Family planning in Pakistan
Encyclopedia
Even though there is considerable demand for Family planning in Pakistan, adoption has been hampered by government neglect, lack of services and misconceptions. Demographics
play a large role in Pakistan
's development and security since the recent change from military rule to civilian leadership. Challenges to Pakistani's well-being, opportunities for education
and employment, and access to health care
are escalated due to the country's continuously-growing population. It was estimated in 2005 that Pakistan's population totaled 151 million; a number which grows 1.9 percent annually, equaling a 2.9 million population growth per year. Though Pakistan's fertility rates still exceed those of neighboring South Asian countries with a total fertility rate at 4.1 (3.3 children in urban settings and 4.5 children in rural areas) and contraception
use is lower than 35 percent, approximately one-forth of Pakistani women wish to either delay the birth of their next child or end childbearing altogether.
According to Dr. Ansar Ali Khan, an advisor of reproductive health
to the United Nations Population Fund
in Pakistan, "A combination of factors like non-availability of services, baseless traditional beliefs and misconception play a big role." In addition, Ali Khan stated that "a fairly large number of the population believes the use of artificial contraceptives for family planning
is against nature and also against Islam
." Unlike Family Planning in Iran
, a neighboring Islamic republic, Pakistan's family planning
program has failed in recent years due to neglect and constant policy changes as a result of political upheaval. While 96 percent of married women were reported to know about at least one method of contraception, only half of them had ever used it.
(UN) has projected that in 2050 it will move into 5th place with around 292 million people.
when her maid died from an attempt to abort her own pregnancy. The FPAP was unsuccessful in changing family planning policies until President and military leader Ayub Khan took interest in the problem of overpopulation in the late 1950s. Khan spoke at the FPAP's first national seminar in 1959, speaking on the ‘menace over overpopulation'. Soon after the seminar, the National Board of Family Planning was established as a policy-advising body for the federal government.
Pakistani journalist/researcher Ayesha Khan has suggested various reasons for Ayub Khan's position on population control. Firstly, religion played a minor role in his government, a position that would change with Pakistan's next leader. Secondly, development ideology during Khan's time of power warned of the economic risks of high population growth rates. Thirdly, it had political utility for a military leader with no popular mandate to his leadership and in need of a development strategy. Lastly, support from international donors.
(IUD)had replaced it has the "corner-stone" of the Scheme. It was said to be "safe, cheap, reversible," and it required "little user action."
did little more than watch as a civil war ripped apart East and West Pakistan in 1971. Wajihuddin Ahmed, the Family Planning Commissioner during Yahya Khan's rule, focused on reducing pregnancies in women "rather than meeting contraceptive targets alone" and introducing the pill to Pakistani women.
In 1971, while the country was split apart and international assistance halted due to army atrocities in Bangladesh, the Pakistan Peoples Party
took power of the Pakistani government. Its leader, Zulfiqar Ali Bhutto, needed to gain legitimacy and popularity by taking an anti-American, anti-capitalist, and anti-Ayub Khan-stance. However, Bhutto found that he could not fund many of his socialist promises, and so allowed economic assistance from USAID. Over the 15 year span of 1964-1979, USAID "spent over $30 million on Pakistan's population programme; during 1965-75 US AID provided 40% of total programme inputs." However, due to extreme and unrealistic goals, the USAID program was highly ineffective.
In 1977 Bhutto's Chief of Army Staff, General Zia ul-Haq, deposed the leader and declared martial law. Zia differed from his predecessors in that he "made the religious-right-wing his political ideology." He had used the religious lobbies and conservative middle-classes as support for his take-over. In a move looking to counter Bhutto's government and as a gesture to his religious constituency, Zia froze the existing family planning program and banned publicity for family planning activities. Zia enforced strict laws against adultery (punishable by death), rape
, intoxication, and theft. USAID funding was suspended, and Pakistan became alienated "from the Western powers that Ayub Khan had so carefully cultivated."
