Chapter 5

 

KNOWLEDGE AND USE OF CONTRACEPTION

 

5.1       Knowledge of Methods

One of the important determinants of contraceptive use is the knowledge of different methods of family planning among the currently married women. A major aim of the Population Welfare programme of Pakistan has been to promote awareness of family planning nation-wide. As in previous surveys, the 2000-01 PRHFPS measured both spontaneous awareness of methods and prompted knowledge (i.e. recognition of a method when a name and brief description is read out by the interviewer). Table 5.1 indicates the prompted knowledge of currently married women regarding contraceptive methods and trends since 1990-91 PDHS.

Table 5.1

Trends in Awareness of Specific Methods, Among Currently Married Women

 

 

The 2000-01 PRHFPS documents a substantial rise in knowledge of different methods of family planning since the beginning of the decade. Among currently married women, 96 percent are aware of any method of family planning, with 95 percent knowing at least one modern method, and 50 percent knowing of any traditional methods. Knowledge of so-called ‘female methods’ (female sterilisation, IUD, Pills, Injectables) is in general higher than that of ‘male methods’, (condom, male sterilization and withdrawal). Part of this difference, however, probably reflects women’s shyness to acknowledge awareness of male methods. The most widely known method is Pill, known by nearly 91 percent of currently married women, but closely followed by Injection, 90 percent and IUD, 84 percent.

 

Table 5.2 and Figure 5.1 show knowledge of contraceptive methods by background characteristics. The PRHFPS, 2000-01 found some variation in knowledge of any modern method according to a range of background characteristics. Figure 5.1 shows the broad picture of variations in awareness by education, and the small differences between provinces. It is striking that awareness is universally high, with Balochistan as an outlier where still only 62 percent women know at least any method. Minor variations in knowledge also occur between educational and urban-rural sectors of the population, with 94 percent of both rural women and non-educated women having knowledge of modern contraception.

 

Table 5.2

 

Awareness of Modern Method Among Currently Married Women, by Province, Residence and Education

 

Residence/Educational level		Province								Total
		Punjab		Sindh		NWFP		Balochistan		Percent	N
		Percent	N	Percent	N	Percent	N	Percent	N
Residence	Total Urban	98.9	1122	96.3	776	92.6	148	92.5	55	97.3	2102
	Major Urban	99.4	680	95.3	568	95.3	41	92.2	20	97.4	1309
	Other Urban	98.3	443	99.1	208	91.6	107	92.7	35	97.3	793
	Rural	97.2	2393	97.5	840	91.4	806	54.2	228	93.9	4268
Level of Education	None	97.0	2350	96.8	1136	90.4	807	58.3	254	93.6	4547
	Upto Primary	99.4	515	98.5	211	98.3	71	98.5	10	99.1	808
	Above Primary	99.1	651	96.3	269	97.6	75	86.2	20	98.0	1015
Total		97.8	3516	96.9	1616	91.6	954	61.7	284	95.0	6370

 

Figure 5.1

 

Awareness of Modern Methods, Among Currently Married Women

by Education and Province

 

5.2       Knowledge of Supply Sources

For methods to be used, awareness of methods themselves usually has to be accompanied by knowledge of places where they can be obtained. For each method known, respondents were asked whether they knew a source where that method could be obtained. Table 5.3 shows the percentage of currently married women who know where specific methods of contraception can be obtained. It should be noted that women who had never heard of a particular method are automatically classified as having no knowledge of a supply source.

Generally, knowledge of where to obtain modern contraceptives is quite high, and has risen sharply since the early 1990s. Around 70 to 77 percent of the currently married women know where to get the pill, the IUD or the injectable, and 76 percent know a place for female sterilisation. In the 1990-91 PDHS only 37 percent knew where they could get sterilisation services and 25 to 30 percent knew where to obtain the pill, the  IUD or the injection.

Table 5.3

 

Percentage of Currently Married Women who Know a Source of Supply or Advice for

Specific Methods, by Residence and Province

 

5.3       Contact with Health and Family Planning Workers and Facilities

The Ministry of Population Welfare (MoPW) has introduced the scheme of Village Based Family Planning Workers (VBFPW) as a major initiative of the Population Welfare Programme at the grass root levels. The village based family planning workers are trained to make home visits and to provide contraceptive services to the women, at their homes. A similar scheme involving Lady Health Workers (LHW) is being implemented by the Ministry of Health. Respondents in the PRHFPS were asked whether they had been visited at home by a health or family planning worker in the last 12 months. Table 5.4 shows the percentage of currently married women who had been visited by any such worker. Figure 5.2 shows the same figures graphically, by Province and Type of Area.

