). A report published in 2018 by WHO states that globally, 222 million women wish to stop or delay the process of childbearing but unfortunately, they are not using any contraceptive methods. These methods have proven to be effective in developing countries around the world as 55 million unplanned births, 25 million miscarriages, and 138 million abortions have been averted (11). Subsequently, Pakistan’s FP 2020 Report (2017-18) informs that 36 million unplanned births, 1 million abortions and 3500 maternal deaths have been prevented with the use of contraceptive methods (4). The successful implementation of Family Planning has remained a difficult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2). Pakistan’s FP 2020 Report of 2018 states that there are 3 million users of contraceptives in Pakistan while the married contraceptive prevalence rate (mCPR) is 20.8%. There are almost 29.3% women who still have unmet needs of contraception (4). Pakistan plans to achieve 55% CPR while Sindh focuses on reaching the 45% mark from 30% by the end of the year of 2020 (12). The report also shows that in Pakistan, 33.6% of males are using condoms as a method of contraception while only 1.1% opt for male sterilization. Contrastingly, 33.2% of Pakistani women are sterilized, 10.7% use injections, 8.8% use Intra-Uterine Device and 6.1% use Pills. Lactational Amenorrhea is another method used by 5.7% of women while 0.8% use other modern methods (12). Thus FP rates need to be improved by focused efforts throughout the country. Health, Education, Literacy Programme (HELP) is a Non-Governmental Organization (NGO). It started its Family Planning services, including counselling, in early nineties in the urban slums of Karachi. This study is the analysis of retrospective secondary data from HELP’s Family Planning clinics, to determine the trends and patterns of contraceptive methods used in two such areas, Khuda ki Basti (KKB) and Neelum Colony, Karachi from 2010-2018. Methodology Study Design and Setting: We collected data from HELP’s archives. The data originated from Mother and Child centers present at KKB and Neelum Colony. These health facilities provide services of family planning, antenatal, postnatal care, perinatal services, immunization and nutrition related services for women and children. It also caters to the unmet need of family planning services at the doorsteps of the community through Community Health Workers (CHWs). Data collection and Statistical Analysis: Records of the monthly data collected by CHWs from their catchments areas were obtained. Data was cumulated annually. Thus annual data of 2010 - 2018 was included for analysis. Variables studied included number of women of childbearing age (CBA), number of married women of childbearing age, information about number of family planning users, number of babies born. The data also included different types of FP methods used by married couples including pills, condoms, injections, intra-uterine contraceptive devices (IUCD), and tubal ligations other natural methods. For analysis, the data was entered in Microsoft Excel and then exported to SPSS version 19. Mean and percentages, graphs and other graphics for all the variables were calculated and created through SPSS 19. Results And Discussions Family Planning Variables in Neelum Colony and KKB The mean number of CBAs from 2010-2018 in Neelum Colony was 2520 and 4225 at KKB. The mean value of married CBAs in Neelum Colony was 1,851 while 2896 was the mean number of married CBAs recorded at KKB. Mean number of babies born from 2010 to 2018 were 11 per month in Neelum Colony and while 26 children per month were born in KKB. The Mean number of FP users were 43% in Neelum Colony and 48% at KKB. Similar data was reported in PDHS 2017-18 that 34% of married women in Pakistan were opting for methods of family planning. It was also reported that 34% women of urban areas were more likely to use contraceptive methods when compared to 29% women of rural area. The statistics of Sindh report that 28% of urban married women while 20% of married women from rural area were using modern contraceptive methods(3). The CHW’s of HELP also provided services of counselling to the community which included topics such as maternal and child nutrition, family planning and its methods and antenatal care. Subsequently, the mean Counselling sessions held in each area, were 542 from 2010-2018 in Neelum Colony and 1477 at KKB per month. Methods opted for Family Planning Use of Condoms was the most commonly used method of family planning in Neelum Colony and in KKB, recorded as being 36%, and 41% users respectively. The FP2020 reports that there are 34% condom users in Pakistan (4). In Sindh 11.4% of urban FP users opted for Condoms while only 1.5% of rural FP users opted for condoms. Tubal ligation (TL) was the second most frequent method opted by females at both the sites with mean number of users recorded to be 26% in Neelum Colony and 29% at KKB. 33% of Pakistani women opted for sterilization (4). Tubal ligation (9%) was the second most common method of FP and in Sindh 10% were urban women and 9% were rural women opted for TL (3). Injections for birth control was the third major method of Family Planning used by the residents of Neelum Colony (17%) and KKB (11%). In Pakistan 11% of the women opted for injections as contraceptive method (4). PDHS reports 2.0% women of urban areas of Sindh were using injections as a method of FP while 3.4% of women from rural areas were using injectable. The number of females using birth control pills in Neelam Colony was 11%, whereas in KKB, the mean number of pill users 8%. However, according to the PDHS Survey 2017-2018, 1.9% of women of Urban Sindh and 2.9% of rural women were utilizing pills. Lastly, IUCD was the least common method opted by married CBAs of both study sites with mean number of users being 8.3% in Neelum and 6.7% recorded at KKB. Based on the PDHS Survey, 1.9% of users were reported in urban Sindh and 1.2% in rural Sindh (3). When the data was reviewed for trends, it was documented that the percentage of 1033 (52%) FP users was maximum in Neelum Colony in 2015. In the same year a maximum number of counselling sessions were also held (906). When compared with KKB, the counselling session frequency remained steady over the years and so did the frequency of FP practiced by couples. It is conceivable that the increase in use of FP in Neelam Colony in a particular year was influenced by increased reminders and nudging techniques during counselling by CHWs. This can be further assessed in chart 1. A study conducted in rural Tanzania reported that education provided by community health workers regarding