Lack of education and awareness has badly hampered our population control ambitions
“Family planning must not be seen as an instrument for population control or its management but an important intervention — public health intervention — covering all aspects of health,” says Dr Amy Ong Tsui, a known researcher and expert associated with Gates Institute for Population and Reproductive Health, Johns Hopkins School of Public Health.
Dr Amy was recently in Pakistan with regard to Johns Hopkins sponsored research-cum-evaluation project to assist contraceptive prevalence and public accessibility to related facilities offered by both public and private sectors.
When asked about the hurdles in the way of promoting the concept on strong lines among many of Afro-Asian nations, she observed that the isolation of family planning as a way to manage population has emerged as the biggest barrier.
On the contrary, it needs to be treated as a basic requirement of life like nutrition, housing, education — with direct bearing on physiological and psychological well-being of families.
Appreciative of the commitment reflected by present leadership in Pakistan, which is concidered to be supportive of family planning units and alive to the needs of reproductive health in the country, she observed that verticality of programmes that separate family planning from public health programmes do effect the intensity of the efforts that are required in countries with considerably high population growth rate and comparatively low contraceptive prevalence rate, which in Pakistan comes to around 20 to 28 per cent.
One of the largest developing countries with 142 million people, Pakistan’s population growth is an important issue in terms of macro-development. It is not only that the country’s growth rate is high, but it also holds an aging structure which may not be able to sustain itself at the existent level in the years ahead.
Answering a question regarding the importance of population policies, with particular reference to Pakistan, she opined that these are not only instrumental for programmes in terms of family well-being, but it also has a lot to do with the security a family enjoys in respect of health and economic well-being.
According to Dr Amy, a very important parameter of security is the status of women viz-a-viz men in any society. It is not that a family system that is patriarchal may necessarily be bad. But this hurts where illiteracy is prevalent, spectacle jointly shared by Pakistan and the thickly populated northern part of India, where education is often not offered to women, while education itself is a major impetus for social development of society in any country.
In societies with higher rates of illiteracy there has to be a slower response to population policy, Dr Amy observed. At the same time, she underscored the need to enhance the accessibility of local boys and girls to education. Education is after all not only a pre-requisite for women, but also for adult and adolescent members of families.
Restricted mobility of women, which prevents them from availing of the available health facilities, should be addressed through the provision of healthcare facilities for them and their child, at their doorsteps and this again could be arranged through strong linkages between non-profit groups.
In the same breath, Dr Amy observes that notions of family planning or reproductive health being non-affordable or out-of-reach have to be countered to make the programme success.
Against all odds she, however, did refer to a silver lining and that was with regards to the growing participation of the local male population in family planning programmes.
The contraceptive profile of Pakistan reflects two positive developments, she said, referring to gradual growth in the use of condoms and the practice of withdrawal.
Since condoms, withdrawal and vasectomy are three of the methods adopted by male populations, the trend in Pakistan suggests that men are taking active role in family planning programmes.
Male contraceptive techniques constituted one-third of all family planning modes used around the globe, a fact rarely mentioned in programmes introduced in Asia and Africa. Even vasectomy was identified to be very common in certain parts of Europe, United States of America — but rarely heard in family planning programmes in Asia and Africa.
In Pakistan, with growing male participation in application of contraceptive techniques, the researcher holding a vast experience of conducting research studies in Muslim world, opined that the attitude of men in a traditional society like Pakistan, is also due to the fact that guidance in the Holy Quran emphasizes male responsibility regarding his wife’s health, and this may actually be encouraging a male role in this.
To substantiate her observation she further elaborated that most of the surveys are women oriented which tended to under-report the use of withdrawal and condoms. And that there only a few surveys with men as respondents, making researchers realize this also as an important component of family planning.
Dr Amy reminded that Pakistani society has also become urban and the media is generally found to be communicative about healthy lifestyle. Men are more exposed to these messages due to higher literacy rates and different media habits. Moreover, being the bread earner, the man of the house may also be more conscious of the significance of amenities, including quality education, better housing and benefits which could be easier to procure through small number of children.
She contended that the emerging situation in Pakistan could be complimented through a strong partnership between public institutions and non-profit sector enabling society to take optimum benefit of changing trends at a point where people in general are willing to avail reproductive health services besides making conscious decisions about their family size.
There is a need for rural health workers to go out to villages and visit houses, providing the masses an updated information, good counselling and guiding them to proper referral. Various strategies can be implemented. Coupons, a strategy initiated in Taiwan, could be replicated in Pakistan, where the revenue generated through the promotion of contraceptive goods and related services, even the in private sector, is negligible as it is provided at subsidized rates.
In Pakistan where the desired family size is not high, ranging to be between three or four, the gap between demand and supply could be adequately bridged. The experience in Taiwan where, the healthcare provider was assigned the responsibility to identify potential contraceptive users and convince them to make use of it, any time they desired to do so, led to the development of close linkage among clients, health visitors and doctors.
In Pakistan, since the demographic base is rising at a much faster pace as compared to the available capacity of service as well as goods providers, a Contraceptive Security Issue may be emerging. This also appears to be a worldwide phenomenon as there are an estimated billion contraceptive users around the world and the number may double by the year 2025.
Dr Amy also noted that infertility is also an important aspect to be catered to under family planning umbrella. The motive of family planning is to achieve reproductive goals which include helping couples to achieve their desired family size.
Health education is after all the most important investment any government could make to protect the health of a society and this has to be continuous.
About the evaluation of family programmes and service delivery in Pakistan, Dr Amy said it was aimed at assessing the contribution made by both private and public sectors towards increasing contraceptive use in Pakistan and its enhancement in their respective capacities.
Lack of education and awareness has badly hampered our population control ambitions 
