PAKISTAN: Urgent need for better family planning - experts

Photo: Kamila Hyat/IRIN

A quarter of married women in Pakistan who want to end childbearing, or space their births, do not use contraception

KARACHI, 6 January 2009 (IRIN) - Pakistan’s rapidly increasing population is placing severe strains on economic resources, development and security, say experts who are urgently calling for more effective family planning.

"The population challenge is the biggest threat facing Pakistan," said Farid Midhet from the Safe Motherhood Pakistan Alliance. "Imagine a Pakistan with nearly 300 million people!"

In 1950 Pakistan had a population of 37 million and was the world's 13th largest country. By 2007 it was the sixth largest country with 164 million people. Pakistan is projected by the UN to move to fifth place in 2050 with 292 million people, after India, China, the USA and Indonesia.

"Everything depends on population: the economy, security, progress, values, culture," said Midhet.

According to him, a proportionate increase in the number of young people of working age relative to children and the elderly played a significant role in the development of Asia's top 10 countries.

However, there is a flip side: "If a country cannot use the youth productively, and there are a lack of opportunities for education and employment, it leads to frustration, increased crime, etc," he said.

Midhet is conducting a study to compare Pakistan's mother, neonatal and child health (MNCH) indicators with those of South Asia and sub-Saharan Africa.

Forty percent of Pakistan's population is below the age of 25. Last week, Prime Minister Yusuf Raza Gilani said: "We have to give education, create jobs and provide opportunities to youth to stop them from falling victim to terrorism and extremism, as vested interests want to use them against the country".

Photo: Zofeen Ebrahim/IRIN

Some experts blame the country's stagnating family planning programme for developmental and security challenges

Stagnating family planning programme

Some link the country's stagnating family planning (FP) programme to developmental and security challenges.

According to the Pakistan Demographic and Health Survey (DHS) 2006-07 FP services are out of reach for millions of Pakistanis. A quarter of married women who want to end childbearing, or space their births, do not use contraception, although 96 percent are aware of at least one modern method of contraception.

Most women want four children. In such circumstances, providing FP services to the general population may be an uphill task, specialists say.

Pakistan saw a surge in contraceptive use in the 1980 and 1990s. But it has reached a plateau in recent years. Twelve percent of couples used contraceptives in 1990-91. This increased to 28 percent in 2000-01 and has remained at around 30 percent since then, according to experts.

Midhet blames "poor quality" programmes, the rule of Gen Zia ul-Haq (1977-88) and the lack of serious government efforts to promote FP.

Lady Health Workers programme “hijacked”

A flagship programme, the Lady Health Workers programme launched in 1994, was seen as a promise to deliver both FP and basic healthcare to the doorstep.

Photo: IRIN

Lady health workers make house to house visits in an effort to detect problems faced by pregnant women

"It started off on a very promising note," agreed Talat Rizvi, the brains behind the programme. "But as with all programmes, this too was hijacked. Because its forte was outreach and had a well laid out infrastructure, the same women were used for other programmes, including campaigns on TB, malaria and polio. This consumed their time and energy."

The only way out of the present stagnation is to merge the ministries of population and health, said Rizvi. "This has been suggested for years. An FP package should be offered as part of a total MNCH package of services.”

"There is no need for a Ministry of Population. If a woman comes for child immunisation, take that opportunity to counsel her on spacing her pregnancies; invest all the money that comes under FP in female education. FP is not a passive activity. A woman has to be fully aware and take responsibility, but she cannot do this unless she is educated,” he said.

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