Increasing contraceptive use in rural Pakistan: an evaluation of the Lady Health Worker Programme

Past efforts to promote family planning in Pakistan have been disappointing, but between 1990–91 and 2000–01 contraceptive use has more than doubled. This rise has coincided with a concerted effort on the part of the Pakistani government to increase access to contraceptive services, particularly in rural areas. The Lady Health Worker Programme (LHWP), initiated under the Ministry of Health in the early 1990s, aimed at integrating family planning into the doorstep provision of primary health care. This paper presents findings from the first national evaluation of this Programme. Data are analyzed from a random sample survey of 4277 women living in households served by the LHWP and those living in control areas. Logistic regression analysis was performed to determine the effect of the Programme on the uptake of modern reversible contraceptive methods, controlling for other independent variables. The data provide strong evidence that the LHWP has succeeded in increasing modern contraceptive use among rural women. Women served by Lady Health Workers are significantly more likely to use a modern reversible method than women in communities not served by the Programme (OR = 1.50, 95% CI = 1.04–2.16, p = 0.031), even after controlling for various household and individual characteristics. The model of providing doorstep services through community-based female workers should remain central to achieving universal access to safe family planning methods by the end of the decade – the long-term objective of Pakistan's most recent population policy adopted in 2002.