The study assesses the impact of The Challenge Initiative (TCI) on public sector provision of modern family planning (FP) services in 15 urban districts from two provinces of Pakistan. TCI partnered with the government’s Departments of Health (DOH) and Population Welfare Department (PWD) for implementation of high-impact interventions.

Patients and Methods: TCI began implementation in Punjab province in June 2022 and in Sindh province in September 2022. Monthly service data were obtained using the contraceptive Logistics Management Information System (cLMIS) from June 2020 to June 2025. Four districts were selected for the study: districts Rawalpindi (Intervention) and Gujrat (Control) from Punjab province and districts Malir (Intervention) and Sukkur (Control) from Sindh province. A difference-in-differences (DiD) analysis estimated the net effect of the intervention on average monthly family planning clients while interrupted time-series analysis (ITSA) assessed changes in trends before and after intervention.

Results: DiD analysis showed a statistically significant overall effect of 3,673 clients (p < 0.01) relative to control districts across provinces and government departments. In the Department of Health (DOH), an estimated statistically significant net effect of 6,100 clients (p < 0.001). ITSA trends aligned with DiD findings, showing sustained increases in client volume in intervention districts compared to declining trends in controls.