Scaling Modern Family Planning Through the Challenge Initiative: Insights from 15 Urban Districts in Pakistan

Abstract

Background:  The Challenge Initiative (TCI) is a global platform operating in 13 countries, with implementation in Pakistan led by Greenstar Social Marketing. Partnering with 15 local governments, TCI delivers high-impact interventions (HIIs) in government’s priority areas to expand universal access to reproductive health and family planning, while advocating for behavioral change. This study aimed to assess the effect of TCI’s HIIs on the uptake of short-acting methods (SAM), long-acting reversible contraception (LARCs), and permanent methods (PM) in 15 urban districts of Pakistan.

Methodology: Starting in June 2022, TCI introduced multiple HIIs across 15 urban districts. Performance was evaluated using data from the Contraceptive Logistics Management Information System (cLMIS) from June 2020 to August 2024. A two-sample t-test was applied to estimate the interventions’ effect on average monthly client volume per district.

Results: Average monthly clients increased by 715 for SAM (1,425 to 2,150), 740 for LARCs (670 to 1,410), and 66 for PM (88 to 154), with total monthly clients rising by 1,521 (2,183 to 3,704). Since June 2022, TCI-supported facilities have served approximately 678,200 modern family planning clients—60% SAM, 35% LARCs, and 5% PM—and generated 288,010 unique additional users across all districts.

Conclusion:  TCI has substantially expanded access to modern family planning services in 15 urban districts, contributing 288,010 additional users—a critical step toward Pakistan’s FP2030 commitments. By strengthening local government capacity, TCI promotes sustainability and long-term program ownership.