maternal healthcare is feasible and effective (13). In a cluster randomized trial conducted amongst Malawi couples, regarding the uptake of Family Planning methods, results showed that community health workers counselling initiative was successful in making couples use modern methods of FP. It also led to an increase in the involvement of males and a trend towards increased use of condoms (14). Conclusion And Recommendations To progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scientific information regarding FP methods be given frequently. Services should always include easy accessibility and the ability of CHWs to be able to respond to queries and allay any anxiety related to FP use. Acceptance of using FP has to be advocated primarily in the male counterpart and therefore, male social mobilisers should form part of a team to bring about acceptance and demand towards the use of appropriate methods of birth spacing and FP. Abbreviations FP: Family Planning NGO: Non-Governmental Organization HELP: Health, Education, Literacy Programme KKB: Khuda ki Basti CHW: Community Health Workers HIV: Human Immunodeficiency Viruses STD: Sexually Transmitted Diseases IUCD: Intrauterine Device TL: Tubal Ligation PDHS: Pakistan Demographic and Health Survey HCW: Health care worker Declarations Ethics approval and consent to participate: Ethical Approval was taken from HELP. Consent for publication: Consent for Publication is taken from HELP. Availability of data and materials: Not applicable Competing interests: Authors have no competing interests. Funding: No funding was received for the manuscript Authors' contributions: Data was provided by Dr. DS Akram’s NGO. She also supervised the manuscript writing and data analysis procedure. She provided her writing and editing services. The data analysis and manuscript writing was done by Farah Khalid. Dr Sobia Taj did data analysis and reporting of results. Dr Yasmeen Hanif helped witb the editing of the manuscript. She also helped in writing the discussion. Acknowledgements: The authors would like to acknowledge all the CHWs who work for HELP. Authors' information (optional): DR DURE SAMIN AKRAM, Professor of Pediatrics,(pride of performance); MBBS, M.D, MPH; Diplomate American Boards in Pediatrics; Hon. Chairperson, Health, Education & Literacy Programme (Pakistan). [email protected] Farah Khalid: Aga Khan University Hospital, Karachi, Pakistan ORCID: 0000-0003-3643-7741 [email protected] Dr. Yasmeen Hanif. Health Education, Literacy Programme (HELP), [email protected] Dr. Sobia Taj: Health Education, Literacy Programme (HELP), Karachi, Pakistan [email protected] References Tolefac PN, Nana TN, Yeika EV, Awungafac NS, Ntsama Y, Njotang PN. Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub-Sahara Africa: the case of Mbalmayo District Hospital, Cameroon. BMC research notes. 2018;11(1):541. PBS. CONTRACEPTIVE PERFORMANCE REPORT 2015-2016: Governement of Pakistan; 2017 [Available from: http://www.pbs.gov.pk/sites/default/files/social_statistics/contraceptive_performance_reports/Final%20Report%20April%2C%202017%28Final%29.pdf . ICF NIoPSNPa. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: National Institute of Population Studies and Macro International Inc; 2019. FP2020. Annual Progress Reports 2017-2018, : FP2020; 2018 [Available from: http://www.familyplanning2020.org/sites/default/files/Pakistan%202018%20CI%20Handout.pdf . Cleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. The Lancet. 2006;368(9549):1810-27. Çalikoğlu EO, Yerli EB, Kavuncuoğlu D, Yılmaz S, Koşan Z, Aras A. Use of Family Planning Methods and Influencing Factors Among Women in Erzurum. Medical science monitor: international medical journal of experimental and clinical research. 2018;24:5027. Okunade KS, Daramola E, Ajepe A, Sekumade A. A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria. African Journal of Medical and Health Sciences. 2016;15(2):69. Jahan U, Verma K, Gupta S, Gupta R, Mahour S, Kirti N, et al. Awareness, attitude and practice of family planning methods in a tertiary care hospital, Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):500-6. Wani RT, Rashid I, Nabi SS, Dar H. Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir–A cross-sectional study. Journal of family medicine and primary care. 2019;8(4):1319. Yangsi TT, Florent FY, Ngole ME, Nelson F. Modern contraceptive choice among patients seen at the “Cameroon National Planning Association for Family Welfare” clinic Yaoundé. Clinical Medicine Insights: Reproductive Health. 2017;11:1179558117713016. WHO. Family planning/Contraception: WHO; 2018 [Available from: https://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception . IPPF. Spotlight on Family Planning: Tracking Progress on the FP2020 Pledges 2015 [Available from: https://www.ippf.org/sites/default/files/spotlight_pakistan_v201_web.pdf . August F, Pembe AB, Mpembeni R, Axemo P, Darj E. Community health workers can improve male involvement in maternal health: evidence from rural Tanzania. Global health action. 2016;9(1):30064. Lemani C, Tang JH, Kopp D, Phiri B, Kumvula C, Chikosi L, et al. Contraceptive uptake after training community health workers in couples counseling: A cluster randomized trial. PloS one. 2017;12(4). Tables Table 1: Details of CBAs and use of FP CBA 15- 49 Married CBA Babies Born/month FP USERS Counseling Sessions Neelum KKB Neelum KKB Neelum KKB Neelum KKB Neelum KKB Mean 2520.11 4225 1851.3333 2896 11 26 810 43% 1416 48% 541.7778 1477 2010 2440 4352 1830. 2906.33 14 29 663.00 36% 1527.67 52% 481.00 1376.83 2011 2562 4608 1870.00 2980.50 14 28 803.00 42% 1365.83 45% 563.00 1614.50 2012 2438 4426 1826.00 2938.33 9 25 803.00 43% 1717.83 58% 601.00 1223.83 2013 2125 4234 1576.00 2862.42 11 25 667.00 42% 1573.75 54% 476.00 1297.00 2014 2773 4199 1830.00 2882.17 12 23 946.00 51% 1331.08 46% 547.00 1489.42 2015 2840 3841 1969.00 2726.67 13 22 1033.00 52% 1385.67 50% 906.00 1341.00 2016 2672 4009 2197.00 2869.33 13 28 869.00 39% 1391.17 48% 499.00 1450.50 2017 2456 4634 1987.00 3335.17 7 28 685.00 34% 1355.50 40% 392.00 1974.08 2018 2375 3727 1748.00 2562.08 10 24 663.00 38% 1094.92 42% 411.00 1523.00 Table 2: Number of FP users and methods of FP FP_USERS. Condoms Pills Injection IUCD Tubal Ligation Neelum KKB Neelum KKB Neelum KKB Neelum KKB Neelum KKB Neelum KKB Mean 810 43% 1416 48% 292 36% 588 41% 96 11.85% 122 8.61% 142 17.5% 168 11.8% 68 8.3% 96 6.7% 213 26.2% 421 29% 2010 663.00 36% 1527.67 52% 211 31% 465 30.4% 139 20% 197 12.90% 168 25% 223 14.6% 69 10.4% 122 7.9% 230 34.6% 521 34.11% 2011 803.00 42% 1365.83 45% 244 30.38% 486 35% 122 15.1% 147 10.7% 155 19.30% 172 12.6% 55 6.84% 110 8.0% 227 28.26% 450 32.9% 2012 803.00 43% 