Daily Times

Unmet need for family planning is defined as abstaining from the use of any contraceptive method despite being sexually active and a preference to delay or avoid future pregnancies. If people are given freedom of choice, many of them would prefer to limit their family size or to establish spacing between pregnancies so as to improve their standards of living. However, family planning programs in developing countries particularly Pakistan are inadequate to fulfil people’s needs.

Over a decade, family planning programs and services nearly remained unchanged due to the supply of, and demand for, family planning needs. A number of determinants are responsible for the unmet need for family planning in Pakistan and for making it a critical public health issue.

In developing countries, regardless of dramatic growth of contraceptive access globally, approximately 137 million women who prefer to avoid pregnancy are not able to do so. Pakistan is one of the most heavily populated countries with a growth rate of 2.0; although Pakistan was the first country in South Asia to introduce national family planning program, the prevalence of unmet need in Pakistan is the highest among all countries in the world.

According to latest Demographic and Health Survey 2017-18, the use of contraceptives has remained stagnant over the past 5 years (34% in the 2017-18 PDHS and 35% in the 2012-13 PDHS). Seventeen per cent of currently married women have an unmet need for family planning services. Moreover, 34% of married women are currently using a contraceptive method.

Punjab has outperformed other provinces in family planning, use of contraceptives and maternal, new-born and child health (MNCH) in addition to greater vaccination coverage. Punjab had the lowest percentage of teenage pregnancy at 6.2 per cent. On the other hand, Sindh has 9.9 percent, KP stands at 14.8 per cent and Balochistan at 11.6 per cent rate of teenage pregnancy.

The latest PDHS further revealed that the use of contraceptives is highest in Punjab, while the province also scored the highest for any method and any modern method. Punjab scored 38.3 for any method and 27.2 for any modern method, Sindh 30.9 and 24.4, KP 30.9 and 23.2, while Balochistan scored 19.8 for any method and 14 for any modern method.

Punjab scored 15.8 in unmet demand for family planning while Sindh scored 17.7, KP 20.5 and Balochistan 21.6.

According to statistics, Punjab has the highest percentage of women with demand for contraception satisfied. For overall statistics of Pakistan, PDHS 2017-18 scored better than PDHS 2012-13 report, with lowest unmet need during the last three decades and highest percentage of demand satisfied with modern methods.

The unmet demand for contraceptives in Punjab stood at 16 per cent, Sindh 18 per cent, KP 21 per cent while stood at 22 per cent. In the modern contraceptive use, Punjab stands at 27 percent, Sindh at 24 percent, KP stands at 23 percent and Balochistan at 14 percent. For the demand satisfied with modern contraceptives, Punjab stands at 50 per cent, Sindh at 50 per cent, KP at 45 per cent and Balochistan at 34 per cent.

To reduce the impact of the unmet need for family planning in Pakistan, several strategies need to be implemented at different levels. Firstly, integration of family planning services with other first-level healthcare facilities is not only an existing demand but also an inexpensive and realistic way to reduce the unmet need. All Basic Health Units (BHU) and Rural Health Centres (RHC) should highlight family planning services as essential components of their basic package of healthcare services.

Secondly, a culturally sensitive communication strategy which includes information, education, communication, and behaviour change communication needs to be planned to motivate, empower and encourage women to transform their behaviour by addressing their apprehensions about family planning. Moreover, engaging older women at the community level and listening to their opinions about family planning may help overcome the prohibitions imposed on women. Also, including contented family planning consumers as ambassadors in the campaigns at the basic healthcare levels would portray family planning as an acceptable social norm.

Thirdly, private sectors which are involved in social marketing should subside in the prices of contraceptives so that to overcome the barrier associated with cost. More commercial sales of the most preferred method such as condoms should be encouraged. The ideal situation would also include improvement of the infrastructure to facilitate people’s access to the family planning centres. However, transporting these services to the doorstep by lady health workers (LHW) and public health nurses should be the main purpose of the national programs.

Regardless of the dramatic growth of contraceptive access globally, approximately 137 million women who prefer to avoid pregnancy are not able to do so

Most importantly, financing in girl’s education should be promoted, as it is not only a reliable strategy to improve women’s decision-making about contraceptive use and birth spacing but also to prompt healthier maternal and neonatal health results. Therefore, women development and youth development programs should work with health and population programs in order to develop meaningful strategies. Finally, role of media, especially campaigns, is important in raising awareness about family planning methods, significance of small family size and change in reproductive preferences. Effective crafted messages should therefore be promoted in communities.

In order to highlight the unmet need for family planning in today’s diverse healthcare system, determinants such as social and cultural constraints, geographical factors, economical and physical access to healthcare facilities, gender biases, women’s education, women’s positions in society, limited access to family planning services, and other factors related to the society at-large need to be explored. Moreover, there is a need to construct a more receptive and gender-sensitive healthcare system. If family planning program assisted most women with unmet need, a significant demographic influence would be seen, with a considerable decrease in fertility and a reduction in population growth. This has become, chiefly, the important requirement for poverty reduction along with social and economic development of Pakistan.

The writer is recipient of Young Global Family Planning Leader Award from Bill & Melinda Gates Institute for Population and Reproductive Health, Baltimore, USA. He can be reached at mqesar@gmail.com. He tweets @mqesar

Published in Daily Times, October 10^th 2018.