Community Perceptions and Experiences of Contraceptive Use in Rural Sindh, Pakistan: A Qualitative Assessment

Abstract

Background: Despite national efforts to improve reproductive health services, contraceptive uptake in Pakistan remains below the national target, particularly in rural and underserved communities where misinformation, gendered decision-making, and limited access to commodities continue to restrict family planning use. Objective: This study explored community perceptions and experiences of contraceptive use and family planning services delivered through Marvi workers in rural districts of Sindh, Pakistan. Methods: An interpretivist qualitative assessment was conducted from October to December 2024 in Umerkot, Dadu, Sanghar, and Ghotki. Data were collected through 13 in-depth interviews with Marvi workers, District Project Managers, and District Programme Women Development Officers, and 12 focus group discussions with married women of reproductive age and male community members. Audio-recorded data were transcribed, translated, cross-verified, and analysed using thematic analysis. Results: Participants perceived Marvi workers as trusted local female intermediaries who improved access to family planning information, supported household-level counselling, and facilitated local availability of contraceptive commodities through Marvi houses and Business-in-a-Box service points. Reported facilitators included cultural familiarity, repeated counselling, community trust, and supervision mechanisms, while persistent barriers included myths, religious concerns, spousal hesitation, gendered decision-making, and worker safety concerns. Conclusion: Marvi worker–delivered family planning services were perceived as acceptable and valuable in rural Sindh, but sustained training, supervision, male engagement, commodity availability, and support for frontline workers are required to strengthen continuity and community acceptability.