Birth control is considered very important for economic development of a nation. Being able to control reproductive functioning is a very necessary component of career preparation and family growth management.
Women have attempted to control their fertility status throughout the history but these methods or techniques were not medicated. Egyptian history indicates that females made a concoction of different acids or compounds that were inserted into the vigina in paste form. It is called early form of diaphragm. Greeks also followed these methods but their medication was different than Egyptian females. Females used different types of teas, juices, septic solutions, to avoid the unwanted pregnancies. Stones were also placed in uterus to protect from pregnancies. This method is an example of modern Intra Uterine Devices (IUD). Early attempts at spermicides agents included different mixtures of acid, juices, honey, alcohol and vinegar. These methods are also used now days but now these methods are in modern form. There are different methods available to control unwanted pregnancies. (Alexander, n.d.).
Pakistan is one of those countries, which are suffering from high population growth rate problems. Pakistan’s population growth rate is 1.98 %( est) (CIA, World Bank fact book, 2004), which is considered dangerous not only for economic growth but also harmful for women’s reproductive health. According to the United Nations projection, Pakistan’s population growth will be over 380 millions by the year 2050. (Rosen, 1996)
To control the population growth rate, family planning program was found in 1953 in Pakistan as a part of International Family Planning Movement. In 1960, General Ayub Khan, the head of Pakistan’s Military Government, took keen interest in family planning and the clinics started providing rarely family planning services. In 1965, Government of Pakistan established a National Family Planning Program with separate clinics infrastructure. Contraceptive use was just 6% in 1969. A continuous motivation system was introduced nation wide in this regard in 1973. But Government was unable to recruit sufficient number of qualified motivators. Another strategy was launched with assistance from USAID, a big donor agency, in 1974.
Its objective was to distribute contraceptives through shopkeepers, clinics and fields workers. A survey was conducted to check the rate of usage of contraceptive methods. But its use was virtually unchanged from 1969 levels. These programs were shut down in 1977 when the military Government of Zia ul Haq took power. However in 1980, Zia’s Government restarted the population program and this program was transferred from Ministry of Health to Ministry of Planning and Development. In 1985, contraceptive use raised slightly to 9%. Now the Government has set up the Non Governmental Organizations Coordinating Councils (NGOCC) to help and mobilize the private voluntarily sector in population’s activities.
The social marketing of contraceptives, which started in 1986, gained momentum in the 1990s. Despite some setbacks, social marketing has probably improved accessibility of contraceptives in urban areas. (Sathar, Zeba, 1998). It was only 12% contraceptive use in1991. Prime Minister Banazir Bhutto launched Community Health Workers Program in 1993. An International Conference on Population and Development was held in Cairo, in 1995. Banazir Bhutto attended this conference and spoke of her dream of Pakistan “where every pregnancy is planned, and every child is nurtured, loved, educated and supported”. The contraceptive prevalence rose to 18% in 1995. (Rosen, 1996).
In social marketing, radio and television played an important role and started campaigns promoting family planning. Both radio and television have picked up momentum, in term of their frequency and the explicitness of the message. The percentage of women who reported that they had heard or seen a family planning massages more than doubled between the 1990-91 and the1994-95, exceeding 60 percent in the latter surveys. The radio and television messages legitimize family planning practice and offered concrete information about how contraceptive can be obtained. An analysis comparing the impact of information, education, and communication programs in Bangladesh, India, and Pakistan has shown substantial improvements in the reach of family planning messages in the Pakistan media and in their association with contraceptive adoption (Zeba, 1998). Contraceptive prevalence rate in Pakistan was 27.6% in 2002. (Pearls, 2002)
There are different mechanisms for contraception available in Pakistan including condoms, oral pills, spermicidal, diaphragms, sponged etc. Generally females experience side effects when they use contraception methods. These side effects are bleeding problems which include heavy prolonged and irregular periods; spotting or constant bleeding or short cycles, abdominal pain, colic, burning, nausea, diarrhea, loss or increased appetite, dizziness, headache, flushed, nervousness, depression, insomnia and blurred vision.
Pakistan Government has involved many NGOs in promoting family planning awareness and in providing family planning services and has developed many mechanisms. But no one method is perfect that can protect women’s health and is effective for prevention of unwanted pregnancies.
In addition to side effects, there are also social hurdles in using contraceptive method. There are at least six components which contribute to the cost of contraception for users: the monetary cost of purchasing contraceptives; the search cost of acquiring information about methods and where to purchase them; the time and travel costs of obtaining them; the costs associated with side effects of use; the variety-constraint cost of not getting one’s preferred method; and the psychic costs of using contraceptives despite perceived social disapproval.
