Determinants of Never Users of Contraception – Results from Pakistan Demographic and Health Survey 2012-13
Introduction: There are multiple social, individual and
cultural factors that influence an individual’s decision to adopt family
planning methods especially among non-users in patriarchal societies
like Pakistan. Non-users, if targeted efficiently, can contribute
significantly to country’s CPR. A research study showed that nonusers
if convinced to adopt lactational amenorrhea method can shift
to long term methods in future. Research shows that if non users are
targeted efficiently a 59% reduction in unintended pregnancies in
Saharan Africa and South-Central and South-East Asia is anticipated.
Methods: We did secondary data analysis on Pakistan
Demographic Heath Survey (2012-13) dataset. Use of contraception
(never-use/ever-use) was the outcome variable. At univariate level
Chi-square/Fisher Exact test was used to assess relationship of
baseline covariates with contraception use. Then variables to be
incorporated in the model were checked for multicollinearity,
confounding and interaction. Then binary logistic regression (with an
urban-rural stratification) was done to find relationship between
contraception use and baseline demographic and social variables.
Results: The multivariate analyses of the study showed that
younger women (≤ 29 years)were more prone to be never users as
compared to those who were >30 years and this trend was seen in
urban areas (AOR 1.92, CI 1.453-2.536) as well as rural areas (AOR
1.809, CI 1.421-2.303). While looking at regional variation, women
from urban Sindh (AOR 1.548, CI 1.142-2.099) and urban
Balochistan (AOR 2.403, CI 1.504-3.839) had more never users as
compared to other urban regions. Women in the rich wealth quintile
were more never users and this was seen both in urban and rural
localities (urban (AOR 1.106 CI .753-1.624); rural areas (AOR 1.162,
CI .887-1.524)) even though these were not statistically significant.
Women idealizing more children (>4) are more never users as
compared to those idealizing less children in both urban (AOR 1.854,
CI 1.275-2.697) and rural areas (AOR 2.101, CI 1.514-2.916).
Women who never lost a pregnancy were more inclined to be nonusers
in rural areas (AOR 1.394, CI 1.127-1.723) .Women familiar
with only traditional or no method had more never users in rural areas
(AOR 1.717, CI 1.127-1.723) but in urban areas it wasn’t significant.
Women unaware of Lady Health Worker’s presence in their area
were more never users especially in rural areas (AOR 1.276, CI
1.014-1.607). Women who did not visit any care provider were more
never users (urban (AOR 11.738, CI 9.112-15.121) rural areas (AOR
7.832, CI 6.243-9.826)).
Discussion/Conclusion: This study concluded that government,
policy makers and private sector family planning programs should
focus on the untapped pool of never users (younger women from underserved provinces, in higher wealth quintiles, who desire more
children.). We need to make sure to cover catchment areas where
there are less LHWs and less providers as ignorance to modern
methods and never been visited by an LHW are important
determinants of never use. This all is in sync with previous literate
from similar developing countries.
 Kent, M. M. Larson, A. Fertility Size Preferences: Evidence from the
World Fertility Surveys. Reports on the World Fertility Survey No.
4.Washington DC: Population Reference Bureau; 1982.
 Darroch, J. E. Singh, S. Trends in contraceptive need and use in
developing countries in 2003, 2008, and 2012: an analysis of national
surveys. Lancet, 2013; 381 (9879): 1756-1762.
 Singh, S. Darroch, J. E. Ashford, L. S. Adding it Up: The Costs and
Benefits of Investing in Sexual and Reproductive Health 2014.
Retrieved from: https://www.guttmacher.org/pubs/AddingItUp2014.pdf.
 Kamran, I. Arif, M. S. Vassos, K. Concordance and discordance of
couples living in a rural Pakistani village: perspectives on contraception
and abortion–a qualitative study. Glob Public Health, 2011; 6 Suppl 1:
 Sohail, Agha. Aslam, Fareed. Joseph, Keating. Clinical training alone is
not sufficient for reducing barriers to IUD provision among private
providers in Pakistan, Reproductive Health, 2011, 8: 40.
 Pakistan Millennium Development Goals Report 2013, Ministry of
Planning, Development and Reform, Retrieved from:
 Demographic and Health Survey 2012-13, National Institute of
Population Studies, Retrieved from:
 Mohamed, M. Ali. Min, Hae. Park. Thoai, D. Ngo. Levels and
determinants of switching following intrauterine device discontinuation
in 14 developing countries, Contraception; 90, 2014; 47-53.
 Swan, M. Zwi, A. Private practitioners and public health: close the gap
or increase the distance. London: London School of Hygiene and
Tropical Medicine, 1997.
 Rajesh, Kumar. Rai. Sayeed, Unisa. Dynamics of contraceptive use in
India: Apprehension versus future intention among non-users and
traditional method users, Sexual & Reproductive Healthcare, 4, 2013;
 Michael, T. Mbizvo. Sharon, J. Phillips. Family planning: Choices and
challenges for developing countries, Best Practice & Research Clinical
Obstetrics and Gynaecology, 28, 2014; 931-943.
 Wu, J. Meldrum, S. Dozier, A. Stanwood, N. Fiscella, K. Contraceptive
nonuse among US women at risk for unplanned pregnancy.
Contraception, 2008; 78: 284-289.
 Carme, Saurina. Laura, Vall-llosera. Marc, Saez. Factors determining
family planning in Catalonia: Sources of inequity, Saurina et al.
International Journal for Equity in Health, 2012; 11: 35.
 Creanga, A. A. Gillespie, D. Karklins, S. Tsui, A. O. Low use of
contraception among poor women in Africa: an equity issue. Bulletin of
the World Health Organization, 2011; 89 (4), 258-266.
 Rahman, A. Rahman, M. Siddiqui, M. R. Zaman, J. A. Contraceptive
Practice of Married Women: Experience from a Rural Community of
Bangladesh, J Medicine, 2014; 15: 9-13.
 Kari, L. White. Joseph, E. Potter. Patterns of contraceptive use among
Mexican-origin women, Demographic Research, 2013; (28) 41, 1199-
 Michelle, J. Hindin. Laura, J. McGough. Richard, M. Adanu.
Misperceptions, misinformation and myths about modern contraceptive
use in Ghana, J Fam Plann Reprod Health Care, 2014; 40: 30-35
 Shabnam, Khowaja. Nigar, Jabeen. Najma, B. Shaikh. Awareness and
prevalence of utilizing family planning services among women attending
at Aga Khan Maternal & Child Care Center Hyderabad (AKMCCC),
MC, 2012; (18) 4, 44-48.
 Pakistan Integrated Household Survey: Round 4. Retrieved from:
02_3.pdf 2001–2002, p. 77.