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.