Pakistan is a complex South Asian country, where women and girls suffer from poor reproductive health, particularly in marginalized and rural communities. Although, knowledge of contraception is almost universal in Pakistan, one in five women has an unmet need for family planning. The use of modern contraception has increased dramatically from 9 percent in 1990-91 to 26 percent in 2012-13. However, there are growing concerns that women do not have access to the quality contraceptive services they need, which is reflected in stagnating rates of contraceptive use. Additionally, regional disparities persist and individuals rely heavily on only three types of contraception — male condoms, female sterilization, and injectables.
PAI worked with HeartFelt and Shirkat Gah in Pakistan to assess the quality of reproductive health services and understand how broader issues of health system governance, gender equity, and the policy environment shape quality of care. Many women in Pakistan never hear about family planning from health workers—and among those receiving information, many are not properly counseled. Quality continues to remain a serious impediment to women who want to use contraception. Beyond simply reproductive health, almost two thirds of women in Pakistan report facing issues when trying to access health care for themselves. Inequitable gender dynamics limit women’s mobility and decision-making, and contribute to women’s inability to access contraception. PAI, HeartFelt and Shirkat examined how broader issues of gender and community norms intersect with the health system with an aim toward improving quality of reproductive health in Pakistan.