Pakistan has not witnessed any significant behavioural change towards family planning (FP) and maternal health continues to worsen as the state fails to provide family planning services.
This was revealed by Pathfinder International’s country representative, Dr Tauseef Ahmed, who was talking to The Express Tribune. He said Pakistan has a very high maternal mortality ratio as every year 15,000 mother lose their lives during childbirth. “The right of woman to live a healthy reproductive life is seriously abrogated by the state due to non-provision of family planning services required to meet her reproductive needs,” he added.
Tauseef said that during the last decade Pakistan’s FP programme was never given due priority in terms of perspective plan implementation. “Rather it has frequently faced limited resource allocations and short and delayed releases. Meanwhile, accountability has been missing at all levels: providers, administrative heads or district managers,” he lamented.
He emphasised that Pakistan needed ‘political will’ to re-design family planning services to reach out all needy women. “We should have a clear and comprehensive policy to be managed by a commission with full authority,” he said.
“Pakistan faces a ‘population explosion’ and yet it maintains a programme with no focus on women,” he added.
He was of the view that one of the major reasons behind the tremendous increase in Pakistan’s population was non-availability of the FP services near people’s homes, in addition to poor services by facility staff and misperceptions regarding husband’s dislike for use of contraception.
“Our service provision has never been client friendly and a large number of facilities never provide such FP services. Furthermore, our system does not have any outlet to provide services to men,” he said.
He said that commodity pushing the FP programme in Pakistan resulted in skewed contraceptive method-mix. “High proportion of women use inefficient methods or adopt tubal ligation as a last resort after having 5-6 births. A small number of women use methods like oral pills, IUCDs and injectables,” he added.
“Lack of access to services is a major factor why poor women have as many as two unwanted pregnancies compared to 0.5 unwanted pregnancies among richer women,” he said.
Contraceptive use rose from 12% to 28% in the period 1991 and 2001 but is currently only 35% according to National Institute of Population (NIPS) 2013.
He said the FP programme, unfortunately, remained in a state of confusion and its significance was not understood by the economist and planners.
“Unfortunately, the bureaucracy and policy makers never factored population in the development process.
Meanwhile research and facts gathered in Pakistan were not used much to evolve a fresh innovative design for the FP programme and it remained commodity-oriented and not bringing necessary reorientation in human behavior to address emerging problems,” he said.
Dr Ahmed said as part of international commitments under International Conference on Population and Development (ICPD) 1994, Millennium Development Goals (MDGs) 2000 and now at London Summit also referred as FP2020, Pakistan needs to re-consider its mode of service provision.
“This approach is referred to as ‘human rights’ approach meaning services should reach out to all women and is incumbent on the state to ensure such quality services to all needy women,” he said.
Published in The Express Tribune, June 21st, 2013.