Two women lose their life in childbirth every hour and seven babies are born every minute, reveal experts who believe that the family planning indicators in Pakistan are in a dismal state. An alarming state of affairs one would think, especially in a country that was the first in the region to come up with a population Plan.
"The family planning movement began in 1953," reveals Imitiaz Kamal, Secretary General of the National Committee for Maternal Health and Vice President of the Maternity and Child Welfare Association, she believes that despite numerous loop-holes in the system, lack of commitment and seriousness from the government is where the evil stems.
According to Dr Babar Tasneem Sheikh, Director Health and Built Environment, Aga Khan Foundation, Pakistan is probably the only country where Family Planning has been separated from health. He asserts that despite being related these two ministries - Health and Population Welfare - never saw each other 'eye to eye', which led to a complete lack of co-ordination, complementation and support.
Ms Kamal discloses the human cost of such a measure: "When Population Welfare was separated from the then 'Ministry of Health, Population and Special Education', the real issue began. The newly formed Division divorced itself from basic health units and asserted the formation of Family Planning Centres. This discouraged women greatly, because the reason of the visit was obvious, leading to laxity of Family Welfare Workers, as well."
Since women hardly ever came here and no means of accountability were available, Family Health Workers put off visiting the Centres for days. Ms Kamal, narrates one such case when she visited a centre as part of an evaluation team. "When the locked Centre was opened, I and Dr SadiquaJafarey, who was visiting with me, were amazed. To our surprise we found a register with details of the next day's chores inscribed init, and that too in the past tense," she added.
Ms Kamal, blames the Zia ulHaq regime for the demise of Family Planning in Pakistan, "His demand for an Ummat was a major cause of decline in family planning practices," she asserts.
But then that wasn't all, lack of awareness and resources have been decisive issues in this battle as well. "The public lacks the concept of a better standard of living, they donot understand the importance of a good education, and sound living conditions," says Dr ArjumandRabbani, who worked previously with the government as Director Research and Family Planning and is now associated with the Midwifery Association of Pakistan. She blames lack of education for numerous misconceptions that prevail.
Sheena Hadi, Executive Director Aahung, is of the view that lack of education, especially in the case of girls has been a major hindrance in spreading awareness and access to reproductive health. She also feels that reproductive health, in this country, has not been given enough importance, primarily due to lack of political commitment.
The allegation is seconded by AshfaqAli. Shah, Additional Secretary Department Population Welfare, Sindh; according to him, this issue has its roots firmly entrenched in the political system, that bases distribution of resources according to population size. "Why would anyone want, fewer resources for their constituency?" he asks.
According to Ms Kamal, Public Private Partnerships are the need of the day, especially to take this service to rural areas. "This is essential," says Dr Sheikh, who feels that despite 60 percent of the urban female population that use contraceptives in the Pakistan, indicators are ruined when women from neglected segments are included in the count.While praising the role of NGOs and the Private Sector, he emphasises the need for engaging the corporate sector as well, pressurising it to dedicate a certain percentage of earned profits to such endeavours.
However, despite all that is said and done experts believe that change cannot be achieved unless a paramount shift in attitudes and behaviour is attained.For this, it is essential,that the hands of the government be strengthened and the 'Project Approach', which is deep-rooted in our work-systems be shunned. Ms Kamal, terms projects a crime, unless the government is willing to sustain these on a long-term basis.
According to Dr Sheikh, "It is important to understand that the forefront financier, for most projects that are imported into Pakistan, is the government." Criticising its inability to negotiate with international development partners, who enter the sphere with a certain agenda and dump pre-selected strategies on the local populace, he stresses the need for the government to take ownership formaximum impact and ensure that when international partners leave, projects are sustained.