About a quarter of women in Pakistan want to have some method of birth control but they either don’t have access to contraceptives or proper information about them.
This figure, 25 per cent, is from the Pakistan Demographic Health Survey but as the statistic dates back to 2006-2007, it can only be treated as an indicator of the situation on the ground. Of the total unmet need, 11 per cent is of women (or couples) who want to “space out” or give a sufficient gap, 24 months recommended, between children. The other 14 per cent is for those who want to “limit” their family.
This unmet need opens up a challenge for health providers. “The most common contraceptives in the country are either permanent or are low in their effectiveness,” explained Dr Mohsina Bilgrami, who is the MD of Marie Stopes Society (MSS). She was speaking at a seminar on reproductive health on Saturday. Bilgrami quoted figures from the survey, saying eight per cent of women used female sterilisation as a method while another eight per cent preferred the ‘rhythm and withdrawal’ technique as contraception. Condoms were used by seven per cent of couples and intrauterine devices (such as the ‘coil’) were limited to just 2.3 per cent. Only 0.1 per cent of women used the implants.
Given the scope, this seminar was organised to promote another contraceptive method to be launched in Pakistan under the Marie Stopes Society banner. Femplant promises “long-term benefits with minimum side-effects.”
Femplant, once inserted into the woman’s arm, is a reversible method of contraception that frees the couple from worrying about conceiving for about four years. There is, nonetheless, a one in 100 chance of conception. Once it is inserted, the women do not need a routine clinical follow-up.
The government does, however, have some concerns. “If the method is adopted by a government programme, we will not be able to ensure proper sanitation and skilled insertion of the [Femplant] rods in rural areas,” pointed out Dr Najma Sultana of the Population Welfare department in Khyber-Pakhtunkhwa. More healthcare providers, male and female, would need to be properly trained so that they ensure counselling on side-effects, benefits, planning.
On family planning at large, the chief guest Shahnaz Wazir Ali of the Pakistan Peoples Party, who is also the co-chair of the Pakistan education task force, shared her thoughts. “Education, especially for girls, is the best method of contraception,” she said. If the woman of the house is educated and is aware of her options then it will manifest through the household, she added. On the barriers to family planning, Wazir Ali said that she was a strong proponent of functional integration with a serious focus on coordination between departments (vertically and horizontally). For her distance (in rural areas) to healthcare units is a “central challenge”. She suggested officials to start looking at health, education, population and nutrition under one umbrella and then address their problems.
The head of training at Greenstar Social marketing, Dr Aleya Ali, projected a dim future with population figures touching 300 million in 40 years if something was not done quickly.
Dr Yasmeen Sabeeh Qazi, a senior country adviser for The David and Lucile Packard Foundation, said that contraceptive use increased with age and parity. She stressed the need to focus on the newly married couple and soon-to-be married couples to get them on to family planning right from the start.
Published in The Express Tribune, April 03rd, 2011.