Daily Times

When it comes to the national commitments about sexual and reproductive health and rights (SRHR) of men and women in Pakistan, there have been substantial developments in terms of legislation and public service programmes during the last 10 years. However, the overall indicators continue to present gaps in terms of quality of services and implementation of laws and policies related to SRHR.

In September 2014, the UN General Assembly will convene a special session on the International Conference on Population and Development (ICPD) beyond 2014 in which the Commission on Population and Development (CPD) delegates from 179 countries will sit together to review the progress and achievements towards the goals set out in the landmark ICPD. The CPD delegates of each participating country will also set out a development agenda for the coming years.

The findings of a study conducted by Shirkat Gah in 11 locations in seven districts of Pakistan highlighted the connections between SRHR and economic conditions, poverty and social justice. Poverty has been a key determinant of public health facility utilization; there has not been a significant difference in reproductive health (RH) services and issues for the poor between the districts with special interventions and those without. According to the study, violence and the fear of violence are also key deterrents for women seeking reproductive health and family planning services. It highlighted that there is widespread, unmet need for family planning, lack of information about emergency contraceptives among rural women, lack of information about laws and available health services, unavailability of safe abortion, post-abortion care, health services and counselling for adolescent girls and boys.

Women’s health issues should not be analysed in isolation and the correlation between poverty, female education, reproductive health issues and women’s health needs to be taken into account. There is a greater desire among women to educate their daughters and to limit family size in order to improve the quality of their lifestyle. Midlevel healthcare providers are more accessible to communities and there is a need to invest more in them.

The family planning programme, which started in 1953, reached its peak CPR in 1980 and has been almost constant since then. Research shows that 96 percent of the spent money of the programme is used to cover administrative costs and only four percent of the available funds are used to buy commodities. The research dispelled the myth that the family planning programme is failing due to non-availability of funds. If used efficiently, the public sector funds alone will cover 80 percent of the CPR. According to the findings of their primary community-based research, which was conducted in Jehlum and Pak Pattan, there is lack of information among unmarried adolescent girls about puberty and reproductive health and mostly they receive this information from their mothers or close female relatives. For married women too, the main source of information about reproductive care is their husbands and very few women consulted lady health workers to get information about reproductive health issues. Some 77 percent of unmarried adolescent girls had no information about family planning.

The need of the hour is for women to have easy access to electronic media (cable channels and satellite channels), used as a tool for mass awareness about RH programmes and services. The communities that do have awareness and information about RH issues and are willing to access them have unmet needs as the services are not widely available and hence result in frustration and helplessness. Adolescent unmarried girls hesitate to ask for information about RH issues for the fear of being labelled as ‘forward’.

Pakistan signed all points of action of the ICPD but reneged its bold stance on SRHR at Beijing in 1995 just a year later and emphasised the need to understand the reasons behind it. We are still suffering from feudalism and a major chunk of our federal budget is reserved for military expenditures. Legislated inequality of women, lack of decision-making and mobility opportunities, lack of access to information, lack of public services and public awareness about services, lack of access to justice and feminisation of poverty are a huge barrier in achieving our ICPD commitments.

During the London Summit 2012, we made a political commitment to increase funding for our national population programme and increase our CPR from 35 percent to 55 percent by 2015. In this context, we will increase the funding for the population programme by 2.5 percent. We have also transferred power to the provinces as the federal population department has been devolved. Our 4,500 family planning service points cannot meet the needs of a 180 million strong population. Lady health workers (LHWs) and health service providers need to provide family planning services; only then will we be able to meet the needs.

Provincial governments were not involved when the federal government made commitments in the London Summit 2012. We respect those commitments but to achieve that CPR goal we need to allocate five times our current budget. We also need to work on the male community to improve the RH situation in Pakistan and for that we need a comprehensive counselling programme for males at the grassroots level. We can only design and implement it if we are diligent and if we receive funds in a timely manner.

Our progress on Millennium Development Goals (MDGs) targets has remained stiff but the situation is not true for all four provinces. Punjab’s situation is very different from the situation in Balochistan. CPR and total fertility rate (TFR) will not improve until we improve family planning services. Many factors have been contributing to slow progress towards achieving MDG goals. But we do have some success stories as well. I would also like to reiterate the need to focus more on midlevel service providers and need to increase their pool in both rural and urban areas. We also need to focus on reducing the five percent maternal deaths that occur in complicated cases and need to make comprehensive emergency obstetric care (EMoC) in DHQ and maternity hospitals in our districts. For a real change, we need a stronger political commitment towards provision of resources and implementation of policies. Inter-sectoral coordination is also needed between departments.

The writer is the Web Editor, Daily Times. He can be reached at shrnaqvi3@gmail.com and on twitter @Hassannaqvi5