ISLAMABAD:
There was a time when the public service message ‘Bachay, do hi achay’ (Kids, two are more than enough) became a household phrase in the 1960s in Pakistan. By 2012, however, it is bandied about like a joke. The reason: a population explosion.
In response to this came a parallel rise in abortions which is the method of choice for family planning instead of condoms, prophylactics, the intrauterine device, the pill, vasectomies. According to gynaecologist Dr Azra Ahsan, hardly 30% of people use contraception in Pakistan even though 96% of people are aware of it. And yet, the fertility rate is declining. “This is because of abortion, which is being misused as a means of family planning,” she pointed out at a seminar on population planning, organised by the Jinnah Post Graduate Medical Centre Saturday. About 890,000 abortions take place annually to get rid of unwanted pregnancies. Unsafe abortion is the fifth leading cause of maternal deaths in Pakistan.
“Data proves that about 43% of women do not have any reason to avoid contraception and believe that if they get pregnant, unplanned, it is ‘Allah ki marzi’ (God’s will),” Dr Ahsan said.
In Pakistan, two mothers die every hour, which, the experts say, is a weakness in the family planning service delivery system. Despite starting about 50 years ago, family planning has declined in Pakistan because of misinformation attributed to religion, disapproval from husbands or in-laws, the subordinate status of women and a lack of knowledge among healthcare professionals.
“[Thus], unwanted pregnanc[ies] may either result in high fertility, leading to a high population or in an abortion, that comes with many risks,” explained Dr Ahsan.
The good news is that 25% of Pakistanis do want family planning services but cannot get access to them. If they did get this kind of help, the country’s contraception use could go up to 55%. International health agencies recommend that there must be no pregnancy before 18 years or after 34 years of age and that a couple should space their children at least three years apart.
The choices for family planning and contraception are wide: female condoms, pills, new progestogens, hormonal vaginal ring, progesterone implants, male pills, reversible male sterilisation, intra-uterine systems and the intrauterine devices. “Of all of these, the oral contraceptive pill that has been is use for the past 50 years is still the best method,” she said. Its safety has been confirmed in one of the largest longitudinal studies involving 46,000 women over 40 years. It found that users are less likely to die prematurely of all causes, including cancer and heart diseases.
Family Planning helps prevent unwanted and high-risk pregnancies, and it also helps improve the woman’s health and lowers maternal mortality. The child who is born is wanted and valued, and has better chances of proper nutrition, care and education. Similarly, for the man, family planning means less stress on meeting the needs of a family and parents can have more time for each other. It is also beneficial for the country as there is less population, poverty and crime and increased resources and economic growth.
Dr Tasnim Ahsan, the executive director of JPMC, shared details of a pilot project of Post-Partum Insertion of Intra-Uterine Contraceptive Device (PPIUCD), which was successfully implemented at the hospital. The project was started by the National Committee for Maternal and Neonatal Health and aims to target family planning right after delivery. The pilot is being carried out at JPMC and Sobhraj Maternity Hospital, where doctors insert the intra-uterine contraceptive device right after pregnancy instead of relying on the old method of asking the mother to come at a later date for discussions. Dr Laila Shah, who oversaw the project at the two hospitals, explained that in six months about 1,900 PPIUCD’s have been inserted. The main purpose of the program is to institutionalise PPIUCD as a means of family planning. Dr Shah said that although they managed 18% results instead of the targeted 30%, it still proved that it can be done. The onus of responsibility will be ultimately passed on the hospitals to continue it permanently.
“If we can do it at our hospital despite the most heavy duties and patient load there is no way other hospitals cannot as well,” said Dr Tasnim Ahsan.
Status of family planning
Pakistan is a signatory to the Program of Action of the 1994 International Conference on Population and Development. Our population policy of 2002 aims to provide universal access to family planning by 2010, increase contraception use to 43% by 2006 and to 57% by 2012. Family planning was originally the responsibility of the Ministry of Health but later the Ministry of Population Welfare was created. It provides services in the public sector through Family Welfare Centres, Reproductive Health Centres, and mobile teams. The programme is managed by provincial population welfare departments. The family welfare centres are run by family welfare workers, who provide all non-surgical contraceptive services. The ministry of health plays a role through lady health workers.