Near the end of Zia's era of power, family planning and population control became tied to the Ministry of Health (Pakistan)
. Unfortunately, the program has remained fairly unchanged over the past 35 years due to implementation problems involving over-centralization, lack of coordination, and structural flaws.
populations are incredibly diverse, varying by race, language, and degree of religious conservatism. Some populations are part of countries run by Islamic law, while others live under secular governments. In Pakistan, extremely conservative Islamic beliefs predominate in many parts of the country, in which purdah
restricts women to their homes unless chaperoned by a male relative. Additionally, levels of schooling are very low in Pakistan, allowing men to have more power in decision-making.
When Ayub Khan was overthrown in 1969, religious demonstrators attempted to discredit the leader morally using the slogan "Family planning, for those who want free sex!" This ideology is still present in Pakistan, as the organized religious party opposes family planning because it is "un-Islamic". Though Pakistani couples commonly site religious regions for avoiding birth control, there is not one definitive agreement about family planning and contraception in Islam. In Pakistan, many local religious figures are supportive of family planning and have begun discussions in their communities in order to promote the health of women and children.
Extending beyond the reach of family planning and contraceptive methods is the issue of women's sexual and reproductive health. According to the World Health Organization
and Population Action International
, as of 2007, "only 16 percent of women receive at least four antenatal care visits during pregnancy, fewer than one-third of births are attended by skilled health personnel, and the maternal mortality ratio, at 320 maternal deaths per 100,000 live births, remains high."
in Cairo in 1994, Pakistan pledged to provide universal access to family planning by 2010. Also in Pakistan's Poverty Reduction Strategy Paper is the objective of increasing contraceptive use 57 percent by 2012.
Demographics
Demographics are the most recent statistical characteristics of a population. These types of data are used widely in sociology , public policy, and marketing. Commonly examined demographics include gender, race, age, disabilities, mobility, home ownership, employment status, and even location...
play a large role in Pakistan
Pakistan
Pakistan , officially the Islamic Republic of Pakistan is a sovereign state in South Asia. It has a coastline along the Arabian Sea and the Gulf of Oman in the south and is bordered by Afghanistan and Iran in the west, India in the east and China in the far northeast. In the north, Tajikistan...
's development and security since the recent change from military rule to civilian leadership. Challenges to Pakistani's well-being, opportunities for education
Education
Education in its broadest, general sense is the means through which the aims and habits of a group of people lives on from one generation to the next. Generally, it occurs through any experience that has a formative effect on the way one thinks, feels, or acts...
and employment, and access to health care
Health care
Health care is the diagnosis, treatment, and prevention of disease, illness, injury, and other physical and mental impairments in humans. Health care is delivered by practitioners in medicine, chiropractic, dentistry, nursing, pharmacy, allied health, and other care providers...
are escalated due to the country's continuously-growing population. It was estimated in 2005 that Pakistan's population totaled 151 million; a number which grows 1.9 percent annually, equaling a 2.9 million population growth per year. Though Pakistan's fertility rates still exceed those of neighboring South Asian countries with a total fertility rate at 4.1 (3.3 children in urban settings and 4.5 children in rural areas) and contraception
Contraception
Contraception is the prevention of the fusion of gametes during or after sexual activity. The term contraception is a contraction of contra, which means against, and the word conception, meaning fertilization...
use is lower than 35 percent, approximately one-forth of Pakistani women wish to either delay the birth of their next child or end childbearing altogether.
According to Dr. Ansar Ali Khan, an advisor of reproductive health
Reproductive health
Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
to the United Nations Population Fund
United Nations Population Fund
The United Nations Population Fund is a UN organization. The work of the UNFPA involves promotion of the right of every woman, man and child to enjoy a life of health and equal opportunity. This is done through major national and demographic surveys and with population censuses...
in Pakistan, "A combination of factors like non-availability of services, baseless traditional beliefs and misconception play a big role." In addition, Ali Khan stated that "a fairly large number of the population believes the use of artificial contraceptives for family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
is against nature and also against Islam
Islam
Islam . The most common are and . : Arabic pronunciation varies regionally. The first vowel ranges from ~~. The second vowel ranges from ~~~...
." Unlike Family Planning in Iran
Family planning in Iran
The Republic of Iran has a comprehensive and effective program of family planning. While Iran's population grew at a rate of more than 3%/year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program...
, a neighboring Islamic republic, Pakistan's family planning
Family planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
program has failed in recent years due to neglect and constant policy changes as a result of political upheaval. While 96 percent of married women were reported to know about at least one method of contraception, only half of them had ever used it.
