Family planning is simply about giving parents a choice. A choice to decide on the number of children they want to have, the spacing between births and the timing of births. To achieve these certain contraceptive methods are used, treatments to terminate unintended pregnancies are also available.
World Health Organization (WHO) states that a female’s ability to space and limit pregnancies has a direct effect on her health and also on the outcome of her pregnancy.
United Nations Population Fund (UNFPA), previously known as United Nations Fund for Population Activates says that voluntary family planning is each individual’s right and family planning would lead to female empowerment and a significant reduction in poverty.
A Demographic Picture
In 1950s Pakistan was the thirteenth most populous country. Today Pakistan is the sixth most populous country and based on current trajectories, its population will double by 2050. These are alarming statistics. The table below gives a quick glance at the relevant fields of the current demographic situation in Pakistan.
These numbers are staggering. According to World Bank Pakistan’s population increased by 23 million from 1990 to 2008, which meant population growth of 54%, compared to India and Bangladesh with the growth of 34% and 38%, respectively, these are big numbers. (Desk, August 6, 2015)
Family Planning Futile in Pakistan
Almost one out of four births are unplanned in Pakistan. 25% of the married women have an unmet need for family planning, which is reflected by 890,000 abortions each year.
Only 2% of the women use least failure contraceptive devices such as oral contraceptive pills, implants and injections and intrauterine contraceptive devices.
Pakistan’s Contraceptive Prevalence Rate (CPR) is stagnant at 35% for the last decade, which is very low compared to Iran which has CPR of 73%, Turkey whose CPR is 73%, Morocco with CPR 63%, Indonesia 61%, Egypt 60%and Bangladesh 61%. (Pal, 2016)
Maternal problems are widespread and frequent in Pakistan. Around 260 women die each day due to preventable complications, either during pregnancy or during childbirth, and most of these pregnancies are unplanned or without proper spacing between childbirths.
Around 17 million women of Pakistan do not use any kind of family planning. Out of these 17 million women, 6 million women are those who want to use family planning, but either they are scared to bring up this topic in their homes or they do not have access to proper family planning or they have double, mostly misconceptions, about family planning. (Khan, 2012)
The Need To Involve Clergymen And Religious Influencers In The Process
Pakistan faces a lot of unusual constraints when it comes to this particular sphere. And among them, the number one is religious constraints. The incumbent government has taken a brave step to involve religious influencers in the process. Pakistan ranks among the top most religious countries in the world. So in majority’s life, religion plays a central role. To touch such a sensitive issue, it is impossible to expect results without indulging clergy in the process. It is imperative for them to play their role, aware the general public and educate them about family planning. Iran and Bangladesh, though had similar societal and religious dynamics to us, have successfully done it.
THE CASE OF BANGLADESH:
Bangladesh had a total fertility rate of 7 during the 1970s. This meant that Bangladesh was in serious trouble. Although several family planning organizations started in 1950s, while Bangladesh was still a part of Pakistan, but it was later during the 1970s that urgency of the problem dawned upon them and government decided to meet this problem head-on.
According to UNICEF Bangladesh had child mortality rate of 139 per 1000 live births in 1990, in 2011 it was 46 deaths per 1000 live births, which is a massive improvement. (Rizvi, 2014)
National Family Planning Program (FPP) was launched as a response to the rapid growth in population. With the help from WHO non-governmental organizations and government joined hands to raise awareness and emphasize on the dire need for family planning.
In 1978 government of Bangladesh started delivering family planning services through family welfare assistants. They basically reached out to the doorsteps on women in villages. This approach was a duplication of the example set by International Center for Diarrhea Disease Research (ICDDRB), which is also based in Bangladesh. ICDDRB had started on a similar program with the aim to reduce birth rate by sending out health workers on regular intervals to deliver messages about contraception, address any misconceptions about contraceptive methods and motivate the mothers to use contraception. Government understood the importance to these programs and decides to cooperate with these NGOs in order to reach the people at grass root level. (Kamal, 2013)
Between 1976 and 1980, 13,500 female family welfare assistants were hired and trained. Currently, there are about 28,000 such women working in their own or nearby villages; nearly three quarters of them are employed by the government. Majority of them have secondary schooling.
Another factor that helped a lot was that the religious clerics understood the problem and did not oppose family planning. (Sidney Ruth Schuler, 1992)
Pakistan can definitely find guidance from Bangladesh’s example. We face the similar problems, our religious, social, cultural and demographic backgrounds have a lot of similarities in them, so understanding examples would help Pakistan better understand the problems is in and will also help to find good viable solutions.
THE CASE OF IRAN:
Iran’s family planning situation is slightly different. Family Planning in Iran has had its ups and downs depending on different regimes prevailing. Iran experienced dramatic demographic changes in the last few decades. Childbearing levels declined faster than any other country, along with it maternal health and child health also improved greatly. These results have surprised many since Iran has a very traditional Islamic society.
This decline in fertility was primarily because of an increase in the use of contraceptive methods. In 1976 only 37% practiced family planning which increased to 74% in 2000. A major change in marriage patterns was also observed. In 1976 average age of mother for first birth was 19.7, which increased to 22.4 by 1996. (Roudi-Fahimi, 2002)
For Iran’s family planning program several new staff was recruited, trained and taught about family planning’s implications for public health and its critical role to the society.
Family planning became an integral part of maternal and child care health and services nationwide. Iranian media played a vital role in spreading the message to every part of Iran. Several seminars were held with the purpose to raise awareness for family planning, spacing between child bearing and contraceptive methods. In a press conference the minister of health and medical education reiterated the late Imam Khomeini’s fatwa regarding family planning, and announced that the Islamic Republic of Iran would establish a family planning program. By the end of 1988, the High Judicial Council declared that “there is no Islamic barrier to family planning.” (Roudi-Fahimi, 2002)
Both the countries have shown significant progress on the front and Pakistan can take inspiration from them to tackle the current emerging challenge.
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