family planning in pakistan

7/29/2019 family planning in pakistan

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By the end of the session,

participants will be able to:

Define Family Planning (FP) and

related terms.

Briefly describe how Family

Planning contributes to the MDGs. Describe the evolution of Family

Planning interventions from 1947

to present.

Illustrate vital trends (situational

analysis) in health indicators

related to Family Planning.

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Continued

Discuss the role of funding

agencies, public sector, and privatesector in implementation.

Sensitize the unmet needs of

vulnerable population.

List the program shortcomings in

Pakistan.

List a few recommendations for

health reforms.

Illustrate one key paper.

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FAMILY PLANNING -

DefinitionFamily planning allows individuals and couples

to anticipate and attain their desired number of

children and the spacing and timing of their

births. It is achieved through use of contraceptivemethods and the treatment of involuntary

infertility. A womans ability to space and limit

her pregnancies has a direct impacton her health

and well-being as well as on the outcome of each

pregnancy.

(WHO. Family Planning. http://www.who.int/topics/family_planning/en/ (accessed 12 November 2012).)

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FP directly promotes Millennium DevelopmentGoals 3 through 8

MDG 3: Promote Gender Equality and EmpowerWomen

MDG 4: Reduce Child Mortality

MDG 5: Improve Maternal Health

MDG 6: Combat HIV/AIDS, Malaria and OtherDiseases

MDG 7: Ensure Environmental Stability

MDG 8: Develop a Global Partnership forDevelopment

FAMILY PLANNING -

Importance

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MDG 1: Eradicate Extreme Poverty and Hunger

MDG 2: Achieve Universal Primary Education

FAMILY PLANNING -

Importance

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7/39BACKGROUND


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FERTILITY DECLINE

At the inception of populationprogram Pakistans fertilitydecline rate (6.6 births perwoman) was between Indias(5.9) and Irans (7) but

experienced fertility decline theslowest in the region (1990s).

Pakistans total fertility rate (TFR)is one birth more than India and

Bangladesh and two births morethan Irans TFR.

With current TFR rate Pakistan isset to reach the proposed 2020goals ten years even later.

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FERTILITY REGULATION

Contraceptive Prevalence:

Contraceptive Prevalence rates

in Pakistan remained relatively

below 10 % during the seventies

but increased significantly by

1990s to almost 28 %. CPR

increased from 21 % in 1991 to

49 % in 2007 amongst married

women. Use of contraceptivesin rural areas has increased over

the past two decades still lacks

behind significantly.

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The Contraceptive Prevalence Rate (CPR) is 30% inPakistan a figure that has virtually remained thesame over the last decade which is

considerably low as compared to other Muslimcountries. Iran has 74 % CPR, Turkey 71%,Morocco 63%, Indonesia 61%, Egypt 60%,Bangladesh 56% and Malaysia, 55%.

SOURCE: Sadiah Ahsan Pal. Family planning: Pakistan still has a long way to go.http://tribune.com.pk/story/442532/family-planning-pakistan-still-has-a-long-way-to-go/ (accessed 5th November 2012).


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SOURCE: National Institute of Population Studies (NIPS) [Pakistan] and

Macro International Inc. 2008. Pakistan Demographic and Health Survey2006-07. Islamabad: NIPS and Macro International Inc.


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Induced Abortions: Induced abortions being

illegal still prevail with an estimate figure of

890,000 in 2002. On a rough scale every 29 of

1000 pregnancies end up with induced

abortions. This trend is heavily exercised by

women bearing more than three children.


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UNMET NEED

In 1991, 40% women wanted to limitchildbearing, in 2007 it increased to 52%.

Although more than 50 percent of women wish tolimit childbearing and around 20 percent wish tospace their next birth, only 30 percent are usingcontraception, indicating unmet needs.

The proportion of recent births that areunplanned rose from 21 percent in 1990-91 to 24

percent in 2006-07 which lead to potentiallyunsafe abortions. These problems are evenintense in rural areas.

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UNMET NEED

Rahnuma-FPAP President Mehtab Akbar Rashdi

said that London Summit will be the largest

family planning event where 69 poorest

countries with HIGHEST UNMET NEED offamily planning will participate.

Unfortunately, Pakistan is one of them.

SOURCE: Myra Imran. Pakistan has worst family planning indicators in the

region. http://www.thenews.com.pk/Todays-News-6-112757-Pakistan-

has-worst-family-planning-indicators-in-the-region (accessed 5th

November 2012).

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Out of those women who opt against contraception, 28% choose to do so by leaving it to God.

This reason is closely followed by opposition fromhusbands;

fear of side-effects;

and lack of knowledge.

Only 5% have a perceived religious prohibition.

SOURCE: Sadiah Ahsan Pal. Family planning: Pakistan still has a long way to go.http://tribune.com.pk/story/442532/family-planning-pakistan-still-has-a-long-way-to-go/ (accessed 5th November 2012).

UNMET NEED

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Vulnerable Group POOR!

Fertility rates in Pakistan vary by womens educationand household wealth status.

Women across all wealth circles desired for lesserchildbearing in 2007 than 1991, but richer women used

contraceptives much more to prevent such cases. Thisgap of contraception usage has raised alarminglybetween women of different wealth status over thepast decade.

Unmet needs during 1991 stood better for poor

women but lack of contraceptive usage in comparisonof desire to limit childbearing takes it to 30% whileunmet needs of richer women are practicallynonexistent.

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LACK OF ACCESS

Access to FP services in Pakistan varies from urban torural areas.

