Contraceptive use intention among women in Pakistan: Application of theory of planned behavior

Unintended pregnancies remain a major public health concern globally and in Pakistan, where family planning (FP) uptake continues to be hindered by entrenched social and behavioral barriers. This study applies the Theory of Planned Behavior (TPB) to examine how attitudes, subjective norms, and perceived behavioral control (PBC) shape women's contraceptive intentions in Pakistan.

We analyzed data from 13,335 non-pregnant women aged 15-49 using the Pakistan Demographic and Health Survey (PDHS) 2017-18. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to test TPB pathways. Model reliability, validity, and fit were assessed using Composite Reliability, Average Variance Extracted, discriminant validity indices, and bootstrapped estimates to ensure analytical rigor.

Over half of respondents lacked formal education, and most (84%) were unemployed. Only 23% had FP knowledge, and 96% were unaware of contraceptive side effects. Subjective norms negatively influenced contraceptive intentions (β = -0.056, p < 0.001), while perceived behavioral control had a positive effect (β = 0.091, p < 0.001). Attitudes showed no significant effect. These findings indicate that women's reproductive choices are shaped more by social expectations and decision-making autonomy than by personal evaluations of contraception.

The study demonstrates the applicability of TPB for understanding contraceptive intentions in a collectivist, patriarchal context. Subjective norms and PBC emerge as critical determinants, underscoring the need for interventions that engage families, strengthen women's autonomy, and improve access to FP services. The findings offer a theoretically grounded and policy-relevant framework for designing behaviorally informed family planning programs in Pakistan.