LAHORE: Pakistan’s unmet need for family planning remains as high as 38 per cent, resulting in a high number of unwanted pregnancies.

‘S’, 34, has five children and she and her husband cannot bring home enough money to support the family.

“I wanted to stop at two, maybe even three,” she confesses. “Unfortunately we did not do much planning.”

Finally in a campaign by an NGO a cleric of her community came to their house and sought a private meeting with her husband.

“He told me later that Maulana Sahib had told him that family planning was integral not just because of income issues, but also for the health of the child and the mother.”

Unmet need for contraception is only of the many problems that families face in a developing country like Pakistan. On the whole family planning comprises several aspects, all interlinked, whether it is malnutrition of mother and child, or birth spacing.

On the whole though there also exists a myth among several people, mostly from the lower socioeconomic classes as they have a propensity to be less educated, that religion itself encourages the birth of a baby and any interference in this process is considered ‘sinful’.

Since a long time now, the government is fully aware of this problem. But with the help of some other organisations, and working towards the Sustainable Development Goals (SDGs) it has come up with a solution to counter such a deadlock.

“The average family size is around four to five children,” says the director general of the Population Welfare Department (PWD). “The fact is that religious leaders have a hold over the community and if they speak about these things during their sermons, a lot can be achieved.”

The change is very slow, but it has begun to happen. After all the communities at grass root level must be told about the Infant Mortality Rate (IMR) and the Maternal Mortality Rate (MMR), one of the direct results of lack of family planning.

In every 1,000 babies born, 78 or 79 die. And although the overall number is decreasing (in 1990 there were 140 babies dying in every 1,000 births), the number is still very high. The same is the case with MMR as 178 women die in every 100,000 live births, pushing Pakistan’s ranking even lower from 146 to 149.

Prof Abdur Rehman Ludhianvi says that when he attended some training sessions he ended up learning a lot.

“We were told about early marriage, birth spacing, malnutrition among children, how a breastfed baby ends up as healthiest - above all how family planning is important to the health of both mother and child.”

Prof Ludhianvi says that being a teacher he already knew some of the problems associated with family planning but now after training by the government they have become important topics to him.

“Suddenly we began to pay attention to all these issues; I made it part of the curriculum there, and told other teachers also to spread the word. Now we treat it as a subject – a social issue,” he says.

But he admits that because religious leaders are mostly men, the target outreach audience is also that of men.

“Women too need to be exclusively taught about these things, so that when they become mothers, they have a clearer understanding of things. But less training is being given to women religious leaders.”

FP2020 is a global collaboration to empower women and girls by investing in rights-based family planning. But Naeemuddin Rathore says that Pakistan may not reach its targets.

“We do hope to increase the use of contraceptives but a lot of work has to be done here,” he says. “There have been some milestones however. Punjab’s growth rate has diminished drastically for example.”

He says the new government has a strong narrative revolving around family planning and other reproductive health issues.

Meanwhile, Allama Hassan Raza Baqir examines the challenges that the ulema have been facing.

“The Punjab government realised that the ulema must be included in their narrative when in the last tenure they issued an advertising campaign worth millions for ‘Kam Bachay Khushaal Gharana’, but was shot down in mosques because many clerics condemned it,” he says.

Today religious congregations such as Islamic conferences are a good portal where such issues are discussed – at least in subtle ways, and also in seminaries and other religious gatherings. Friday sermons comprise around 1,000 to 1,500 people, he says. But TV shows are good places where millions of people are reached at the same time.

“Change to be honest, is slow. But the biggest problem we face is that people will not listen if you are direct with them. They need to be given reasons for a smaller family.”

He says if the religious leader tells them of less children, it is met with suspicion of a ‘foreign agenda’ being advocated.

Pakistan’s population has been growing drastically and continues to do so. If effective methods are not derived to fight this problem, the results will soon be disastrous.

Published in Dawn, December 11th, 2018