Leadership in family planning and reproductive health: a university based capacity building and networking initiative in Pakistan

Pakistan's DHS 2006-07 showed gloomy indicators of reproductive health in the country especially of the women and children. Family planning [FP] and reproductive health [RH] programs date back to late 50's and yet failed to deliver the desired results. Among other weaknesses in the programs, it has been recorded that lack of effective management and good governance have resulted in either questionable quality of FP and RH services and low utilization of services. This dismal state of affairs has left the country with a high growth rate [1.9%], a large unmet need for contraception [33%] with a fertility rate of over 4 children /woman, an unacceptably high maternal mortality ratio [276/100,000], an under 5 mortality of 0.4 million a year, and an ironically strong urban bias of doctors [80%] and that also focusing on curative care. Lack of training and incentives for staff have resulted in a fragile health system and weak human resource management. For redressing this appalling situation in the country, and particularly in RH and Population sector, a new vision has to be thought out through strategic thinking of all the issues. A pilot training course comprising a whole range of pedagogy on 'Leadership in Family Planning and Reproductive Health' was launched and was successfully implemented in 2008 at the Aga Khan University, Karachi with the underlying objectives of capacity building of mid-top level managers, policy makers, advocacy specialist, academia, NGO and civil society representatives to work effectively and acquire leadership positions in family planning and population programs with deeper understanding of RH. This critical mass of trained leaders would work effectively with leadership skills using multi-sectoral approach; and will create and implement a strategic action plan to improve quality of and access to FP/RH services in their respective areas in the wake of achieving the millennium development goals by 2015.

Health seeking behavior of couples with secondary infertility

To determine the factors affecting the health-seeking behavior of couples with secondary infertility in Karachi. A descriptive case series. The data was collected from women attending infertility clinics in five tertiary care hospitals in Karachi from March to June 2003. All currently married women, between the age of 15-35 years, with at least one previous conception, irrespective of outcome, attending an infertility clinic and consenting to participate in the study, were included. Women with corrective surgery on vagina and uterus, and cases of primary infertility, were excluded. Multiple logistic regression models were used to determine the association of various factors, affecting the health-seeking behavior, with statistical significance set at p < 0.05 for the covariates and the interaction terms between various factors. The women consulted multiple health care providers for treatment of secondary infertility. The main reasons for seeking treatment were couple's wish [54.2%], family pressure [22.6%] and want of a son by husbands or in-laws [20.4%]. The most commonly sought providers were physicians [74.7%], Traditional Birth Attendants [TBA, 39.5%], Spiritual healers [26%], Hakeems [23%] and Homeopaths [17.2%]. Most of the women who consulted non-physicians were illiterate [69.4%] as compared to those who consulted a physician [37.8%, p-value = 0.00]. The non-physicians were more commonly consulted by women belonging to low socioeconomic group. The posttreatment complications were more common among women who consulted non-physicians. Pressure from husbands and in-laws compels women for consulting multiple providers. Health seeking behavior for infertility is affected by the literacy and socioeconomic status of the women

Psycho-social consequences of secondary infertility in Karachi

To explore the experiences of social consequences among women suffering from secondary infertility. Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan. More than two thirds [67.7%] of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce [20%], husband's remarrying [38%] or to be returned to their parent's home [26%] by their in laws or husbands. Majority [68%] of the women threatened did not have any live births. However, those who had live births [32%] had a girl child only followed by difficulty in conceiving again. Secondary infertility was described as a cause of violence against infertile women. The women reported that they were being physically and verbally abused by husbands [10.5%] and in-laws [16.3%] for being infertile. Nearly 70% of women facing physical abuse and 60% of the women facing verbal abuse suffered severe mental stress. The experience of infertility is a stressful condition itself. This becomes particularly traumatic with previous pregnancies ending up in abortions, stillbirths and neonatal/infant deaths or the live births being daughters only. However, it subjects the woman to contempt and exploitation resulting in severe psychological

quality of care issue: appropriate use and efficacy knowledge of five contraceptive: views of men and women living in low socioeconomic settlements of Karachi, Pakistan

To assess knowledge regarding availability, affordability, appropriate use and efficacy for five non-permanent contraceptive methods.Married Muslim women and men [500 each] were randomly selected from two low socioeconomic settlements in Karachi, Pakistan. Interviews to assess their knowledge on a range of contraceptive and abortion themes were conducted. Four hundred men and 357 women were selected from this larger sample based on their knowledge of condoms, withdrawal, oral pills, injectables and IUDs. Nearly half of the sampled men [56%] and women [48%] were contraceptive users. Knowledge regarding contraception, a specific method, its availability and affordability was high. Appropriate use knowledge for condoms was 73% among men [users 78%, non-users 60%; p-value<0.001] and 5% among women. Efficacy knowledge was generally poor. Low knowledge levels regarding appropriate use and efficacy even among contraceptive users suggests, that quality of family planning services should not be limited to service delivery issues but extend to appropriate use and efficacy knowledge levels among clients