History
In 1950, Pakistan's population reached 37 million people, making it the world's 13th most populous country. Though Pakistan was one of the first Asian countries to begin a family planning program with some help from international donors, fertility has declined slower than in neighboring countries. In 2007, Pakistan had increased in world population ranking to 6th, with over 164 million people and the United NationsUnited Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
(UN) has projected that in 2050 it will move into 5th place with around 292 million people.
Beginnings
The Family Planning Association of Pakistan (FPAP), now called "Rahnuma", was founded in Lahore by Saeeda Waheed in 1953. Waheed, a member of the All-Pakistan Women's Association, began advocating for birth controlBirth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
when her maid died from an attempt to abort her own pregnancy. The FPAP was unsuccessful in changing family planning policies until President and military leader Ayub Khan took interest in the problem of overpopulation in the late 1950s. Khan spoke at the FPAP's first national seminar in 1959, speaking on the ‘menace over overpopulation'. Soon after the seminar, the National Board of Family Planning was established as a policy-advising body for the federal government.
Pakistani journalist/researcher Ayesha Khan has suggested various reasons for Ayub Khan's position on population control. Firstly, religion played a minor role in his government, a position that would change with Pakistan's next leader. Secondly, development ideology during Khan's time of power warned of the economic risks of high population growth rates. Thirdly, it had political utility for a military leader with no popular mandate to his leadership and in need of a development strategy. Lastly, support from international donors.
Family planning policy in the 1960s
Pakistan's first Family Planning Scheme was a part of the country's Third Five Year Plan (1965–1970). This scheme became the template for all subsequent family planning strategies. The scheme's goal was to have a vast impact in the shortest time possible, with a reduction of the birth rate from 50 to 40 per 1000 by 1970. At the onset of the program, condoms were the most available method of contraception, but by 1966 the Intrauterine DeviceDevice
-Computing and electronics:* A component of personal computer hardware* Peripheral, any device attached to a computer that expands its functionality* Electronic component-Other uses:* Appliance, a device for a particular task* Device...
(IUD)had replaced it has the "corner-stone" of the Scheme. It was said to be "safe, cheap, reversible," and it required "little user action."
Family planning amid political turmoil
In 1969, Ayub Khan was overthrown by the joint action of right-wing religious parties and the left-wing Pakistan People's Party. His successor Yahya KhanYahya Khan
General Agha Mohammad Yahya Khan Qizilbash, H.Pk, HJ, S.Pk, psc was the third President of Pakistan from 1969 to 1971, following the resignation of Ayub Khan...
did little more than watch as a civil war ripped apart East and West Pakistan in 1971. Wajihuddin Ahmed, the Family Planning Commissioner during Yahya Khan's rule, focused on reducing pregnancies in women "rather than meeting contraceptive targets alone" and introducing the pill to Pakistani women.
In 1971, while the country was split apart and international assistance halted due to army atrocities in Bangladesh, the Pakistan Peoples Party
Pakistan Peoples Party
The Pakistan Peoples Party , is a democratic socialist political party in Pakistan affiliated with Socialist International. Pakistan People's Party is the largest political party of Pakistan...
took power of the Pakistani government. Its leader, Zulfiqar Ali Bhutto, needed to gain legitimacy and popularity by taking an anti-American, anti-capitalist, and anti-Ayub Khan-stance. However, Bhutto found that he could not fund many of his socialist promises, and so allowed economic assistance from USAID. Over the 15 year span of 1964-1979, USAID "spent over $30 million on Pakistan's population programme; during 1965-75 US AID provided 40% of total programme inputs." However, due to extreme and unrealistic goals, the USAID program was highly ineffective.
In 1977 Bhutto's Chief of Army Staff, General Zia ul-Haq, deposed the leader and declared martial law. Zia differed from his predecessors in that he "made the religious-right-wing his political ideology." He had used the religious lobbies and conservative middle-classes as support for his take-over. In a move looking to counter Bhutto's government and as a gesture to his religious constituency, Zia froze the existing family planning program and banned publicity for family planning activities. Zia enforced strict laws against adultery (punishable by death), rape
Rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...
