By Zubeida Mustafa
ON March 23, a day for soul-searching, two professional bodies working for women`s health highlighted an issue that is fundamental to our survival and progress, namely, population planning.
They got Sheema Kermani to stage Har aurat anmol, a play that focused on all that is wrong with the reproductive health sector in Pakistan today.
Few people take a holistic view of `population welfare` as birth control is now euphemistically called. The common perception is that an ineffective family planning policy leads to rapid population growth which burdens the national exchequer and skews development planning. A smaller population is easier and less expensive to plan and manage. True, the aging of a population brings its own economic and social maladies as the West and Japan are now discovering to their chagrin.
But as Sheema`s poignant play demonstrated, in Pakistan`s context a failed population policy has a human face. It brings in its wake maternal death, infant mortality, pregnancies in quick succession, abortions and appalling gynaecological problems for women and malnourishment and disease for their children. The socio-cultural prejudices that accompany many of these problems are no less a burden for the sufferers.
The play was most timely because only a few weeks ago the government announced a population policy that aims at reducing the fertility level to three births per woman by the year 2015 and a replacement level of 2.1 births by 2025 by ensuring universal access to safe family planning services by 2015 and achieving a contraceptive prevalence rate of 70 per cent by 2025.
Birth spacing is central to the achievement of these goals. All this seems to be a tall order, especially if you compare some of the targets to be achieved in five years with the current rates spelt out in the Pakistan Demographic and Health Survey 2006-07 (PDHS). It gave the fertility rate as 4.1 births which is pretty high.
Without easy access to contraceptive delivery services no population targets can be achieved. The present contraceptive prevalence rate is given as 30 per cent in the population policy which is highly misleading. The PDHS has another story to tell. Only 21.7 per cent of married couples in the reproductive age group use modern methods to prevent births whereas over nine per cent take recourse to conventional — read unreliable — methods.
If evidence is needed of the failure of our contraceptive delivery policy it comes in the form of the shockingly high number of induced abortions in the country. The Population Council in Islamabad put the figure of abortions at 890,000 in 2004.
Will ambitious goals help to reduce the tragedies that Sheema`s play depicted? Far from it. It is action on the ground accompanied with political will that is needed but which has been missing. An active communication strategy has created awareness among the people but has failed to mobilise them.
The administrative structure that is entrusted with the task of implementing the population policy has changed from time to time — first it was the federal government that promoted population welfare. It was then shifted to the provinces in 2001 but the approach didn`t work. Moreover, the health department has kept itself aloof from contraceptive delivery although shrewd planning could have used health visitors as social mobilisers.
An interesting fact to emerge from the PDHS report is the higher rate of female sterilisation (8.2 per cent) as compared to 0.1 per cent for men and the decline in the use of condoms (6.8 per cent of all acceptors).
This shift of onus to women indicates the growing awareness and their desire to empower themselves though they are often constrained by social prejudices, family concerns and lack of economic power. But it also signifies the male indifference to responsibility in population affairs. Surprisingly, there is no effort in the policy announced now to draw men into the net by focusing on them and making them active participants in the population planning programme. They are kept on the sidelines.
Another significant feature that emerges from the survey is that only five per cent of the respondents cited religious opposition as their reason for not using contraceptives. `It is up to God` was the reason given by 28 per cent to explain why they did not adopt any birth control method. This fatalistic mindset betrays a lack of desire on the part of the respondent to gain control over her life.
The government now plans to mobilise religious leaders to provide the necessary support to overcome misperceptions regarding family planning and promote birth-pregnancy spacing initiatives. This is important because the population policy confirms that ulema with the exception of a few do not vehemently oppose family planning as they once did a few decades ago. But they need to take a more proactive approach and make their voices heard in favour of small families as has happened in Iran and Indonesia.
It is also time the government adopted an integrated approach to population planning so that various departments recognise the need for a slowdown in the demographic growth rate. Setting up a separate population department concentrated the responsibility of lowering birth rate in one department when others also have an equally important role to play.
For instance the health department should have close links with family planning and should mobilise the people and provide contraceptive services where required. The education department should include in its curricula population issues so that from a young age people acquire awareness of the importance of having in place a rational population policy. This can be easily done as a textbook for class V informs students through an interesting lesson about the whys and wherefores of population dynamics and the impact of rapid population growth rate on a country.
These are isolated examples. The time has now arrived to take the whys and wherefores of birth control seriously. Even today one meets women who have given birth to eight or nine children though few link it to the missing factor — the poor status of women in Pakistan.