Journal of Community Medicine & Health Education
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Statement of the Problem: Over last many years contraceptive prevalence rate in Pakistan is slightly improved but the situation
in rural areas are unchanged. The high population growth rate, poor maternal and child health indicators are the main challenges
affecting the economic status of the families and the country. In rural remote areas, access to quality care services, availability
and sustained supplies of contraceptives are the major hurdles.
Methodology & Theoretical Orientation: For improving access to birth spacing services, an innovative approach was
introduced. 600 female community-based workers, in under-served areas were selected and trained. They did the community
mobilization and facilitated the assigned female health care providers (LHVs) for provision of birth spacing services within
their communities. The government health and population welfare departments were involved as a partner to provide FP
products and other FP services to referral clients. The data of Married Women of Reproductive Age (MWRA) was collected and
maintained. The same data was used to generate new clients and for their follow up. The data was regularly followed/checked,
validated by monitoring and back check at various levels.
Findings: Female workers registered all married women of reproductive age in their catchment population and collected sociodemographic
information about the women and families. Majority of the women (95.8%) are illiterate. Average number of
children is 4.3 and average age of youngest child is 1.8 years. Out of these women, only 4.5% were current users of FP, 3.8%
are ever users and 91.7% are never users. In the intervention (24 months period), female workers reached 98.5% of the target
women, deliver messages and information through group meetings and follow up on home visits. Supervisors LHVs provided
birth spacing services through mobile clinics in each village. 46% of the women adopted one of the contraceptive methods for
birth spacing. The trend of contraceptives by methods is condoms 13%, oral pills 20%, injectable 46% and IUCD 21%. The most
encouraging thing in the pattern is the adoption of modern contraceptive methods and mostly long term. It reduces the cost and
exposes the clients to lesser side effects and provides more durable and sustained birth spacing.
Conclusion & Significance: In rural remote areas, the improved access to the continued birth spacing services and commodities
through community based female workers and supervisors trained LHVs for clinical services may be one of the effective and
sustainable approach for bringing sustainable behavior change for adoption of birth spacing as a health behavior. These effects
largely in reducing the economic burden on the family and contributed in national economy by reducing the DALYs.
Muhammad Sarwat Mirza possesses wide experience in the field of program/project designing and development, program management, monitoring, evaluation and research especially related to reproductive health, nutrition and family planning, working with Health and Nutrition Development Society for last 22 years. He had pursued his MBBS and Master’s in Public Health and had served at the Department of Pediatrics, The Aga Khan University Hospital, Pakistan. He had experience of developing behavior change communication material for promotion of breast feeding, dietary habits of pregnant and lactating women, nutrition for children and adolescents among the rural communities. He has played a major role in organizing the Pakistan SUN movement (Scale up Nutrition) CSO Alliance. He has worked on several clinical research projects such as dietary management of diarrhea, control trial of local food, zinc supplementation in malnourished children. He is serving as a Research Advisor for community health initiatives related to food, nutrition and research at Allama Iqbal Open University, Pakistan for post graduate medical students.