Addressing the population explosion – Part II

While resources are scant, those that have been allocated towards family planning have not been utilized appropriately. There has been ample research reflecting Pakistan’s dismal service delivery.

In 2019, Pakistan had a CPR of 34 percent, in contrast with India’s 56 percent and Bangladesh’s 62 percent. Many experts in the field have highlighted poor service delivery as the cause for low CPR in the country, due to which the poorest of women in Pakistan, mainly residing in rural areas, are adversely affected. In fact, research also indicates that only one third of married Pakistani women use some form of birth control.

So while abortion is illegal in Pakistan, our state’s inability to protect women led to around 890,000 induced abortions in 2002 (it must be noted that these are just the reported instances). The health complications unwanted pregnancies and induced, unsafe abortions cause for women in this country have been documented at length. In fact, in 2002, around 197,000 women were hospitalized in Pakistan as a result of complications culminating from unsafe abortions.

As per the National Institute of Population Studies, in 2018, the most commonly used contraceptive methods in Pakistan were condoms and female sterilization. The government of Pakistan is the largest provider of contraceptives in the country, so it is directly responsible for its failure to not only improve service delivery, but also its failure in making available more contraceptive methods.

While the Iranian family planning programme is light-years ahead of what we in Pakistan can emulate, one of its key reasons for success was because of its targeting of the most remote, rural locations. Its rural health houses and mobile clinics now cover over 90% of the population.

It is perhaps understandable why Pakistan’s political governments do not take the necessary measures to ensure effective family planning across the country, but this foolish populism has cost us and will cost us even more dearly in the future unless we reform. There is a clear discrepancy between our international commitments and the work actually carried out on-ground.

What is required urgently is a comprehensive and coordinated policy, with clearly identifiable principles and goals. All the way from the top, from the Prime Minister’s Office, to the grassroots level, of health centres, a concerted effort and commitment is required to emphasize the urgency of the situation. Innovative ideas and approaches are the need of the hour, as there are evidently loopholes in monitoring service delivery.

Involving the media, academics, NGOs and CSOs in awareness and advocacy on the issue is equally important. This is particularly crucial with respect to dissemination of information on contraceptive methods. At present, people are unable to make informed decisions regarding contraceptive methods due to a lack of information concerning use and side effects. Moreover, we must simultaneously improve our data collection, whether through the Pakistan Bureau of Statistics or through planning departments at the provincial level.

The lack of leadership commitment at the highest level would ordinarily indicate that perhaps there is little voter support for family planning. However, at present, we cannot draw any definitive conclusions on that front. What is required immediately and on a priority basis is a baseline survey on reproductive age groups, premarital concepts regarding family planning, post-marital approaches to family planning, etc. A knowledge, attitudes and practices (KAP) survey needs to be carried out across the country to assess what current behaviours and attitudes towards family planning are.

There has been input from experts in this area through several research articles and studies, including a 2015 KAP study of married men and women in rural Pakistan, which provides important insights into the issue. The 2015 study highlighted how around 28,000 women in Pakistan die annually as a result of pregnancy-related complications. Moreover, the study identified that only half of the deliveries in Pakistan occur in the presence of a skilled health provider, while rural and less educated women are less likely to receive skilled care.

In fact, the average distance to a reproductive health facility in Pakistan’s rural areas is greater than that to urban areas, which effectively renders these health facilities useless for rural women who do not have transportation or finances. Another important fact the 2015 study highlighted was that over 70 percent of our population tries to access private sector healthcare, thus reflecting an appalling lack of both availability of and confidence in public health facilities.

Our own demographic and health surveys reflect that neonatal mortality rate in Pakistan has remained largely unchanged in the last fifteen years, with such mortality most prevalent in Punjab, then Sindh, followed by Khyber Pakhtunkhwa and lastly Balochistan. There is also an unmet need for contraception (around 20 percent). Adding to these problems are the socio-cultural constraints on women in the country. There is a lack of communication between spouses with respect to family planning decisions, immense interference from in-laws and ultimately men in Pakistan have final decision-making authority with respect to women’s reproductive health rights (something that cannot possibly be condoned in the 21st century). None of this has been discussed by any government, let alone redressed.

In fact, each successive government’s messaging on family planning has fallen short. Perhaps that is partly also because our leadership does not understand the far-reaching implications of this population explosion on our resources, the law and order in the country and our international standing.

Our population is expected to swell beyond 300 million by the year 2050. We have the highest growth rate in the region. Then why is it that family planning is not at the top of any government’s agenda? That very reality reflects our inability, as a collective, to take this seriously or to understand the implications of failed family planning approaches on female literacy, maternal mortality, infant mortality and neonatal mortality.

As a result of Bangladesh’s family planning programme, the country has experienced a huge reduction in child mortality rates (barring some problems they are still struggling to address vis-à-vis the rate of under-five mortality). In fact, between 1990 and 2010, there was a reduction in maternal mortality in Bangladesh from 574 deaths per 100,000 to 194 deaths per 100,000. The decline in maternal mortality was attributed to a reduced total fertility rate, increased and improved service delivery, improved access to health services, improvements in female education and increases in per capita income.

Pakistan’s family planning strategy needs a jumpstart and revamp. At this stage, we cannot afford the Government’s messaging being poorly framed and targeted, as per routine. The government must involve communication experts in its messaging on family planning. Clearly, the “kam bachay, khushaal gharaana (fewer children, prosperous home)” is not helping with our family planning programme.

Our unabated population growth is a time bomb waiting to explode and will affect us in ways we have not even begun to imagine due to the shortsightedness of our leadership.

Concluded

The writers are lawyers.