It takes 40 minutes on average to reach a RH facility inurban areas while it takes 96 minutes in rural areas.(1991 DHS)

Distressingly, the amount of poor population in ruralareas is far higher causing lack of contraceptive usageand superfluous childbearing.

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QUALITY OF SERVICES

Quality of FP services remainsa huge block in the path ofapplying population policies.

It is found that over time

increasing numbers ofwomen have reportedfear ofside effects and healthconcerns as their primaryreason for not intending touse contraception in thefuture both in urban and ruralareas.

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The National Programme for Family

Planning & Primary Health Care

Also known as the Lady Health WorkersProgramme (LHWP) was launched in 1994 by theGovernment of Pakistan.

The Lady Health Worker Model: employment ofover 100,000 Lady Health Workers (LHWs).

Recruitment and trainings: First Level of CareFacility (FLCF).

Scope of work: 1 LHW = 1000 person/150 homes.

Supervision and monitoring: Lady HealthSupervisors and Field Program Officers.

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The National Programme for Family

Planning & Primary Health Care

4th third party evaluation:

LHWs play a substantial role in preventive andpromotive care and in delivering some of the

basic curative care in their communities, as wellas providing a link to emergency and referralcare.

It also concluded that LHWProgramme hassignificant impact on the population it servesand it has maintained the impact despitesignificant expansion of the Programme (OxfordPolicy Management: 2009)

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CURRENT SITUATION


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CONTRACEPTIVE PROCUREMENT

Directorate of Procurement

Material and Equipment (PME).

Expected to increase from

reported 8.4 million in 2008-09

to 10.8 million in 2014-15. Dependant on international

funds.

Local manufacturing of pills and

injectables is already underway

and feasibility studies are under

consideration for establishing

IUD/CU-T manufacturing units in

Pakistan.

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FUNDING STREAMS

Funds were primarily producedby Federal government andthen distributed to provinces.

Shift in international funds

from FP to RH in 1990s and toHIV/AIDS recently hasdamaged the progress of theFP program.

Major funding is provided by

KFW, UNFPA and USAID. Bulk of these funds are used in

social marketing acquiringcontraceptives.

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PUBLIC PRIVATE PARTNERSHIPS

Social Marketing NGOs and CBOs

Public-Private Sector Organizations (PPSOs)/Target

Group Institutions (TGIs)

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CURRENT SOCIO-ECONOMIC FACTORS

Economic growth but Low Education:

economic growth progress in social sector neglect of education + low social growth.

Agrarian country44% employment fromagriculture.

Low focus on educational aids to use FP Services.

Past 2 decades increased primary education , lowsecondary education.

Literacy rate 53% (poorest/lowest rate)

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CURRENT SOCIO-ECONOMIC FACTORS

Low Participation of Women in Society: maledominated societyimpedes women to use FPservices.

RH and FP Survey 2003, one in three women was

not allowed to leave her home alone and 42% ofwomen who were able to go to health centers ontheir own were using contraception compared tohalf that proportion. 21%, who were not allowed

to go to these facilities at all. Pakistan has the highest gender gap in labor

force: women employment (19% from 13%).

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PROGRAM SHORTCOMINGS The Population Policy (2002) was strong in principles but frail in

application. No Proper planning before starting new programs.

Instead of introducing new programs and addressing latest issues

only old plans were reinforced.

Expansion ofFP services remained restricted to urban areas. Use

of contraceptives remained confined to urban areas throughorganizations such as Key and Greenstar Social Marketing.

Lack of Understanding of Population Issues: Politicians,

bureaucrats and other organizations have rarely considered

population a huge issue.

Other public-officials hesitate from even discussing it due to

religious pressures.

Provinces often support population growth to get handed with

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RECOMMENDATIONS


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FEMALE EDUCATION

Without making education accessible to all

corners of the society; particularly women

CPR of global standards cant be achieved in

the long run. Women education can lead toPakistans transformation from agrarian

society to an industrialized base where gender

roles, abilities and powers will be workedmore imperatively leading to better

implementation of FP policies and RH services.

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ROLE OF STAKEHOLDERS

The economic and finance partners, including theMinistry of Finance who need to understand thateconomic growth is directly proportional to betterFP services.

The health partners: Improving FP and RH servicesby working together and putting organizationalefforts would further helpprivate andpublicproviders of health services in their own goals.

International Community and Donors need to

emphasize on FP services along with other medicalaids as it can help reducing those medical issues inthe future. Furthermore, they must use thisopportunity to help Pakistan when it eagerly wants

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OWNERSHIP TO STRENGTHEN PROGRAM

GOVERNANCE: FP services in Pakistan can onlyimprove if responsibilities are fully owned by people,organizations and authorities.

SERVICE DELIVERY of family planning services at allhealth outlets; with population welfare outlets playing

a complementary and specialized role. COORDINATION: Strong body to steer, assist and

coordinate the role of the private and not-for-profitsector.

ACCESS & EQUITY: Maximum number of NGOs andCBOs providing services in areas whereunderprivileged, hard to reach populations are located.

Strong MONITORING and oversight role at the centerbut withfull participation of provinces.

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KEY PAPER

Karen Hardee, Elizabeth Leahy.

Population, Fertility, and Family

Planning in Pakistan: A Program in

Stagnation. Population Action

International.October 2008;3(3)


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Working toward success

in family planning

programming is partscience and part art.

(http://www.populationreports.org/j57/j57.pdf)

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family planning in pakistan

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