Family Planning Programs in Pakistan

Introduction

Family Planning Programs in Pakistan started in the mid-1960s and have tried many initiatives and policies. And yet the current contraceptive prevalence rates (CPR) stand at 30%, reflecting around 0.5% annual increase since the start of the family planning programs in 1964. Approximately 30% of women report using some form of family planning. 22% use a modern and 8% use a traditional method. This means that of the nearly 24 million married women of reproductive age (MWRA), approximately 5 million women use a modern method and nearly 2 million women use a traditional means and a staggering 17 million do not use any family planning at all. These 17 million include around 6 million women who would want to use FP, but are not using it and therefore have an unmet need for family planning.

Body

The use of family planning has increased in Pakistan over the past 50 years from around 5% in the early 60s to around 30% in 2006-7 or around 0.5% annually. A comparison of DHS surveys from 1990 and 2006 shows an increase in the use of family planning by approximately 3.5 fold in the past 2 decades or around 1% annually – a much accelerated pace compared to the years before 1990. This increase has been for both traditional and modern methods and is more pronounced in rural locations as can be seen in the table below which depicts changes in both the CPR and actual number of women using family planning. While family planning has improved all over, gains in rural locations far outpaced any progress in urban locations. Whereas urban contraception rates doubled, rural rates increased over 6-fold with traditional methods increasing nearly 10-fold.1 While its difficult to completely explain this phenomenon, its abundantly clear that there has been (and perhaps remains) a great unmet need for contraception in Pakistan, particularly in the rural locations. This is particularly exemplified by the corresponding increase in traditional methods along with modern ones. Additionally, the experiences with Lady Health Workers and some NGOs (particularly in the years following the DHS) have shown that there are a great number of women and couples in these locations who would adopt family planning if these services and commodities were made available to them. In other words there is a fairly large group of women/couples who would readily avail family planning services and family planning – public health programs and policy makers would do well to target this group more effectively with services.

The overall method mix is diverse in Pakistan. Among women who use a modern method, most are sterilized (38%) followed by those who use a condom (31%). However, women seeking sterilization are 30 years or older (mean age: 39 years) and have around 6 children.

Sterilization can be better promoted at an earlier age or number of children. Condom users are usually younger women – in their early 20s. They are both urban and rural and most obtain these from pharmacies, chemists or other shops through self-payment. Finally, a third of women receive pills, IUDs or injectable contraceptives. Male sterilization and implants – new to Pakistan – are rare. As is described below in the section on services, the majority of the methods are those that are controlled by the women or couples. These include the 1.9 million traditional method users and the 1.6 million condom users, adding up to 3.5 million or about half of all contraception users. These constitute two-thirds of all nonpermanent method users and likely reflects the quality of services provided and the faith that women/ couples have in them.

Within all modern method users 38% are those that have undergone female sterilization4 and 11% are using an IUD. Since not all women who received either of these methods did so in the past year, women who received family planning services within the past year is arrived at by counting only those women who received IUD or sterilization within the past year.

Thus, the overall service delivery foot-print is small with only around 12% of all MWRA being served in a given year by all service providers (public and private) combined with most services being procured by women/ couples directly from shops, chemists or other outlets. This means that they procure these supplies without a formal health provider, obtain no counseling and therefore have nowhere to turn to when side effects – which may be frequent – arise. Public health planners and policy makers should revisit the structural aspects and outreach coverage of family planning services in order to reach and engage these women/couples to regularly use family planning.

The total number of women who received family planning services in any one given year is around 2.9 million with condoms constituting the most favored method and self-procurement being the most common means of obtaining contraception.

Conclusion

Family planning is a preparation for responsible parenthood. Parents who want to have harmony among family members need to plan the number of children they can support and take care of well. Parents consider family planning to space pregnancies, limit family size, and delay childbearing. Family planning protects the health of the mother and the children. It can protect the health of the father as well, since it limits the responsibility of the father to support the family size he can only afford.

Family planning can help the mother who wishes to pursue careers or other activities where unplanned pregnancies would be very difficult. In terms of emotional and financial stability, parents who plan the number of children tend to achieve this status of stability. They are better off and happier compared to those who do not plan and have too many children they cannot afford to support.

Recommendation

It is recommended that policy-makers and planners combine efforts to meet the family planning needs of the population through the provision of quality reproductive health services with a simultaneous investment in the health workforce. Doing so will have synergistic effects in meeting the health needs of families and mitigating the health workforce crisis in individual countries around the world.