The Acceptability of Contraceptives by Women in Pakistan
A Proposal for a Research Project
Samina Shaheen Ali
Maternity and Child Welfare Association of Pakistan
This project has been proposed with the ultimate goal of expanding access to reproductive health through an increased choice in the appropriate methods of fertility regulation. A research strategy will be proposed to understand how, especially women appraise different contraceptive methods and their attributes. More specifically how users and potential users assess their particular needs and weigh the different characteristics of available methods to choose and subsequently continue to use a method. Such an understanding will shed light on the future demand for a specific methods or any methods, on the need for information and programmatic intervention and on the development or modifications of contraceptive methods. The following project has been presented and further improvement on the methodology will be incorporated after a discussion with the Executive Director and the statistician at MACWAP in Pakistan.
The research project will be conducted to find out the reasons why there is such a low acceptability of methods of contraception in Pakistan, where conventional methods of family planning are failing miserably- Why is the contraceptive prevalence rate in Pakistan only 23.9, why aren’t the people of Pakistan using these methods when their immediate neighbours, India and Bangladesh are slowly and steadily increasing their contraceptive rates. It is important to pinpoint the methods that are preferred by the women of Pakistan. What is it that the people will accept to put a brake on the population explosion in Pakistan. This is no longer an explosion the growing rate of the population in Pakistan more resembles the intensity of a nuclear blast at present! It is imperative that the government be shown where the problem lies, so that they may adjust their family planning programmes according to what the people want, and so that the people may be given a choice of contraceptive methods that they find easy to use and is practical for them to obtain and use continuously. The problem has to be defined that is the reason for this survey.
The proposed research deals with opinions, attitudes, perceptions, preferences and behaviour related to contraceptive adoption. Choice of a particular method and continuation of use. The research will include and integrate both quantitative and qualitative approaches.
2. GROUNDING IN PREVIOUS RESEARCH
In order for the proposed research to advance existing knowledge it should be guided by the relevant literature, (see literature review that is attached) the proposed project will improve in the existing knowledge that is lacking in the facts as to why the women of Pakistan are not utilising the existing facilities for contraception provided in the country . The project will find out why there is a poor regulation of fertility in Pakistan.
The research should cover a broad range of settings and the findings are to be interpreted with references to the size of the groups in the population. The will be adapted to the specific study population.
1. LITERATURE REVIEW
A review of the available information for the study populations and topics of investigation. The purpose of the literature review is (a) to develop a knowledge base (b) to identify gaps and ambiguities in the existing knowledge.(c) to formulate a research hypothesis.(d) to identify the strengths and the weaknesses of the various methodologies that have been applied. Where the demographic and health surveys have been conducted in . Further analysis of the survey will be considered and updating the information. Attitudinal and behavioural will be designed. A preliminary description of such studies is given below.
The project will be conducted as a survey and some focal group discussions will be held.A total of 1200 women will be interviewed, 600 will be of the urban area and 600 from the rural areas. The most recent demographic surveys will be consulted to see the various sub groups according to socio-economic conditions taking for example three groups in the urban area
- families with an income of less than Rs. 1000.
- families with an income of between Rs. 1000-15000.
- families with a monthly income of over Rs. 15000.
The six villages that will be selected will be demographically and socio-economically similar. every third house will be selected for the interviews. the houses left out will be similar to the selected houses in all respects. The women who refuse to give the interview will be included in the final analysis too.
3. SELECTION OF WOMEN
The women to be interviewed will be from various cross sections of the urban and rural areas to ensure that all the subgroups in the society are sufficiently covered.
4. INCLUSION CRITERIA
Married women will be included between the ages of 15-49 years.
5. EXCLUSION CRITERIA
Women who are divorced, widows or separated unmarried i.e. not sexually active and post menopausal will be excluded.
6. OUTCOME MEASURE
A questionnaire will be designed taking guidance from the questionnaires used in the demographic health surveys these will include questions related to the following investigations.
Attitudinal studies will be conducted to ascertain the perceptions of and preferences for specific contraceptive methods and attributes of the methods. Focal group discussions will be used to identify the norms or the attitudes of the people in the community under study.
FOCAL GROUP DISCUSSIONSFour focal group discussions will be held by a trained mediator .The groups will consist of six persons each from the rural and the urban areas.
- Group one will be six married women below 30 years of a rural area.
- Group two will be six married women above 30 years of a rural area.
- Group three will be married women below 30 years of an urban area.
- Group four will be married women above 30 years of an urban area.
- A topic for discussion is selected and a guide is developed with key questions which are open ended and generate discussion.
- A group of six homogeneous persons are recruited it is critical that important subgroups of the population be represented at each focal group discussion.
- A skilled moderator leads the discussion using the guide and another person takes notes.
- A content analysis of the information will be under taken.
