Barriers to family planning service use among the urban poor in Pakistan

Although fertility has shown some decline in Pakistan in recent years, contraceptive use remains low. Despite high knowledge of modern methods of contraception (94 per cent of married women know of a modern method of contraception) only 17 per cent of married women of reproductive age currently use a modern method of contraception (Pakistan Reproductive Health and Family Planning Survey, 2001; Sathar and Casterline, 1998). This is in part a product of poor physical access to family planning services. The coverage and quality of family planning services is poor, with only 10 per cent of the population living within easy walking distance of government-operated family planning services (Rosen and Conly, 1996). Consequently, there exists a large unmet need for family planning services in Pakistan (Mahmood and Ringheim, 1997). Previous research, however, into the barriers to family planning service use has highlighted the importance of looking beyond physical access to examine barriers that arise from the socio-economic and cultural environment in which an individual lives (Bertrand and others, 1995; Foreit and others, 1978). Pakistan presents an interesting context for examining the range of potential barriers to the use of family planning services, with a low level of economic development and strict cultural norms that may inhibit service utilization. This paper identifies the barriers to family planning service use among women in urban slum areas. The paper also examines the characteristics of urban poor women who report different types of barriers to using family planning services. Gaining a better understanding of the types of women who are likely to experience particular barriers to family planning services is valuable for developing service promotion strategies and for informing service delivery protocols.