title: Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey.
abstract: BACKGROUND
  Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed.
  
  
  METHODS
  A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression.
  
  
  RESULTS
  Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future.
  
  
  CONCLUSIONS
  The baseline results highlight the need for quality, affordable long-term family planning services close to women's homes. Furthermore, targeted community mobilization and behavior change efforts can lead to increased awareness, acceptability, and use of family planning and birth spacing services.
authors.affiliation: Department of Uro-gynecology, University of Ghent, Ghent, Belgium. SyedKhurram.Azmat@UGent.be.|Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. SyedKhurram.Azmat@UGent.be.
authors.forename: Syed Khurram
authors.initials: SK
authors.lastname: Azmat
authors.affiliation: Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. alimoa@who.int.
authors.forename: Moazzam
authors.initials: M
authors.lastname: Ali
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ishaque.sheikh@mariestopespk.org.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ishaque
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ghulam.mustafa@mariestopespk.org.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mustafa
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. waqas.hameed@mariestopespk.org.
authors.forename: Waqas
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. dr.omar@mariestopespk.org.
authors.forename: Omar Farooq
authors.initials: OF
authors.lastname: Khan
authors.affiliation: Research, Monitoring & Evaluation Department, Marie Stopes Society, Karachi, Pakistan. ghazanfer.abbas@mariestopespk.org.
authors.forename: Ghazunfer
authors.initials: G
authors.lastname: Abbas
authors.affiliation: Department of Uro-gynecology, University of Ghent, Ghent, Belgium. temmermanm@who.int.|Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland. temmermanm@who.int.
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.affiliation: Research, Monitoring and Evaluation Department, Marie Stopes International, London, United Kingdom. erik.munroe@mariestopes.org.
authors.forename: Erik
authors.initials: E
authors.lastname: Munroe
mesh_terms: D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D003267:Contraception / Q000706:statistics & numerical data*; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D010154:Pakistan; D011247:Pregnancy; D011795:Surveys and Questionnaires; D055815:Young Adult