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Impact of social franchising on contraceptive use when complemented by vouchers: a quasi-experimental study in rural Pakistan.
PLoS One 2013; 8(9):e74260Plos

Abstract

BACKGROUND

Pakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society - a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in rural areas of Pakistan.

METHODOLOGY

We used a quasi-experimental study design with controls, selecting one intervention district and one control district from the Sindh and Punjab provinces. In each district, we chose a total of four service providers. A baseline survey was carried out among 4,992 married women of reproductive age (MWRA) in February 2009. Eighteen months after the start of intervention, an independent endline survey was conducted among 4,003 women. We used multilevel logistic regression for analysis using Stata 11.

RESULTS

Social franchising used alongside free vouchers for long term contraceptive choices significantly increased the awareness of modern contraception. Awareness increased by 5% in the intervention district. Similarly, the ever use of modern contraceptive increased by 28.5%, and the overall contraceptive prevalence rate increased by 19.6%. A significant change (11.1%) was recorded in the uptake of IUCDs, which were being promoted with vouchers.

CONCLUSION

Family planning franchise model promotes awareness and uptake of contraceptives. Moreover, supplemented with vouchers, it may enhance the use of IUCDs, which have a significant cost attached. Our research also supports a multi-pronged approach- generating demand through counselling, overcoming financial constraints by offering vouchers, training, accreditation and branding of the service providers, and ensuring uninterrupted contraceptive supplies.

Authors+Show Affiliations

No affiliation info availableMarie Stopes Society, Karachi, Pakistan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24069287

Citation

Azmat, Syed Khurram, et al. "Impact of Social Franchising On Contraceptive Use when Complemented By Vouchers: a Quasi-experimental Study in Rural Pakistan." PloS One, vol. 8, no. 9, 2013, pp. e74260.
Azmat SK, Khurram Azmat S, Shaikh BT, et al. Impact of social franchising on contraceptive use when complemented by vouchers: a quasi-experimental study in rural Pakistan. PLoS ONE. 2013;8(9):e74260.
Azmat, S. K., Khurram Azmat, S., Shaikh, B. T., Tasneem Shaikh, B., Hameed, W., Mustafa, G., ... Bilgrami, M. (2013). Impact of social franchising on contraceptive use when complemented by vouchers: a quasi-experimental study in rural Pakistan. PloS One, 8(9), pp. e74260. doi:10.1371/journal.pone.0074260.
Azmat SK, et al. Impact of Social Franchising On Contraceptive Use when Complemented By Vouchers: a Quasi-experimental Study in Rural Pakistan. PLoS ONE. 2013;8(9):e74260. PubMed PMID: 24069287.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of social franchising on contraceptive use when complemented by vouchers: a quasi-experimental study in rural Pakistan. AU - Azmat,Syed Khurram, AU - Khurram Azmat,Syed, AU - Shaikh,Babar Tasneem, AU - Tasneem Shaikh,Babar, AU - Hameed,Waqas, AU - Mustafa,Ghulam, AU - Hussain,Wajahat, AU - Asghar,Jamshaid, AU - Ishaque,Muhammad, AU - Ahmed,Aftab, AU - Bilgrami,Mohsina, Y1 - 2013/09/12/ PY - 2012/11/05/received PY - 2013/08/03/accepted PY - 2013/9/27/entrez PY - 2013/9/27/pubmed PY - 2014/5/9/medline SP - e74260 EP - e74260 JF - PloS one JO - PLoS ONE VL - 8 IS - 9 N2 - BACKGROUND: Pakistan has had a low contraceptive prevalence rate for the last two decades; with preference for natural birth spacing methods and condoms. Family planning services offered by the public sector have never fulfilled the demand for contraception, particularly in rural areas. In the private sector, cost is a major constraint. In 2008, Marie Stopes Society - a local NGO started a social franchise programme along with a free voucher scheme to promote uptake of IUCDs amongst the poor. This paper evaluates the effectiveness of this approach, which is designed to increase modern long term contraceptive awareness and use in rural areas of Pakistan. METHODOLOGY: We used a quasi-experimental study design with controls, selecting one intervention district and one control district from the Sindh and Punjab provinces. In each district, we chose a total of four service providers. A baseline survey was carried out among 4,992 married women of reproductive age (MWRA) in February 2009. Eighteen months after the start of intervention, an independent endline survey was conducted among 4,003 women. We used multilevel logistic regression for analysis using Stata 11. RESULTS: Social franchising used alongside free vouchers for long term contraceptive choices significantly increased the awareness of modern contraception. Awareness increased by 5% in the intervention district. Similarly, the ever use of modern contraceptive increased by 28.5%, and the overall contraceptive prevalence rate increased by 19.6%. A significant change (11.1%) was recorded in the uptake of IUCDs, which were being promoted with vouchers. CONCLUSION: Family planning franchise model promotes awareness and uptake of contraceptives. Moreover, supplemented with vouchers, it may enhance the use of IUCDs, which have a significant cost attached. Our research also supports a multi-pronged approach- generating demand through counselling, overcoming financial constraints by offering vouchers, training, accreditation and branding of the service providers, and ensuring uninterrupted contraceptive supplies. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/24069287/Impact_of_social_franchising_on_contraceptive_use_when_complemented_by_vouchers:_a_quasi_experimental_study_in_rural_Pakistan_ L2 - http://dx.plos.org/10.1371/journal.pone.0074260 DB - PRIME DP - Unbound Medicine ER -