Provider and health facility influences on contraceptive adoption in urban Pakistan.
CONTEXT: Although the vast majority of Pakistani women are familiar with family planning methods, use of contraceptives remains low. Identifying the characteristics of family planning providers and health facilities that are associated with women's initiation of contraception may help program administrators devise interventions to increase contraceptive use. METHODS: Logistic regression analysis of data from a survey of urban Pakistani health facilities, their clients and their staff was used to identify individual, provider and health facility characteristics that predict women's receipt of contraceptives during visits to urban clinics. RESULTS: Women who had a secondary or higher level of education and three or more children had elevated odds of receiving a method (odds ratios, 1.8-9.3). Women had reduced odds of receiving contraceptives when visiting facilities where providers had higher levels of family planning experience. They had higher odds of receiving services at facilities that displayed educational materials about family planning than at those that did not (1.8), and those odds increased with the proportion of contraceptive methods offered that were in stock, the number of staff doctors and the number of staff members who provided family planning (1.2-2.4). CONCLUSION: Providers should be aware of the contraceptive needs of women with all levels of education and parity. Additionally, family planning facilities may be able to increase clients' contraceptive use by providing diversity in method choice, keeping offered methods in stock, displaying informational materials, and raising staff levels.