1717.83 58% 285 35.49% 640 37.25% 104 12.9% 162 9.4% 157 19.55% 199 46.35% 48 5.9% 106 6.17% 209 26% 612 35.6% 2013 667.00 42% 1573.75 54% 254 38% 561 35.6% 70 10% 142 9.0% 133 19.9% 230 14.6% 50 7.4% 105 6.67% 168 25% 537 34.1% 2014 946.00 51% 1331.08 46% 406 42% 640 48% 99 10.4% 87 6.55% 166 17% 151 11.3% 62 6.5% 79 5.9% 214 22% 366 27.4% 2015 1033 52% 1385.67 50% 402 39.3% 721 52% 101 9.7% 87 6.2% 198 19% 147 10.6% 80 7.7% 93 6.7% 255 24% 330 23.8% 2016 869.00 39% 1391.17 48% 317 36% 715 51.4% 91 6.5% 84 6.0% 138 15.8% 137 9.8% 76 8.7% 90 6.4% 248 28% 356 26.9% 2017 685.00 34% 1355.50 40% 247 36% 632 46.6% 76 11% 103 7.6% 91 13.2% 140 10.33% 89 12.9% 83 6.1% 182 26.5% 331 24.4% 2018 663.00 38% 1094.92 42% 262 39% 434 42.4% 62 9.3% 89 8.1% 73 11% 116 10.6% 85 12.8% 74 6.7% 180 27.1% 288 26.3% Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-111188","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":4970552,"identity":"68a06d37-d43a-4e6e-a9dd-e9c306ee4716","order_by":0,"name":"Dure Samin Akram","email":"","orcid":"","institution":"Health,Education, Literacy Programme Pakistan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dure","middleName":"Samin","lastName":"Akram","suffix":""},{"id":4970553,"identity":"f8708e67-3d56-4482-a50f-86e0d34bc5f3","order_by":1,"name":"Farah Khalid","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBAC9h7mww8+GNjIMbY3ALkGFoS18JxhSzOcUZBmzNxzAKRFghgtPAbSPB8OJ7bPSADxidHCc8DAmMfgcGLvzOdXN/wokGDgb+9OwK+FtyHh4RyDdOOZs3PKbvYAHSZx5uwGvFrs+RkOGLwxsJbdODsn7QYPUIuBRC5+LTz8jA0SPAbMjPtvnkm7+YcoLbzNDJI8Bs6KjTPYj90mzhaeY2yGMwzSjBl7cthuyxhI8BD0Cw9P/ucHH/6AovL4s5tvgAz+9l78WpB1G4BJYpWDAPsDUlSPglEwCkbBCAIAi6xJzI+VW30AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-3643-7741","institution":"Aga Khan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Farah","middleName":"","lastName":"Khalid","suffix":""},{"id":4970554,"identity":"ca9a8835-18bd-4793-a606-47ca853b1e6d","order_by":2,"name":"Yasmeen Hanif","email":"","orcid":"","institution":"Health, Education, Literacy Programme (Pakistan)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yasmeen","middleName":"","lastName":"Hanif","suffix":""},{"id":4970555,"identity":"9bcc42c7-c6eb-4d58-a8bb-b43e6d526612","order_by":3,"name":"Sobia Taj","email":"","orcid":"","institution":"Health, Education, Literacy Programme Pakistan","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sobia","middleName":"","lastName":"Taj","suffix":""}],"badges":[],"createdAt":"2020-11-18 17:39:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-111188/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-111188/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":3734566,"identity":"8d742841-3988-4fd5-919b-b35e68dc22e4","added_by":"auto","created_at":"2020-11-20 20:36:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79493,"visible":true,"origin":"","legend":"Trends of Family Planning users and Counselling sessions in Neelum Colony","description":"","filename":"Figure1.JPG","url":"https://assets-eu.researchsquare.com/files/rs-111188/v1/5851e7f5c7b269b1f202b38e.JPG"},{"id":3734567,"identity":"127bfb3d-e44e-4a90-b986-64192d6dfffe","added_by":"auto","created_at":"2020-11-20 20:36:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94437,"visible":true,"origin":"","legend":"Trends of Family Planning users and Counselling sessions in KKB","description":"","filename":"Figure2.JPG","url":"https://assets-eu.researchsquare.com/files/rs-111188/v1/78040b0696ea1ab16ff4dd29.JPG"},{"id":13617325,"identity":"6aaf506e-be50-4aff-a3be-4631e167ad21","added_by":"auto","created_at":"2021-09-17 06:53:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":384528,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-111188/v1/ebe73d69-281d-4db7-bb10-faf6dbd081f8.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003ePractice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling\u003c/p\u003e","fulltext":[{"header":"Plain English Summary","content":"\u003cp\u003eThe methods and services used for the prevention of pregnancies are called Family Planning. In this study, the authors collected eight years of Family Planning trends in two urban slums of Karachi. The data collection was focused on the number of family planning users, common methods of family planning, and counseling sessions held by CHWs.\u003c/p\u003e\n\u003cp\u003eThrough analysis of the data, it was found that there were 40% to 50% FP users in both the urban slums. The condom was the popular choice for family planning, whereas IUCD was the least opted method. It was also seen that during the year when the maximum number of counseling sessions was held, the trend in the use of FP methods was also increasing.\u003c/p\u003e\n\u003cp\u003eIn relation to this, it can be concluded that the provision of scientific information regarding Family Planning can help to increase the use. CHWs can play a vital role in disseminating the anxiety and myths associated with FP. Empowerment of CHWs through ability and accessibility can be a good initiative. It is also emphasized that male counterparts should be targeted to increase the acceptance of FP methods.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). This method helps a couple or individuals to take informed decisions regarding the number of children they plan to have, when to start having children, to give space between the birth of their children by means of contraception or complete their family by sterilization (5, 6). Family Planning is of significant importance as it gives a couple the power to make decisions according to their preference of giving birth whenever they feel ready. It also empowers women to care for their own health (7). Contraceptive methods are also important for improved reproductive health due to its central role in preventing the transmission of Human Immunodeficiency viruses (HIV) and other sexually transmitted diseases (STDs) (8, 9). Maternal and infant mortality rates are reduced by increasing use of contraception and optimum birth spacing. It curtails the rate of population growth which in turn benefits the economy and environment of the country (10, 11).\u003c/p\u003e\n\u003cp\u003eA report published in 2018 by WHO states that globally, 222 million women wish to stop or delay the process of childbearing but unfortunately, they are not using any contraceptive methods. These methods have proven to be effective in developing countries around the world as 55 million unplanned births, 25 million miscarriages, and 138 million abortions have been averted (11). Subsequently, Pakistan\u0026rsquo;s FP 2020 Report (2017-18) informs that 36 million unplanned births, 1 million abortions and 3500 maternal deaths have been prevented with the use of contraceptive methods (4). The successful implementation of Family Planning has remained a difficult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2).