Determining the Barriers and Facilitators that Influence Perspectives and Decisions on Contraception via Telemedicine in Pakistan
Written by APF Pakistan Virtual Fellow (2023) Dr. Naila Khan
WOMEN’S EMPOWERMENT
Reproductive health is a fundamental human right that provides women the freedom to enjoy life, liberty, healthcare, privacy, and non-discrimination. It is an unfortunate truth that women in Pakistan are denied these basic rights. Despite shifting cultural attitudes, women are disadvantaged from birth as gender disappointment remains a pervasive stigma. This continues throughout childhood and adolescence, as a notable gender gap exists in primary school enrollment of girls compared to boys, and millions of girls have no access to education. Girls are expected to marry at young ages and the annual birth rate, while overall declining, remains alarmingly high and contributes to infant and maternal mortality. Pakistan is struggling to efficiently control its population – exceeding 200 million, it ranks as the world's fifth most populous country. This rapid and unprecedented growth is driven by an era of better life expectancy due to improved sanitation and public health; but another major factor is neglected family planning and lack of focus on reproductive health. Contraception allows safe birth spacing and reproductive autonomy, prevents unwanted pregnancies, abortions, and obstetric complications.
Sehat Kahani, founded and led by Pakistani women, truly exemplifies female empowerment through its organization and efforts. The mission of Sehat Kahani empowers female healthcare providers to remain in the workforce by utilizing the growing telemedicine platform to provide quality healthcare throughout Pakistan – including access to under-served and rural communities. Through a partnership between the American Pakistan Foundation (APF) partnership and Sehat Kahani, I had the privilege to explore the impact of telemedicine on access to birth control in rural and urban Pakistan.
Dr. Naila Khan
Perhaps one day, through diligent work…from interactive learning experiences such as the APF/Sehat Kahani fellowship and more, health disparities between American and Pakistani women, amongst other groups, will decrease, working to develop and sustain stronger health initiatives across the world in marginalized groups.
THE STUDY
The principal focus of the research study was to determine the barriers and facilitators that influence perspectives and decisions on contraception via telemedicine. The study was conducting by one-on-one interviews utilizing two validated questionnaires to assess both contraceptive intent and telemedicine perceptions. A summary of key findings in the analysis between women from urban and rural regions include:
Half of the rural population believed that their partners were against them using contraception compared to the urban respondents.
There was a notable knowledge gap regarding contraception use and awareness in the rural population compared to the urban population. For instance, half of the rural patients stated it would “definitely” be hard to use contraception correctly and believed it caused more harm than good.
The ideal number of children desired was averaged at 2.87.
69% of respondents considered it very important to achieve certain life milestones, such as completing school or establishing a career, before having children.
Both populations believed it was almost equally “very important” (40%) to be using contraception at this time.
When it came to planning for the next pregnancy, women in the urban population were willing to delay pregnancy for up to two years, whereas the rural population was more inclined to have their next pregnancy sooner.
When inquiring whether patients would be open to utilizing telemedicine to obtain contraception, such as the Sehat Kahani telemedicine platform, the majority (76.9%) stated they would consider it.
The top reasons participants opted for telemedicine to obtain contraceptive care included privacy and convenience, followed by access to more counseling and education, and preference for female health care providers.
The quantitative analysis from this research study supports the hypothesis that telemedicine can be utilized to provide contraception and reproductive health counseling. Prior studies also confirm that there is currently inadequate access to contraception in Pakistan despite the presence of contraceptive intent. The study highlights the disparity in family planning in rural populations; telemedicine can potentially provide access to bridge that gap. Telemedicine service utilization has increased worldwide including in low-income and middle-income countries, and there is an overall positive attitude towards its use in Pakistan. With proper implementation, government funding, allocation of resources, and awareness, telemedicine can be optimized to provide improved access to reproductive health. The major benefits of this include reducing unintended pregnancies, improving maternal and child health, promoting women’s wellness, and gender and income equality – leading to an increase in economic diversification while curbing poverty: creating a better Pakistan for everyone.
CATALYZING CHANGE
The use of advanced technology for reproductive health in Pakistan remains an innovative field with limited current research despite growing awareness. There is vast potential to explore these innovations, including surveying healthcare professionals for perspectives, training providers for standardized reproductive care methods and protocols, determining if contraception use is influenced by the gender of existing children, and exploring the usage of various contraceptive modalities. Despite the constraints of time and limitations of this study, the findings create a foundation for further discussion as catalysts for further change. As advocates across the Pakistani diaspora, we can bring our unique perspectives to develop the framework to promote this growth and innovation for our motherland. Through this exchange of knowledge through collaboration and advocacy, Sehat Kahani and the American Pakistan Foundation allow us to promote development in Pakistan while keeping Pakistani-Americans connected to our culture and identity.