KARACHI, Oct 22: Findings of a United States Agency for International Development-funded study on population and health issues presented a grim picture of planning, implementation, monitoring and evaluation of relevant programmes over the past many years across the country.
This was noted by the participants of a provincial dissemination seminar on the “Pakistan Demographic and Health Survey (PDHS), 2006-07”, held here on Wednesday. A similar survey was also conducted in 1990-91.
Representatives from the government and the private sector at the seminar expressed apprehension that the targets set by the country under the millennium development goals (MDGs) on improved maternal health and reduced child mortality rates were hard to be achieved by 2015, unless the government and the policy-makers, legislators and thousands of the social sector managers and executers joined hands together for a progressive and promising future.
The health survey finds a large gap between contraceptive knowledge and use among local population. While 96 per cent of married women across the country know about modern methods, only 22 per cent are using them. One in four married women has an unmet need for family planning.
The most widely-used method is female sterilization (eight per cent), followed by the use of condoms (seven per cent), while use of male sterilization and the more recently-introduced methods of implant are negligible. In Sindh, the current use of any method of contraception among married women of age 15-49 is 27 per cent, while the use of any modern method is 22 per cent.
The statistics show that there has been a decline in the total fertility rate from 5.4 children born to a mother in 1990-91 to 4.1 children in 2006-07, indicating a drop of one child in 16 years.
The survey reveals one third of the births take place within 24 months of the previous birth, the same proportion as in 1990-91, which can be cited for increased child mortalities.
More than nine of every 100 children die before their fifth birthday. The infant mortality (between birth and first birthday) in Sindh is found at 8.1 per cent while it is 7.8 per cent in the rest of the country. The maternal mortality rate in Sindh has been determined at 314 deaths in every 100,000. Twenty per cent of female deaths are attributed to maternal causes (complications of pregnancy, childbirth and post-birth six weeks). More than one third of deaths of women age 25-29 are due to maternal causes, more often taking places in rural areas.
The findings show that 35 per cent women receive no parental care at all during pregnancy. Almost three out of five women (ie 56 per cent) receive some parental care from a medical professional, commonly from a doctor. Half of the births are assisted by a dai (traditional birth attendant) while only 39 per cent of births are assisted by a skilled doctor, nurse, midwife or lady health visitor.
The survey finds that 47 per cent of children between 12 and 23 months receive all recommended vaccines, while in Sindh the rate of vaccination is 37 per cent against the Millennium Development Goal-IV requirement of 90 per cent in 2015.
Only 44 per cent of ever-married women have heard of Aids, the survey reveals. Knowledge of Aids (acquired immune deficiency syndrome) is the lowest in Balochistan where only 24 per cent women have heard of it. Only 20 per cent of the surveyed women know that HIV can be prevented by using condoms, while 31 per cent women understand that it can be prevented by having sex with only one uninfected partner.
Use of bed nets against mosquitoes is found quite low across the country. Only two per cent of children under five and two per cent of the pregnant women sleep under a net, according to the survey.
Sustainable input
Ghulam Akbar Bhutto, director-general of the provincial population welfare department, Syed Mubashir Ali of the Pakistan Demographic and Health Survey, Dr Zafarullah Gill of the TACMIL health project, Qamar Siddiqui of the NIPS, who were the key speakers at the seminar, called for adaptation of evidence-based high input activities and programmes that were sustainable with strategic approaches.
It was recommended that an improved service delivery infrastructure of family planning programme would reduce unmet need for family planning. It was also recommended that a body should be constituted to ensure provision of health system and facilitation in the context of management, technical aspects and human resource development for their smooth functioning. The speakers noted that while education would ensure a progressive future, coordination among all stakeholders working on health and population issues would help meet the challenges in reducing the child and maternal deaths.
During the question and answer session, a couple of the participants stressed the need for focusing on accountability and good governance, effective monitoring and evaluation, quality control mechanism, establishment of competency-based training programmes in education and health sectors.
They stressed that women be made aware of the importance of family planning to ensure better health of their children and themselves.
The US Consul-General in Karachi, Kay Anske, said that the nationwide survey results could be considered as the gold standard for all the household health surveys. This would help further more researches and identification of approaches to improve the health indicators of the country, which was a signatory to the UN’s millennium development goals.
“The survey helps both the government of Pakistan and donors to priorities their investments and efforts to address the most crucial problems affecting women and children,” the counsel-general observed.
MPA Humera Alwani said that situation pertaining to mother and child health could not be changed without joint and concerted efforts of all the stakeholders, including politicians and legislators. She was of the view that due to the unsecured and poorly implemented health programmes in the past the less educated and unprivileged women had no option for family planning. She also highlighted the importance of changing the mindset of husbands to control population growth.
The health survey was conducted under the aegis of ministry of population welfare and implemented by the National Institute of Population Studies. For the study, which was aimed at furnishing policy-makers and planners with detailed information on fertility, family planning, infant, child and adult mortality, maternal and child health, nutrition and knowledge of HIV/AIDS and other sexually-transmitted infections, the survey teams visited 972 sample points comprising 95,000 households across the country.
Dear visitor, the comments section is undergoing an overhaul and will return soon.