Overall 28.5 percent of currently married women have been visited by a health or family planning worker compared to 16 percent in the 1996-97 PFFPS. Urban-rural  differentials are more pronounced in Punjab, NWFP and Balochistan province. Generally these figures on home visits seem rather low, but this is partly due to the fact that not all communities are covered by any of these workers schemes. Table 5.4 also shows, for women who had been visited at home, the percentage of workers who raised the topic of family planning or family health on the last visit. It is observed that health issues were discussed more than family planning.

Table 5.4

 

Percentage Visited in the Last 12 Months by a Health or Family Planning Worker, Among

Currently Married Women and Nature of Discussion at Last Visit

 

Residence/Province		Visit at home by VBFPWs/LHW		Discussed Family planning	Discussed Health	Number
		Percent visited	Number
Residence	Total Urban	25.9	2102	61.8	77.5	543
	Major Urban	17.8	1309	73.9	74.1	232
	Other Urban	39.2	793	52.8	79.9	311
	Rural	29.8	4268	41.6	85.5	1273
Province	Punjab	31.3	3516	38.3	85.8	1099
	Sindh	28.4	1616	65.5	81.2	459
	NWFP	24.9	954	54.1	73.9	238
	Balochistan	7.1	284	72.8	82.7	20
Total		28.5	6370	47.6	83.1	1816

 

 

Figure 5.2

 

Percentage Visited at Home by a Health or Family Planning Worker

by Province and Residence

5.4       Exposure to Family Planning Messages, Discussion and Approval

The PRHFPS collected information about exposure of women to family planning messages and about the extent of discussion of family planning with friends and family. Results are summarised in table 5.5. The Ministry of Population Welfare has mainly used the electronic media to disseminate messages on family planning. The table indicates that television is the most important medium for reaching women with information about family planning. This is indeed consistent with the higher rates of exposure to electronic media reported in table 2.8. Reading materials reach fewer women, primarily because literacy is low.

 

Table 5.5

 

Percentage of Ever-Married Women Who Have Heard a Family Planning

Message on Radio, TV or the Printed Media During the Last Few

Months by Selected Background Characteristics

 

 

5.5       Ever Use

The PRHFPS measured use of contraception in two main ways: “ever” and “current” use of contraception. Table 5.6 shows comparison with results on ever use from previous surveys leading to an evaluation of the extent to which the Population Welfare Programme is achieving its stated objectives for raising use of contraceptives among couples in Pakistan.

Table 5.6

 

Percentage of Currently Married Women who Ever-used Specific Method

by Different Sources

 

 

The overall proportion of currently married women who have ever used any method of contraception in the 2000-01 PRHFPS is 40.2 percent, up from 20.7 percent in the 1990-91 PDHS, 28.0 percent in 1994-95 PCPS and 36.4 percent in 1996-97 PFFPS (table 5.6). In particular, ever use of the pill, IUD and injectables has become more widespread. However, the condom has been used by more couples than any other modern method.

As expected, table 5.7 shows that ever use is higher in urban than in rural areas. Over half of the urban couples (57 percent) have ever used a method of birth control, and 49 percent have ever used a modern method. Across provinces, ever use of any method is highest in Punjab (43 percent) followed by NWFP, Sindh and Balochistan. Balochistan lags behind from other provinces, with ever use of only 21 percent of any method and 18 percent of women reporting ever use of modern contraception. It is of interest to note that ever use of two modern reversible methods pill and injectables is higher in NWFP, compared to other provinces.

Table 5.7

 

Percentage Who Ever Used Specific Methods, Among Currently Married

Women by Province and Residence

 

 

5.6       Current Use

A more commonly used measure of contraceptive uptake is current use of family planning. Current use refers to the proportion of women who report using any method of contraception at the time of the survey. Table 5.8, figures 5.3 and figure 5.4 show that the upward trend in current use of contraceptives has continued over time. Nationally, 27.6 percent of women reported in PRHFPS 2000-01 that they currently use some method of contraception, which was 23.9 percent four years ago in the 1996-97 PFFPS. This is not a substantial rise and shows that the Population Welfare Programme is not exactly meeting the targets set in the Ninth Five Year Plan (1998-2003). It is evident that contraceptive prevalence increased 100 percent from 1990-91, PDHS (11.8) to 1996-97, PFFPS (23.9) in six years. In later part of 1990s, it increased only by 16 percent from 1996-97 PFFPS (23.9 percent) to 2000-01 PRHFPS (27.6 percent). Hence the momentum of contraceptive prevalence built in early 1990s has been slowed down in 2000, which need serious attention of planners and programme managers.

Table 5.8

Percentage of Currently Married Women who are Currently Using

Specific Methods by Various Sources