\u003c/p\u003e\n\u003cp\u003ePakistan\u0026rsquo;s FP 2020 Report of 2018 states that there are 3 million users of contraceptives in Pakistan while the married contraceptive prevalence rate (mCPR) is 20.8%. There are almost 29.3% women who still have unmet needs of contraception (4). Pakistan plans to achieve 55% CPR while Sindh focuses on reaching the 45% mark from 30% by the end of the year of 2020 (12). The report also shows that in Pakistan, 33.6% of males are using condoms as a method of contraception while only 1.1% opt for male sterilization. Contrastingly, 33.2% of Pakistani women are sterilized, 10.7% use injections, 8.8% use Intra-Uterine Device and 6.1% use Pills. Lactational Amenorrhea is another method used by 5.7% of women while 0.8% use other modern methods (12). Thus FP rates need to be improved by focused efforts throughout the country.\u003c/p\u003e\n\u003cp\u003eHealth, Education, Literacy Programme (HELP) is a Non-Governmental Organization (NGO). It started its Family Planning services, including counselling, in early nineties in the urban slums of Karachi. This study is the analysis of retrospective secondary data from HELP\u0026rsquo;s Family Planning clinics, to determine the trends and patterns of contraceptive methods used in two such areas, Khuda ki Basti (KKB) and Neelum Colony, Karachi from 2010-2018.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe collected data from HELP\u0026rsquo;s archives. The data originated from Mother and Child centers present at KKB and Neelum Colony. These health facilities provide services of family planning, antenatal, postnatal care, perinatal services, immunization and nutrition related services for women and children. It also caters to the unmet need of family planning services at the doorsteps of the community through Community Health Workers (CHWs).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection and Statistical Analysis:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRecords of the monthly data collected by CHWs from their catchments areas were obtained. Data was cumulated annually. Thus annual data of 2010 - 2018 was included for analysis. Variables studied included number of women of childbearing age (CBA), number of married women of childbearing age, information about number of family planning users, number of babies born. The data also included different types of FP methods used by married couples including pills, condoms, injections, intra-uterine contraceptive devices (IUCD), and tubal ligations other natural methods.\u003c/p\u003e\n\u003cp\u003eFor analysis, the data was entered in Microsoft Excel and then exported to SPSS version 19. Mean and percentages, graphs and other graphics for all the variables were calculated and created through SPSS 19.\u003c/p\u003e"},{"header":"Results And Discussions","content":"\u003ch2\u003eFamily Planning Variables in Neelum Colony and KKB\u003c/h2\u003e\n\u003cp\u003eThe mean number of CBAs from 2010-2018 in Neelum Colony was 2520 and 4225 at KKB. The mean value of married CBAs in Neelum Colony was 1,851 while 2896 was the mean number of married CBAs recorded at KKB. Mean number of babies born from 2010 to 2018 were 11 per month in Neelum Colony and while 26 children per month were born in KKB.\u003c/p\u003e\n\u003cp\u003eThe Mean number of FP users were 43% in Neelum Colony and 48% at KKB. Similar data was reported in PDHS 2017-18 that 34% of married women in Pakistan were opting for methods of family planning. It was also reported that 34% women of urban areas were more likely to use contraceptive methods when compared to 29% women of rural area. The statistics of Sindh report that 28% of urban married women while 20% of married women from rural area were using modern contraceptive methods(3). The CHW\u0026rsquo;s of HELP also provided services of counselling to the community which included topics such as maternal and child nutrition, family planning and its methods and antenatal care. Subsequently, the mean Counselling sessions held in each area, were 542 from 2010-2018 in Neelum Colony and 1477 at KKB per month.\u003c/p\u003e\n\u003ch2\u003eMethods opted for Family Planning\u003c/h2\u003e\n\u003cp\u003eUse of Condoms was the most commonly used method of family planning in Neelum Colony and in KKB, recorded as being 36%, and 41% users respectively. The FP2020 reports that there are 34% condom users in Pakistan (4). In Sindh 11.4% of urban FP users opted for Condoms while only 1.5% of rural FP users opted for condoms. Tubal ligation (TL) was the second most frequent method opted by females at both the sites with mean number of users recorded to be 26% in Neelum Colony and 29% at KKB. 33% of Pakistani women opted for sterilization (4). Tubal ligation (9%) was the second most common method of FP and in Sindh 10% were urban women and 9% were rural women opted for TL (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInjections for birth control was the third major method of Family Planning used by the residents of Neelum Colony (17%) and KKB (11%). In Pakistan 11% of the women opted for injections as contraceptive method (4). PDHS reports 2.0% women of urban areas of Sindh were using injections as a method of FP while 3.4% of women from rural areas were using injectable. The number of females using birth control pills in Neelam Colony was 11%, whereas in KKB, the mean number of pill users 8%. However, according to the PDHS Survey 2017-2018, 1.9% of women of Urban Sindh and 2.9% of rural women were utilizing pills. Lastly, IUCD was the least common method opted by married CBAs of both study sites with mean number of users being 8.3% in Neelum and 6.7% recorded at KKB. Based on the PDHS Survey, 1.9% of users were reported in urban Sindh and 1.2% in rural Sindh (3).\u003c/p\u003e\n\u003cp\u003eWhen the data was reviewed for trends, it was documented that the percentage of 1033 (52%) FP users was maximum in Neelum Colony in 2015. In the same year a maximum number of counselling sessions were also held (906). When compared with KKB, the counselling session frequency remained steady over the years and so did the frequency of FP practiced by couples.\u003c/p\u003e\n\u003cp\u003eIt is conceivable that the increase in use of FP in Neelam Colony in a particular year was influenced by increased reminders and nudging techniques during counselling by CHWs. This can be further assessed in chart 1.