{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:21:54Z","timestamp":1793402514135,"version":"4.5.0"},"reference-count":38,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T00:00:00Z","timestamp":1600819200000},"content-version":"unspecified","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007447","name":"Susan Thompson Buffett Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007447","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,8,27]]},"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later; and (3) the exposure-adjusted impact at program close and follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective, cross-sectional matched control study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Karachi, Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>2561 married women aged 16\u201349 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>The Willows Program, a community-based family planning counselling and referral program implemented from 2013 to 2015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was community-level modern contraceptive prevalence rate (mCPR), measured for January 2013 (baseline), June 2015 (program close) and at follow-up 36 months later. A secondary outcome was exposure-adjusted mCPR (among women reporting a family planning home visit) at program close and at follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was no significant effect on community-level mCPR at program close (2.4 percentage point increase in intervention over comparison; 95% CI \u22122.2 to 7.0) or at follow-up (1.9 percentage point decrease; 95% CI \u22126.7 to 2.8). Only 18% of women in the intervention area reported receiving a family planning visit in the preceding 5\u2009years. Among those reporting a visit, we observed a significant 10.3 percentage point increase (95% CI 4.6 to 15.9) from baseline to close, and a non-significant 2.0 percentage point increase (95% CI \u22123.8 to 7.8) from baseline to follow-up, relative to matched women in the comparison area. The cost per new modern method user was US$1089, while the cost per user-year during the intervention period was US$455.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The program had a positive short-term effect on women who received a family planning visit; however, this effect was not sustained. Program coverage was low and did not significantly increase community-level family planning use. Findings highlight the need to increase community coverage of high-quality counselling and contextually relevant interventions for family planning demand generation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-039835","type":"journal-article","created":{"date-parts":[[2020,9,23]],"date-time":"2020-09-23T17:16:04Z","timestamp":1600881364000},"page":"e039835","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3969-659X","authenticated-orcid":false,"given":"Kristy","family":"Hackett","sequence":"first","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2547-597X","authenticated-orcid":false,"given":"Elizabeth","family":"Henry","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imtiaz","family":"Hussain","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirbaz","family":"Khan","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Feroz","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navdep","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoko","family":"Sato","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4192-8406","authenticated-orcid":false,"given":"Sajid","family":"Soofi","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4041-1229","authenticated-orcid":false,"given":"David","family":"Canning","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8850-4374","authenticated-orcid":false,"given":"Iqbal","family":"Shah","sequence":"additional","affiliation":[{"name":"Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,23]]},"reference":[{"key":"2026062608040972000_10.9.e039835.1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-15-00374"},{"key":"2026062608040972000_10.9.e039835.2","unstructured":"Guttmacher Institute . 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