, intoxication, and theft. USAID funding was suspended, and Pakistan became alienated "from the Western powers that Ayub Khan had so carefully cultivated."
Near the end of Zia's era of power, family planning and population control became tied to the Ministry of Health (Pakistan)
Ministry of Health (Pakistan)
The Ministry of Health of Pakistan is a government agency responsible for Pakistan's health system. It is a branch of the Government, that is the department for provision of medical services, responsible to frame the health policies and to enforce the same at a national level...
. Unfortunately, the program has remained fairly unchanged over the past 35 years due to implementation problems involving over-centralization, lack of coordination, and structural flaws.
Religious influences
MuslimMuslim
A Muslim, also spelled Moslem, is an adherent of Islam, a monotheistic, Abrahamic religion based on the Quran, which Muslims consider the verbatim word of God as revealed to prophet Muhammad. "Muslim" is the Arabic term for "submitter" .Muslims believe that God is one and incomparable...
populations are incredibly diverse, varying by race, language, and degree of religious conservatism. Some populations are part of countries run by Islamic law, while others live under secular governments. In Pakistan, extremely conservative Islamic beliefs predominate in many parts of the country, in which purdah
Purdah
Purdah or pardeh is the practice of concealing women from men. According to one definition:This takes two forms: physical segregation of the sexes, and the requirement for women to cover their bodies and conceal their form....
restricts women to their homes unless chaperoned by a male relative. Additionally, levels of schooling are very low in Pakistan, allowing men to have more power in decision-making.
When Ayub Khan was overthrown in 1969, religious demonstrators attempted to discredit the leader morally using the slogan "Family planning, for those who want free sex!" This ideology is still present in Pakistan, as the organized religious party opposes family planning because it is "un-Islamic". Though Pakistani couples commonly site religious regions for avoiding birth control, there is not one definitive agreement about family planning and contraception in Islam. In Pakistan, many local religious figures are supportive of family planning and have begun discussions in their communities in order to promote the health of women and children.
Current contraceptive use
Historical political strife and cultural restrictions on women constraining their empowerment have hampered implementation of family planning strategies throughout the country. Most women who say they do not want any more children or would like to wait a period of time before their next pregnancy do not have the contraceptive resources available to them in order to do so. One-fourth of married women are estimated to have an unmet need. In the 1990s, women increasingly reported to wanting fewer children, and 24 percent of recent births were reported to be unwanted or mistimed. The rate of unwanted pregnancies is higher for women living in poor or rural environments; this is especially important since two-thirds of women live in rural areas. While only 22 percent of pregnant married women report to be currently using a modern method of birth control and 8 percent reported to be using a traditional method, lack of widespread contraceptive use could be due to the lack breadth of the current family planning program. The most commonly reported reasons for married women electing not to use family planning methods include the belief that fertility should be determined by God (28 percent); opposition to use by the woman, her husband, others or a perceived religious prohibition (23 percent); infertility (15 percent); and concerns about health, side effects or the cost of family planning (12 percent).Extending beyond the reach of family planning and contraceptive methods is the issue of women's sexual and reproductive health. According to the World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
and Population Action International
Population Action International
Population Action International is an international nongovernmental organization that uses research and advocacy to improve global access to family planning and reproductive health care...
, as of 2007, "only 16 percent of women receive at least four antenatal care visits during pregnancy, fewer than one-third of births are attended by skilled health personnel, and the maternal mortality ratio, at 320 maternal deaths per 100,000 live births, remains high."
Current policy
Dating from 2002, Pakistan's current family planning policy reflects the government's concern with rising population trends and poverty. The policy's goals include reducing population growth (from 2.1 percent in 2002 to 1.3 by 2020), reducing fertility through voluntary family planning (from 4 births per woman in 2004 to 2.1 births per woman by 2020), and as a signatory to the Programme of Action developed at the International Conference on Population and DevelopmentInternational Conference on Population and Development
The United Nations coordinated an International Conference on Population and Development in Cairo, Egypt from 5–13 September 1994. Its resulting Program of Action is the steering document for the United Nations Population Fund ....
in Cairo in 1994, Pakistan pledged to provide universal access to family planning by 2010. Also in Pakistan's Poverty Reduction Strategy Paper is the objective of increasing contraceptive use 57 percent by 2012.