Determining the factors associated with unmet need for family planning: a cross-sectional survey in 49 districts of Pakistan

Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch national family planning program. The aim of this paper is to estimate the prevalence of unmet need for contraception and to indentify the factors associated with it Across-sectional survey was conducted in forty nine districts of Pakistan across all four provinces from September 2008 to March 2009. Using an adapted version of PDHS questionnaire, interviews were conducted with approximately 10,000 married women of reproductive age in each district. Sample was later weighted according to district population at the time of analysis to control over and under representation. Logistic regression analysis was used to assess the association between risk factors and unmet need. The total unmet need for contraception was 23.5%. Muinvariable analysis showed that unmet need was found significantly higher in Balochistan and Sindh province compare to Punjab. The unmet need was quite prevalent among the specific groups that include older age women, low or uneducated women, those who have higher number of living children, had no history of miscarriage or abortion, those who are not exposed to mass media once a week, and among the women in lowest wealth quintiles. Despite all the efforts made to increase in uptake of contraceptive method the contraceptive prevalence rate has hardly changed over the last decade. However, several groups of women continue to have high unmet need for family planning. Thus, the family planning programmes may need to shift their focus from increasing uptake of contraceptives to satisfying unmet need for contraception with special focus on those underserved marginalized groups and areas with highest levels of unmet need