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  • Title: Pakistan's low contraceptive use tied to medical issues.
    Author: Hardee K.
    Journal: Netw Res Triangle Park N C; 1993 Mar; 13(3):24-6. PubMed ID: 12318098.
    Abstract:
    Pakistan's low contraceptive use has been linked to cultural factors, a large rural population, women's lack of independence and mobility, but more importantly to what providers know about various methods and to who provides family planning (FP). The most popular methods are female sterilization (4%) and condoms (3%), followed by IUDs (1.5%) and the pill and injectables (1%). About 4% use traditional methods, such as periodic abstinence and withdrawal. The goal of increasing awareness and knowledge of contraception means expanding educational opportunities in FP for medical personnel, providing clear guidelines for eligibility criteria at local clinics, and providing adequate support for dedicated providers. The example of clinic conditions and of how health workers provide services is told through the eyes of Khurshid Abbasi, a female health visitor at the Takht Bhai family welfare center near the Afghanistan border. The center provides oral contraceptives, injectables, condoms, spermicidal foam, and IUDs. Each family welfare center follows its own management system. When oral contraceptives are out of stock, Abbasi will not encourage pill use and will advise current users to but their pill packets at the local market, or go without protection, or switch methods. A pelvic examination is required before oral contraceptives can be dispensed. The center's policy is to provide a month's supply of pills, and the client must pay for additional supplies. The center provides IUDs only to women who have a son and one other child, because IUDs are thought to lead to infections and sterility. The Medical Council of Pakistan encourages only those trained at medical institutions to insert IUDs. It is not surprising, then, that pills and IUDs have a low prevalence rate. There are 1300 family welfare centers with family welfare workers, who receive 18 months training in FP. Government FP outlets and nongovernmental organizational organization programs provide coverage for 15-20% of the population. 7000 medical centers are run by the Department of Health, but do not provide FP. Doctors, nurses, and midwives do not receive academic training in FP. Proposals have been made, but not coordinated,, to train in FP the 8000-10,000 doctors working in the government medical system. Sterile medical conditions and adequate follow-up treatment are also required.
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