Obstacles to contraceptive use in Pakistan: a study in Punjab.

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Survey data are analyzed that were collected in Punjab province in 1996 and that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband's preferences and attitudes, health concerns, and perceived access to services. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future, in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman's perception that such behavior would conflict with her husband's fertility preferences and his attitudes toward family planning and her perception of the social or cultural unacceptability of contraception. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning.