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March 31, 2019

Family planning in Sindh


March 31, 2019

The ever-increasing population has been a major challenge for Pakistan for at least 50 years. When East and West Pakistan separated in 1971, the population of East Pakistan was around 70 million whereas West Pakistan had around 60 million people.

Now, after almost five decades, Bangladesh has around 40-50 million fewer people than we have in Pakistan. This population control has enabled Bangladesh to perform better than Pakistan in many development indicators such as education and health. In 2019, Bangladesh has a better literacy rate and lower mortality rates among infants and mothers, in addition to better foreign exchange reserves and higher exports.

In Pakistan, although all provinces have strived to control population with various degrees of success, Sindh has recently made some strides that must be shared with readers who are constantly fed negativities about corruption in the province. This is not to say that corruption is not there, or that it has been eliminated. Corruption is very much there all over Pakistan, from the ‘legal’ appropriation of land and resources by the civil and military bureaucracies to the selective regularisation of the occupied land, and from inappropriate reduction in development funds to disproportionate hike in non-development expenditure.

One of the areas of population welfare where the government of Sindh leads is the development and implementation of Costed Implementation Plan (CIP) on family planning in the province. Sindh was the first and only province in the country to develop such a plan in 2015, with help and technical assistance from Gates Foundation and Pathfinder International. Unlike most other plans which fail to deliver, this CIP was developed with the lead role played by the Population Welfare Department and in collaboration with the public and private sectors, relevant development partners, and international and local NGOs.

First, we need to remind ourselves that it was the landmark 18th Constitutional Amendment, passed in 2010 during the much-maligned PPP government, that devolved inter alia health and population functions to the provinces. This amendment was not something imposed by a dictator who got judicial approvals for his unconstitutional transgressions. Neither was it an amendment that was not discussed properly, as our former Chief Justice Saqib Nisar wanted us to believe. This amendment is the single most democratic and far-reaching change in the 1973 constitution; it is also not particularly liked by the powers that be.

It was thanks to this amendment that Sindh was able to spearhead a Costed Implementation Plan on family planning in the province. That other provinces lagged behind should be a cause of concern for their respective governments. A look at this plan helps us understand the dynamics of family planning. Sindh has committed itself to attain a contraceptive prevalence rate (CPR) of 45 percent by 2020. In its urban areas, Sindh is already claiming to have touched the 40-percent mark. In terms of unmet needs, the figure has been reduced to just 17 percent according to the Pakistan Demographic and Health Survey (PDHS).

Total fertility rate (TFR) has also declined to 3.5. One of the steps that the government of Sindh took to achieve these targets was a functional integration of the health and population departments. In other provinces, health and population departments tend to function in relative isolation – resulting in a lack of coordination. Sindh realised this need and took a step in the right direction. Secondly, lady health visitors (LHVs) and lady health workers (LHW) were joined in a loop for task sharing. This facilitated their work and resulted in rapid improvement of their performance.

Third, the department of health started notifying the first dose of injection by all LHWs. Then an initiative was taken to provide free contraceptives to all relevant NGOs working in family planning in Sindh. In other provinces such NGOs have complained of lack of cooperation by the government departments and officials, who are not in favour of NGOs and rather look at them with suspicion. This negative attitude towards NGOs has been the result of not only local religious leaders but also of state institutions that create hurdles in the way of smooth functioning of civil society organisations.

Another area that needed special attention was the provision of post-pregnancy family planning (PPFP). Especially in rural areas, in the absence of family planning services, women are prone to get pregnant within months after giving birth to a child. This reduces birth spacing and some women give birth almost every year. Malnutrition causes increased infant mortality and maternal mortality rates. That’s why a focus on providing post-pregnancy family planning is the need especially in the rural areas of all provinces, and Sindh has taken a lead here too. This is something other provinces may emulate.

Another first is the introduction of life-skills based education (LSBE) in Sindh. As an educationist, this writer can testify that other provinces have not shown much interest in this area of vital importance. An attempt was made in Punjab to introduce LSBE but all hell broke loose when the religious lobby launched a campaign against it on the pretext that it was harming their traditional values. The Punjab government backed down and the LSBE was never discussed again. So, what is this LSBE? Is it really something harmful to our values?

A look at its details show that LSBE is a scheme of education that benefits young boys and girls and helps them understand biological changes that occur at puberty. This is an entirely neglected area in our traditional culture, and needs immediate attention. Especially with increasing incidents of child abuse and molestation, our children should be able to understand right from wrong in terms of their body and personal space. Due to a complete lack of education about the sanctity of their private parts, abusers, molesters and rapists take advantage of unsuspecting children.

And this needs to be addressed through life-skills based education. It is the government’s responsibility to take a strong stand when traditionalists create a ruckus against any positive and progressive change in the education system. Our governments and state have been surrendering too easily in front of the obscurantists who take umbrage at each step forward. Just listen to the recent tirades from leaders such as Maulana Manzoor Ahmed Mengal who have used the most foul language and threats against women marchers. Such mindset prevents initiatives such as LSBE too in schools and colleges.

Luckily, the Sindh government has stood fast and is actively promoting in syllabus and through training events awareness about life skills. Moreover, male mobilization by the name of Sukhi Ghar counsellors has also been initiated, which conducts awareness sessions in which men and young boys participate. This writer has seen some of the youth awareness seminars in the universities of Sindh where life-skills based education is imparted. This is a tremendous initiative and it should not only thrive but also expand to include all boys and girls colleges in Sindh. It remains to be seen how and when other provinces follow the lead set by Sindh.

With the PTI governments in the other three provinces, it appears highly unlikely that – with the party’s ultra-conservative posturing and uber-religious sensitivities – much will be done in this matter.

The writer holds a PhD from the University of Birmingham, UK and works in Islamabad.

Email: [email protected]

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