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Working Paper

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The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Our concern is those factors that prevent women from translating a desire to avoid becoming pregnant into contraceptive practice, a common predicament in Pakistan in recent decades. We analyze survey data collected in Punjab province in 1996 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. For each of these, the survey data provide a block of measured indicators. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future (the two years subsequent to the survey) 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 views (that is, his fertility preferences and his attitudes toward family planning) and her perception of the social or cultural unacceptability of contraception. Of lesser importance but also significant is the woman’s awareness and knowledge of contraception. The other three obstacles do not show statistically significant effects. 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. Punjabi women confront many obstacles to adopting and continuing to practice contraception, and policies and programs that overcome these obstacles should be developed.