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

PLOS ONE RESEARCH ARTICLE Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan Zoha Zahid Fazal1☯, Noor ul Huda Zeeshan1, Ghazal Moin2, Alishan Bachlany2, Yasir Shafiq3,4☯, Ameer Muhammad ID2* a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Medical College, The Aga khan University, Karachi, Pakistan, 2 VITAL Pakistan Trust, Karachi, Pakistan, 3 Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan, 4 Department of Translational Medicine and Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health (CRIMEDIM), Università degli Studi del Piemonte Orientale “Amedeo Avogadro, Novara, Italy ☯ These authors contributed equally to this work. * Abstract OPEN ACCESS Citation: Fazal ZZ, Zeeshan NuH, Moin G, Bachlany A, Shafiq Y, Muhammad A (2023) Client-centered counseling and facilitation in improving modern contraceptive uptake in urban slum of Karachi Pakistan. PLoS ONE 18(7): e0289107. https://doi. org/10.1371/journal.pone.0289107 Editor: Sidrah Nausheen, Aga Khan University pakistan, PAKISTAN Received: June 21, 2022 Accepted: July 12, 2023 Published: July 31, 2023 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.0289107 Copyright: © 2023 Fazal 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. 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. Data Availability Statement: The de-identified dataset is available with all the key variables. Results Funding: The authors received no specific funding for this work. 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 PLOS ONE | https://doi.org/10.1371/journal.pone.0289107 July 31, 2023 1 / 17 PLOS ONE Competing interests: The authors have declared that no competing interests exist. Client-centered counseling for contraceptive use in Karachi 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. Introduction Enhancing the accessibility of family planning (FP) services is vital for the realization of Sustainable Development Goals (SDGs), particularly in the promotion of gender equity and women’s empowerment, the improvement of maternal and newborn health, and the advancement of quality education [1]. As of 2017, approximately 214 million women in low-and middleincome countries (LMICs) desired to prevent pregnancy but did not utilize modern contraceptive methods [2, 3]. These figures are highest in Sub-Saharan Africa and Southern Asia, accounting for 39% of all women in developing regions seeking to avoid pregnancy and 57% of those with an unfulfilled demand for modern contraception [3]. To address the issue of unmet needs, it is crucial to enhance both access to and acceptance of modern contraceptive techniques. Pakistan has a population of approximately 225 million people, making it the fifth most densely populated country in the world. However, projections indicate that this figure could exceed 300 million by 2040 [2, 4]. FP have huge complexities and sensitivities in Pakistan [5]. Although the government and various partners in the FP domain have endeavored to promote FP, challenges remain in increasing the optimal uptake [5, 6]. An insufficient understanding of family planning and the available methods, cultural and religious barriers that discourage contraception and promote large families, limited availability of quality services and FP supplies, especially in low-income areas, and a lack of female empowerment and reproductive health decision-making power are the major factors contributing to the low modern contraceptive prevalence rate (mCPR) [7, 8]. According to recent data, mCPR in Pakistan is only 25%, and unmet needs are among 17% of married women of reproductive age (MWRA) [9]. Consequently, Pakistan faces challenges in reducing population growth, improving maternal health, and achieving sustainable development [10]. Pakistan committed itself (...truncated)