\u003c/p\u003e\n\u003cp\u003eA study conducted in rural Tanzania reported that education provided by community health workers regarding maternal healthcare is feasible and effective (13). In a cluster randomized trial conducted amongst Malawi couples, regarding the uptake of Family Planning methods, results showed that community health workers counselling initiative was successful in making couples use modern methods of FP. It also led to an increase in the involvement of males and a trend towards increased use of condoms (14).\u003c/p\u003e"},{"header":"Conclusion And Recommendations","content":"\u003cp\u003eTo progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scientific information regarding FP methods be given frequently. Services should always include easy accessibility and the ability of CHWs to be able to respond to queries and allay any anxiety related to FP use. Acceptance of using FP has to be advocated primarily in the male counterpart and therefore, male social mobilisers should form part of a team to bring about acceptance and demand towards the use of appropriate methods of birth spacing and FP.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFP: Family Planning\u003c/p\u003e\n\u003cp\u003eNGO: Non-Governmental Organization\u003c/p\u003e\n\u003cp\u003eHELP: Health, Education, Literacy Programme\u003c/p\u003e\n\u003cp\u003eKKB: Khuda ki Basti\u003c/p\u003e\n\u003cp\u003eCHW: Community Health Workers\u003c/p\u003e\n\u003cp\u003eHIV: Human Immunodeficiency Viruses\u003c/p\u003e\n\u003cp\u003eSTD: Sexually Transmitted Diseases\u003c/p\u003e\n\u003cp\u003eIUCD: Intrauterine Device\u003c/p\u003e\n\u003cp\u003eTL: Tubal Ligation\u003c/p\u003e\n\u003cp\u003ePDHS: Pakistan Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003eHCW: Health care worker\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n\u003cli\u003eEthics approval and consent to participate: Ethical Approval was taken from HELP.\u003c/li\u003e\n\u003cli\u003eConsent for publication: Consent for Publication is taken from HELP.\u003c/li\u003e\n\u003cli\u003eAvailability of data and materials: Not applicable\u003c/li\u003e\n\u003cli\u003eCompeting interests: Authors have no competing interests.\u003c/li\u003e\n\u003cli\u003eFunding: No funding was received for the manuscript\u003c/li\u003e\n\u003cli\u003eAuthors' contributions: Data was provided by Dr. DS Akram\u0026rsquo;s NGO. She also supervised the manuscript writing and data analysis procedure. She provided her writing and editing services. The data analysis and manuscript writing was done by Farah Khalid. Dr Sobia Taj did data analysis and reporting of results. Dr Yasmeen Hanif helped witb the editing of the manuscript. She also helped in writing the discussion.\u003c/li\u003e\n\u003cli\u003eAcknowledgements: The authors would like to acknowledge all the CHWs who work for HELP.\u003c/li\u003e\n\u003cli\u003eAuthors' information (optional):\u003c/li\u003e\n\u003cul\u003e\n\u003cli\u003eDR DURE SAMIN AKRAM, Professor of Pediatrics,(pride of performance); MBBS, M.D, MPH; Diplomate American Boards in Pediatrics; Hon. Chairperson, Health, Education \u0026amp; Literacy Programme (Pakistan).\n\u003cp\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003eFarah Khalid: Aga Khan University Hospital, Karachi, Pakistan ORCID: 0000-0003-3643-7741\n\u003cp\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003eDr. Yasmeen Hanif. Health Education, Literacy Programme (HELP),\n\u003cp\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003eDr. Sobia Taj: Health Education, Literacy Programme (HELP), Karachi, Pakistan\n\u003cp\u003e\u003ca href=\"mailto:[email protected]\"\[email protected]\u003c/a\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTolefac PN, Nana TN, Yeika EV, Awungafac NS, Ntsama Y, Njotang PN. Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub-Sahara Africa: the case of Mbalmayo District Hospital, Cameroon. BMC research notes. 2018;11(1):541.\u003c/li\u003e\n\u003cli\u003ePBS. CONTRACEPTIVE PERFORMANCE REPORT 2015-2016: Governement of Pakistan; 2017 [Available from: \u003ca href=\"http://www.pbs.gov.pk/sites/default/files/social_statistics/contraceptive_performance_reports/Final%20Report%20April%2C%202017%28Final%29.pdf\"\u003ehttp://www.pbs.gov.pk/sites/default/files/social_statistics/contraceptive_performance_reports/Final%20Report%20April%2C%202017%28Final%29.pdf\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eICF NIoPSNPa. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: National Institute of Population Studies and Macro International Inc; 2019.\u003c/li\u003e\n\u003cli\u003eFP2020. Annual Progress Reports 2017-2018, : FP2020; 2018 [Available from: \u003ca href=\"http://www.familyplanning2020.org/sites/default/files/Pakistan%202018%20CI%20Handout.pdf\"\u003ehttp://www.familyplanning2020.org/sites/default/files/Pakistan%202018%20CI%20Handout.pdf\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eCleland J, Bernstein S, Ezeh A, Faundes A, Glasier A, Innis J. Family planning: the unfinished agenda. The Lancet. 2006;368(9549):1810-27.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;alikoğlu EO, Yerli EB, Kavuncuoğlu D, Yılmaz S, Koşan Z, Aras A. Use of Family Planning Methods and Influencing Factors Among Women in Erzurum. Medical science monitor: international medical journal of experimental and clinical research. 2018;24:5027.\u003c/li\u003e\n\u003cli\u003eOkunade KS, Daramola E, Ajepe A, Sekumade A. A 3-year review of the pattern of contraceptive use among women attending the family planning clinic of a University Teaching Hospital in Lagos, Nigeria. African Journal of Medical and Health Sciences. 2016;15(2):69.\u003c/li\u003e\n\u003cli\u003eJahan U, Verma K, Gupta S, Gupta R, Mahour S, Kirti N, et al. Awareness, attitude and practice of family planning methods in a tertiary care hospital, Uttar Pradesh, India. Int J Reprod Contracept Obstet Gynecol. 2017;6(2):500-6.\u003c/li\u003e\n\u003cli\u003eWani RT, Rashid I, Nabi SS, Dar H. Knowledge, attitude, and practice of family planning services among healthcare workers in Kashmir\u0026ndash;A cross-sectional study. Journal of family medicine and primary care. 2019;8(4):1319.\u003c/li\u003e\n\u003cli\u003eYangsi TT, Florent FY, Ngole ME, Nelson F. Modern contraceptive choice among patients seen at the \u0026ldquo;Cameroon National Planning Association for Family Welfare\u0026rdquo; clinic Yaound\u0026eacute;. Clinical Medicine Insights: Reproductive Health. 2017;11:1179558117713016.\u003c/li\u003e\n\u003cli\u003eWHO. Family planning/Contraception: WHO; 2018 [Available from: \u003ca href=\"https://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception\"\u003ehttps://www.who.int/en/news-room/fact-sheets/detail/family-planning-contraception\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eIPPF. Spotlight on Family Planning: Tracking Progress on the FP2020 Pledges 2015 [Available from: \u003ca href=\"https://www.ippf.org/sites/default/files/spotlight_pakistan_v201_web.pdf\"\u003ehttps://www.ippf.org/sites/default/files/spotlight_pakistan_v201_web.pdf\u003c/a\u003e.