{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T01:50:52Z","timestamp":1769565052634,"version":"3.49.0"},"reference-count":33,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Family planning (FP) services are essential for reproductive health and women\u2019s empowerment, yet quality gaps persist in low-income urban areas of Pakistan. This study explores women\u2019s perspectives on FP service quality in the underserved communities of Malir Town, Karachi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a phenomenological qualitative design, in-depth interviews and focus group discussions were conducted with current and past users of modern contraceptives from three Union Councils: Saudabad, Khokhrapar and Kala Board. Data were collected through 12 in-depth interviews and four focus group discussions (n=25 participants). Data were analysed thematically using Judith Bruce\u2019s \u2018Quality of Care\u2019 framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants reported inadequate contraceptive options, poor counselling, lack of follow-up and limited decision-making autonomy. Respectful provider interactions, clear communication and community health worker support were identified as key facilitators. Structural issues, such as fragmented service delivery and poor integration, hindered consistent contraceptive use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Improving FP service quality in poor urban settings requires a client-centred approach that strengthens counselling, ensures method availability, integrates services and leverages community-based support. Further research should include non-users to inform scalable, equity-focused interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003105","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:10:15Z","timestamp":1769519415000},"page":"e003105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Contraceptive choices in Karachi: a phenomenological analysis of women\u2019s perspectives on the quality of family planning services in low-income urban areas"],"prefix":"10.1136","volume":"4","author":[{"given":"Nazia","family":"Ahsan","sequence":"first","affiliation":[{"name":"Pediatrics & Child Health, The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3545-0808","authenticated-orcid":false,"given":"Jawaria Mukhtar","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Community Health Sciences, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farina G","family":"Abrejo","sequence":"additional","affiliation":[{"name":"Community Health Sciences, The Aga Khan University Faculty of Health Sciences, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neelofar","family":"Sami","sequence":"additional","affiliation":[{"name":"Public Health, SZABIST, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5321-8885","authenticated-orcid":false,"given":"Zahid Ali","family":"Memon","sequence":"additional","affiliation":[{"name":"The Aga Khan University, Karachi, Sindh, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Saleem","sequence":"additional","affiliation":[{"name":"Community Health Sciences, The Aga Khan University, Karachi, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012705100437000_4.1.e003105.1","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1093\/inthealth\/ihac063","article-title":"Distance-quality trade-off and choice of family planning provider in urban Pakistan","volume":"15","author":"Hussain","year":"2023","journal-title":"Int Health"},{"key":"2026012705100437000_4.1.e003105.2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0140-6736(12)60478-4","article-title":"Maternal deaths averted by contraceptive use: an analysis of 172 countries","volume":"380","author":"Ahmed","year":"2012","journal-title":"The Lancet"},{"key":"2026012705100437000_4.1.e003105.3","doi-asserted-by":"crossref","first-page":"111","DOI":"10.35335\/laweco.v17i2.4","article-title":"Catalyzing Sustainable Development: Assessing the Impact of Family Plan-ning Programs on Population Control, Reproductive Health, and Gender Empowerment","volume":"17","author":"Hatcher","year":"2023","journal-title":"LawEco"},{"key":"2026012705100437000_4.1.e003105.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.contraception.2014.06.025"},{"key":"2026012705100437000_4.1.e003105.5","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.eap.2021.02.001","article-title":"Where do we stand on the 17 Sustainable Development Goals? An overview on progress","volume":"70","author":"Halkos","year":"2021","journal-title":"Econ Anal Policy"},{"key":"2026012705100437000_4.1.e003105.6","doi-asserted-by":"crossref","unstructured":"Nakuya Z . Revitalizing and expanding commitment to family planning: summary of the fp2030 anglophone africa workshop. 2023.","DOI":"10.31899\/pc2023.1020"},{"key":"2026012705100437000_4.1.e003105.7","unstructured":"worldometer . Population of Pakistan. n.d. Available: https:\/\/www.worldometers.info\/world-population\/pakistan-population"},{"key":"2026012705100437000_4.1.e003105.8","unstructured":"Nations U . World fertility report 2024. 2025."},{"key":"2026012705100437000_4.1.e003105.9","unstructured":"LLC -M . Pakistan fertility rate 1950-2025. 