Family planning through the lens of men: Readiness, preferences, and challenges

Family planning (FP) is urgently needed in Pakistan but progress remains slow. In its 2002 Population Policy, the country pledged to reduce its total fertility rate to 2.2 by 2020; at the London Summit in 2012, it committed to increase the contraceptive prevalence rate (CPR) to 55 percent by the same year. Despite important achievements, Pakistan’s current CPR is only 35 percent, the total fertility rate is 3.8, and 20 percent of married couples of reproductive age express unmet need for FP. FP programming has largely been directed at women, and husbands have been regarded, at best, as interested bystanders. However, recent research indicates that men’s attitudes are changing and they are eager to be involved. In several recent studies, the Population Council has focused on men’s perspectives of FP to support an evidence-based agenda that brings men into mainstream FP programming. This policy paper synthesizes the data from these studies, and other research, on Pakistani men’s readiness to be more involved in FP, the challenges they face in FP adoption, and the preparedness of the health sector to respond to their needs

Adolescent girls\u27 voices on enhancing their own productivity in Pakistan: Highlights 2019

Of the 11 million girls aged 15 to 19 years in Pakistan, nearly half (47 percent) are “not in education, employment, or marriage” (NEEM). This brief presents highlights from a qualitative study conducted in Punjab province of Pakistan to probe the lives, perspectives, and aspirations of NEEM girls regarding education and involvement in economic activity and identify locally acceptable ways in which their lives may be positively transformed through access to education and safe and fair work opportunities

Situation analysis of reproductive health of adolescents and youth in Pakistan

This report presents a situation analysis of the reproductive health of adolescents and youth in Pakistan. It is intended to contribute to evidence-based policies and programs for realizing reproductive rights and choices for young people through health information and services, education programs, and strategic partnerships. The study included a literature review, secondary analysis of data from the Pakistan Demographic Health Surveys and Multiple Indicator Cluster Surveys, and a qualitative study of perspectives of unmarried adolescent boys and girls (aged 15–19), including both school-going and out-of-school individuals, as well as boys and girls with disabilities, in peri-urban areas of Islamabad, Lahore, Karachi, Peshawar, and Quetta. Major themes of the research include puberty, marriage, fertility, family planning, utilization of reproductive health services, rights awareness, and gender-based violence. Findings about married young people are based on secondary data analysis, while qualitative findings concern unmarried adolescents

Adolescent girls\u27 voices on enhancing their own productivity in Pakistan

This study was conducted in the Punjab province of Pakistan to examine the lives, aspirations, and perspectives of the largely invisible and marginalized group of older adolescent girls (ages 15–19 years) who are “not in education, employment for pay or profit, nor in marriage” (“NEEM”). The study seeks to identify the reasons for the exclusion of the NEEM girls from education and participation in paid work; explore opportunities and avenues for changing these girls’ existing opportunity structures; and probe the gender norms and behaviors underlying their marginalization to obtain insights into what it would take to change their situation

Reproductive health care in the time of COVID-19: Perspectives of poor women and service providers from Rahim Yar Khan, Punjab

This study was conducted by the Population Council in Rahim Yar Khan district of Punjab, with the support of the United Nations Population Fund (UNFPA), to uncover urgently needed evidence about the challenges and needs of poor women and health care providers during the COVID-19 pandemic. Over 200 poor women—beneficiaries of the Benazir Income Support Programme (BISP), one of the largest social protection programs in the world—and 60 public and private sector health care providers participated in this investigation of BISP beneficiaries’ knowledge of COVID-19, the effects of the pandemic on their lives, mental health and wellbeing, and their access to reproductive health (RH) and family planning (FP) services, as well as the knowledge, attitudes, practices, and challenges of service providers during the COVID-19 pandemic

