Credit: MSI/Pakistan

Increasing access to family planning services through a voucher system

A growing population and increasing levels of poverty in Pakistan have increased the burden on the state for delivery of services. Unplanned pregnancy is a major cause of maternal death, and women’s need for contraception is high. However, the use of modern contraceptive methods has remained constant for the past decade, with poor women living in more remote areas facing the biggest challenges in accessing family planning services.

We worked in conjunction with Marie Stopes Society to increase women’s access to safe contraception close to their homes. The project distributed vouchers house-to-house in poor communities entitling women to free services in their local area.

As a project partner, Options:

  • Designed the voucher scheme to ensure that the programme would effectively reach women and families most in need.
  • Undertook rapid ethnographic studies to understand the barriers women were facing in accessing family planning services. We used PEER (Participatory Ethnographic Evaluation and Research), a method developed by Options, which is ideal for gathering sensitive information rapidly and at low cost.
  • Advised health planners and health care providers on the design of services to ensure that they were in line with what women wanted from their services.
  • Developed IT systems and mobile-based solutions to reduce paperwork, enabling service providers to spend more time with clients.

Project achievements:

  • Removing financial barriers by providing women with vouchers for services resulted in a dramatic increase in uptake of family planning. In the programme areas, the contraceptive prevalence rate increased from 27 per cent to 48 per cent compared to 28 per cent to 30 per cent in control areas.
  • Our PEER research with husbands provided critical information to strengthen family planning services and increase their use. The study found that most husbands supported women’s access to family planning but had little access to information themselves, resulting in low levels of service use and the use of less reliable methods of contraception.
  • Through innovative approaches, such as working with midwives, nurses and lady health workers in the private sector, the programme brought services closer to women’s homes, increasing both access  to family planning services and contraceptive use.

Quick facts

Contraceptive prevalence rate increased in the programme areas from 27% to 48% after 1 and a half years

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