Fail to plan, plan to fail

The fifth International Conference on Family Planning (ICFP) concluded earlier this month in Kigali, the capital of Rwanda. More than 3,700 people – including over 600 youth leaders – participated in the conference, making it the largest ICFP in history.

Governments, advocates and the youth reaffirmed their commitment to ensuring every woman and girl has access to high-quality, affordable family planning information and services. The speakers emphasised that despite advancements made in many countries, the FP2020 partnership is unlikely to meet its goal of fulfilling the contraceptive needs of 120 million additional women by 2020. Along with the accessibility of contraceptives for young people, it is also important to increase the acceptability of contraceptive use among the youth.

At the London Summit in 2012, the family planning community had pledged to enable 120 million additional women and girls to use contraceptives by 2020, creating the FP2020 global partnership. The FP2020’s goal is based on the fundamental belief that all women, regardless of their marital status, should have access to the high-quality family planning services of their own choosing. Therefore, FP2020 monitors modern contraceptive use among all women, rather than just married women. This represents a global shift in how contraceptive prevalence is normally reported at both the international and national levels.

Among the major countries of Asia, Pakistan is an outlier in terms of demographic transition. Its transition was considerably delayed by the slow onset of fertility decline. Over a long period – from the late 1960s to the late 1990s – the rate of population growth was barely below three percent per annum. It is, therefore, not surprising to find that Pakistan’s population grew by 3.3 times between 1970 and 2015 – a considerably greater increase than India (2.4times), Bangladesh (2.5 times) or Indonesia (2.2 times) over the same period. Between 1990 and 2015, the number of children aged 0-15 in Pakistan increased by 43 percent, compared with 14 percent in India, six percent in Bangladesh and eight percent in Indonesia.

Projects such as the FALAH by the Population Council, the MARVI Programme by the HANDS, an urban slums project in Karachi and demand-side financing projects show potential to raise contraceptive prevalence rates among unnerved or under-served populations. The main issue is how to scale up effective small-scale programmes into programmes with a broader impact.

Since it made a commitment to FP2020 in 2012, Pakistan has demonstrated ongoing efforts toward promoting family planning. As of this year, all four provinces have drafted costed implementation plans for family planning and developed family planning taskforces comprised of public and private-sector stakeholders. Each province is also drawing upon domestic resources to procure contraceptives.

The government is committed to ensuring a range of available methods in the country and has trained mid-level service providers in the public and private sectors to provide IUDs and implants. In addition, to promote the acceptability of family planning, the government is collaborating with men and religious leaders as part of its social mobilisation efforts. Punjab, Sindh, and Khyber Pakhtunkhwa have established health centres, specifically for adolescents. To continue promoting strong government commitment, Pakistan will work to strengthen collaboration among regions under a devolved system in order to reach 6.7 million additional users and increase CPR to 50 percent by 2020.

Preliminary results from a new national census – the first conducted since 1998 – show that the population has grown by 57 percent since then, reaching 207.7 million and making Pakistan the world’s fifth-most-populous country, surpassing Brazil and ranking behind China, India, Indonesia and the US. The annual birthrate, while gradually declining, is still alarmingly high. At 22 births per 1,000 people, it is at par with Bolivia and Haiti, and among the highest outside Africa.

The chief causes of the continuing surge, according to population experts, include religious taboos, political timidity and public ignorance, especially in rural areas. Only a third of married Pakistani women use any form of birth control, and the only family-planning method sanctioned by most religious clerics is spacing births by breast-feeding newborns for two years.

Even if the birth rate slows down, some experts estimate that Pakistan’s population could double again by the middle of the century, putting catastrophic pressures on water and sanitation systems, swamping health and education services, and leaving tens of millions of people jobless – prime recruits for criminal networks and terrorist groups.

It is important that the country’s population growth rate is at a staggering 2.4 percent that is at least double of other regional countries like India, Bangladesh and Sri Lanka. The situation indeed warrants steps on an urgent basis to reverse this growth, and the initiative to this effect was taken by CJP by constituting a taskforce on the matter which, in fact, has already furnished some concrete suggestions, including that of making pre-marital counseling on family planning mandatory for nikkah registration as well as holding a ulema conference on the issue on a regular basis.

It is heartening to note that the federal and provincial governments appear to be serious to implement these very recommendations. We saw the positive gesture towards achieving this end at the meeting of the Council of Common Interests, where the decision was taken to constitute national and provincial taskforces to consider the recommendations of the taskforce established by the Supreme Court and then formulate an action plan, taking into account the future implementation strategy.

As the taskforces are to be headed by the chief executives of both the centre and the provinces, one may expect that the future plan of action will be completed without any delay after due deliberations and taking into account the recommendations of the apex court’s taskforce – which, in fact, provides a very clear way forward to deal with the issue effectively.

The most important strategy is to create necessary awareness through different forums about the importance of family planning for the overall health of women and children. Those living in remote areas could be reached through lady health workers as well as the media to remove myths and misperception about contraceptives, which should be provided to them free of charge.

There are countries that have devised policy to regulate birth rates. We also need to introduce necessary legislation to achieve this end after taking religious scholars onboard.

The writer is a freelance writer and the recipient of the Young Global Family Planning Leader Award.

Email: mqesar@gmail.com

Twitter: @mqesar.