\u003c/li\u003e\n\u003cli\u003eAugust F, Pembe AB, Mpembeni R, Axemo P, Darj E. Community health workers can improve male involvement in maternal health: evidence from rural Tanzania. Global health action. 2016;9(1):30064.\u003c/li\u003e\n\u003cli\u003eLemani C, Tang JH, Kopp D, Phiri B, Kumvula C, Chikosi L, et al. Contraceptive uptake after training community health workers in couples counseling: A cluster randomized trial. PloS one. 2017;12(4).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Details of CBAs and use of FP \u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"123\"\u003e\n\u003cp\u003eCBA 15- 49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"123\"\u003e\n\u003cp\u003eMarried CBA\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" width=\"123\"\u003e\n\u003cp\u003eBabies Born/month\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"113\"\u003e\n\u003cp\u003eFP USERS\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" width=\"132\"\u003e\n\u003cp\u003eCounseling Sessions\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"55\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"67\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"63\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2520.11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4225\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"67\"\u003e\n\u003cp\u003e1851.3333\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"60\"\u003e\n\u003cp\u003e2896\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e810\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 43%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1416 \u0026nbsp;\u0026nbsp;48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e541.7778\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1477\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2440\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4352\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1830.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2906.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e663.00 36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1527.67 52%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e481.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1376.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2562\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4608\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1870.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2980.50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e803.00 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1365.83 45%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e563.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1614.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2438\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4426\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1826.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2938.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e803.00 43%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1717.83 58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e601.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1223.83\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4234\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1576.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2862.42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e667.00 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1573.75 54%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e476.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1297.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2773\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4199\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1830.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2882.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e946.00 51%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1331.08 46%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e547.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1489.42\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2840\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e3841\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1969.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2726.67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e1033.00 52%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1385.67 50%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e906.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1341.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2672\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e2197.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2869.33\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e869.00 39%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1391.17 48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e499.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1450.50\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2456\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e4634\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1987.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e3335.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e685.00 34%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1355.50 40%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e392.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1974.08\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"85\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"67\"\u003e\n\u003cp\u003e2375\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e3727\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003e1748.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"61\"\u003e\n\u003cp\u003e2562.08\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"62\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"53\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"58\"\u003e\n\u003cp\u003e663.00 38%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"58\"\u003e\n\u003cp\u003e1094.92 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"67\"\u003e\n\u003cp\u003e411.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"65\"\u003e\n\u003cp\u003e1523.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Number of FP users and methods of FP\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" width=\"0\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"100\"\u003e\n\u003cp\u003eFP_USERS.