Social determinants of fertility behaviours

The deleterious impact of a rapidly growing population on all our development prospects has already begun to show and will continue to do so until we are able to lower our fertility rate (ie the average number of children a woman has during her reproductive life span) and attain a sustainable population growth rate.

In the decade of the 80s Pakistan witnessed a fertility decline that was markedly rapid but in the last two decades this decline has been sluggish resulting in our fertility rate being one of the highest in the region. Determining the size of one’s family is a personal decision that is influenced by several factors which in the Pakistani context are both social and personal.

A study conducted some years ago by the Population Council determined that among women who wanted to adopt family planning but were unable to do so, major reasons were perceived opposition from the husband and social disapproval. While the importance of these two factors has abated over the years, yet social pressures still guide procreative patterns resulting in early marriages, the pressure to produce children soon after marriage and preference for having at least one and preferably two sons. To counter the social dimensions influencing fertility behaviours, it is important to frame the ethos of population planning on a culturally, socially and religiously endorsed premise.

In recent times, responsible parenthood implies the will and ability of parents to respond to the needs and aspirations of their family and children by providing them with proper care and supporting them in attaining the best possible future. It also includes determining the desired number, spacing and timing of their children.

From the Islamic perspective, the Quran stresses the need for proper premarital planning and preparations. According to verse 33 of Surat An-Nur 24:33, the Almighty has ordained “that those who do not have the means [ie who cannot afford] marriage should abstain [from sexual relations] until such time that Allah enriches them from his bounty.” Marriage in Islam is encouraged and seen as a sacred obligation that must be fulfilled with responsibility and, therefore, cannot be taken lightly or casually. According to the above commandment, individuals must enter into the contract of marriage who have by the grace of the Almighty, attained a state of being financially independent or well-off in order for them to afford the requirements of marital life which includes the ability to clothe, provide food, shelter and security to the family (referred to as ‘Nafkah’ in Islamic jurisprudence). In surah al Baqarah 2:233 Allah ordains the man to bear the cost of his wife’s food and clothing on a reasonable basis. Clearly if the children born remain uneducated, weak and unhealthy and their upbringing is also wanting, it means that the parents are not fulfilling their parental responsibilities as enshrined in the teachings of Islam. Pre-marital planning and responsible parenting can help couples overcome many of the prevalent societal pressures that contribute to high fertility.

Almost all Muslim countries, including Saudi Arabia, have been successful in lowering their population growth rate by reducing their family size. Iran to its credit implemented one of the most successful family planning programmes in the world bringing down its fertility rate in the shortest possible time. In 1984 on an average an Iranian woman was having 6.4 children which declined to 1.9 in 2010.The Iranian programme offers many insights that Pakistan can adopt to address the social norms and traditional mindset surrounding the high fertility pattern of the country.

The success of the Iranian programme can be attributed to five major interventions. First was the unequivocal support to family planning efforts by the clergy based on the ‘Fatwa’ issued by the supreme leader on the permissibility of family planning. Second a strong media campaign spearheaded by the Iranian broadcasting corporation under the supervision of the Ministry of Islamic Culture and Guidance helped raise awareness on population issues thus influencing the social milieu around family planning. Third the Iranian Ministry of Health recognised that behaviours can only be changed when people’s belief systems are challenged through accurate and appropriate information. Therefore all young couples were provided premarital counselling to empower them to make informed choices about their family size and wellbeing. Participation in the counselling session was mandatory before the issuance of a marriage licence. These sessions provided information on dangers of pregnancy before 18 years and after 35 years. It also included reproductive health and family planning education, genetic counseling, the need for proper nutrition during pregnancy, lactation and vaccination. This was coupled by service provision through the vast network of community health workers — the male and female Behvarz who provided domiciliary services. Fourth was the promulgation in 1993 by the Iranian parliament of a law on reducing infant mortality, promoting women’ education and employment; and above all extending social security and retirement benefits to all thereby decreasing parental pressures to have more children for old age security purposes. Fifth and foremost a major step that helped to open the discussion on population was the inclusion of population education from school to university level. Underlying these efforts a significant contributor that challenged social behaviours and long-held beliefs was the phenomenal increase in literacy levels. The literacy rate for men doubled in Iran from 48% in 1970 to 84% in 2000, while female literacy rate showed an even faster growth from less than 25% in 1970 to more than 70% in 2000 and in the same period school enrolment increased from 60% to 90%.

In the Pakistani context it is important how we frame the narrative and messaging around family planning which should be able to positively influence people’s mindset and help overcome the social obstacles that challenge family planning adoption. The messaging should move away from being prescriptive and setting limits on family size but conversely on establishing the importance of raising healthy, educated and well-cared for children — which is their basic right. Accordingly steps must be taken with the help of religious scholars and legislators to ensure that couples entering matrimony have the means to support and take care of their new family. The concept of responsible parenthood framed in consonance with religious teachings can help muster support for changing fertility behaviours. At the same time efforts must also be made to remove the social barriers to accessing family planning services by offering high quality voluntary family planning services that respect client’s right to confidentiality and privacy and good counselling provided by well-trained staff at all public and private sector health facilities of the country.

Published in The Express Tribune, January 31^st, 2019.

Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily pieces.