Proximity and Other Geographical Factors in Family Planning Clinic Utilization in Pakistan

An understanding of the social and psychological forceseffecting the use that people make of existing medical care and healthfacilities is essential to programme planning and administration. Yet,little is known about these forces as they operate in Pakistan andelsewhere with regard to the utilization of such specialized facilitiesor services as family planning clinics. This analysis of clinic recordsfrom the Karachi Family Planning Association (FPA)1 explores certainsocial forces in clinic utilization in terms of their geographicaldistribution in this urban area of Pakistan. In the last section of thispaper we generalize the term "clinic" to include the wide variety ofsources or centres of contraceptive supply provided in the Third FiveYear Plan (such as village volunteers, dais1, and shopkeepers) andconsider the implications of our findings in terms of this broaderconcept of clinic. One of the dilemmas faced by administrators ofcertain clinic-centred public health and family planning programmes iswhether to place their clinics within or very near the residential areaof the people for whom the service is mainly intended, or to place theclinic somewhat more distant from this primary target group. The mainargument for proximity is that most potential clients or patients willnot avail themselves of clinic services unless the services orfacilities are