Pakistan has been going through an unprecedented demographic shift. Rapid population growth is a major problem confronting Pakistan as it lies at the centre of the country’s social, economic and political problems. This situation will burden its limited resources making it difficult for the country to meet the requirements of its people. Due to increasing population the generation of resources has been diminishing. The state of social positioning and quality of life is getting worse for women. This fact can be gauged from the recent report issued by the World Economic Forum on the global gender gap, published last week. Pakistan is ranked 141 out of 142 countries included in the report. That is second to last showing us how far we are lagging behind in overall status of women when compared with other countries.
Historically, Pakistan has witnessed a rapid increase in population since its inception, making it the world’s sixth most populous country while the population is continuously rising at a rapid pace. Comparing the population issue with other Muslim countries, the Pakistan Economic Survey 2013-14 figures suggest that Pakistan is leading in population growth with a 1.95 percent growth rate, leaving behind Bangladesh, Indonesia, Iran, Turkey, Morocco, Egypt and Malaysia at a growth rate between 1.2 to 1.6 percent.
The use of contraception remained unaltered in Pakistan in the previous decade, bringing about a high number of badly timed pregnancies and births, increasing baby and maternal death rates and constraining Pakistan’s advancement in achieving its millennium development goals (MDGs). While the maternal mortality ratio and total fertility rate have been diminishing gradually, the pace intimates that Pakistan may be short of reaching its targets for the MDGs by 2015. The unmet need for family planning is a valuable concept that is widely used for advocacy, the development of family planning policies and the implementation and monitoring of family planning programmes worldwide. The population issue in Pakistan is more likely to be associated with unmet needs for harnessing a demographic shift. The unmet need for family planning is defined as the percentage of women who do not want to become pregnant but are not using contraception. Though the concept seems straightforward, the calculation is extraordinarily complex and has changed over time. This unmet need is the major contributor towards controlling the population growth rate. This concept has gotten a remarkable level of importance since it turned into a MDG indicator in 2008, guaranteeing that the marker can be figured in a predictable manner, which is crucial.
The major segment of Pakistani society has faith in customary and social practices to convey a few customs from generation to generation. Women often feel that their spouses’ objection to contraception in exceptionally patriarchal societies is a reality and hence contraception is something that cannot be debated with men. Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of this unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch a national family planning programme.
The unmet need for contraception is one of several frequently used indicators for the monitoring of family planning programmes. Some other indicators that are used in combination with unmet needs are the contraceptive prevalence rate (CPR), the method mix, sources of contraceptive supplies and reasons for not using contraception. This column deals mainly with the unmet need indicator but I believe that other indicators should also be part of monitoring and evaluation of family planning programmes to broaden the understanding of the use of family planning in countries.
The existence of this unmet need is sometimes interpreted as evidence of lack of access to a source of contraceptive supplies. However, there are many reasons why women do not use contraception, and this unmet need should not be equated with the lack of access to contraception due to supply constraints (such as distance to a source for obtaining contraceptives, out-of-stock contraceptives among providers, or legal obstacles), or to financial costs associated with using family planning. As assessed by surveys, women with an unmet need may still not have any intention to use contraception were it readily accessible and of good quality. Non-use of contraception may be due to demand side reasons, including cultural or religious objections to contraception, objections from a spouse, lack of knowledge or fear of side effects.
Awareness of family planning for the male has a huge impact on acceptance of contraceptive use. Hence, in Pakistan, to bring an impact on behaviour and increase in the uptake of the unmet need, healthcare professionals require to actively involve males in the decision making process. Therefore, campaigns that stress the importance of child spacing are likely to have an impact when the male will be involved. Client perceptions of the quality of care are important determinants of intentions to use contraceptive methods in Pakistan. In addition, despite all odds and losses, the only approach is to move forward and that can be effectively achieved only by involving men in family planning practices to create new heights of empowerment for women rather than dependencies.
The writer tweets @JanjuaHaroon and can be contacted at [email protected]