John B. Casterline (1996) conducted a study in Pakistan about obstacles to contraceptive use and concluded that husband’s opposition, fear of side effects, no access to contraceptive services, religious unacceptability of contraceptive use is the main obstacles to contraceptive use in Pakistan.
There are different kinds of barriers to family planning services uses. The greatest obstacles are psychosocial barrier, which includes opposition of religion. There is a debate about whether family planning Islamic or not. Husband’s opposition against contraception, low level of education of females in Pakistan, low level of decision making power of females and prevalence of purdah system contribute in this regard. Women who can go to neighbors easily r out side the home have great personal freedom to utilize family planning services particularly those who required permission from their husbands. The perception of people that family planning services are of poor quality and fear of using services due to reports of bad experience of others is another barrier. Although there are many facilities for females to choose and use contraceptive but the cost of transport and absence from household economic activities become a significant barrier for poor households. Most Pakistani females have no access to media, although social marketing of contraceptives have increased rapidly in Pakistan in 1990’s and as a result women have better access to media and they are more aware about contraception. (Casterline, 1996: Rosen, 1996: Stephenson, 2004)
1.1. Statement of the problem
This study aims to know about the physical, social and financial problems of females using various methods of contraception like condoms, oral pills, spermicidal, diaphragms, sponges etc.
This study explored in detail that why women use contraceptive methods in limited numbers. It also highlighted the subsequent available contraceptives and indicated n how women use these methods and their effects on health their females.
1.2. Objectives of the study
The study aims to:
- find out the perceptions of females about contraceptive methods.
- identify the contraceptive methods mostly used by females.
- find out the financial problems faced by females using contraceptive methods.
- identify the social problems faced by females using contraceptive methods.
- find out the physical changes and problems faced by females using contraceptive methods .
- find out the extent of choice of females in contraceptive methods usage.
- solicit suggestions from females to improve the services of family planning.
1.3. Significance of the study
The research will deal with the opinions, hurdles, preferences and perceptions related to contraceptive adoption by females. This may help the Government for policy making, social health associations and people to find out easy ways to use contraceptives and to make its services practical for them to obtain and use contraceptives continuously.
This study proposes the ultimate goal of expanding access to reproductive health services through an increased choice in the appropriate methods of fertility regulation. A research strategy may be proposed to understand how; especially women appraise different contraceptive methods and their attributes. More specifically how users and potential users assess their particular needs and weigh the different characteristics of available methods to choose and subsequently continue to use a method. Such an understanding may shed light on the future demand for specific methods or any method, on the need for information and programmatic intervention and on the development or modifications of contraceptive methods. The study will also highlight the social barriers, which influence the usage of contraception.
1.4.Operational definitions of variables
Contraception is a specified term for any procedure used to prevent fertilization of an ovum. There are different methods of contraception that are used in this regard. This study will include all methods, which have been used by the respondents.
1.4.2. Social problems
Social problems mean that:
- Is there any restriction for females to use contraceptive methods from their family or relatives?
- Are the behaviors of people hurdle for females to use contraceptive methods?
1.4.3. Financial problems
Financial problems are that the contraceptive methods are expensive and females cannot afford these methods in their limited financial resources.
1.4.4. Physical changes
Physical changes mean that females feel some changes in their body because of contraceptive usage. These changes are not comfortable for the body of a female.
This research was a quantitative in nature and was a survey research.
The population of the study was married contraceptive female users coming to the government hospitals for advice or treatment about contraceptive methods, living in Lahore city.
1.5.2. Sample of the study
Sample of the study was 100 married contraceptive female users visiting government hospitals in Lahore for advice or treatment about contraceptive methods. Four hospitals namely; Ganga Ram hospital Lahore, General hospital Lahore, Lady Willington hospital and Mayo hospital Lahore selected conveniently. Twenty-five respondents from each hospital selected conveniently.
1.5.3. Instrument for the study
Data collected through questionnaire. Questions were both close-ended and open-ended. The questionnaire drafted keeping in view the objectives of the study and will include questions on the physical, financial and social problems of females using contraceptive techniques. The researchers administered the questionnaire personally to ensure maximum return.
1.5.4. Piloting of the study
Five females selected for the piloting of the study to remove the ambiguities in questionnaire, instrument of the study.
1.5.5. Delimitations of the study
ü The study was delimited only in Lahore city.
ü The other limitation of the study was that the respondents of the study were only those females who came to the government hospital.