INTRODUCTION:

Family Planning - the practice of controlling the number of children one has and the
intervals between their births particularly by means of contraception or voluntary
sterilization.(1) OR
According to WHO, family planning is defined as “a way of thinking and living that is
adopted voluntarily upon the basis of knowledge, attitude and responsible decisions by
individuals and couples, in order to promote the health and welfare of the family group
and thus contribute effectively to the social development of the country.
The current population of the world is about 7.67 billion, and it rises another 75-78
million per yearly. (2) The determination of decreasing the growing population was
particularly driven by the National Program for Family Planning and Primary Health via
encouraging the use of contraception. As the population of Pakistan has increased
beyond 200 million, it is evident that the country's family planning program has been
unable to sufficiently expand contraceptive use. Researchers and policymakers
estimated that if the growth rate of Pakistan remains the same, then up till 2050,
Pakistan becomes 5th most populous country in the world. Pakistan has a commitment
of FP2020 that Pakistan will achieve a CPR rate of 55% at the national level, but it
seems difficult to achieve as Pakistan Demographic Health Survey conducted during
2017-18 shows that overall contraceptive prevalence rate of Pakistan is 34%. In this
review, we have identified barriers that can restrict the use of family planning, which
includes: lack of knowledge and motivation, lack of agency, communication gap and
limited availability and accessibility. There is a need to increase awareness and
understanding of contraceptive methods, change negative attitudes and help couples to
change their behaviors. A rapid population growth is a burden on the resources of many
developing countries.(3) As men play a prominent role in reproduction, it is therefore
extremely useful to assess and encourage them to be involved in contraception,
particularly in developing countries, where contraceptive goals have not been reached.
Even though many studies have been conducted in this field which is based on the
basis of awareness aimed at exploring knowledge, attitude and practices regarding
family planning and factors that influence the need for and use of modern
contraceptives.(4) Pakistani family planning programming and policy makers have
framed Islamic beliefs related to religious proscriptions and fatalism as a key obstacle to
increasing the country's Contraceptive Prevalence Rate.(5) Evaluating the use of
contraceptives signifies that general population of Pakistan has had very slow progress
on the Contraceptive Prevalence Rate (CPR) which is 29.6% with the use of modern
contraceptive methods at only 21% in 2013. (6) According to the recent studies the
prevalence rate is about 49.7. (7)
Despite the wide variety of different interventions in place (4) there is scant literature
evaluating degree of family planning amongst men of different socioeconomic statuses
and the limitations of its implementation in Pakistan. There is no evidence-based
universal strategies for promotion of means of contraception in men other than the basic
methods such as use of condom or the pull-out method. In a developing country like
Pakistan, men play a prominent role in family planning and decision making.(8) Ignorant
behavior of men in family planning is the potential cause of increasing population.(8)
Despite the magnitude of problem, no documented evidence exists on the awareness
and practices of the male population of different social classes regarding family
planning. Contraception has been developing progressively since years, yet the males
tend to lag behind in comparison to the females. The fear of infertility has been a
potential issue amongst the cultural barriers that discourage them. The primary concern
is to develop a safe and reversible mode that may not affect male fertility. Male
engagement is crucial in promoting family planning program and it is the component of
many interventions. Previous studies suggested that the use of contraceptives tends to
go up when couples have discussed family planning. Moreover, other factors which
cause the reluctance towards family planning are family restrictions, social constraints,
lack of motivation, low chances of conceiving and communication gap between couples.
Given this void, the aim of our study is to assess the level of knowledge about family
planning in men of different social backgrounds, its practice concerning family planning
and birth spacing; perceptions about quality of care; health seeking behavior;
community need assessment; and implementation of men among the population of
Karachi, a city worst hit by population crisis in recent times. While these commitments
and ongoing efforts are important and necessary because the role of married men is not
fully addressed. Family panning through contraception tries to achieve the principal
objective to have only the desired number of children hence, the study warrants
improving the attitude of the men, in favor of family planning and special strategies are
to be planned to improve the involvement of men. The engagement of married men in
family planning will be critical to achieving the ambitious national goals, particularly in
light of the decision-making power yielded by men. We are also keen to find out that
married men should know benefits and types of family planning methods and the level
of awareness regarding the contraceptive measures in use and appropriate intervention
measures devoid of misconceptions.

OBJECTIVE: ‘To assess the level of knowledge, attitude & practices about family
planning among men in Karachi.

MATERIAL AND METHODS:

Study Design and setting: It is a cross sectional in which we collected data from
317 subjects across Pakistan although the sample size was 384. Initially it was planned
to be carried out by asking structured questions using both interviews and physical
forms from patients from PNS SHIFA HOSPITAL, JINNAH POST MEDICAL CENTER
and CIVIL HOSPITAL KARACHI. However, due to the ongoing COVID 19 pandemic,
there were growing concerns as to the health and safety of both the participants as well
as those conducting the research. As a result of these concerns, along with difficulties in
transit due to the lockdown that had been imposed at the time, we were not able to go
the desired areas for data collection. To overcome these difficulties and safely proceed
with the step of data collection, an online survey was made, and data was collected with
the help of Google forms which were filled by males within certain age limits (18 -
60year-olds) across Pakistan. The desired sample size wasn’t reached until the 8 th of
July, so the collected data was used for analysis and eventual interpretation of results.

