Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan

Abstract

Background Population growth in Pakistan necessitates the implementation of comprehensive family planning (FP) initiatives. The adoption of modern contraceptives, especially long-acting reversible contraceptives (LARC), and permanent family planning methods in the country is challenging and has yet to reach an optimal level. These challenges are deeply rooted in the lack of informed decision-making, as well as demographic and maternal obstetric history. Interventions tailored according to women’s needs can address the challenges faced by FP programs. This paper presents the findings of the implementation of a client-centered counseling and facilitation approach in an urban slum in Karachi, Pakistan. Such an approach has the potential to inform women and help them make better decisions regarding their health. Methods In Rehri Goth, a slum located in Karachi, client-centered counseling along with facilitation at the facility was implemented to encourage the adoption of any modern contraceptive methods, with a specific emphasis on promoting the use of LARCs and permanent methods (where needed) among married women of reproductive age (MWRA). This approach was integrated into the existing Maternal, Neonatal, and Child Health (MNCH) services established in 2014. During the routine delivery of services, data were collected on various aspects including demographic characteristics, obstetric history, motivation to adopt LARCs, and reasons for refusal. Results A total of N = 3079 eligible MWRA received client-centered counseling, and 60.3% accepted modern contraceptive methods after counseling. Furthermore, 32.5% of these MWRA adopted LARCs or permanent methods. Factors explaining reluctance to adopt any method by MWRA despite specialized counselling were: age >25 years (AOR:1.28, 95% CI:1.08–1.51), no formal education (AOR:1.58, 95% CI:1.36–1.89), having no decision making role at household (AOR:1.60, 95% CI:1.36–1.89), the desire of female or male progeny (AOR:1.86, 95% CI:1.59–2.25) and age of youngest alive ≥3 years (AOR:1.50, 95% CI:1.22–1.84). Factors explaining adoption of short-term methods instead of LARCs or permanent method were: being resident in high under-five mortality clusters (AOR:1.56, 95% CI:1.14–2.14), maternal age > 25 years (AOR:1.88, 95% CI: 1.47–2.40), no decision-making role (AOR:11.19, 95% CI:8.74–14.34), no history of abortions (AOR:2.59, 95% CI:1.79–3.75), no female child (AOR:1.85, 95% CI:1.30–2.65) and ≤ 2 children (AOR:1.74, 95% CI:1.08–2.81). Conclusion Considering the obstacles mothers face when it comes to accessing extended contraception, public health officials can devise effective strategies that empower MWRA to make well-informed and empowered choices regarding their families and reproductive health.

Uncovering the causes and socio-demographic constructs of stillbirths and neonatal deaths in an urban slum of Karachi

“…In 2014, the VITAL Pakistan Trust implemented integrated package of MNCH interventions (the Caplow project)at Rehri Goth in recognition of the high under-five mortality [23]. A holistic and multifaceted approach enabled the project to provide a full continuum of care to women through including antenatal, skilled delivery, nutrition and assistance in access to family planning counseling and provision of services [24]; as well as to the children under-five years of age through community newborn and child care, nutritional counseling interventions, immunization, primary health care services, and referral system [23]. Additionally, transportation assistance was provided to pregnant women and enhanced links were established with existing healthcare facilities to ensure access to timely referral and coordination of MNCH services in Rehri Goth [24].…”

“…A holistic and multifaceted approach enabled the project to provide a full continuum of care to women through including antenatal, skilled delivery, nutrition and assistance in access to family planning counseling and provision of services [24]; as well as to the children under-five years of age through community newborn and child care, nutritional counseling interventions, immunization, primary health care services, and referral system [23]. Additionally, transportation assistance was provided to pregnant women and enhanced links were established with existing healthcare facilities to ensure access to timely referral and coordination of MNCH services in Rehri Goth [24]. As a part of this work, VITAL built a collaboration and signed a memorandum of understanding with Koohi Goth Women Hospital (KGWH), a secondary care hospital at distance of 6-7 kilometers from Rehri Goth.…”