Karachi: When it comes to success in family planning, population constraint and maternal and child morbidity Pakistan is still significantly lagging behind some of its neighbours, especially Bangladesh. However, it would be unfair to say there haven’t been any improvements. Despite family planning being almost always been viewed with scepticism in Pakistan the total fertility rate, meaning the number of children per woman on average, has declined to float around 3.6, down from almost six.
Highlighting the topic the Department of Community Health Sciences at Aga Khan University AKU organized a two-day seminar titled ‘Advocacy seminar on family planning and reproductive health’ which commenced on Tuesday. The seminar allowed a diverse range of perceptions and policies to be highlighted and discussed as local and international experts from Indonesia, India, Nepal and Bangladesh spoke on the topic.
In Pakistan maternal and child morbidity have also declined but remain in the high range. According to WHO estimates in 2011 infant mortality was 65.1 per 1,000 live births compared to 90 per 1,000 in 1999, whereas maternal mortality ratio stands at 276 per 100,000 in 2011 from 450 in 1999. The major chunk of the improvement, experts say, began once policy makers pegged family planning to healthy mothers producing healthy babies. For decades Pakistan’s policy makers pitched the ‘Bachay do hi achay’ campaign without success. “That campaign proved counterproductive,” says Country Director for Pakistan Population Council Dr Zeba Sathar. “However, there has been no opposition since family planning has been linked to maternal and child morbidity.”
Chair for the Department of Paediatrics and Child Health at AKU Dr Anita Zaidi says, “Some mothers in Pakistan are so malnourished that they do not have the reserves to nourish their child.” Family planning is not “just about population control” Zaidi argues it is “about wanting healthy mothers and healthy children.” Infant mortality, meaning a child dying within the first year of life is also at a disturbing rate in Pakistan. Worse still, is that “about two thirds of infant mortalities are within the first month of life.”
If a mother is malnourished her baby is more than likely born with low birth weight, less than 2.5 kilograms, leaving them highly susceptible to infection and inability to keep their body warm. “Twenty five to 30 per cent of children are born of low birth weight in urban Pakistan whereas in rural areas it is about 40 per cent,” Zaidi adds.
Presently, the country’s population has officially crossed 182 million and counting. Looking back Pakistan’s population has doubled at least twice since its independence. Associate professor and Head Population and Reproductive Health Program at AKU Dr Sarah Saleem puts matters into perspective. “In 1950, the country was measured 13th largest in terms of population with about 37 million people. By 2007, the population swelled to 164 million taking Pakistan to the sixth place.”
If the country continues at the same rate she says, “By 2050 Pakistan’s population is expected to exceed 292 million and be in fifth place, after India, China, United States and Indonesia.” Experts warn that decisive action must be taken before the country’s robust population becomes a huge economic and social burden. Even then according to Population Council’s Dr Sathar it will take another 10 to 15 years before Pakistan can stabilize its population.
Muslim neighbour Indonesia also came across similar obstacles during its initial ‘population control’ policy. Their campaign ‘Dua Anak Cukup’ or ‘Two children are enough’ was later changed to ‘Having two children is better than mourning two children’ achieve wider acceptance.
Speaking at the seminar, Chair of the Department of Public Health and the Centre for Reproductive Health, Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Indonesia, Prof. Siswanto Agus Wilopo spoke on the ‘role of family planning as not about limiting children but rather about improving their health’. Comparing the religious aspect of family planning Prof. Wilopo says, “family planning is consistent with the teaching of Islam and the Quran.” Quoting an excerpt from the Holy Book he adds, “The Quran says women should breastfeed their children for at least two years.” Medically if a woman is breastfeeding for two years it will biologically impact her ability to conceive. Experts also recommend two years as the period for ‘child spacing’.
Girls and women’s education also plays a vital role. Educating a woman is educating a household, experts say. If the woman is educated she will be empowered to control her fertility and contribute to her family’s wellbeing on a micro level as well as the nation’s prosperity at the macro level. Meanwhile, there are also families in Pakistan who want to use contraceptives but do not have access to them.
This ‘unmet’ need constitutes 25 per cent of women, and if met it can help lift the use of contraceptives to 60 per cent. It was barely 20 years since policy makers in Pakistan have paid any serious attention to the issue. Despite a larger population at the time of its independence in 1971, today Bangladesh’s health indicators specifically maternal, child and infant mortality are impressive.
“Bangladesh has created an example in the world with its success in family planning,” says Director for Health Program BRAC Centre in Dhaka Dr Koasar Afsana. From a population with 75 million in 1972 the population doubled in 2010 with an impressive improvement in age specific fertility rate as well as use of contraceptives. India has witnessed a paradigm shift to focusing on ‘birth spacing’ as well. Bangladeshis are also being encouraged to delay in marrying young girls and control their fertility rate as well.
Speaking on the strategies in India Country Director for JHPIEGO, New Delhi Dr Bulbul Sood says, “There are strategies to address the unmet need including strengthening postpartum family planning with introducing postpartum IUCD services.”
Keeping in mind that 60 per cent of our population is below 30 years of age youth icon Shahzad Roy started off the seminar with a performance advocated family planning.
Other speakers included Dr Yasmeen Sabeeh Qazi, Country Director, The David and Lucile Packard Foundation, Pakistan; Dr Fauziah Rabbani, Head, Department of Community Health Sciences, AKU, Ms Poonam Muttreja, Executive Director, Population Foundation of India; Dr Ubaidur Rob, Country Director, Population Council, Bangladesh; Dr Giridhari Sharma Paudel, Nepal Health Sector Support Programme, Ministry of Health and Population , Nepal; Dr Mehtab S. Karim, Professor, George Mason University, USA; and Professor M. Nizamuddin, Vice Chancellor, University of Gujrat, Pakistan.