By staff reporter 

Underlining the need for a collaborative effort to manage population, speakers at a programme on World Population Day have said that lack of support from healthcare providers, reluctance to reach out directly to rural communities and misconceptions about birth control methods are major reasons for failure of family planning initiatives in Pakistan where abortion, quite often in unsafe conditions, is increasingly being used as a substitute for contraception.

Originally published by Dawn

The government must realise the implications of the country’s high growth rate of population that upsets all plans of development and is required to promote safe birth control methods as a life-saving initiative, they said.

The programme held at the Jinnah Postgraduate Medical Centre auditorium on Wednesday was earlier scheduled for July 15, but was postponed due to the city’s volatile law and order situation.

The event was organised under a project, Every Woman Counts, of the Society of Obstetricians and Gynaecologists of Pakistan (SOGP).

Giving a presentation on the magnitude of increasing population and an overview of the Millennium Development Goals (MGDs), Prof (Dr) Sadiqua N. Jafarey, president of the National Committee for Maternal and Neonatal Health (NCMNH), said that India, Pakistan and Nigeria were among the nine countries which would account for half of the world’s population between 2005 and 2050.

Pakistan with a population of about 91.6 million women was also among the sixth most female populated countries in the world.

“Currently, we have a population of about 173.5 million rising at a rate of 2.05 per annum. The country has four to five million births annually. That means eight babies are born every minute,” she said, emphasising that expenditure on family planning helped in national savings by reducing expenses on other areas of the social sector.

Highlighting the maternal mortality issues in the country, she said that one in 89 women might probably die of maternal causes in a lifetime which was a very high ration as compared to the ratio in developed countries.

“If maternal health efforts by the government and non-government organisations continue with the same pace, the country will never be able to meet the MDGs of maternal and child mortality by 2015,” she said.

Sharing the results of a survey done in Khairpur, Dr Nighat Shah, secretary general of the SOGP, said that a vast majority of healthcare providers associated birth control methods that included oral pills, injectables, intrauterine device, tubal ligation, vasectomy and condoms with adverse health effects.

“The fact, however, is that modern contraception is safer than both pregnancy and abortion. It is estimated that up to 100,000 maternal deaths could be avoided every year if women who didn’t want children use effective contraception,” she said.

While showing a slide with a mother and her two daughters, all pregnant at the same time, in rural Sindh, she asked what future a country could have where women were perpetually pregnant.

“The girls are married at a very young age, most of whom often have multiple pregnancies in a short period of time. In 15 years, they start looking of 50-year-old and die young. The child mothers are the most precarious population of Pakistan,” she said.

Hurdles in the way

A significant population of women, she said, living in the rural areas would never visit a health facility and there was a dire need that the government and non-governmental organisations involved in maternal health projects reached out to them.

“Our experience has showed that women in the rural Sindh are desperate to seek support for contraception. The major barrier, therefore, in family planning services are the unaware healthcare providers and not the community,” she said.

Dr Samrina Hashmi, president of the Pakistan Medical Association-Sindh, stressed the need for having a national strategy for repositioning reproductive health with a realistic goal and objectives.

“Low literacy rate, poverty, low status of women in society, social cultural taboos, low male participation in family planning programmes and poor access to quality family planning services are major factors contributing to the increase in population,” she said.

Doctors reluctant

Dr Samina Afzal representing Greenstar Social Marketing, an NGO involved in various health projects, said that Pakistan’s 70 per cent population sought medical services from private healthcare providers, most of whom were reluctant to encourage contraception.

“A majority of private healthcare providers fear that their income would reduce if people start using contraceptives. That’s a fact proved by our national survey. This attitude is a major hurdle in the way,” she said.

Pakistan’s population would double to 300 million by 2020 and it had the lowest use of contraceptives in the South Asia region ie 30 per cent, she said.

Dr Azra Ahsan of the NCMNH said that a post-partum intrauterine device was a safe and only long-lasting reversible method for contraception and it didn’t interfere with breastfeeding.

“The ideal time to insert the device is just after the delivery. It can be taken out anytime and can be kept up to 12 years,” she said.