16 December 2004	Thursday	03 Ziqa'ad 1425

KARACHI, Dec 15: Speakers of a panel discussion at the international population and research development conference on Wednesday expressed the view that capacity and resource constraints in population and reproductive health could be overcome by doing away with the donors' driven policies and depending on local research and commitment.

The discussion was held, in addition to four scientific sessions and poster session, as part of the three-day conference of the Pakistan Association of Pakistan on "Sharing population and development research across South and West Asia", organized by the Sociology Department of Karachi University.

Dr Ghazala Mahmood of the Pakistan Institute of Medical Sciences said that there was no regular system for capacity building of different institutions working in the areas of population welfare and reproductive health. She called for in-service training of paramedics, involvement of community in order to cope up with the reproduction health problem at grassroots level.

Dr Muhammad Hafeez of the University of Punjab said that capacity constraints were related to priorities which were largely donor driven, short-term and crises-oriented.

He remarked that in view of the foreign donors' phenomena government attached not very much importance to population researches and studies, which was a major obstacle in understanding the country's population problems, having an integrated and holistic review of the demographic structures and projected goals in the population sector.

Another panellist, Afsheen Ahmad of Pavhna, said that NGOs should turn proactive instead of crises-driven. She stressed the need for understanding funding mechanism for projects and having a more decentralized structure.

Peter C. Miller of the Population Council, Islamabad, noted that in addition to physical and financial constraints, institutions working in the population sector were also facing intellectual constraints.

He called for building capacity of knowledge and care for its management, as according to him organizations most of the time did not know what to do with the knowledge coming in, available around or going out.

A former senior official of the federal government, Muzaffar Mahmood Qureshi, suggested for undertaking the population works through activists at district level. At the same time, he suggested that the service providers should be motivated and efforts should be made for a behavioural change of the community.

The moderator of the panel discussion, Dr Mehtab S. Karim of the AKU, said that there was need to educate people about family planning practices, and share the related knowledge available with the countries of the region, including India, Bangladesh, Iran and Nepal. Dr Elmar-Vinh Thomas of the David and Lucile Packard Foundation chaired the session.

In her presentation at a scientific session on "fertility and family planning", Unnati Rani Saha of Bangladesh summed up the discussion by saying that discontinuation of contraceptive use had been identified as a major contributor to the stagnation of the total fertility rate at 3.3 births per woman, while on the other hand switching of methods also resulted in unwanted pregnancies.

She found that discontinuation was significantly related to the contraceptive method, duration of use, incidence of side effects, education of woman and her religion.

Follow up and lack of quality care were associated with switching of methods, she added, emphasizing on quality of care, as well as providing supplementary vitamins to the vulnerable groups to overcome the effect of malnutrition.

In another presentation, Paramita Dutta of India discussed the relation between quality of family planning services, contraceptive switching and discontinuation in different India states. She said that acceptance of contraception was very poor in the demographically backward states, including Uttar Pradesh, Bihar, and Rajasthan.

According to her findings, the highest proportion of never users of contraceptives were staying in Uttar Pradesh, while as compared to other states highest proportion, i.e. 78.9 per cent, of women in West Bengal were ever users. She noted that in all the states highest proportion of women opted sterilization as a method of permanent contraception.

She said that contraceptive decision-making was a complex process in which person considered various factors, including the context of their lives, both familial and personal, as well as the psychological and physical ease with which they could obtain and use contraceptives.

Another population scientist from India, Aparajita Chattopadhyay, said that among the demographic issues, the Hindu-Muslim fertility differential had been a subject of intense preoccupation in recent times.

Desire for son, which is almost unanimous irrespective of castes, creeds and states in India, contradicted with family planning, she added, saying that as safeguard against infant mortality, couples reproduced more and until the ideal sex composition of children was achieved, which was generally skewed for sons, couples willingly did not stop reproduction in majority of cases.

Dr Neelofar Sami said that about 10 to 15 per cent of the couples globally were infertile and secondary infertility outnumbered the primary. She said that infertility in Pakistan was 22 per cent, primary was four per cent and secondary infertility was about 18 per cent.

In Karachi, she said that out of 4,500 women surveyed for her research, 212 reported that they had never been pregnant, thus suggesting the prevalence of primary fertility of 4.7 percent.

Of the 400 suffering from secondary fertility, about two-third (i.e. 64.7 per cent) women were below 30 years of age, about 16 per cent were aged between 31 and 34 years and 20 per cent were from 35 to 38 years of age.

She said social consequences of infertility was that more than two-third of women reported that secondary fertility had affected the inter-spousal relationship negatively, while it was also responsible as cause of argument between the couple in day-to-day life.

She recommended that people in general and infertile couples in particular be provided with appropriate information regarding causes of infertility and either of partner could be responsible for that and it was important to investigate both partners.