Major NGOs providing family health services
Rahnuma - FP Association of Pakistan (FPAP)
National Committee for Maternal and Neonatal Health (NCMNH)
Association for Mothers and Newborns (AMAN)
Midwifery Association of Pakistan (MAP)
Green Star Social Marketing
Marie Stopes Society
Facts and Figures:
30% of people in Pakistan use contraception, says gynaecologist
Dr Azra Ahsan
890,000 abortions take place in Pakistan annually to get rid of unwanted pregnancies
43% of women do not have any reason to avoid contraception and believe that if they get pregnant, unplanned, it is ‘Allah ki marzi’
96% of Pakistanis have knowledge about contraception
25% of people want to use family planning services but don’t have access in Pakistan
55% is the portion of the population that could use contraception if services were improved
Published in The Express Tribune, October 14th, 2012.
COMMENTS (12)
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the fertlity rate( average children a woman bears) is as follows as of 2010: china :1.7 india: 2.6 pakistan :4.1 bangladesh : 2.2 india and pakistan should reach 2.1....2.1 is the replacement rate guys.....i mean population stability takes place at 2.1................. russia on the other hand is facing severe shortage of population...wow!!!!!!!!! could never imagine :D
Very important subject. Figures seem to be wrongly quoted as several statements do not make sense. F.i. "96% of Pakistanis have knowledge about contraception". This figure is very confusing more than 40% of the Pakistani population is under the age of 15. Secondly having knowledge has hardly any meaning. Does it include heard of? Equally, "30% of people in Pakistan use contraception" does not make sense. If you consult the Quarterly Contraceptive Performance Report published by the Pakistan Bureau of Statistics these figures do not add up. With an assumed birth rate of 24.3/1000 the number of abortions (890,000) would show that about 17% of pregnancies end up in abortion. More shockingly is that almost 50% of the readers of ET taking part in a poll on sex education in school are against sex education. Who is educated here? Must be all God's will.
@Baba Ji In China only one child allowed per family. If a woman gets pregnant again she has to abort. They are extreme in population control measures. India, Bangladesh doing better then EU is a joke.
In PK 3 years ago it became a common story on media that people would come out on street to sell their children. Media would cover it then Shehbaz sharif or some politician would go to their house to give them money. If you can't feed kids that you have to sell them; then stop having them.
Pakistan cannot afford a population increase. It is a matter of the population:resource ratio. A rapidly growing population places an extreme pressure on water and power infrastructure. Natural resources can support a smaller population. On a micro-economic scale, the more children a family has, the less money they have to spend on each child. Thus, they are less likely to be educated and brings another generation into a cycle of poverty. Numerous studies show contraception and family planning lead to prosperous families, bringing them out of poverty within the passage of a single generation. Thailand is a great example of how curbing population growth directly led to economic growth.
Muslim umah will reduce, will not grow. Then what?
Nooooo !!!! I read this in Swat in 1994 ... "Barra Khandaan, Jihad Asaan" !!!!! i.e. bigger family easier the Jihad !!!! and statistically China, India, Bangladesh are doing better than European union ... we need to put our population to work .. all will be ok !!! don't be afraid of population ... think positively ... you have twice as many hands to work ... No ?
One of the few things Benazir's government did was using lady health workers to improve access to contraception and improve women's health. that should be continued. population explosion in pakistan is a menace and the root of most of our problems.
We need great population and should compare with India ofter China, after all we always quote India in everything, moreover, good population is good for the future.
sad state of affairs.
Pakistan seriously needs a population control policy. An out of control population is a curse, you should see what it is like in India although they are progressing even India has a population curse which needs to be controlled and unfortunately I think the lower socieconomic population in both Pakistan and India has too many children. No money, nothing to eat, just produce. Not a very smart mindset at all.