Beneficiaries of family planning

By Zubeida Mustafa
Source: Dawn

POPULATION control — or population welfare, if you want to be genteel — is the buzzword today. The focus has been on the economic impact of a rapidly growing population and its implications for employment.

Some scholars have been concerned with the religious dimension since the general impression is that Islamic leaders are opposed to contraception on religious grounds, and so people are reluctant to limit their family size.

But the reality is far from this. If this had been the case, we would not have had a big unmet need of 34 per cent among women which is much larger than the percentage of users (23 per cent). This means that nearly a third of married women in the reproductive age group want to prevent a birth but cannot do so. Most say that opposition from their husbands deters them from using contraceptives. Others believe that the unavailability of the required services hampers them.

Why should many husbands want large families? It is not so much the family size as the gender factor that is the crucial determinant of the number of children desired by the parents. In the patriarchal set-up that exists today, no family is generally considered to be complete without a son — preferably two sons. Family planning workers have observed that women with a number of daughters continue to give birth to children until the desired number of sons have been born. Men are even known to abandon their wives and marry another woman in the hope that she will give birth to a son.

This perception is confirmed by the ratio of men to women in Pakistan. Here males have always outnumbered the females, although in societies where unnatural phenomena like wars/epidemics do not upset the biological growth rate, women constitute the bigger segment of the population. Today, Pakistan is estimated to have 72.6 million women as against 78.8 million men. This ratio reflects the higher mortality rate in women who do not receive the same healthcare and nutrition as the men. Daughters are still discriminated against compared to their brothers.

It is the low status of women that determines social attitudes towards the girl child. Mercifully, opinion is now changing and a daughter is not always rejected as she was before. Nevertheless, she cannot take the place of a boy when it comes to carrying on the family name, protecting the family property/business and providing support to the parents in old age. So the aims of the family planning advocates are defeated if the first-born is not a boy.

What has not received enough emphasis is the role of birth control in the reproductive health of women. Given the unreliable statistical base we have, one cannot be too certain about some of the data given. When it comes to women, even the more optimistic figures are really not so rosy, especially when we remember that we are low down on the list. For instance, 500 women per 100,000 births die of pregnancy related causes while infant mortality is a high 74 per 1,000 live births, the highest in South Asia.

One major cause of the high mortality rate is not simply lack of pre-natal healthcare which leads to many women becoming victims of tetanus or haemorrhaging to death because iron deficiency has made them anaemic. Multiple pregnancies also weaken many women as well as their infants. Even a child, who survives when his mother dies, has relatively few chances of living very long. The men who insist on their wives bearing more children in spite of the risks frequent pregnancies incur for many women betray an uncaring attitude towards their spouses. Of course, poverty compounds the situation.

Unfortunately, the government’s population welfare programme also reflects this bias and apathy although it should be in the lead in setting a direction for the small family norm and a pro-woman approach. In the public-private partnership scheme of things, it has been left to the NGOs to carry on the job — which many of them are doing excellently — but within the limits of their meagre resources. As has been the trend in other social sectors the government has gradually been disengaging itself from the field of population welfare. The public sector does not have much to show by way of performance. As a result, the Pakistan Economic Survey, 2005-06 does not even record any statistics to show the categories and quantity of contraceptives dispensed as was the practice several years ago.

Only the institutions have been listed and they do not inspire much hope. The number of family welfare centres, supposedly the linchpin of the programme, have increased from 1,777 in December 2003 to 2,206 in March 2006 which works out to an increase of 24 per cent in three years. The reproductive health A centres, which perform sterilisation procedures, have gone up from 108 to 204 in the same period which is a more impressive increase of 88 per cent. But the number of the mobile service units declined from 146 to 118 in 2003-2006 (a decrease of 19 per cent).

As for the funds allocated for the programme, they have consistently been on the decline. Population welfare is essentially a provincial subject and managed by the provincial governments. While the Sindh budget for 2006-07 shows the amount allocated under this head as nil, the NWFP has given it five million rupees, Balochistan gives it Rs 11.8 million and Punjab has earmarked Rs 18.5 million. The federal budget shows a bigger sum for the population sector — Rs 172 million for 2006-07.

What is surprising is that the development budget for the current year runs into billions for the federal programme (Rs 4.3 billion) and Punjab (Rs 1.7 billion). Sindh and Balochistan show a more hefty sum for the development expenditure on population compared to the revenue budget. In the NWFP, the ADP for population is Rs 47 million and Rs 6.8 million for the current expenditure. How are the development funds to be used? How will a meagre revenue budget sustain a massive project presumably envisaged by the annual development programme?

There are 264 NGOs with 479 outlets reporting to the National Trust for Population Welfare playing an “innovative” — to use the government’s words — role in this field. But their resources are limited and the flow of funds from NATPOW is not always steady and assured. The 58,000 outlets of social marketing projects make contraceptive services available at a subsidised rate.

Instead of transparency what we have is a clouded picture of the population programme making it difficult to assess the strategy that has been adopted. This ambiguity militates against the success of the programme. This hardly promotes the women’s cause. Dr Akhter Hameed Khan, the great social activist and founder of the Orangi Pilot Project, once said in an interview in 1986, “Actually economic forces have undermined the traditional perception of Islam. Inflation, urbanisation (which has led to the breakup of the joint family system) and the compulsion for female employment have brought about changes in attitudes. Now women with many children feel distressed … The official programme is in no way responsible for this change in attitude… Family planning is closely related to the emancipation of women. But the government does not see it that way.” Neither do many others.