'Reproductive rights make economic sense' an interview with Alvaro Bermejo, DG IPPF Pakistan

Dr. Alvaro Bermejo is the Director General, International Planned Parenthood Federation(IPPF) since 1^st March, 2018. He is a medical doctor and holds an MA in public health from the University of Leeds. He has more than 20 years’ experience as senior executive in global federations, working across HIV and AIDS, humanitarian issues and health policies.

Before joining IPPF, Alvaro was the Executive Director Survive & Thrive portfolio at the Children’s Investment Fund Foundation, which included work on nutrition, health, deworming and education.

BR Research recently met Dr. Alvaro Bermejo to discuss family planning challenges the country is facing and what Rahnuma-FPAP, a member association of IPPF is doing to address them. Following are the edited transcripts:

BR Research: Population growth is a big issue in Pakistan, and so is rising gender disparity that comes with it. How critical is reproductive health of women in addressing these challenges?

Alvaro Bermejo: It is really important for people to understand that while you can claim that gender equality and reproductive rights are human rights, it is also true that they make economic sense. A woman who cannot control her fertility and her life, cannot engage in economic activity.  Our approach is that women need to take control of their fertility, life and future in order to make a more productive society. Birth spacing, and people being able to decide when to have children is very important.

BRR: But in Pakistan, there is a social stigma attached to ideas such as birth control, birth spacing, and decisions on when to have children. How can this be dealt?

AB: This is not unique to Pakistan. We work in over 150 countries and majority of them faced these pressures. But that is changing now; with more educated women who want to join the workforce or have other plans are now making rational decision about when to have children. We need to give women in Pakistan the opportunities and an enabling environment to do the same. Peer pressure can play a positive role in creating that change. I am pleased to see that one province in Pakistan has elevated the age of marriage to 18 years for both genders. Hopefully, other provinces will follow suit. We could argue that only legislation is not the answer; societal norms need to change as well. But it is a starting point and a contributing factor. Reproductive health and related decisions are not only important for women health and their economic participation, but also for children in terms of health and better economic opportunities in the future.

BRR: This understanding seems to be missing especially among people at the bottom of the pyramid. They still see large number of children as earning prospects. How can this psyche be changed?

AB: You are right. Poor people see children as an investment. This changes with economic growth. You will see that happens in Pakistan too. But what we also need is to change how women are seen in the society. In this particular economic sector, women are valued in relation to their fertility. Those who have more children, especially sons are considered better women. Given how Pakistan scores on the Gender Inequality Index, we need to work with the community leaders, clerics and religious leaders. It is hard work and there is no magic wand, but I believe we will have to invest in it today with a long term goal of attaining sustainable results.

BRR: Do you think that policies such as one-child policy in China to control population growth could work in Pakistan?

AB: We as an organisation have always argued that it has to be a voluntary decision from the couple, and particularly women. We have seen that if people are given the information and the opportunity to space their births or delay first births, it works. We have never advocated one-child policy in the sense of a governmental or normative rule to impose as the number of children people can have.

BRR: What are the objectives of IPPF?

AB: We invest in delivering reproductive healthcare rights around the world. We are doing the same in Pakistan through Rahnuma-FPAP.

Today, there is a global backlash against women rights where they are being pushed back to their very traditional roles. I call it an era of macho-politics where leaders show how strong they are by attacking women. We must invest more in this area because the opposition is better organised, financed and more aggressive than ever before.

In addition to the work we are doing specifically on reproductive health and rights, we are looking at all our programs through the gender lens to understand how intimate partner violence and gender equality are very closely linked. Globally, one third of women have experienced gender-based violence at some point in their lives, and it is thriving in very patriarchal societies.   Economic empowerment and financial literacy of women are also areas we are supporting. We are supporting the movement call SheDecides, which is about enabling women to take more active role in politics and business.

BRR: What kind of interventions and investment tools are you looking at?

AB: One area that we are working with Rahnuma-FPAP is starting early in school with life skills-based education. Discussions are held with young people around relationships, decision-making, personal hygiene, and reproductive health. I know it is a contested area but Nordic countries, which were the pioneer in this type of investment have been able to develop more equal societies as a result.

BRR: Do you think any kind of legislation is required in this area?

AB: Yes; and that is why we have the support of the parliamentarians. As I said before, normative framework is important, but legislative framework is key and parliamentarians are the enablers. Generally, legislative framework is designed by men for men in most places in ways that we are not even conscious of. These include inheritance laws, laws around property ownership, and decisions related to families, investments etc. Therefore, we need to review laws that are stigmatising, pushing women down, or not allowing them to incorporate themselves in the economic setup. Women participation in politics is key, and I see some progress here. But there is still a long way to go.

BRR: Any other community-based or fiscal incentive that could be provided to families to restrict the number of children in a family?

AB: There are lots of incentives that if provided can make such decisions easier. First, they have to be possible. Pakistan was the pioneer of what was called population control program in 60s and 70s. There was a lot of political will behind these reproductive health programs, which got lost later. In light of what this government is doing, I think there is a renewed momentum.

Having said that, we are seeing stock outs on family planning commodities across the country. Without the product, there is no program. We need to make sure that women have access to the products. Secondly, we need to scale the programs to every corner of the country. These family-planning products are easy to use, and we have the logistics and technology infrastructure to make them accessible.

BRR: Are you thinking of any women-specific economic opportunities and out of the box solutions for women in rural areas or in far flung areas to nudge them in the right direction?

AB: Yes, we are. We are partnering with companies that are investing both on the credit access side as well as job creation for women. Globally, many countries are creating economic trade zones, and we are partnering with companies working there. This mode has been successful not only for us where we are trying to provide economic opportunities to women to be able to join the workforce, but also the companies that have suffered less absenteeism, less unwanted pregnancies and inculcated more gender diversity in their workforce.  That kind of model should be emulated here as well.

BRR. You talked about how Pakistan was more progressive in the 60s and 70s in terms of family planning. But then the will was lost, which it is argued may in some part be a result of resistance from religious quarters. Do you agree and how can it be addressed?

AB: The change has to come from within. In countries such as Malaysia, Bangladesh, and to some extent Indonesia, the mosque has played an important part in their success stories - not supporting it very vocally but by remaining neutral as it was good for the country and its people. I believe, we are moving in that direction here too; the institutions are working for it. You need to build the momentum, and people will join you. Influencers can play a huge role in changing the perceptions. The change will only come if we understand values of the people in a certain country – and not by challenging them but linking our message to their values to make them understand the benefits.

BRR: You also said that things are changing now and there is a renewed political momentum. What kind of support are you getting from the government?

AB: The Council of Common Interest (CCI) has approved ambitious targets; it has determined who is responsible and is working towards a plan. It has agreed to the creation of a fund and placed additional money behind it to finance family planning. There is political will from the top; in the past you did see the Prime Minister making statements about population control. But is all of that trickling down? That’s the challenge. And that is why we are here. The civil society needs to support the government in this process.

BRR: How can you intervene in trickling down the political will and resources in this area?

AB: Through Rahnuma-FPAP, we are conducting a lot of trainings of public health officials at both the service delivery and management levels. We have recently signed an agreement with National Disaster Management Authority (NDMA) where Rahnuma-FPAP will be training their staff because women are the ones who suffer the most in a disaster.