Practice of Modern Methods of Family Planning in Two Urban Slums of Karachi and Effect of Counselling


 BACKGROUNDThe means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). The successful implementation of Family Planning has remained a difficult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2). METHODOLOGThis study is the analysis of retrospective secondary data from an NGO, HELP’s Family Planning clinics, to determine the trends and patterns of contraceptive methods used in two squatter settlements(Neelam Colony and KKB) in Karachi from 2010-2018. The data originated from Mother and Child centers of HELP. Records of the monthly data collected by CHWs from their catchments areas were obtained and it was cumulated annually. Variables studied included number of women of childbearing age (CBA), number of married women of childbearing age, information about number of family planning users, number of babies born. The data also included different types of FP methods used by married couples. For analysis, the data was entered in Microsoft Excel and then exported to SPSS version 19. Mean and percentages, graphs and other graphics for all the variables were calculated and created through SPSS 19 and Excel.RESULTSThe Mean number of FP users were 43% in Neelum Colony and 48% at KKB. Similar data was reported in PDHS 2017-18 that 34% of married women in Pakistan were opting for methods of family planning (3). Use of Condoms was the most commonly used method of family planning in Neelum Colony and in KKB, recorded as being 36%, and 41% users respectively. The FP2020 reports that there are 34% condom users in Pakistan (4). Our study also found that that that the increase in use of FP was influenced by increased reminders and nudging techniques during counselling by CHWs. CONCLUSIONSTo progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scientific information regarding FP methods be given frequently. Acceptance of using FP has to be developed primarily in the male counterpart and therefore, male social mobilisers should form part of a team.


Introduction
The means and services used for prevention of pregnancies is referred as Family Planning (FP) (1). This method helps a couple or individuals to take informed decisions regarding the number of children they plan to have, when to start having children, to give space between the birth of their children by means of contraception or complete their family by sterilization (5, 6). Family Planning is of signi cant importance as it gives a couple the power to make decisions according to their preference of giving birth whenever they feel ready. It also empowers women to care for their own health (7). Contraceptive methods are also important for improved reproductive health due to its central role in preventing the transmission of Human Immunode ciency viruses (HIV) and other sexually transmitted diseases (STDs) (8,9). Maternal and infant mortality rates are reduced by increasing use of contraception and optimum birth spacing. It curtails the rate of population growth which in turn bene ts the economy and environment of the country (10, 11).
A report published in 2018 by WHO states that globally, 222 million women wish to stop or delay the process of childbearing but unfortunately, they are not using any contraceptive methods. These methods have proven to be effective in developing countries around the world as 55 million unplanned births, 25 million miscarriages, and 138 million abortions have been averted (11). Subsequently, Pakistan's FP 2020 Report (2017-18) informs that 36 million unplanned births, 1 million abortions and 3500 maternal deaths have been prevented with the use of contraceptive methods (4). The successful implementation of Family Planning has remained a di cult task in Pakistan because of socio-cultural beliefs, lack of information or misinformation and lack of access to contraceptive services. Cultural taboos and social bonds related to women are major factors in the low uptake of FP services (2).
It is conceivable that the increase in use of FP in Neelam Colony in a particular year was in uenced by increased reminders and nudging techniques during counselling by CHWs. This can be further assessed in chart 1.
A study conducted in rural Tanzania reported that education provided by community health workers regarding maternal healthcare is feasible and effective (13). In a cluster randomized trial conducted amongst Malawi couples, regarding the uptake of Family Planning methods, results showed that community health workers counselling initiative was successful in making couples use modern methods of FP. It also led to an increase in the involvement of males and a trend towards increased use of condoms (14).

Conclusion And Recommendations
To progressively increase the practice of couples using modern FP methods, it is crucial that repeated messages giving correct scienti c information regarding FP methods be given frequently. Services should always include easy accessibility and the ability of CHWs to be able to respond to queries and allay any anxiety related to FP use. Acceptance of using FP has to be advocated primarily in the male counterpart and therefore, male social mobilisers should form part of a team to bring about acceptance and demand towards the use of appropriate methods of birth spacing and FP.  Figure 1