ISLAMABAD: As the 7th census put the country’s population growth rate at 2.8pc, family planning initiatives have started to get traction, beginning with a project costing over Rs35bn for implementation in 10 critical districts of Punjab.

Sources told Dawn that the five-year Punjab Family Planning project, sponsored by the World Bank, involving a $130 million loan, including substantial technical grants, was presented in a meeting of the Central Development Working Party with very aggressive targets, like reducing the total fertility rate (TFR) from 3.4pc to 2.5pc and decreasing unmet need from 17pc to 7pc till 2027.

The planning commission has raised certain questions before formally approving the project. The sources said the healthcare and population welfare departments of Punjab responded by naming the targeted districts but were asked to document ’10 lagging districts to be focused on under the project along with the data about the districts where the contraceptive prevalence rate (CPR) remained low and justify how to achieve the ‘over-ambitious’ transition challenges.

Over Rs35bn to be spent to reduce fertility rate from 3.4pc to 2.5pc

The planning commission also wanted a result-based monitoring framework for the project along with a separate impact assessment report resulting from similar other interventions through the provincial annual development plans. It also wondered how the project could be allowed without first knowing the terms and conditions of the loan.

Provinces responsible for planning

After the 2010 devolution, the departments of population welfare and health are responsible for the provision of family planning services. About 44pc of the total sources of contraceptives in Pakistan are provided by the government sector, private medical facilities provide about 43pc, and the rest is provided by shops and pharmacies.

To rapidly achieve visible results, Punjab needs to focus on reducing unmet needs for contraceptives and expanding service provision to underserved areas and population groups, such as rural and urban slums. According to the Punjab government, global evidence showed a well-organised family planning could reduce fertility by 1.5 births per woman. In the long run, this also averts the cost related to antenatal, delivery and post-abortion care.

The project’s primary goal is to enhance CPR from 27pc to 45pc and ensure four million additional women in Punjab have access to effective family planning information and services by 2025 to minimise unintended pregnancies. The CPR actually declined in recent years from over 29pc to 27pc.

Interestingly, the project designers claimed the project would integrate family planning services in health systems to enhance coverage and availability of quality services by utilising all public sector facilities but said the “sustained political and institutional would be required to implement these measures”.

The project aims to ensure within five years that 70pc of facilities have the availability of the required mix of contraceptives, modern CPR is increased by 1.5pc points per year, and 60pc family planning users should have received appropriate counselling.

Of the $130m, about $19.6m is targeted for spending on the strengthening of procurement and management of family planning commodities, $34.5m on improvement in the use of modern contraceptives and quality care, and a much larger part of $38.5m on social marketing and private sector’s involvement for advocacy campaigns.

Around $13.4m is aimed at spending on improved demand for family planning services and another $10m on technical advisory services for advocacy and leadership.

Published in Dawn, May 22nd, 2023