➢ Duration of Study: The study commenced on April 2021, with data collection
taking place from 1st May to 8th July. Subsequently data was analyzed, and
research report drafted by 30th August.
➢ Sample Size: By using “Epi info “the sample size is calculated is to be 384 by
using prevalence 49.7% by keeping 95% confidence interval and 5% error rate.
This was affirmed by using the formula N=z²pq/e², where N is sample size, z is
constant at 1.96, p is prevalence, q is 1 – prevalence and e is margin of error set
as 0.05 or 5%.
➢ Sampling Technique: It will be a non-probability convenience sampling.

➢ Sample Selection:
a. Inclusion criteria: Married men older than 18 years, younger than 60
years.
b. Exclusion criteria: Unmarried men younger than 18 years, and older than
60 years, diagnosed with any mental illness.
➢ Data Collection Procedure: Due to unusual circumstances being faced in
light of ongoing pandemic, data collection is limited to only Online Survey which
will be designed, used and analyzed online using GOOGLE FORMS and it will be
circulated amongst our contacts in our social circle. The survey will consist of 4
sections. Section A will contain questions about the socio demographics of the
participants including age, occupation, income, ethnicity, education level and
 their number of children. These factors will also serve as our independent
variables in the research. Section B, C and D will focus on the extent of
knowledge, practices and attitude of men. Consequently, these 3 sections will
give data about the dependent variables of our study.
Questionnaire will consume 5-10 minutes of every respondent and it will be in
two languages, Urdu and English both.

➢ Data Analysis procedure: The data collection will be done using a pre-
tested semi structured validated questionnaire which consisted of sections on
knowledge, attitude and practices of family planning of the men. The collected
data was coded and entered in SPSS version 16. Comparison across the groups
was done using chi-square test and p-˂0.05 was considered as statistically
significant.
➢ Ethical Consideration:
a. Seeking permission from BUMDC Ethical Committee.
b. Consent will be taken from participants to participate in study. They will
be informed that their participation in this research will be voluntary, and
they can withdraw their names from study if desired. The participants will
remain anonymous and their personal information will be kept confidential
and no one will be harmed in the making of this study.
RESULTS:

Graph 1: Percentage of men currently using family planning method (n = 316).

Graph represents percentage of men currently using any family planning in Karachi. Out
of total sample of 316, 139 (44%) were using family planning method. While only 177
(56%) were not using any family planning method.
Graph 2: Percentage of men self-reported barriers to family planning (n=316).

Graph two represents percentage of men self-reported barrier to their family planning.
Out of total 316 men, 56(17.72%) mentioned religious believes as the barrier to family
planning, 34 (10.76%) reported family pressure, 23 (7.25%) partner refusal, 22 (6.96%)
social stigma, 26 (8.23%) Rumors and myths, 58 (18.35%) some other reason, and
majority 97 (30.70%) reported nothing acted as barrier to their family planning.

Table 1: Sociodemographic characteristics of the participant (n= 316).

Sociodemographic data Frequency(n=316) Percentage

 (%)
Age 18 to 25 167 52.84%
26 to 40 97 30.69%
41 to 45 24 7.59%
46 to 50 17 5.37%
50+ 11 3.48%
Level of education Un-educated 12 3.79%
Primary 18 5.69%
Intermediate 57 18.03%
Undergraduate 135 42.72%
Postgraduate 94 29.74%
Occupation Unemployed 60 18.98%
Government 54 17.08%
servant
Armed forces 28 8.86%
Business men 57 18.03%
Laborer 8 2.53%
Private job 44 13.92%
Other 64 20.25%
Area of residence South Karachi 77 24.36%
East Karachi 64 20.25%
West Karachi 45 14.24%
Central Karachi 67 21.20%
District Malir 62 19.62%

