IF the floods were a natural calamity, Pakistan’s population explosion is no less than a man-made disaster. Dr Shershah Syed, a well-known gynaecologist, estimates that there are 75,000 pregnant women in Sindh’s flood-affected areas who need antenatal care.
This is not surprising. It has been conclusively observed that fertility rates are closely linked with the status of women, female education and employment. Pakistan Health and Demographic Surveys have also established this connection.
How can Pakistan’s runaway population be controlled? I set out to look for the answer. Some months ago, I had read in the Journal of the Pakistan Medical Association that in an experimental project of the Akhter Hameed Khan Foundation (AHK Foundation), Islamabad, it had been demonstrated that the population growth rate could be reduced through intelligent and dignified intervention. Dr Ayesha Khan set up a resource centre in 2010 to propagate her father’s philosophy. It transitioned in 2016 into an urban research and action lab to test models for economic health pilots. She found in the course of her research that urban slums could be drivers of prosperity if the right conditions were created for women.
The project was launched in a low-income locality of Rawalpindi with a population of 248,000 (45,000 families). The community comprised predominantly day labourers with 37,000 married women of reproductive age participating in the survey. The focus was mainly on girls and women but included 30 per cent men and boys too.
A large number of women have no access to contraceptives.
The women were engaged in nano-micro enterprises and businesses. Girls were drawn into digital and financial literacy along with routine schooling. Married and about-to-be-married couples were given access and information on good reproductive and family planning choices.
Dr Ayesha Khan is satisfied with the results of her pilot. The contraceptive prevalence rate for modern methods stood at 46pc, an increase of 13pc. Pakistan’s CPR stands at 30pc, the increase rate being 0.5pc.
The secret of success of the AHK Foundation’s project is that women are treated with great dignity and their voices heard with sensitivity. When given a choice in the matter of contraceptives, couples/women respond. They are willing to plan their families if their needs are met.
For this, the foundation has initiated the ‘Aapis’ — sisters — programme in Rawalpindi (funded by a Punjab government grant). The aapis are the crucial element.
Dr Khan observes there is clear evidence that if demand and supply sides match, the population growth rate will slow down. This is a significant observation as many surveys have shown that the ‘unmet need’ in Pakistan is stupendously high as a large number of women who want to use birth control methods have no access to contraceptives. This is a violation of a citizen’s fundamental right to reproductive health. Corruption and ineptitude have ensured the failure of the supply side. The demand side should also be boosted as the process of changing mindsets is the slower factor. It depends on intangible factors such as appropriate ‘conversation’ with the community and a relationship of trust between the two sides. In the project, the aapis are designed to play a key role in this process.
Dr Khan tells me that AHK Foundation method is based on the development philosophy of Akhter Hameed Khan and the OPP model as he developed it in 1980. The model believes that women/communities know their problems and the solutions. It is thus important to listen to them carefully. Supportive NGOs/CBOs can facilitate them through mobilisation, technical resources and collective linkages to existing services and systems.
These linkages are based on different factors in rural and urban settings. Thus in Kheiro Dero in Larkana, the Ali Hasan Mangi Memorial Trust launched its population programme more than a decade after it was established. Its health workers tell me that they don’t have to create ties on the basis of personal connections. The AHMMT is so well known that they gain easy entry into any household on the basis of their being AHMMT health workers.
The AHMMT with its holistic approach has provided development to the people. They owe to the trust the houses they live in with solar panels and water pumps. The trust also caters to their healthcare needs at its clinic and provides early schooling to children at the community school and has gifted a park where children play. So anyone coming from AHMMT can be trusted.
Besides the health workers are trained and take good care of women if any are taken for tubal ligation. In fact, once when a patient had tubal ligation and was in discomfort the next day and had nothing to eat, the health worker even brought her some food to restore her strength. For the women of the community, such a woman had to be trusted and she could never give wrong advice. Above all, she listens carefully.
Published in Dawn, November 4th, 2022