World Population Day 2020: Message from Dr. Talib Lashari (Technical Advisor, CIP Population Welfare Department, Focal Person, FP2020 Sindh)

TEXT: COVID-19 and Future of the Population Agenda

According to a historian "as human civilizations rose, diseases struck them down". This is what COVID-19 pandemic has potentially been doing. Historically, as civilizations thrived, so did epidemics and pandemics. Due to increasing numbers of population they tend to live in densely populated areas with poor environmental conditions. Ancient trade routes and modern day globalized world both have contributed in spread of contagious diseases. History is known for pandemics since Plague of Justinian in 541 CE (Common Era). The Justinian Plague started in Constantinople, the capital of Byzantine Empire earned from Egypt. The plague spread through Europe, North Africa, Arabia and Asia and killed estimated half of the population in the ancient world. Second plague hit the worldespecially Europe in 1347 called Black Death. It killed millions of people. According to a historian Mockaitis, during this period, first quarantine was introduced in city of Ragusa by isolating newly arriving sailors. Third plague hit Great Britain intermittently 40 times during 1348 and 1665. Fourth pandemic was the Smallpox that killed 30% of the population through Europe, Asia and Arabia. Before 1858 Cholera hit the world especially England's capital London. This heralded the advent of public health through ground breaking work of John Snow who proved that Cholera is caused by contaminated drinking water. In 1918, the world was hit again by another contagion, Influenza, known as Spanish Flue, it killed around 50 million of the population of the world. During later part of 20th century, HIV/AIDS killed estimated 32 million people across the globe. Since 2005 onwards there were continuous indications through outbreaks and epidemics of SARS, Middle Eastern Respiratory Syndrome, Ebola and Zikaviruses that sooner or later the world will struck with a pandemic. Thus, end of 2019 marked the beginning of a deadly disease COVID-19 caused by a novel Corona virus. Spreading to 213 countries and the regions, as of now, there are 12.153 million cases of COVID-19 with more than half a million deaths worldwide. Pakistan is amongst top 12 countries with 70% of all cases including US, Brazil, India, Russia, Peru, Chile, Spain, UK, Mexico, Iran, Italy and Pakistan accounting for 8.541 million cases. On July 8, 2020 there were 237,489 cases and 4922 deaths in Pakistan. On March 14, 2020 there were 8 confirmed cases in Pakistan with 8 new cases while on July 8, 2020 there were 2980 new cases. On April 30, there were 8,28 new cases, however, during May which coincided with Ramzan and Eidul Fitre the number of new cases dramatically increased and on May 30, 2020 it rose to 2,429. This number keeps on rising. In Sindh, on July 9, 2020 there were 97,626 confirmed cases with 1,614 deaths and 54,676 recoveries with 56% recovered. On June 30, 2020 Sindh conducted 2,587 tests on July 8, 2020 there were 1390 new cases with 9,317 tests on that day. It shows Sindh has kept on increasing its capacity oftesting. With increasing coverage of tests the number of cases has been going down. The Government of Sindh has been a case of best practices which has been globally acknowledged. Besides highest level of political leadership, the Chief Minister Syed Murad Ali Shah and the Minister for Health and Population Welfare, Dr. Azra Fazal Pechuho and other ministers and their teams have been leading the province in an exemplary manner. In a record time, Isolation Centers in all districts; Quarantine centers; High Dependency Units (HDU) were set up. A large number of human resource was trained in a short span of time and PPEs were procured. Setting aside any political differences, the political leadership offered all out support to the Federal Government during this global and national crisis. Sindh, imposed a strict lock down in March, 2020 to contain the spread of virus. In the absence of a vaccine and a treatment, lock downs remain one of the effective measures to save the lives of people. Sindh Government also provided ration through charity organizations. That strategy paid back and cases remained under control till the time lock down was lifted through a federal government decision. On the contrary, theFederal Government differed to strategy of Sindh, denounced taking measures like lock downs. Doctors who are our heroes and front line soldiers on war on COVID they were not listened when they held press conferences to present scientific evidence. With such a flawed policy direction, we as a country, could not contained the virus and the numbers increased dramatically. A sizeable number of doctors and paramedics have been contracting the virus and several died. There is health, social and economic cost attached to this crisis. Population Agenda In this backdrop, the worst sufferers are the women and girls especially in peri-urban and rural areas. The world is celebrating the Population Day in the midst of the pandemic. The theme of the Day is most logical which calls for "Putting the brakes on COVID-19: how to safeguard the health and rights of women and girls now". As Farid Zakarya in his popular CNN program said, gains made against Millennium Development Goals (MDGs) during last decade have been wasted specially, poverty halved during the last decade will be reversed due to COVID-19. The World Bank projects that "advanced economies overall will decline by sevenpercent", let alone economies in developing countries. UNFPA has translated this situation in terms of how women will be affected. It says "in the informal economy, nearly 60 percent of w omen worldwide are at increased risk of poverty. As a result of school closures and increased needs of the elderly, the work of w omen in unpaid care has increased". Initiatives by the Government of Sindh and Future of Population Agenda Women and girls being 50% population in Pakistan remain weaker element in terms of school enrolment, ratio in labor market, poverty, nutrition and health needs. Only 34% of Married Women of Reproductive Age (MWRA) use family planning methods with 17.7% of Unmet Need for family planning. Unintended pregnancies and induced abortions are alarmingly high which indicate lack of access to family planning and reproductive health. During the past two decades Pakistan had committed to MDGs, and later on Family Planning 2020 (FP2020). The country is currently also signatory to Sustainable Development Goals (SDGs) with a commitment that it will increase its OPR to 60% by 2030. In 2018, the Supreme Court of Pakistan took suomoto on alarming level of population growth and consequently, the Council of Common Interest (CCI) approved its recommendations on balancing the population growth. A Federal Taskforce and Country Engagement Group on FP (CEWG) have also been set up. Sindh has taken measures to significantly contribute towards this agenda. The Population Welfare Department, Sindh has been procuring contraceptive commodities since 2016. A Costed Implementation Plan (CIP) was approved as a roadmap for FP2020. All the relevant public sector and development partners, civil society were provided a platform under "Sindh FP2020 Working Group" led by the Minister for Health and Population. In the wake of CCI recommendations, The Chief Minister's Taskforce on Population has been set up. Post pregnancy family planning (PPFP) is being emphasized. LHWs role has been rejuvenated through focus on family planning. Besides, other methods, a new method of Sayana press and Emergency Contraceptive Pills (ECP) are being focused during COVID-19. Sindh has also introduced highly critical legislations like Early Child Marriage Restraint Act; Reproductive Health Rights Act; Domestic Violence Act etc. Currently, work is under way to legislate on Marital Counseling. Due to these reforms, Sindh has been able to double its annual rate of increase in CPR from 0.4% in 2015 to 0.8% (around 1%) in 2019. Impact of COVID and Future of Population Agenda the COVID has certainly pushed back achievements of the past several years. To mitigatethe negative impact, Sindh introduced in March, 2020 the 'Guidelines on Family Planning and Reproductive Health during COVID-19'. The PWD, Sindh asked all FP centers to continue their services. In post COVID and in line with FP2030 and SDGs, the agenda of Population would be re-strategized. There would be more focus on demand side so as to address determinants of family planning that have lasting impact on behavior change i.e. promoting girls education; engaging adolescents; women empowerment; further integration of health and population for effective FP service delivery; more engagement through public private partnerships etc. These reforms would create awareness and sustained behavior changes consequently leading to more and voluntary utilization of family planning and reproductive health services.