Monthly family >30,000 33 10.44%

income (PKR) 30,000-50,000 52 16.45%
50,000-1,00,000 107 33.86%
More than 92 29.7%
1,00,000
Out of the 316 participants, the highest percentage of participants, which is 52.84, are
from the age group 18 to 25 years. Coming second in place is the 26 to 40 age group,
holding a percentage of 30.69 and then the age group 41 to 45, with a percentage of
7.59 and lastly, the age group 46 to 50 has a percentage of 5.37. On the level of
education, 42.72% of the participants completed graduation, then 18.03% had received
higher secondary education, and 29.74% had achieved post-graduation education,
3.79% had received no education and 5.69% received only primary education.
Assessing the occupation of the participants, 18.98% of the participants are
unemployed, 20.25% selected others, 17.08% are government servants, 18.03% are
doing their own business, 8.86% are from armed forces and 2.53% are laborer. When
recording the monthly family income in PKR, 33.86% of the participants are receiving
50,000-1,00,000 PKR, 29.7% selecting more than 1,00,000 PKR, 16.45% receive
30,000-50,000 PKR and 10.44% receive >30,000 PKR.
Knowledge:
Table 2: Association between education level and knowledge of
different contraceptive methods in men in Karachi (n=316).
Education Level Pearso P-
n Chi- Value
Square
Graduate No Total
Graduation
Knowledge of
contraceptive methods
(attitude)
121(38.3% 26(8.2%) 147(46.5%)
Yes ) 61(19.3%) 169(53.5%) 13.352 0.000
No 108(34.2% 87(27.5%) 316(100%)
Total )
229(72.5%
)

Between group comparison:

Out of total 316 men, percentage of men who were graduates and had knowledge of
contraceptive methods (38.3%) was higher than those who had no graduation (8.2%).
Similarly, participants who were not a graduate and had knowledge of contraceptive
methods was 34.2%, as compare to those who had no graduation (19.3%).

Within group comparison:

However, percentage of men with graduation and had knowledge of contraceptive
methods was higher as compare to those who had no knowledge. Conversely, among
no graduation group with knowledge of contraceptive methods percentage of men was
less 8.2% as compared to those with no knowledge (19.3%).

Additionally, analysis using the Chi square test showed that there is a significant
association between the education level and knowledge of contraceptive methods
among men in Karachi, X2(2) = 13.352, p = 0.000.

Attitude:
Table 3: Association between education level and
responsibility to adopt of family planning method in men in
Karachi (n=316).
Education Level Pearson P-
Chi- Value
Square
Graduate No Total
Graduation
Responsibility to adopt
family planning (attitude)

Female only 13(4.1%) 6(1.9%) 19(6%)

Male only 23(7.3%) 11(3.5%) 34(10.8%)
Both 181(57.3% 50(15.8%) 231(73.1%) 24.176 0.000
None ) 20(6.3%) 32(10.1%)
12(3.8%)
Total 87(27.5%) 316(100%)
229(72.5%
)

Out of total 316 men, percentage of men who were graduates and thinks that family
planning responsibility is on female only was higher 13(4.1%) than those who had no
graduation 6(1.9%). Percentage of men who were graduates and thinks that family
planning responsibility is on male only was higher 23(7.3%) than those who had no
graduation 11(3.5%). Likewise, percentage of men who were graduates and thinks that
family planning responsibility is on both partners was higher 181(57.3%) than those who
had no graduation 50(15.8%). Conversely, percentage of men who were graduates and
thinks that family planning responsibility is on no one was less 12(3.8%) than those who
had no graduation 20(6.3%).
However, within groups (graduate and no graduation) comparison shows that the
percentage of men was higher who thinks that family planning responsibility is on both
partners.

Additionally, analysis using the Chi square test showed that there is a significant
association between the education level and responsibility to adopt of family planning
method among men in Karachi, X2(2) = 24.176, p = 0.000.
Practices:
Table 4: Association between education level and priority of
contraceptive method use in men in Karachi (n=316).
Education Level Pearson P-
Chi- Value
Square
Graduate No Total
Graduation
Priority of contraceptive
method use

Effectiveness 37(11.7%) 12(3.8%) 49(15.5%)

Feeling important 13(4.1%) 15(4.7%) 28(8.9%)
Convenience of buying 36(11.4%) 12(3.8%) 48(15.2%) 23.570 0.000
and using
Safe to use 89(28.2%) 15(4.7%) 104(32.9%)
Other reason 54(17.1%) 33(10.4%) 87(27.5%)

Total 229 87(27.5%) 316(100%)

(72.5%)

Between group comparison:

Out of total 316 men, percentage of men who were graduates and use contraceptive
because of its effectiveness were higher (11.7%) than those who had no graduation
(3.8%). Conversely, participants who were graduates and use contraceptive because
they feel it important were less (4.1%), as compare to those who had no graduation
(4.7%). Participants who were graduates and use contraceptive because of the
convenience was higher (11.4%), as compare to those who had no graduation (3.8%).
Similarly, participants who were graduates and use contraceptive because of safety to
use was higher (28.2%), as compare to those who had no graduation (4.7%). Likewise,
participants who were graduates and use contraceptive because of other reason was
higher (17.1%), as compare to those who had no graduation (10.4%).

Within group comparison:

Percentage of men with graduation and who use contraceptive for safety was higher
than any other group. While, among no graduation group percentage of men in who use
contraceptive for other reason was higher as compare to other groups.
Additionally, analysis using the Chi square test showed that there is a significant
association between the education level and priority of contraceptive method use
among men in Karachi, X2(2) = 23.570, p = 0.000.

DISCUSSIONS AND CONCLUSIONS