Planning families

In the fifth most populous country in the world, with approximately nine million pregnancies every year, it’s ironic that women rarely, if ever, have the freedom and choice to plan their families in Pakistan.

Various factors hinder that freedom for many young girls and women. For instance, there is an obvious lack of awareness regarding the various reproductive health services and family planning methods that are officially available in the country, difficulties with affordability and accessibility of these services, fears about the side effects of contraceptive usage, and lack of agency in being able to make choices for themselves and their bodies in a patriarchal society.

Which is why it’s important to raise this discussion specifically on International Women’s Day. Without access to safe and high-quality reproductive health services, women are held back from availing their economic, social, cultural, and political rights in Pakistan. Health is still not considered a fundamental right and is often deprioritized when it comes to allocation of funds and mobilizing the health workforce to focus on health areas that are particularly critical to women. Add to that the lack of concern regarding women’s issues in general, and other religious and socio-cultural factors, and reproductive health is often shrouded in controversy.

Let us remember that Pakistan ranks 154 on the United Nations gender development index, lower than other countries in South Asia.

The situation warrants immediate attention. Currently, the infant mortality ratio (IMR) is 67 deaths per 1,000 births, a consequence of unsafe or inaccessible reproductive care. The maternal mortality ratio has decreased from 276 deaths per 100,000 live births, as per the Pakistan Demographic and Health Survey of 2006-7, to 186, according to the latest Pakistan Maternal Mortality Survey (PMMS), but the numbers are still too high for us to celebrate. Pakistan continues to be the sixth most dangerous country for women, where one in every five women is subjected to physical violence. In Sindh, the minimum age for marriage of girls and boys is 18, but in the rest of the country, it is still 16.

All is not grim though; the government is taking active steps to ensure an enabling environment towards family planning. It’s international commitments to the Sustainable Development Goals (SDGs), and FP2020/FP2030, a global partnership of 69 countries, ensures that Pakistan prioritizes the health and well-being of its citizens. For its FP2020/30 commitments, Sindh developed and launched a roadmap, called the Costed Implementation Plan (CIP) to ensure those goals are achieved, and a secretariat was set up to oversee and provide policy guidelines. The main aim is to increase Pakistan’s contraceptive prevalence rate (CPR). Other provinces are following suit and also reporting on a regular basis to the Planning Commission. The provincial taskforces formed at the recommendation of the Council of Common Interests are also working with top provincial leadership to further this cause.

A lot more can be done. For instance, what are we doing to amplify the voices of young girls, women and communities who are bearing the economic, social, and health burdens arising from an alarmingly high population growth? The voices of the end-users need to be taken into account through formal public health mechanisms such as village health committees. Community based organizations that are grounded in the realities of their localities need to be supported to form a bridge to the women and to connect women and girls to the public health systems.

Last but not least, men are often the reproductive health decision-makers and need to be engaged to emerge as supporters as well as adopters of family planning methods. Citizens need access to information so that they may make more informed decisions that benefit them and their families. A more enabling environment may also address gender-based violence that stems from young people and women being unable to make choices for themselves.

It’s going to be a long journey, especially since the outbreak of Covid-19 has overwhelmed and exhausted the health systems and has further restricted access for women. Not only has women’s mobility decreased, we also see stark gender disparities in the digital landscape of Pakistan; the Mobile Gender Gap Report 2020 highlights that Pakistan has the highest gender gap of 38 percent over mobile phone ownership. It claims that, while 81 percent Pakistani men own mobile sets, the number is at 50 percent for women. Covid-19 has taught us to be adaptive and innovative and more and more health systems are using digital technology across the globe. However, for such initiatives to be successful, women and girls would need to access digital space without fear for their safety and privacy.

And while the government is in process of setting up policies that would alleviate future generations from the burdens of climate change and economic stress, all related to a high population growth, the problems that we face as a developing country are many. At this crucial time all actors including community networks, NGOs, philanthropists, human rights activists, academics need to work together so that we make up for the time lost, and fulfill our common goals.

Pathfinder International’s project Naya Qadam (NQ) in partnership with the government of Pakistan and five organizations – National Committee for Maternal and Neonatal Health, Greenstar, Ipas, Aahung, and Shirkat Gah – is aiming to increase access to post pregnancy family planning and ensure access to quality services and an expanded basket of choices for women and girls across six districts in Sindh and Punjab. This is being done at various levels: development of provincial policies, strengthening the DHIS to include more women’s health indicators, pre service and in-service trainings of providers and lady health workers and strengthening community referral mechanism.

According to the UN’s population prospects, Pakistan’s population will reach 243 million in 2025 and 400 million by 2050. Which means that we must respond to the growing demands soon, and this can only be achieved by a strong political will and in partnership with all concerned citizens.

Dr Tabinda Sarosh is the country director of Pathfinder International.

Manal Faheem Khan is the marketing, learning and communications manager of Pathfinder International.