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By the end of the session,
participants will be able to:
Define Family Planning (FP) and
related terms.
Briefly describe how Family
Planning contributes to the MDGs. Describe the evolution of Family
Planning interventions from 1947
to present.
Illustrate vital trends (situational
analysis) in health indicators
related to Family Planning.
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Continued
Discuss the role of funding
agencies, public sector, and privatesector in implementation.
Sensitize the unmet needs of
vulnerable population.
List the program shortcomings in
Pakistan.
List a few recommendations for
health reforms.
Illustrate one key paper.
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FAMILY PLANNING -
DefinitionFamily planning allows individuals and couples
to anticipate and attain their desired number of
children and the spacing and timing of their
births. It is achieved through use of contraceptivemethods and the treatment of involuntary
infertility. A womans ability to space and limit
her pregnancies has a direct impacton her health
and well-being as well as on the outcome of each
pregnancy.
(WHO. Family Planning. http://www.who.int/topics/family_planning/en/ (accessed 12 November 2012).)
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FP directly promotes Millennium DevelopmentGoals 3 through 8
MDG 3: Promote Gender Equality and EmpowerWomen
MDG 4: Reduce Child Mortality
MDG 5: Improve Maternal Health
MDG 6: Combat HIV/AIDS, Malaria and OtherDiseases
MDG 7: Ensure Environmental Stability
MDG 8: Develop a Global Partnership forDevelopment
FAMILY PLANNING -
Importance
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MDG 1: Eradicate Extreme Poverty and Hunger
MDG 2: Achieve Universal Primary Education
FAMILY PLANNING -
Importance
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FERTILITY DECLINE
At the inception of populationprogram Pakistans fertilitydecline rate (6.6 births perwoman) was between Indias(5.9) and Irans (7) but
experienced fertility decline theslowest in the region (1990s).
Pakistans total fertility rate (TFR)is one birth more than India and
Bangladesh and two births morethan Irans TFR.
With current TFR rate Pakistan isset to reach the proposed 2020goals ten years even later.
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FERTILITY REGULATION
Contraceptive Prevalence:
Contraceptive Prevalence rates
in Pakistan remained relatively
below 10 % during the seventies
but increased significantly by
1990s to almost 28 %. CPR
increased from 21 % in 1991 to
49 % in 2007 amongst married
women. Use of contraceptivesin rural areas has increased over
the past two decades still lacks
behind significantly.
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The Contraceptive Prevalence Rate (CPR) is 30% inPakistan a figure that has virtually remained thesame over the last decade which is
considerably low as compared to other Muslimcountries. Iran has 74 % CPR, Turkey 71%,Morocco 63%, Indonesia 61%, Egypt 60%,Bangladesh 56% and Malaysia, 55%.
SOURCE: Sadiah Ahsan Pal. Family planning: Pakistan still has a long way to go.http://tribune.com.pk/story/442532/family-planning-pakistan-still-has-a-long-way-to-go/ (accessed 5th November 2012).
FERTILITY REGULATION
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SOURCE: National Institute of Population Studies (NIPS) [Pakistan] and
Macro International Inc. 2008. Pakistan Demographic and Health Survey2006-07. Islamabad: NIPS and Macro International Inc.
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FERTILITY REGULATION
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Induced Abortions: Induced abortions being
illegal still prevail with an estimate figure of
890,000 in 2002. On a rough scale every 29 of
1000 pregnancies end up with induced
abortions. This trend is heavily exercised by
women bearing more than three children.
FERTILITY REGULATION
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UNMET NEED
In 1991, 40% women wanted to limitchildbearing, in 2007 it increased to 52%.
Although more than 50 percent of women wish tolimit childbearing and around 20 percent wish tospace their next birth, only 30 percent are usingcontraception, indicating unmet needs.
The proportion of recent births that areunplanned rose from 21 percent in 1990-91 to 24
percent in 2006-07 which lead to potentiallyunsafe abortions. These problems are evenintense in rural areas.
