Barriers and perceptions regarding different contraceptives and family planning practices amongst men and women of reproductive age in rural Pakistan: a qualitative study

Background: Pakistan ranks as one of the most poorest and most populous in the world with poor reproductive health indicators. This study helps in understanding barriers and perceptions regarding Family Planning (FP), modern contraception, quality of care and free of charge FP services amongst men and women in rural Pakistan. Methods: Employing purposive sampling and Focus Group Discussion (FGD) technique, this qualitative study was conducted with men and women of reproductive age in Pakistan. A total of eight FG Ds were conducted in Sindh and Punjab provinces. Being descriptive in nature, the study provided a thematic analysis of the relevant health issues by using an adapted constant comparison analysis process. Results: The contraceptive knowledge and uptake was low and misinformation was prevalent. Men thought of vasectomy as against men' pride and both males and females viewed removal of uterus as a permanent method. The women claimed neighbors, mother-in-law, friends and sister in-law and husband as main sources of information. Women seemed to have a greater exposure since they regularly come into contact with lady health workers and lady doctors but that information is not passed on to their husbands or discussed openly. There were many misconceptions prevalent among the participants, most of which were spread by untrained providers, such as the undesirable impact contraception can have on a woman's ability to conceive children. In addition, restrictions on female mobility and side effects were seen as barriers to contraception by majority of women whereas, most of the men perceived religio-cultural factors as barriers and considered FP as an additional expenditure. Conclusions: Though importance of family planning was recognized by the participants for the well being of the children and financial benefits of raising fewer children but the wellbeing of the woman was not considered a meaningful goal to pursue FP. Besides access, barriers towards use included money, where frequency of use and choice of method was affected by financial limitation. A gendered perspective also prevailed with reference to provider seeking behavior. Spousal communication is a topic mostly neglected by family planning programs, yet many of the barriers are linked to it. There is a need to design health interventions that devise counseling techniques to improve spousal communication, debunk the myths and misinformation in the community, and link the health of the child and mother with birth spacing and smaller family size.