The World Health Organisation affirms that promotion of Family Planning (FP)is indispensable, for the well-being and autonomy of women, while supporting the health and development of communities. Currently, 214 million women of reproductive age in developing countries who want to avoid pregnancy are not using a modern contraceptive method.
Patriarchal arrangement,(vain) bargain and discrimination, function as strategic stumbling blocks in shaping genderised union between population and development, in Pakistan, as well. A fitting example is women’s access to their health. Demographic and Health Survey 2012-13, of Pakistan, reported that almost two-thirds of women face at least one problem in accessing health care. More than half of women were concerned about going alone. Four in ten women were concerned about management of transportation. More than one-third of women were concerned about distance to the health facility. About 30% of women in Balochistan receive, ante natal care, from a skilled provider compared to 94 percent in Islamabad.
It is pertinent to recall that Pakistan’s population grew by 3.3 times between 1970 and 2015, a considerably greater increase than India (2.4 times), Bangladesh (2.5 times) or Indonesia (2.2 times), during the same period. 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.
The first setback to Pakistani FP program, that started in 1950s, became conspicuous when in 1977, Gen Ziaul Haq, after toppling the elected government of Bhutto, arrested the existing program and barred the publicity of any FP-related activity. The hurried devolution by Zardari Government, in 2010, too jolted the program. The value of human capital, volume of monetary resource allocation, scale of community connection, quality of contraceptive products and candour of policies, too, manipulate and manage the efficiency and influence of population related interventions. The nexus of National Finance Commission Award and FP programme in Pakistan is not highlighted unambiguously in official statements. The media, mullah and men in family and in policy-making with the shared sum of economic benefits; dictate the knotty and thorny choices in reproductive health including FP.
There is no magical wand to implement healthy spacing and timing on pregnancy. Respect for human dignity including women, empathy at the level of decision making and setting right priorities must be the measurable indicators
The landmark International Conference on Population and Development of Cairo in 1994 established FP as a fundamental human right but took the lime light to the umbrella term reproductive health. One of the primary goals of its Programme of Action (PoA) was to make FP universally available by 2015 as part of a broadened approach to reproductive health and rights. It was later extended indefinitely. Pakistan is a signatory to the PoA adopted by the conference, that to date remains largely unfinished. The London Summit 2012 that renewed the international interest in FP is mainly owed to the foresightedness of Melinda Gates. The Gates Foundation funds a number of pro-abortion groups, like Planned Parenthood affiliates globally and Marie Stopes International. According to our government’s updated pledge2020, in July 2017, at the FP Summit, London, Pakistan will contribute 6.7 million additional users, (3.4 million already reported and an additional 3.3 million to be added), in attaining a contraceptive prevalence rate of 50%. This will be achieved through additional resources, raising the per capita expenditure on FP to $2.50.
The land of pure is characterised by not only by dismal statistics on socio-economic and gender indices but is also an outlier in the Asian region regarding demographic transition. Pakistan has to honour its own pledge through sincere actions and not merely interventions that can be politely referred to conference-tourism. There is no magical wand to implement healthy spacing and timing on pregnancy. Respect for human dignity including women, empathy at the level of decision making and setting right priorities must be the measurable indicators. If hormonal contraceptives are risky the information should be public. Ensuring informed reproductive choices are required in the bureaucratic visions.
Men are not only the usual head of the family in Pakistan but also occupy most of the powerful positions in formal economy. Thus engaging men realistically, in FP so as to see a discernible impact in the terrain of population and development is relatable. This however, by no means, is meant to create a new dependency for women in Pakistan who are experiencing unmet need in FP besides enduring the physical and psychological costs of the ‘responsibility’ of giving birth to sons, ‘accessing’ contraceptives and coping with failures and or unsafe abortion to name a few.
Sagacious economic policies and structural transformation are supposed to support the process demographic transition. This sweeping schema is not only strenuous but sore too, for the critical mass of our free-riding and inattentive political elites.
A woman’s ill health, maternal morbidity and mortality are not seen as ‘abnormal’ and ‘preventable’ situations but have attained a normative position, both in the mindsets of the state and the society. The desired power of political will for a successful FP program is absent in Pakistan. Therefore, a self-evident, improved access to contraception and freedom to delay child birth through civic will has to be demonstrated in Pakistani society. Our Women and girls have to speak up for their individualism, control on their own bodies and should empower themselves with information that could save them in the journey of their lives from preventable disasters and death. They themselves and no one else should control their choices in contraception.
The writer is a gender expert, Public Health Specialist, researcher, author, activist and a free thinker. Twitter handle@survivorwins
Published in Daily Times, November 22nd 2017.