Factors associated with modern contraceptive use among men in Pakistan: Evidence from Pakistan demographic and health survey 2017-18

PLOS ONE RESEARCH ARTICLE Factors associated with modern contraceptive use among men in Pakistan: Evidence from Pakistan demographic and health survey 2017-18 Ahmad Ali ID1☯*, Abu Zar1☯, Ayesha Wadood2☯ 1 Department of Medicine, Nishtar Medical University, Multan, Pakistan, 2 Nuclear Institute for Agriculture and Biology, Faisalabad, Pakistan a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 ☯ These authors contributed equally to this work. * Abstract Objective OPEN ACCESS Citation: Ali A, Zar A, Wadood A (2022) Factors associated with modern contraceptive use among men in Pakistan: Evidence from Pakistan demographic and health survey 2017-18. PLoS ONE 17(9): e0273907. https://doi.org/10.1371/ journal.pone.0273907 Editor: Syed Khurram Azmat, Marie Stopes International, PAKISTAN Received: July 23, 2021 The role of men in family planning is critical in patriarchal societies like Pakistan. The objective of this study is to explore the predictors of modern contraceptive use among Pakistani men. Methods This study is a secondary analysis of Pakistan demographic and health survey (PDHS) 2017–18 data. The study sample consists of 3691 ever married men aged 15–49 years. Pearson’s chi square test and logistic regression were used to find out the determinants of modern contraceptive use among men. Data analysis was carried out in December, 2020. Accepted: August 17, 2022 Published: September 1, 2022 Results Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0273907 Findings of logistic regression showed that men who were uneducated (aOR = 0.746; 95% CI = 0.568–0.980), residing in Sindh (aOR = 0.748; 95% CI = 0.568–0.985), Baluchistan (aOR = 0.421; 95% CI = 0.280–0.632) or FATA (aOR 0.313; 95% CI 0.176–0.556) and those who belonged to the poorest wealth quintile (aOR = 0.569; 95% CI = 0.382–0.846) were less likely to use modern contraceptives. Men who did not wish for another child (aOR = 2.821; 95% CI = 2.305–3.451) had a higher likelihood of modern contraceptive use. Finally, men who thought that contraception was women’s business (aOR = 0.670; 95% CI = 0.526–0.853) and those who did not discuss family planning with health worker (aOR = 0.715; 95% CI = 0.559–0.914) were also less likely to use modern contraceptives. Copyright: © 2022 Ali et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Conclusion Reproductive health education of males, targeting males, in addition to, females for addressing family planning issues and improvement of family planning facilities in PLOS ONE | https://doi.org/10.1371/journal.pone.0273907 September 1, 2022 1 / 12 PLOS ONE Funding: The authors received no specific funding for this work. Predictors of uptake of contraceptive measures by Pakistani men socioeconomically under-privileged regions are suggested to improve contraceptive use among couples. Competing interests: The authors have declared that no competing interests exist. Abbreviations: OR, = odds ratio; 95% CI, 95% confidence interval; aOR, adjusted odds ratio; KPK, Khyber Pakhtunkhwa; FATA, Federally administered tribal areas. Introduction Contraception plays a pivotal role in the improvement of sexual and reproductive health. It also serves to reduce maternal deaths resulting from unsafe abortions and unwanted pregnancies [1]. A significant association has been observed between fertility reduction and decrease in infant, child and maternal mortality [2]. It was observed that about 13% of infant deaths, 25% of under-five mortalities, and 35% of maternal deaths could be prevented by increasing birth interval by three years [3]. Comparing the Data from Pakistan demographic and health survey (PDHS) conducted in 2017–18 to that of PDHS 2012–13, it becomes evident that the use of modern contraceptives did not improve during this period (35% in PDHS 2012–13 and 34% in PDHS 2017–18) [4]. The contraceptive prevalence rate in Bangladesh (2014) and India (2015) is 62.4% and 52.4% respectively [5, 6]. Pakistan is situated in south Asia and is among the top ten most populous countries in the world. Population growth rate of Pakistan is 2% [7]. Government of Pakistan has taken several measures to reduce population growth rate. Among these measures, improvement in family planning services is worth mentioning. The annual expenditure of family planning services is about US $55 per woman [8]. Despite these efforts the uptake of contraceptives by couples remains low in Pakistan. The unmet need of family planning reported in PDHS 2017–18 was 17% which is less than that reported in PDHS 2012–13 (20%) [4]. Various factors like socioeconomic status, education, cultural beliefs, area of residence, religion and wrong perceptions about family planning determine the utilization of modern contraception [9]. In agriculture based societies, men usually wish to have large number of children because they serve as a source of livelihood. This perception of men creates hinderance in the utilization of contraceptives by couples [10–12]. Studies have also reported that educated parents can better perceive the benefits of having fewer children. In addition, better contraceptives uptake in urban areas may be accounted for by the availability of better health care services and access to information [13]. A study conducted in Karachi reported various myths and beliefs that may lead to reduced contraceptive uptake by couples. These included, perceived adverse effects of contraceptives like weight gain, birth defects, infertility and reduced sexual pleasure. Furthermore, cultural disapproval and perception that practicing contraception leads to displeasure of God were found to be prevalent [14].Decisions about the number of children are largely dependent on males in patriarchal societies like Pakistan [15, 16]. International conference on population and development held in Cairo (1994) highlighted the importance of involving males in the issues of reproductive and sexual health. Despite this, participation of males in family planning issues remains limited [17, 18]. Pakistan also participated in the international conference on population and development (ICPD) held in Nairobi. During this summit, Pakistan committed to achieve universal sexual and reproductive health coverage, increase contraceptive prevalence rate to 60% by 2030, finance ICPD programs and to eliminate gender based violence. However, Engagement of males in family planning pro (...truncated)