How we grow

September 13, 2019

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Zubeida Mustafa
Zubeida Mustafa

MAHNOOR is 13 years. She studies in the afternoon shift of a school in Neelum Colony. Mahnoor is often late for class because she babysits her six-month-old brother. Her mother is a domestic worker and is away from home the whole day. Mahnoor can go to school only when her nine-year-old sibling returns home from his school to take charge of the baby.

The failure of population planning in Pakistan has robbed many Mahnoors of the joy of childhood and has impacted their education. It has also frustrated our policymakers who have another story to tell. The backlog of 22 million out-of-school children in the country may never be wiped out as 4m new aspirants join the list of admission seekers annually. The government’s capacity to open new schools is limited.

The fact is that Pakistan’s family planning programme is in the doldrums. The 2017 census should have been an eye-opener. Our population jumped to 208m from 130m in 1998. As a result, today Pakistan has the dubious distinction of being the sixth most populous state in the world.

I decided to investigate and that took me to Dr Sadiqua Jafarey, president of the National Committee for Maternal and Neon­atal Health. Always a reliable source of information, she was somewhat sceptical about progress in this sector. Her team has come up with innovative ideas on slowing down the birth rate (2.4 per cent) and increasing modern contraceptive prevalence (a measly 25pc) but the lack of effective implementation is frustrating. This is a formidable and multidimensional challenge, and I could see the disconnect between those who plan, advise and research (NCMNH) and those who execute. There is lack of will at the political level and apathy in the health sector that is now involved in the programme in a big way. The less said about the Population Welfare Department the better. The media is silent.

The failure of population control has robbed many of the joys of childhood.

Above all, resistance has resurfaced from the orthodoxy that has also seeped into a large number of medical practitioners. In this case, many obstetricians and gynaecologists do not show the commitment to fight back.

Ironically, the four demographic and health surveys held regularly since 1990 have shown that most women and men do not oppose family planning on religious grounds as is widely believed. Some doctors I spoke to cast doubts on the data recorded in the surveys. They claimed to know the reality on the ground as they are dealing with it day after day.

Hospitals are crowded and doctors — that is those who work (as someone said) — are overworked and tired. One even said she doesn’t invest time in counselling as she has had bitter experiences.

But others seem to be committed. They admitted there were problems mainly because of the myths surrounding contraceptives. Yet they spend time counselling women and even succeed, but within their limited sphere only.

Another factor that came up was that of corruption and mismanagement in the population programme, now preponderantly funded by foreign donors. A recent Popula­tion Council report appeared to confirm this suspicion. It said that $81m is spent every year on contraceptives in Pakistan, yet 3.8m mothers end up with unwanted pregnancies. If full cover is to be provided, another $92m is needed. This explains the shortage of contraceptives in public-sector hospitals which all doctors I spoke to complained of.

We are back to square one. The emphasis on mobilisation, motivation and engagement of all sectors of government in the programme that marked the policy many decades ago is now dead. One doesn’t hear of health workers going from door to door to create public awareness in men and women about family planning or to deliver contraceptives. I am told that male motivators are now being trained.

This is an example of regression. The status of women, which determines the success or failure of the family planning programme, is on the decline. Social and cultural prejudices have left a huge mass of women without any recognition of their reproductive rights. The most reliable indicator of this is Pakistan’s unnatural gender ratio: men outnumber women.

Since men are perceived to be the privileged sex, they are exempted from all birth control responsibilities. The programme also directs its focus mainly on women, and according to Family Planning 2020, only 33pc acceptors are men. Vasectomies are minimal, not deserving a mention. IUDs, injectables, implants and pills preponderantly provide protection to women.

We need to re-launch a movement to give women control over their bodies and involve men in it. Hindsight and experience should help us do better this time. The vital factor to be kept in mind is the importance of an integrated approach. Not only should men and women be equally engaged in this discourse, the focus should also be on the dignity of both.

www.zubeidamustafa.com

Published in Dawn, September 13th, 2019