title: Quantitatively evaluating the effect of social barriers: a case-control study of family members' opposition and women's intention to use contraception in Pakistan.
abstract: BACKGROUND
  Uptake of family planning services in Pakistan has remained slow over the past decade despite a rapid increase in availability and awareness, indicating that social barriers may be preventing uptake. Social barriers such as opposition by family members have largely been studied qualitatively; there is a lack of quantitative evidence about the effect of different family members' opposition on women's intention to use contraceptives. The objective of this study was to quantitatively evaluate the effect of family members' opposition to family planning on intention to use contraception amongst poor women in Pakistan who have physical access to family planning services.
  
  
  METHODS
  An unmatched case control study (nested within a larger cohort study) was conducted in two public hospitals in Karachi, Pakistan. Univariable and multivariable logistic regression analyses were conducted to compare risk factors between women that were not intending to use any contraceptive methods in the future (cases) and women that were planning to use contraceptive methods (controls).
  
  
  RESULTS
  248 cases and 496 controls were included in the study. Negative contraceptive intent was associated with no knowledge of contraception (AOR = 3.79 [2.43-5.90]; p < 0.001), husband's opposition (AOR = 21.87 [13.21-36.21]; p < 0.001) and mother-in-law's opposition (AOR = 4.06 [1.77-9.30]; p < 0.001).
  
  
  CONCLUSIONS
  This study is the first to quantitatively assess the effect of opposition by different family members on women's contraceptive intent in Pakistan. Our results indicate that of all family members, husband's opposition has the strongest effect on women's intention to use contraception, even when the women have knowledge of and physical access to family planning services.
authors: London School of Hygiene and Tropical Medicine, London, UK ; Research Alliance for Advocacy and Development, Aga Khan III Road, Karachi, Pakistan.
authors: Mishal S
authors: MS
authors: Khan
authors: Research Alliance for Advocacy and Development, Aga Khan III Road, Karachi, Pakistan.
authors: Farah Naz
authors: FN
authors: Hashmani
authors: Research Alliance for Advocacy and Development, Aga Khan III Road, Karachi, Pakistan.
authors: Owais
authors: O
authors: Ahmed
authors: Imperial College, London, UK.
authors: Minaal
authors: M
authors: Khan
authors: Pakistan National Forum on Women's Health, Karachi, Pakistan.
authors: Sajjad
authors: S
authors: Ahmed
authors: Pakistan National Forum on Women's Health, Karachi, Pakistan.
authors: Shershah
authors: S
authors: Syed
authors: Research Alliance for Advocacy and Development, Aga Khan III Road, Karachi, Pakistan.
authors: Fahad
authors: F
authors: Qazi
keywords: Case–control; Family opposition; Family planning; Pakistan
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