Analysıs of The Prevalence, Trends, Determınants and Dynamıcs of Contraceptıve Use and Estımate of Unmet Need For Famıly Plannıng in Pakıstan
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AHMED, F. Analysis of the Prevalence, Trends, Determinants and Dynamics of Contraceptive Use and Estimate of Unmet Need for Family Planning in Pakistan. Hacettepe Unıversity, Graduate School of Health Sciences, Epidemiology Program Doctor of Philosophy Thesis, Ankara, 2018. Family Planning is widely recognized as a cost-effective intervention linked to the Sustainable Development Goals. The world 6th most populous yet, lower middle income country Pakistan is at the cusps of demographic dividend. However, the slow fertility decline urged Government of Pakistan to scale up family planning program combined with robust population and developmental polices. That will not only control over population but also provide advantage of demographic dividend. The objective of the study was to examine the trend in contraceptive prevalence and level of unmet need for family planning, and to identify association between individual, spousal, household and community level covariates with the contraceptive use and unmet need for family planning in Pakistan. Together with this, contraceptive discontinuation, switching behavior and user failure rates were also examined. Data was extracted from Pakistan Demographic Health Surveys (1990-91, 2006-07 and 2012-13). Frequency tables were constructed to examine the trends. Logistic regression was employed to explore the relative effects of covariates on use of contraception and unmet need for family planning among currently married aged 15-49 women. Life tables were used for analysis of contraceptive discontinuation, switch and user failure rates. Results shows that current use of contraception increased from 11% in 1990 to 35% in 2012 meanwhile unmet need for family planning declined from 32 % to 20%. Remarkable heterogeneity in contraceptive use as well as unmet need was evident among different regions and different ethnic groups. The mean ideal number of children desired remained at four and intention for future use of contraception was decreased. The husband fertility desire, number and sex of children, exposure to media message, visit by Lady Health worker, place of residence and wealth status were significantly associated with current use and level of unmet need for family planning in Pakistan. It was found that one-third of episodes of contraceptive use were discontinued within a year of initiation. The highest discontinuation rate was for hormonal methods, side effects were the main reason for discontinuation. The 12 month gross failure rate for pill, condom, and withdrawal was 10.3%, 9.3% and 10.4% respectively.