EVALUATING THE IMPACT OF COMMUNITY-BASED OUTREACH METHODOLOGY USING TRAINED LOCAL WOMEN ON FAMILY PLANNING SERVICE ACCEPTANCE AND CONTRACEPTIVE PREVALENCE IN RURAL SINDH, PAKISTAN: A QUASI-EXPERIMENTAL STUDY

Abstract

Background
 Evidence on scalable, community-based models to improve reproductive health outcomes in underserved rural settings remains limited. We evaluated the impact of a women-led outreach intervention implemented by HANDS Welfare Organization in rural Sindh, Pakistan, on contraceptive use, family planning (FP) uptake, and women’s autonomy.

Methods
 We conducted a quasi-experimental study using secondary data from the DAFPAK baseline (2017–2018) and endline (2024) surveys. The Marvi model trains local women to deliver FP counselling, distribute commodities, and facilitate referrals in communities with restricted access to services. Intervention districts were compared with government-led Lady Health Worker (LHW) areas and matched control sites. Outcomes included contraceptive prevalence, exposure to FP counselling, indicators of women’s autonomy, and engagement with ICT-based FP learning. Logistic regression and Difference-in-Differences (DiD) models were used to estimate intervention effects.

Findings
 Contraceptive use increased significantly in intervention areas (18% to 23%; adjusted odds ratio [aOR] 1.45, 95% CI 1.23–1.71), accompanied by improvements in FP awareness and community-level participation. However, gains in women’s decision-making autonomy were limited. Uptake of nutrition counselling and engagement with digital FP learning remained low, suggesting persistent structural and sociocultural constraints.

Interpretation
 Women-led community outreach can substantially improve access to and uptake of family planning services in resource-constrained settings. However, improvements in service delivery do not necessarily translate into enhanced autonomy. Future programmes should integrate gender-transformative approaches and strengthen digital health strategies to address entrenched social norms and improve sustainability.