\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"104\"\u003e\n\u003cp\u003eCondoms\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"104\"\u003e\n\u003cp\u003ePills\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"95\"\u003e\n\u003cp\u003eInjection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"92\"\u003e\n\u003cp\u003eIUCD\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"116\"\u003e\n\u003cp\u003eTubal Ligation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003eNeelum\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003eKKB\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;Mean\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e810 \u0026nbsp;43%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1416 48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e292\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e588 41%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e96\u0026nbsp;\u0026nbsp;\u0026nbsp; 11.85%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e122 8.61%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e142\u0026nbsp;\u0026nbsp;\u0026nbsp; 17.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e168 11.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e68\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 8.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e96 6.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e213\u0026nbsp;\u0026nbsp; 26.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e421\u0026nbsp;\u0026nbsp;\u0026nbsp; 29%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp; 2010\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e663.00 36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1527.67 52%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e211\u0026nbsp;\u0026nbsp;\u0026nbsp; 31%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e465 30.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e139\u0026nbsp;\u0026nbsp;\u0026nbsp; 20%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e197 12.90%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e168\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 25%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e223 14.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e69\u0026nbsp;\u0026nbsp; 10.4%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e122 7.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e230 34.6%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e521 34.11%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2011\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e803.00 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1365.83 45%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e244 30.38%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e486 35%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e122 15.1%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e147 10.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e155 19.30%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e172 12.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e55\u0026nbsp;\u0026nbsp; 6.84%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e110 8.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e227\u0026nbsp; 28.26%\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e450 32.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2012\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e803.00 43%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1717.83 58%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e285 35.49%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e640 37.25%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e104 12.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e162 9.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e157 19.55%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e199 46.35%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e48\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 5.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e106 6.17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e209\u0026nbsp;\u0026nbsp;\u0026nbsp; 26%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e612 35.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e667.00 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1573.75 54%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e254\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 38%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e561 35.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e70\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 10%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e142 9.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e133\u0026nbsp;\u0026nbsp;\u0026nbsp; 19.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e230 14.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e50\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 7.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e105 6.67%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e168\u0026nbsp;\u0026nbsp;\u0026nbsp; 25%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e537 34.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2014\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e946.00 51%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1331.08 46%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e406\u0026nbsp;\u0026nbsp;\u0026nbsp; 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e640 48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e99\u0026nbsp;\u0026nbsp; 10.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e87\u0026nbsp;\u0026nbsp; 6.55%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e166\u0026nbsp;\u0026nbsp;\u0026nbsp; 17%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e151 11.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e62\u0026nbsp;\u0026nbsp; 6.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e79\u0026nbsp; 5.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e214\u0026nbsp;\u0026nbsp;\u0026nbsp; 22%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e366\u0026nbsp;\u0026nbsp; 27.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2015\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e1033 52%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1385.67 50%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e402 39.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e721 52%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e101\u0026nbsp;\u0026nbsp; 9.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e87\u0026nbsp;\u0026nbsp; 6.