Predictors of voluntary uptake of modern contraceptive methods in rural Sindh, Pakistan

Introduction The use of modern contraceptive methods (MCMs) in Pakistan has been stagnant for the last decade. In Sindh, current contraceptive use is at 28.9%, of which 25% is MCMs use. Such a low uptake translates into high unmet need 17% amongst married women. To bridge the gap between the health system and beneficiaries, there is a need to assess predictors that influence voluntary uptake of MCMs among women, at the health services and individual levels. Methods A cross-sectional household survey was conducted in two districts of Sindh, Pakistan namely Matiari and Badin. In total, 1684 Married Women of Reproductive Age (MWRA) 15-49 years were interviewed. For the selection of eligible respondents, a two-stage stratified cluster sampling strategy was used. Univariate and multivariable logistic regression was used to determine the predictive factors for the increase in the use of MCM. Results Mean age was 32.3 ±SD 7.1 years. Average number of children per woman was 4.0 ± 2.0. Use of modern methods of contraceptive was 26.1% [n=441).Statistically significant socio demographic predictors of MCM included: Number of children 4 or more (AOR 5.234 95%CI 2.78-9.84), Mother having primary education (AOR 1.730 95% CI 1.26-2.36), and Husband having middle education [AOR 1.69 95% CI 1.03 – 2.76).Maternal health services indicators included postnatal checkup of mother (AOR 1.46 95% CI 1.09 – 2.05); women who were visited by Lady Health Workers in their postnatal period and were counseled on family planning (AOR 1.83 95% CI 1.386 - 2.424). Conclusion Voluntary uptake of modern contraceptive methods is higher in women having 2 or more children, having primary education and husband having middle education. Significantly, receiving post-natal checkup at facility, and Lady Health Worker visit after delivery have more likelihood to opt for contraception. Additionally, young couple counseling on family planning is imperative to bridge the gap between knowledge and its translation into practice. There is also a need to focus on the provision of integrated family planning and maternal, newborn, and child health services through facility-based and community engagement platforms.