Increasing access to reproductive health care through improved service delivery

The study documented in this report examines the provision and utilization of public and private sector maternal and child health services in Punjab, Pakistan with a focus on family planning (FP) services. It is aimed at enabling a better understanding of the specific demand and supply dynamics leading to low contraceptive prevalence despite unmet need, and the opportunities that must be seized to enhance access to quality family planning services. The report is part of a larger project being implemented by the Population Council with the assistance of the Department for International Development, UK entitled “Sustaining Focus on Provincial Governments for FP 2020 Goals and Increasing Access to Reproductive Healthcare through Improved Service Delivery.” The findings of the study suggest that there is scope for improving delivery of FP services and methods through all four major sectors, i.e., the public health facilities, the private health facilities, Lady Health Workers, and pharmacies. Based on its findings, the report recommends specific measures and approaches to address unmet need for family planning and the skewed method mix in Punjab

Optimizing provision of rights-based family planning services by community midwives (CMWs) in Tando Allah Yar

Community Midwives (CMWs) are a key cadre of community-level reproductive health service providers in Pakistan. CMWs provide a range of maternal and child health (MCH) services including family planning (FP), but due to a lack of supplies and training and other reasons they are currently not providing FP services. This pilot study examined the effects of providing training in client-centered FP service provision, a regular supply of free contraceptives, and necessary equipment on the uptake, outreach, and quality of CMWs’ FP services. The study was conducted in Tando Allah Yar, a district of Sindh with average provincial demographic and socioeconomic characteristics. The aim was to identify expeditious and cost-effective ways of utilizing existing health resources to improve women’s rights-based access to FP services in Sindh, particularly its rural areas. The longer-term goal was recommending the involvement of CMWs in strategies to enhance availability of quality FP services to Pakistani women and men elsewhere. The study used a quasi-experimental mixed-methods design, and data were used to assess changes in the quality, uptake, and outreach of FP services provided by CMWs

The availability and quality of family planning services across eight districts in Pakistan: The potential and the constraints

This report forms part of a multipronged investigation to determine why, despite evident unmet need for family planning, contraceptive prevalence especially for modern methods remains so low in Pakistan. The research, conducted by the Population Council with the support of the Research and Advocacy Fund, consists of four component studies: 1) review of relevant academic, program, and policy literature; 2) a qualitative study of perspectives of men, women, and service providers in the country on family planning; 3) a situation analysis of contraceptive quality, supply, and access factors at health facilities; and 4) an examination of supply issues affecting the availability of contraceptives. This report presents the latter two studies

Gendered effects of COVID-19 school closures: Pakistan case study

This brief summarizes a case study conducted to assess the gendered impacts of COVID-19 school closures on adolescent girls and boys in three districts in the province of Punjab in Pakistan. Data as well as discussions and interviews with adolescents, teachers, and parents shed light on difficulties in accessing and adjusting to remote learning, learning loss, deterioration of behaviors and health, and other effects. Based on these findings and further reflections by stakeholders on the successes and gaps of mitigation measures, the case study proposes recommendations for improved teacher training, digital access, alternative learning options, and a gendered focus in interventions

Triphasic Helical CT Scan :Value of Arterial Phase Acquisition in Detection of Focal Lesion in Cirrhotic Liver

Background: To determine the value of triple phaseCT scan and the phase acquisition in which maximumtumour conspicuity can be obtained, in a population ofpatients with chronic liver disease.Methods: In this descriptive study tripahsic CT scan of50 chronic liver disease patients who presented withsonographic suspicion of space occupying lesion, wereevaluated. CT scan appearances of different focal liverlesions , in arterial and portal venous phases, wereevaluated . Tumour conspicuity was assessed on differentphases of CT acquisition to determine the phase whichprovided maximum tumour to parenchymal difference,while using multidetector CT with fixed timing delay.Results: Focal hepatic lesion was found to be present in41 out of 50 patients. 24 patients had morphologicalcharacteristics of hepatocellular carcinoma(HCC). Tumourwas found to be most conspicuous in late arterial phase ofacquisition in 30 patientsConclusion: Triphasic helical CT of liver, using early,late arterial and portal venous phases with fixed timingdelays is quick, easy and non-invasive useful imagingmodality in detection and characterization of focal lesionsand especially diagnosis of HCC in cirrhotic patients