title: A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.
abstract: BACKGROUND
  High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.
  
  
  METHODS
  This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period.
  
  
  CONCLUSIONS
  The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. Khurram.azmat@gmail.com.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.forename: Ghazanfer
authors.initials: G
authors.lastname: Abbas
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ishaque
authors.forename: Mohsina
authors.initials: M
authors.lastname: Bilgrami
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000328:Adult; D001721:Birth Intervals; D001723:Birth Rate; D003267:Contraception; D003268:Contraception Behavior; D005193:Family Planning Services / Q000191:economics*; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services; D008429:Maternal Welfare; D010154:Pakistan; D011203:Poverty; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D012959:Socioeconomic Factors