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July 2002, Vol 92, No. 7 | American Journal of Public Health 1168-1172
© 2002 American Public Health Association

RESEARCH AND PRACTICE

Assessment of a New Approach to Family Planning Services in Rural Pakistan

Mehboob Sultan, MSc, John G. Cleland, MA and Mohamed M. Ali, PhD

Mehboob Sultan is with the National Institute of Population Studies, Islamabad, Pakistan. John G. Cleland and Mohamed M. Ali are with the Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England.

Correspondence: Requests for reprints should be sent to John G. Cleland, MA, Centre for Population Studies, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, England (e-mail: john.cleland{at}lshtm.ac.uk).

Objectives. In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas.

Methods. A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account.

Results. Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio = 1.74; 95% confidence interval = 1.11, 2.71).

Conclusions. After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded. (Am J Public Health. 2002;92:1168–1172)






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