January 8, 2004

Marie Stopes Society is one NGO that is committed to addressing the population problem Pakistan faces, writes Zia Mutaher

Sitting in a tiny meeting room on the second floor of the NGO Marie Stopes Society’s head office, I come face to face with Pakistan’s problem number one — population. Dr Mohsina Bilgrami the NGO’s managing director, spread out a fact sheet. My eyes pop out as I look at the figures.

With an average fertility rate of 4.3, our population is increasing at the rate of 2.1 per cent per year making Pakistan’s population of 148.6 million people the seventh largest in the world. But our adult literacy rate remains a low 47 per cent, our infant mortality rate — 84 per 1,000 live births — is the highest in the region and with our GNP per capita a paltry $470, 34 per cent of our people live below the poverty line, surviving at a mere one dollar per day. No doubt that 21 per cent of our population does not have access to safe drinking water and 44 per cent lives without proper sanitation.

“People just don’t see the link,” says Dr Bilgrami. “Our women are married at a young age, they bear several children. A high fertility rate causes a higher population growth rate. Every year we add 3.14 million people to our ranks. This equals the population of Faisalabad, Pakistan’s third largest city. Forty three per cent of our population is below 15 years of age. It needs to be provided with food, clothing, shelter, proper education and health care. Where do we have the resources to keep pace with an ever increasing demand? And it is here that we at Marie Stopes, are committed to make a dent.”

Sajid Imam Jafri, the external relations director, tells me that Marie Stopes Society (MSS) was registered as an independent NGO in Pakistan in 1990. It set out with the mission of improving the reproductive health of the country’s population. Until now 37 clinics have been established, all over the country. In Karachi alone there are seven clinics in low-income areas like Baldia, Korangi, Mehmoodabad and Orangi. Centres extend from Gwadar and Turbat in Mekran, to Dera Ismail Khan and Peshawar in the NWFP.

Services provided include information and education on reproductive health, provision of condoms and contraceptive pills to consenting couples, insertion and removal of Intra Uterine Contraceptive Device (IUCD), female sterilization (tubal ligation), male vasectomy, health and nutritional advice to expecting and lactating mothers, as well as immunization. Each clinic is staffed with a lady doctor and reproductive health workers, who are matriculate girls recruited from the community and imparted with six months’ training in family planning and reproductive health.

Services are both clinical as well as community based. Mobile teams visit remote areas and hold camps. These camps are organized in collaboration with the Family Planning Association of Pakistan, the Population Welfare and Health Departments and the local CBOs. The laboratories at each clinic are equipped with facilities for the screening of sexually transmitted infections. HIV screening facilities are also being set up.

The reproductive health workers are the front-line force, trained to overcome deep-rooted socio-cultural and gender barriers which prevent women from gaining access to reproductive health services. Twenty-one-year-old Shaheen Akhtar is one such member of the MSS team. Sharing her experience she says: “In the beginning I felt awkward talking about such issues and coaxing others to use contraceptive methods when I was myself unmarried. I was blamed for advocating what was against religious norms. But the confidence I acquired while working with the MSS team made my task less difficult.”

As a result of the hard work put in by young workers like Shaheen, the contraceptive prevalence rate in areas where MSS has established its community based distribution network has shown a remarkable increase. In Khairpur alone, it went up from five per cent to 28 per cent during the year 2002.

In recent years the focus has, however, shifted to increasing male participation, geared towards gender equity. With the appointment of male motivators, the number of male sterilization procedures (vasectomies) has gone up. Last year the Frontier saw its first vasectomy performed at an MSS centre. The target group includes young men and adolescent boys. Male motivators go from house-to-house, meet fathers having children under five years of age, as well as religious and community leaders. They distribute IEC (information, education, communication) material and hold awareness sessions. Then there are school-based activities, like debates and sports.

Such intensive efforts have brought about visible changes in perceptions and attitudes. Men are no more seen as just irresponsible users of contraceptives or transmitters of sexually transmitted diseases. Their role as partners, fathers, decisionmakers, community leaders, service providers and potential clients is being increasingly recognized.

Qazi Mohammad Shah, 37, is an example. A high school teacher, he has been married for 13 years and has three children. He concedes to having had information about contraceptive methods, prior to getting married. But he was strongly opposed to their use. Conceiving children was doing the will of God. Man had no right to interfere.

“But our honeymoon was over after the birth of our first two kids, one after the other. Every day I came home to a sick, irritable wife and two kids, clamouring for attention. I was caught up in a helpless situation. Just then, the Marie Stopes team approached me and tried to convince me to adopt family planning. Reluctantly I read their literature and realized that even our religion allowed spacing of children, by way of encouraging breast feeding. ” A content father, he is now a vocal advocate of family planning and reproductive health programmes.

ISO 9002 Certification has endorsed the quality of MSS’s services. Acquiring certification in 1999, MSS is the very first amongst service delivery organizations to have had its services thus acknowledged.

“This wouldn’t have been possible without a team of dedicated workers, committed to the cause of improved reproductive health for our nation,” adds a smiling Dr Bilgrami.

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