Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study
Objectives To assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later; and (3) the exposure-adjusted impact at program close and follow-up.Design Retrospective, cross-secti...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e039835.full |
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| author | Iqbal Shah Sajid Soofi Ryoko Sato David Canning Kristy Hackett Elizabeth Henry Imtiaz Hussain Mirbaz Khan Khalid Feroz Navdep Kaur |
| author_facet | Iqbal Shah Sajid Soofi Ryoko Sato David Canning Kristy Hackett Elizabeth Henry Imtiaz Hussain Mirbaz Khan Khalid Feroz Navdep Kaur |
| author_sort | Iqbal Shah |
| collection | DOAJ |
| description | Objectives To assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later; and (3) the exposure-adjusted impact at program close and follow-up.Design Retrospective, cross-sectional matched control study.Setting Karachi, Pakistan.Participants 2561 married women aged 16–49 years.Interventions The Willows Program, a community-based family planning counselling and referral program implemented from 2013 to 2015.Primary and secondary outcome measures The primary outcome was community-level modern contraceptive prevalence rate (mCPR), measured for January 2013 (baseline), June 2015 (program close) and at follow-up 36 months later. A secondary outcome was exposure-adjusted mCPR (among women reporting a family planning home visit) at program close and at follow-up.Results There was no significant effect on community-level mCPR at program close (2.4 percentage point increase in intervention over comparison; 95% CI −2.2 to 7.0) or at follow-up (1.9 percentage point decrease; 95% CI −6.7 to 2.8). Only 18% of women in the intervention area reported receiving a family planning visit in the preceding 5 years. Among those reporting a visit, we observed a significant 10.3 percentage point increase (95% CI 4.6 to 15.9) from baseline to close, and a non-significant 2.0 percentage point increase (95% CI −3.8 to 7.8) from baseline to follow-up, relative to matched women in the comparison area. The cost per new modern method user was US$1089, while the cost per user-year during the intervention period was US$455.Conclusions The program had a positive short-term effect on women who received a family planning visit; however, this effect was not sustained. Program coverage was low and did not significantly increase community-level family planning use. Findings highlight the need to increase community coverage of high-quality counselling and contextually relevant interventions for family planning demand generation. |
| format | Article |
| id | doaj-art-13846f8bda5f4021b225343d46c0ad31 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-13846f8bda5f4021b225343d46c0ad312025-01-06T13:45:12ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2020-039835Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control studyIqbal Shah0Sajid Soofi1Ryoko Sato2David Canning3Kristy Hackett4Elizabeth Henry5Imtiaz Hussain6Mirbaz Khan7Khalid Feroz8Navdep Kaur91 Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USACenter of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, PakistanGlobal Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA2 Harvard T H Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USAInstitute on Ethics & Policy for Innovation, McMaster University, Hamilton, Ontario, CanadaGlobal Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA1 Center of Excellence in Women & Child Health, The Aga Khan University, Karachi, Sindh, PakistanPaediatrics and Child Health, Aga Khan University, Karachi, PakistanPaediatrics and Child Health, Aga Khan University, Karachi, PakistanDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USAObjectives To assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later; and (3) the exposure-adjusted impact at program close and follow-up.Design Retrospective, cross-sectional matched control study.Setting Karachi, Pakistan.Participants 2561 married women aged 16–49 years.Interventions The Willows Program, a community-based family planning counselling and referral program implemented from 2013 to 2015.Primary and secondary outcome measures The primary outcome was community-level modern contraceptive prevalence rate (mCPR), measured for January 2013 (baseline), June 2015 (program close) and at follow-up 36 months later. A secondary outcome was exposure-adjusted mCPR (among women reporting a family planning home visit) at program close and at follow-up.Results There was no significant effect on community-level mCPR at program close (2.4 percentage point increase in intervention over comparison; 95% CI −2.2 to 7.0) or at follow-up (1.9 percentage point decrease; 95% CI −6.7 to 2.8). Only 18% of women in the intervention area reported receiving a family planning visit in the preceding 5 years. Among those reporting a visit, we observed a significant 10.3 percentage point increase (95% CI 4.6 to 15.9) from baseline to close, and a non-significant 2.0 percentage point increase (95% CI −3.8 to 7.8) from baseline to follow-up, relative to matched women in the comparison area. The cost per new modern method user was US$1089, while the cost per user-year during the intervention period was US$455.Conclusions The program had a positive short-term effect on women who received a family planning visit; however, this effect was not sustained. Program coverage was low and did not significantly increase community-level family planning use. Findings highlight the need to increase community coverage of high-quality counselling and contextually relevant interventions for family planning demand generation.https://bmjopen.bmj.com/content/10/9/e039835.full |
| spellingShingle | Iqbal Shah Sajid Soofi Ryoko Sato David Canning Kristy Hackett Elizabeth Henry Imtiaz Hussain Mirbaz Khan Khalid Feroz Navdep Kaur Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study BMJ Open |
| title | Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study |
| title_full | Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study |
| title_fullStr | Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study |
| title_full_unstemmed | Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study |
| title_short | Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study |
| title_sort | impact of home based family planning counselling and referral on modern contraceptive use in karachi pakistan a retrospective cross sectional matched control study |
| url | https://bmjopen.bmj.com/content/10/9/e039835.full |
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