2025. Available: https:\/\/www.macrotrends.net\/global-metrics\/countries\/PAK\/pakistan\/fertility-rate"},{"key":"2026012705100437000_4.1.e003105.10","doi-asserted-by":"crossref","first-page":"34","DOI":"10.71000\/jcz83r08","article-title":"Family planning effects on maternal and child health in pakistan- a narrative review","volume":"3","author":"Shah","year":"2025","journal-title":"IJHR"},{"key":"2026012705100437000_4.1.e003105.11","first-page":"187","article-title":"Assessing Family Planning Service Quality And User Experiences In Social Franchising Programme - Case Studies From Two Rural Districts In Pakistan","volume":"30","author":"Azmat","year":"2018","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"2026012705100437000_4.1.e003105.12","doi-asserted-by":"crossref","DOI":"10.1186\/s12961-022-00950-y","article-title":"Raising the contraceptive prevalence rate to 50% by 2025 in Pakistan: an analysis of number of users and service delivery channels","volume":"21","author":"Abdullah","year":"2023","journal-title":"Health Res Policy Syst"},{"key":"2026012705100437000_4.1.e003105.13","first-page":"245","article-title":"Quality of family planning services in primary health centers of Jimma Zone, Southwest Ethiopia","volume":"23","author":"Tafese","year":"2013","journal-title":"Ethiop J Health Sci"},{"key":"2026012705100437000_4.1.e003105.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0001780","article-title":"\u201cYou could find a good or a bad provider, I would say you just have to go and see\u201d: A qualitative study of the influence of perceptions of service quality on family planning service use in Burkina Faso","volume":"3","author":"Castle","year":"2023","journal-title":"PLOS Glob Public Health"},{"key":"2026012705100437000_4.1.e003105.15","doi-asserted-by":"crossref","unstructured":"Al-Worafi YM . Contraception-related issues in developing countries. In: Handbook of Medical and Health Sciences in Developing Countries: Education, Practice. and Research: Springer, 2024: 1\u201330.","DOI":"10.1007\/978-3-030-74786-2_89-1"},{"key":"2026012705100437000_4.1.e003105.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0165627","article-title":"Factors Determining Quality of Care in Family Planning Services in Africa: A Systematic Review of Mixed Evidence","volume":"11","author":"Tessema","year":"2016","journal-title":"PLoS One"},{"key":"2026012705100437000_4.1.e003105.17","unstructured":"Kamran I , Niazi R , Parveen T , et al . Improving Access to Family Planning Services through the Private Sector in Pakistan a Stakeholder Analysis . Pakistan: Population Council, 2019."},{"key":"2026012705100437000_4.1.e003105.18","unstructured":"Azmat SK . Models to accelerate modern family planning\/contraceptive services access and uptake among married women in rural Pakistan [doctoral research]. Ghent, Ghent University, 2017"},{"key":"2026012705100437000_4.1.e003105.19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.7748\/nr2010.01.17.2.7.c7457","article-title":"Understanding phenomenology","volume":"17","author":"Flood","year":"2010","journal-title":"Nurse Res"},{"key":"2026012705100437000_4.1.e003105.20","unstructured":"Munhall P . Nursing Research. Jones & Bartlett Learning, 2012."},{"key":"2026012705100437000_4.1.e003105.21","unstructured":"Islamabad PC . Landscape analysis of the family planning situation in pakistan\u2014district profile. Karachi, 2016."},{"key":"2026012705100437000_4.1.e003105.22","unstructured":"Masud AA . Inductive vs deductive research: difference of approaches: questionpro. 2025. Available: https:\/\/www.questionpro.com\/blog\/inductive-vs-deductive-research"},{"key":"2026012705100437000_4.1.e003105.23","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"2026012705100437000_4.1.e003105.24","doi-asserted-by":"crossref","unstructured":"Noble H , Heale R . Triangulation in Research, with Examples. Royal College of Nursing, 2019:67\u20138.","DOI":"10.1136\/ebnurs-2019-103145"},{"key":"2026012705100437000_4.1.e003105.25","doi-asserted-by":"publisher","DOI":"10.1097\/DCC.0000000000000253"},{"key":"2026012705100437000_4.1.e003105.26","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/sifp.12081","article-title":"Evaluating Quality of Contraceptive Counseling: An Analysis of the Method Information Index","volume":"50","author":"Chang","year":"2019","journal-title":"Stud Fam Plann"},{"key":"2026012705100437000_4.1.e003105.27","doi-asserted-by":"publisher","DOI":"10.1111\/sifp.12052"},{"key":"2026012705100437000_4.1.e003105.28","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.bpobgyn.2014.04.014","article-title":"Family planning: Choices and challenges for developing countries","volume":"28","author":"Mbizvo","year":"2014","journal-title":"Best Practice & Research Clinical Obstetrics & Gynaecology"},{"key":"2026012705100437000_4.1.e003105.29","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1186\/s12913-021-07247-w","article-title":"Quality of care in public sector family planning services in KwaZulu-Natal, South Africa: a qualitative evaluation from community and health care provider perspectives","volume":"21","author":"Kriel","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"2026012705100437000_4.1.e003105.30","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0228714","article-title":"Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)","volume":"15","author":"Hrusa","year":"2020","journal-title":"PLoS One"},{"key":"2026012705100437000_4.1.e003105.31","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.11.04034","article-title":"Structured and sustained family planning support facilitates effective use of postpartum contraception amongst women living with HIV in South Western Uganda: A randomized controlled trial","volume":"11","author":"Atukunda","year":"2021","journal-title":"J Glob Health"},{"key":"2026012705100437000_4.1.e003105.32","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-020-01121-3"},{"key":"2026012705100437000_4.1.e003105.33","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-018-0460-4"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-003105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:10:21Z","timestamp":1769519421000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-003105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjph-2025-003105"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-003105","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}