Contraception mainstreaming in health sector strongly advocated

Islamabad : Pakistan may have invested heavily in maternal, neonatal and child healthcare during the last two decades but the country’s top planning minds strongly feel that the investments have underperformed.

Blaming the problem on the population control programme’s failure on both curative and preventive fronts and lack of governance and accountability in it as well as the health sector’s overall unresponsiveness to birth control initiatives, they have strongly advocated the mainstreaming of contraception in the nationwide health sector to ensure optimal mother and child health and reduction in high fertility rate.

“The health sector has massive outreach, possesses vast resources, and fulfils the people’s reproductive health needs and aspirations. The use of family planning increases when it is embedded in health sector as a key mother and child health intervention. The integration of family planning and mother-child healthcare has the advantage of offering broad range of services at the same place and from the same provider. This initiative will save lives, money, and time by lengthening the birth interval, reducing the number of high risk pregnancies, ensuring the efficient and cost-effective provision of health services, and saving travel and time cost,” declares the Planning Commission’s Health Wing in a policy paper.

Painting a gloomy picture of mother and child healthcare in the country, the paper authors insist that despite heavy investment in current and development spending to improve MCH status, gains had been suboptimal during the period of the last two five-year plans (2005-10 and 2013-18) as the maternal mortality rate was 178 deaths per 100,000 live births, infant mortality rate 66 deaths per 1,000 live births, child mortality rate 81 deaths per 1,000 live births, and rate of trained personnel attending deliveries 58 per cent.

Also, the curative interventions by the devolved maternal, neonatal and child health programme like filling of gaps and provision of necessary infrastructure at primary and secondary healthcare levels, and creation of the specialised cadre of community midwives to reach population without fixed health facilities have failed to deliver the goods due to missing links in the preventive domains, especially birth spacing through contraception. By and large, the health sector has remained unresponsive to this mother and child health measure.

Regretting the use of modern contraceptive methods by only 47% of women of reproductive age, and high (44%) birth rates among adolescents aged 10-14 years and 15-19 years per 1,000 women despite heavy investment in population control programme over many decades, the planners observed that the population, especially youths, continued to find it a ‘stigma’ to visit family welfare centres to get contraceptive services.

According to them, poor governance and lack of accountability in the programme make the things even worse.

On the supply side, the programme has issues of poor access, stock-outs, lack of knowledge of contraception side effects among service providers, and weak monitoring and evaluation, while the demand side problems include the people’s dissatisfaction, poor quality of oral contraceptive pills, myths and conceptions, especially religious antagonism, and poor coverage. All this causes high unmet family planning need, unwanted pregnancy and births, and unsafe abortions.

Besides, the family planning programme also suffers from high risk fertility behaviours, including short (less than 24 months) and too long (59 months) birth interval, higher number of total live births, and too early (before age 18) or too late childbearing patterns (after age 34) and thus, causing population growth rate to increase rather than decline.

Recommending an out-of-box approach to address the unmet family planning need, the experts said the health sector should be effectively involved in birth spacing as a means to women and child health, which would also deal with the clerics’ hostility to the population welfare programme.

Declaring their adoption at the Islamabad Capital Territory, provincial and sub-provincial levels a national priority, they called for the integration of birth spacing into health strategy, plans and institutional arrangements to ensure optimal implementation, broadening of the grounds for legal abortion and improvement of the people’s access to safe abortion services, proper training of service providers, and provision of the safe abortion option to people to protect the health and life of women.

The planners also called for contraceptive supply and security at all tiers of health service delivery, with basic health units and rural health centres offering non-surgical contraceptives and tehsil headquarters, district headquarters and tertiary care hospitals contraceptive surgery and said contraception should be included in the essential health services delivery packages and essential drugs list.

They emphasised that family welfare centres should be put up within the premises of primary health care, while lady health workers and community midwives should be integrated with primary healthcare system.

When contacted, Dr Muhammad Asif, chief health at the Planning Commission and one of the policy paper authors, said though health and such service delivery in social sector had been devolved, there continued to be a need for a common vision and identification common national priority areas, and action on them by provinces.

“This document has been developed to focus efforts as a nation on the area of birth spacing and contraception for mainstreaming within health sector to ensure optimal mother and child healthcare and decline in fertility rate,” he said asking experts to give feedback on the policy paper at drmasif@msn.com and baloch.asma@gmail.com.