- Convenience of use
Refers to contraceptive security i.e. is protection against pregnancy (and STD’s), as well as a low likely hood of physical harm to health.
Refers to the practical convenience of the contraceptive method i.e., ease and straight forwardness of some methods as opposed to the awkwardness of others. Also less mental forethought and effort are required by some methods.
Cost also plays a role in the acceptability of a contraceptive.
Are these methods easily available and accessible to the users.
INTERVIEWS OF WOMEN
Interviews with a range of respondents as well as with a review of the existing literature will lead an extensive set of hypothesis about behavioural, situation and personal influences on the choice of method. After a pilot study to test and refine study instruments a field survey with a questionnaire containing scales will be administered. In addition to giving a personal socio-economic and demographic back ground characteristics, respondents will rate the contraceptive methods, on scales developed on the basis of the literature review, in-depth studies and the pilot study. These scales may include for example the following questions about each contraceptive method.SAFETY
- Less safe/more safe.
- Little or no chance of pregnancy/ chance of pregnancy.
- More risk to health /less risk to health.
- May cause discomfort /unlikely to cause discomfort.
- Awkward to use /easy to use.
- Ambiguous / straight forward.
- Reduces pleasure or satisfaction / does not reduce pleasure or satisfaction.
- Needs intervention /needs no intervention.
- Needs mental effort /needs no mental effort.
- Needs more fore thought /needs little forethought.
- Reduces the frequency of intercourse /does not reduce the frequency of intercourse.
- Psychological effects such as regrets /no psychological effect.
- Any religious inhibition / no religious inhibitions about its use.
- Do you have any objection to this method / you have no objection to this method.
- More expensive /less expensive.
- Litte known /well known.
- Less widely used /more widely used.
- Easily accessible /not easily accessible.
- For use on occasions /for regular use .
- Under the women’s control /under the men’s control.
- Less moral / more moral.
- Less condoned by religion/more condoned by religion.
- More for the working class /more for the upper class.
- For more educated people /for less educated people.
- For methodical people / for impulsive people.
- For informed people /for uninformed people.
- Under the users control / not under the users control.
Each respondent would rate each available method on the above scales. A statistical analysis would be performed to identify the users relative importance of each factors for the users of each method . In addition the importance of each factor for the users of each method.
NUMBER OF SUBJECTS
A number of 1200 women will be interviewed.
TIME TABLEA timetable will be arranged as follows,
- 1 month to plan and recruit staff.
- 1 month for pilot study .
- 7 months for the interviews.
- 3 months for data analysis.
A total of 12 months will be required from the time of receiving the funds for this project.
This project is quite feasible a period of one year shall be adequate to carry out this project.
The project will be conducted by the Maternity and child welfare Association of Pakistan (MCWAP), 30F Gulberg II Lahore, Pakistan.The data collected will be reviewed by the staff of the project .i.e.
- The lady health visitors.
- The Medical Director.
- The Executive Director who is also an experienced statistical analyst.
The computer operator will enter all the information on the computers in the organisation.
DATA ANALYSISThis will be done by the Medical Director and the statistician. The following estimations will be calculated in percentage of the women interviewed i.e.
- The number of women using contraception.
- Why they are using these methods.
- the nonusers and reasons for non use.
- Reasons for non use will be categorised and the most prominent will be identified.
- Any other relevant information that may be discovered will also be analysed.
Management of the project will be undertaken by the President and the Executive Director of MCWAP.
The main problem anticipated is that the rural areas become inaccessible in the rainy season. This may delay the data collection.
The outcome should give some reasons for the non acceptability of contraceptive methods in Pakistan. That is why the women of Pakistan are not using the various methods of fertility regulation that are available in the country. What do these women want, what services can be provided to them to make it easier for them to use contraceptive methods. It is vital that the women of Pakistan reduce the number of children that they have, so that they can improve their health. It is necessary to improve the reproductive health status of the women of Pakistan and a healthy mother is able to take much better care of her family .Reproductive health should be the priority of Pakistan and family planning is a essential part of this, a healthy nation will also improve the socio-economic conditions of the country.
The confidentiality of the women’s answers in the survey and focal group discussions will be strictly observed.
This project is very necessary to find out why the contraceptive prevalence rate is the lowest in the subcontinent. What are the reasons for the acceptability and non acceptability of contraceptive methods in Pakistan. The former literature search suggests that the socio-economic conditions, religion, and lack of education in Pakistan are the reasons, but as we can see these factors are the same in Bangladesh so it appears that the problem lies else where. We have yet to put our finger on the real problem , what is it that the people of Pakistan want ? what are the factors that come into play when they want to decide that they want to limit their family. How can we convince them to reduce their ideal family size, what services can be offered to them to make it easier for them to use contraceptive methods.