Assessing the sustainability of single versus multiple voucher-based family programs in Pakistan: a 24-months post-intervention evaluation

Abstract Introduction Family planning vouchers have emerged as a promising approach to improve coverage of underserved groups or underutilized services. The current study was designed to measure the residual/longer term impact of FP voucher programs on the practices of women beyond the life of the programme. Methods A cross-sectional survey conducted, as part of the larger mixed-method study, approximately 24 months after the close-down of Marie Stopes Society and Greenstar Social Marketing family planning voucher intervention programmes in Punjab, Pakistan. Following necessary ethics approvals, a total of 338 voucher MSS clients & 324 voucher GSM clients were interviewed using a structured questionnaire at the household level. Results Compared with end-line data, a significant decrease in the modern contraceptive uptake in both MSS (90% at endline to current ( or post-endline ) 52%) and GSM (from 84% to current 56%) intervention sites among the voucher clients was noted. Among MSS voucher clients, the highest decline in use was observed in IUCD (54% at endline versus to current 13%); however no change between the surveys was noted among GSM clients. In both projects, following closure of voucher intervention 34% of the discontinued users in MSS and 29% in GSM sites adopted/switched to a new modern contraceptive again. In the post-intervention survey, wealth-based inequality in GSM data depicts more pro-rich utility for modern methods, indicating pro-rich inequality, in contrast, the post-intervention survey in MSS found mixed results such as pro-poor inequality for any method and modern method use. Conclusions The prevalence for contraception in study sites, following closure of voucher intervention remained high than national average. This study provides evidence that family planning vouchers can bring about an enduring positive change in clients’ behaviours in using modern contraceptive methods among poor populations. These results are useful to design family planning programs that will sustain when the donor funding terminates.