Family planning is the foundation for women empowerment. It is a priority health issue for women. Currently, one in every five woman would want to use contraceptives but does not have access to them.
Expansion of family planning information and services remains a challenge as Pakistan acknowledges at the London Summit that all citizens are entitled to high quality Family Planning (FP) information.
The five commitments Pakistan made at the London Summit 2017, were to raise the CPR (contraceptive prevalence rate) to 50 per cent by 2020, offer greater contraceptive choices, better counseling and expanding the use of long acting reversible methods, expand the programme focus by providing services and information to men and gatekeepers, focus on addressing the FP service needs of nearly 100,000 married adolescent girls aged 15-19 and raise the spending on FP to $2.50 per capita by 2020.
CPR goals for 2020 for Punjab is 55 per cent, Sindh 45 per cent, KP 42 per cent and Balochistan 42 per cent.
At a moot organised by the Population Council of Pakistan on the Population Day, representatives of all the four chief ministers presented what their province is doing, according to which: In Sindh the budget for family planning has gone up five times in the last five years. There is a pilot project going on life-skills based education in which the education department is a partner. The Sindh government is reaching out to adolescent girls, moving towards longer acting methods of contraception. The CPR target in Sindh is 45 per cent. At present the CPR is 33 per cent there. Twenty two organisations are working in collaboration with Population Welfare Department of Sindh. Shahnaz Wazir Ali was representing Sindh CM.
In Punjab social mobilisers are active — reaching out to men and elders. The focus is on expansion of service provision. Dr Mukhtar Ahmad, Minister Population Punjab, spoke for Punjab.
In Khyber Pakhtunkhwa, the focus is on rural areas. The CM representative from KP Shaukat Yousafzai underlined the need to interact with the people to convince them for family planning.
Dr Zeba Sathar, Country Director Population Council of Pakistan, says contraceptives prevalence rate is the lowest in Pakistan — 35 per cent. “The pace at which we are going we will achieve 47 per cent CPR. We need more push. We need to introduce new method mix. Our programme is doctor driven. We need to bring it to lower level,” she said at a conference on World Population Day 2017.
The lower level is midwife — crucial to reduction in maternal mortality rate. Everywhere in the world normal deliveries (98.6 pc) are handled by midwives. “In Pakistan to a doctor a midwife has a very low stature.”
“She welcomes a new person in this world every time she attends to a delivery. In the West all work is respectable. In urban centres midwives do not get a chance to actually deliver babies while they are supposed to deliver 25 babies during their training. That is not happening,” says Basharat Naseer, President of Midwifery Association, Lahore chapter.
“So many girls are getting certificates without delivering a baby. It is important to train them in the relevant skills to bring the mortality rate down. Whosoever is a nurse, is also a trained midwife. There are community midwives (CMWs), lady health visitors (LHVs) and people midwife which is being merged in CMW.”
“In government’s healthcare team there is a doctor, a nurse, a pharmacist — why not a midwife? Let everybody do their part. Every member of health team is important in their own right,” says Basharat Naseer.
“In the west there is one midwife for every mother so no mother dies of APH (Antepartum haemorrhage), PPH (Primary postpartum haemorrhage) or eclampsia,” she says. Basharat Naseer has organised many trainings for midwives. “Now mothers do not die from PPH.”
“At least there should be one midwife for 100 mothers. Ideally, there should be one midwife in every three kilometers radius. That is not there. It is important to make her available 24 hours in every community,” she says. Naseer underlines the importance of training midwives and lady health workers who can make a great difference. A midwife can open a clinic but they do not know.
Naseer has helped some of them open maternity homes which have been received well by the women in these localities.
“Whatever work has been done in Punjab has been done by Chief Minister Shahbaz Sharif and there is a lot of improvement,” says Naseer. Still without provision of family planning and delivery services in the rural areas, we cannot make a difference. “All basic health units (BHUs) and rural health centres (RHCs) need to be made functional to save mothers from dying. Transportation is also an issue,” Naseer stresses.
In every hospital the gynae department receives patients in hundreds every day. Naseer, who is committed to midwifery and saving mothers’ lives, arranges trainings for midwives. Recently, she trained 250 girls in placing Copper-T “which requires skill, knowledge and attitude.”
The key problems of the population are personal hygiene, sexually transmitted diseases and family planning. Women don’t know how to prevent pregnancy. Health professionals come across women who resort to strange tricks to avert that. One of them told me that a woman came with a wood placed inside to block pregnancy, another with a piece of metal inside her to prevent conception. The foreign elements were taken out of their body and they were saved.
Teaching people cleanliness is important, in whose absence complaint of being unable to get up and walk after sleeping with husband is common. Health workers tell women to ask their husbands to do wuzu before going to bed and do the same themselves.
The poor women who do not know how to prevent pregnancy find abortion easy. Abortion is illegal, only untrained people are doing it. This increases the risk to life, results in health complications and sometimes death. Naseer says there is need to “involve community women in policy making.”
Population Council report “Pakistan 2017, Progress and Commitments in Family Planning” puts unwanted pregnancies in the country at five million. An estimated two million are resorting to abortion every year. The report says, “If all women with unmet need and users of the less reliable traditional methods were able to use modern contraceptives, there would be 9.2 million additional users of modern contraceptives in the country.”
Family planning is crucial for combating poverty and realising Pakistan’s economic, social, and political potential.