PAKISTAN: Softly softly on family planning messages
KARACHI, 25 June 2009 (IRIN) - Getting the family planning message out among the estimated two million internally displaced persons (IDPs) in North West Frontier Province (NWFP) has not been a top priority, according to a senior health official from Punjab Province.
Islam Zafar, director of health in the province, is currently leading a team of 140 paramedics running a hospital for IDPs in Mardan District, NWFP.
“We’re trying not to topple the applecart by promoting family planning messages [among IDPs],” he said.
Doctors had been concentrating on saving lives, obstetric care and immunization activities rather than taking up “the more culturally and religiously sensitive” issue of contraceptives, Zafar said.
“It is not easy to work in this conservative area and we must not be seen as interfering with their culture,” he added.
The Mardan Medical Complex, where Zafar and his team are working, was opened on 20 May, and has a state-of-the-art-gynaecological ward. In part this is the result of efforts by the Punjab chief minister, Shahbaz Sharif, to boost quality healthcare for IDPs, especially mothers and children.
According to the Reproductive Health and Family Planning Survey conducted in 2000-01 by Pakistan’s National Institute of Population Studies, Pakistan’s fertility rate was estimated at 4.8 (the average number of children born to a woman over her lifetime), with a slightly higher figure (5.1) for NWFP.
Some experts say high maternal and child mortality rates are related to high fertility rates and poor access to health services before and during deliveries.
Missed opportunity?
Khalid Khan, a UN Population Fund (UNFPA) district project officer working with IDPs, described the current IDP situation with regard to family planning as “a missed opportunity”.
It has not been possible to “actively” promote family planning (FP) practices in the more than 20 camps because medical staff did not want to “face unnecessary resistance” from the IDPs, many of whom are not accustomed to discuss the issue openly, Khan said.
“The cultural and religious taboos stop us from actively promoting this.”
However, UNFPA is working with the NWFP government’s Population Welfare Department to provide services to all those seeking them. It has a well-equipped pharmacy in Yar Hussain camp, in Swabi District, not far from Mardan, where all kinds of contraceptives - injectibles, intrauterine contraceptive devices (IUCDs), pills and condoms - are available, according to Khan.
“Some women have come to us for injections, some for insertion of the IUCD and some for pills,” said Tahera Bano, a lady health visitor working with UNFPA at Yar Hussain camp.
She said some female IDPs were familiar with various contraceptive methods but not aware that contraceptives and advice were available for free in the camps. Around 24,000 IDPs are believed to be living in Yar Hussain camp.
Dilraz Khakistar is a UNFPA female welfare councillor at the camp and her job is to go round the tents and try and talk to women about FP methods.
“In between encouraging them to come for antenatal and postnatal checkups, and vaccinations, I slide in FP messages too,” she said, adding: “All my efforts come to nothing when women turn around and say they want to have 5-10 children.”
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