Four children will share a mattress for one, and in a house made for five people a family of ten will reside. These instances will be pedestrian observations in the Pakistan of 2050—the year when country’s population will, ostensibly, double. To circumvent such an apocalyptic future, Pakistan must popularize and embrace birth spacing. This step, however, will not come without challenges, especially the creation and implementation of sustainable and plausible policy actions.
As a first step in this direction, the government must build on the history of community participation in family planning (FP) that grew out of the 1994 International Conference on Population and Development (ICPD), and which is a central pillar of the global FP2020 movement.FP2020—a consequence of the 2012 London Family Planning Summit— is a global moment that supports the rights of women & girls to decide – freely & for themselves – whether when, and how many children they want to have. While Pakistan has pledged to involve more women in its FP policy, planning & implementation, participation of civil society, in particular that of women,does not stand out as a regular feature in the country’s FP processes. Strategic measures encouraging direct engagement between women and FP providers will add important voices to the broader framework of family planning programming, while also enabling government to evaluate firsthand the effectiveness of its FP programs.
For family planning and birth spacing practices to take hold in Pakistan, there is also a need to design and implement male centered FP programs. Pakistan is a patriarchal society where men circumscribe women’s birth spacing decisions. Methods targeted towards men are also viewed as antithetical to masculinity. Added to this are the prevailingmyths and falsehoods aboutFP that need to be addressed.Awareness raising programs for men are needed, and they must be launched through different mediums such as traditional and social media, panel discussions, community lectures, dissemination of easy to understand booklets in local languages, etc. Men should be involved in family planning practices with the objective of promoting the empowerment of women, and not dependencies – with their involvement essentially encouraging shared decision making between husbands and wives and not shifting decision making from wives to husbands.Another requirement isthe involvement of Male Health Workers indifferent FP programs with roles like that of Lady Health Workers, who canprovide services and information to men at the community level.Male FP service providers can better exhort men to use FP methods. They can also help distinguish fact from myths, correct fallacies about male family planning methods, and help address concerns regarding possible side effects. Whatever measures are adopted, one thing is elemental – men’s issues and health must be addressed to make FP successful in Pakistan.
Counseling religious leaders and mothers-in laws is another area that would address issues in FP programs’ implementation. Though religious leaders adhered to birth spacing by participating in the 2018’s National Symposium on Alarming Population Growth in Pakistan, a vast majority of religious leaders are still not fully on board. Similarly, mothers-in-law are another important actor who influence a couple’s choice to adopt birth spacing. There is a need to train and counsel these actors on the importance of government’s FP and population goals and to highlight family planning benefits at the personal and patriotic level, as will be witnessed within their families as well as in the nation at large. Introducing them to FP knowledge will also reduce society’s taboos about birth spacing and provide a supportive environment.
All of the policy actions and societal conversations for FP will not matter if FP materials are not available, thereby making supply chain management a hidden but essential tool. The existing logistics and supply chain management system needs to be enhanced by strengthening procurement, quantification, and distribution, with the use of Logistics Management Information System (LMIS). The discrepancy in availabilityof stock in alldepartments, with some items in great excessand others out of stock has been documented. There have also been complaintsranging from a lack of training or refresher courses and nonuniformityinmethods of data acquisition, to connectivity andcommunication issues that have kept the ServiceDelivery Points(SDPs) out of the loop. All these issues need to be rectified to improve the effectiveness of the existing supply system.
Client-oriented FP services with choices and a full range of contraceptives need to be introduced.Family planning providers need to have a supply of a range of contraceptives to offer clients to meet the health and lifestyle requirements of women and their families. Most importantly, training of FP service providers, particularly in side effects management, is an absolute must. Focus should be on the needs of clients and not the number of clients seen. At present, a supply-side approach dominates the FP model whereas for an effective FP program emphasis needs to be on the demand side. More attention should be given to filling the gaps in needs of clients with a better provision of information and choice as well as continuity of care. For if the needs of women are not met, and their voices are not heard then they will not take advantage of FP methods, as the message going out to them will be that nobody is putting the time in to help them find the method that works best for them.
Legislation developed on the above given lines would significantly reduce Pakistan’s population growth and save the country from being crushed by its population pressure. Harnessing partnerships with civil society, in particular women, will help the government set the foundation for citizen-based accountability. Whereas, managing supply chains, involving men, mothers-in-law, and religious leaders will enable it to realize its FP related goal. Taking these steps will ensure a Pakistan in 2050 where a mattress for one is used by one, where a breadwinner can feed all the mouths, where neighbors live in peace and harmony, and where a high standard of living is a norm rather than an exception.