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e198\u0026nbsp;\u0026nbsp; 19%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e147\u0026nbsp;\u0026nbsp; 10.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e80\u0026nbsp;\u0026nbsp; 7.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e93\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 6.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e255\u0026nbsp;\u0026nbsp;\u0026nbsp; 24%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e330 23.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e869.00 39%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1391.17 48%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e317\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e715\u0026nbsp; 51.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e91\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 6.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e84\u0026nbsp; 6.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e138\u0026nbsp;\u0026nbsp;\u0026nbsp; 15.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e137 9.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e76\u0026nbsp;\u0026nbsp; 8.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e90\u0026nbsp; 6.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e248\u0026nbsp;\u0026nbsp;\u0026nbsp; 28%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e356\u0026nbsp; 26.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2017\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e685.00 34%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1355.50 40%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e247\u0026nbsp;\u0026nbsp;\u0026nbsp; 36%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e632\u0026nbsp; 46.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e76\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e103 7.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e91\u0026nbsp;\u0026nbsp;\u0026nbsp; 13.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e140 10.33%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e89\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 12.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e83\u0026nbsp; 6.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e182\u0026nbsp; 26.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e331 24.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"69\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp; 2018\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"49\"\u003e\n\u003cp\u003e663.00 38%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"51\"\u003e\n\u003cp\u003e1094.92 42%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e262\u0026nbsp;\u0026nbsp;\u0026nbsp; 39%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e434\u0026nbsp; 42.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e62\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; 9.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e89\u0026nbsp; 8.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e73\u0026nbsp; 11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\n\u003cp\u003e116\u0026nbsp; 10.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"48\"\u003e\n\u003cp\u003e85\u0026nbsp; 12.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"47\"\u003e\n\u003cp\u003e74\u0026nbsp;\u0026nbsp; 6.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"57\"\u003e\n\u003cp\u003e180 27.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"56\"\u003e\n\u003cp\u003e288\u0026nbsp; 26.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Family Planning, Slum areas, NGO, Family planning users, Condoms, Pills, IUCDs, Injections, Sterilization, Child-bearing Age, Karachi","lastPublishedDoi":"10.21203/rs.3.rs-111188/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-111188/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBACKGROUND\u003c/p\u003e\u003cp\u003eThe means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). The successful implementation of Family Planning has remained a difficult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2). \u003c/p\u003e\u003cp\u003eMETHODOLOG\u003c/p\u003e\u003cp\u003eThis study is the analysis of retrospective secondary data from an NGO, HELP’s Family Planning clinics, to determine the trends and patterns of contraceptive methods used in two squatter settlements(Neelam Colony and KKB) in Karachi from 2010-2018. \u003c/p\u003e\u003cp\u003eThe data originated from Mother and Child centers of HELP. Records of the monthly data collected by CHWs from their catchments areas were obtained and it was cumulated annually. Variables studied included number of women of childbearing age (CBA), number of married women of childbearing age, information about number of family planning users, number of babies born. The data also included different types of FP methods used by married couples. For analysis, the data was entered in Microsoft Excel and then exported to SPSS version 19. Mean and percentages, graphs and other graphics for all the variables were calculated and created through SPSS 19 and Excel.\u003c/p\u003e\u003cp\u003eRESULTS\u003c/p\u003e\u003cp\u003eThe Mean number of FP users were 43% in Neelum Colony and 48% at KKB. Similar data was reported in PDHS 2017-18 that 34% of married women in Pakistan were opting for methods of family planning (3). Use of Condoms was the most commonly used method of family planning in Neelum Colony and in KKB, recorded as being 36%, and 41% users respectively. The FP2020 reports that there are 34% condom users in Pakistan (4).\u0026nbsp;Our study also found that that that the increase in use of FP was influenced by increased reminders and nudging techniques during counselling by CHWs. \u003c/p\u003e\u003cp\u003eCONCLUSIONS\u003c/p\u003e\u003cp\u003eTo progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scientific information regarding FP methods be given frequently. Acceptance of using FP has to be developed primarily in the male counterpart and therefore, male social mobilisers should form part of a team.\u003c/p\u003e","manuscriptTitle":"Practice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-11-20 20:36:52","doi":"10.21203/rs.3.rs-111188/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4dcf4bf4-1131-43c4-822c-5eff7705a815","owner":[],"postedDate":"November 20th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":1147529,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2020-12-08T15:52:05+00:00","versionOfRecord":[],"versionCreatedAt":"2020-11-20 20:36:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-111188","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-111188","identity":"rs-111188","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}