In Pakistan the contraceptive prevalence rate is only 30 per cent — a figure that has remained static over the last decade and is considerably lower than in other Muslim countries.
Initiatives taken worldwide show that to make any family programme successful it has to be planned in a way that it enables an individual to choose from the various methods available and she does not feel restricted if one method is not suitable for her. Often contraceptive use is discontinued due to side-effects or fear of rare but serious risks such as breast cancer or fear of weight gain.
Dr Samrina Hashmi, a gynaecologist and executive committee member of Society of Obstetrics/ Gynaecology Pakistan, says, “A wide range of products, including emergency contraception should be available at all primary health centres. Information and communication material should be available at all primary health centres, hospitals where women deliver and waiting areas of public places. There should be awareness campaigns on electronic media, which should dispel the myths and misconceptions, while making the health benefits known.”
Health personnel, including doctors, nurses and primary healthcare workers, should be trained to provide correct information of the benefits and side effects of contraception, and to offer alternative methods of choice. They should also be trained to treat all those who request contraceptive information and service with respect, whether they are married or single, young or old, wealthy or poor, male or female.
Dr Hashmi believes, “Family planning can only be made accessible if there is will on the part of the government. We need to change the mind-set, and that is not possible without education. Reproductive biology should be made a part of the school curriculum, in all types of schools and madressahs”.
For people to avail family planning services it is important that they have easy access to it. This calls for outreach and community-based provisions. In certain sections of our society women’s mobility is restricted and they often fail to continue or avail the services at all if they have to travel a long distance for regular supply. An important feature of community-based programmes is that workers operate in their own communities, sharing the same language and customs and have greater credibility.
Prof Sadiqua Jafarey, chairperson, National Commission on Maternal and Child Health, believes, “One of the strategies to make the FP services available to the hard to reach and the poor is through the Lady Health Worker (LHW) Programme initiated in 1994. The primary function of the over 100,000 trained LHWs is to provide preventive and promotive services, which includes FP services, to the community. The LHWs need to have information regarding contraceptives, including dispelling the myths and misconceptions prevailing within the community.”
Besides making the services easily available where they are most needed, it is important to enlist the support of key sectors of society including religious scholars and community leaders. “Religious leaders and khatibs of mosques, should be trained to make this important issue a part of their sermons and tell the public that family planning is not against Islam,” says Hashmi.
An official at the Family Planning Association says, “One way to tackle this issue is through introduction of demand-based financing programmes for comprehensive sexual and reproductive health services with focus on FP services either through cash incentives or through vouchers that cover all health service costs or conditional social transfers, etc. But the approach can only lead to behaviour change when the investment through these approaches is continued for decades and not merely donor-funded two-to-three-year programmes; small interventions do not lead to behaviour change, it needs to be taken up as a long-term strategy.
“At the same time supply of contraceptives needs to be strengthened. Presently 48 per cent of users of modern methods go to a public source. USAID has agreed to provide and bear the cost of contraceptive needs till 2014. What after that? No commitment from either provincial or federal government has yet surfaced.”
Any family planning programme cannot be successful without involving men; this is more important in societies like ours where a large number of women want to plan their families but cannot do so as their husbands do not agree to it. When the husbands are aware of the advantages of planned family — the health of the mother, better health of children, more children surviving and overall well being of the whole family — they will be more willing to cooperate.