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UNMET NEED
Rahnuma-FPAP President Mehtab Akbar Rashdi
said that London Summit will be the largest
family planning event where 69 poorest
countries with HIGHEST UNMET NEED offamily planning will participate.
Unfortunately, Pakistan is one of them.
SOURCE: Myra Imran. Pakistan has worst family planning indicators in the
region. http://www.thenews.com.pk/Todays-News-6-112757-Pakistan-
has-worst-family-planning-indicators-in-the-region (accessed 5th
November 2012).
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Out of those women who opt against contraception, 28% choose to do so by leaving it to God.
This reason is closely followed by opposition fromhusbands;
fear of side-effects;
and lack of knowledge.
Only 5% have a perceived religious prohibition.
SOURCE: Sadiah Ahsan Pal. Family planning: Pakistan still has a long way to go.http://tribune.com.pk/story/442532/family-planning-pakistan-still-has-a-long-way-to-go/ (accessed 5th November 2012).
UNMET NEED
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Vulnerable Group POOR!
Fertility rates in Pakistan vary by womens educationand household wealth status.
Women across all wealth circles desired for lesserchildbearing in 2007 than 1991, but richer women used
contraceptives much more to prevent such cases. Thisgap of contraception usage has raised alarminglybetween women of different wealth status over thepast decade.
Unmet needs during 1991 stood better for poor
women but lack of contraceptive usage in comparisonof desire to limit childbearing takes it to 30% whileunmet needs of richer women are practicallynonexistent.
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LACK OF ACCESS
Access to FP services in Pakistan varies from urban torural areas.
It takes 40 minutes on average to reach a RH facility inurban areas while it takes 96 minutes in rural areas.(1991 DHS)
Distressingly, the amount of poor population in ruralareas is far higher causing lack of contraceptive usageand superfluous childbearing.
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QUALITY OF SERVICES
Quality of FP services remainsa huge block in the path ofapplying population policies.
It is found that over time
increasing numbers ofwomen have reportedfear ofside effects and healthconcerns as their primaryreason for not intending touse contraception in thefuture both in urban and ruralareas.
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The National Programme for Family
Planning & Primary Health Care
Also known as the Lady Health WorkersProgramme (LHWP) was launched in 1994 by theGovernment of Pakistan.
The Lady Health Worker Model: employment ofover 100,000 Lady Health Workers (LHWs).
Recruitment and trainings: First Level of CareFacility (FLCF).
Scope of work: 1 LHW = 1000 person/150 homes.
Supervision and monitoring: Lady HealthSupervisors and Field Program Officers.
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The National Programme for Family
Planning & Primary Health Care
4th third party evaluation:
LHWs play a substantial role in preventive andpromotive care and in delivering some of the
basic curative care in their communities, as wellas providing a link to emergency and referralcare.
It also concluded that LHWProgramme hassignificant impact on the population it servesand it has maintained the impact despitesignificant expansion of the Programme (OxfordPolicy Management: 2009)
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CURRENT SITUATION
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CONTRACEPTIVE PROCUREMENT
Directorate of Procurement
Material and Equipment (PME).
Expected to increase from
reported 8.4 million in 2008-09
to 10.8 million in 2014-15. Dependant on international
funds.
Local manufacturing of pills and
injectables is already underway
and feasibility studies are under
consideration for establishing
IUD/CU-T manufacturing units in
Pakistan.
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FUNDING STREAMS
Funds were primarily producedby Federal government andthen distributed to provinces.
Shift in international funds
from FP to RH in 1990s and toHIV/AIDS recently hasdamaged the progress of theFP program.
Major funding is provided by
KFW, UNFPA and USAID. Bulk of these funds are used in
social marketing acquiringcontraceptives.
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PUBLIC PRIVATE PARTNERSHIPS
Social Marketing NGOs and CBOs
Public-Private Sector Organizations (PPSOs)/Target
Group Institutions (TGIs)
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CURRENT SOCIO-ECONOMIC FACTORS
Economic growth but Low Education:
economic growth progress in social sector neglect of education + low social growth.
Agrarian country44% employment fromagriculture.
Low focus on educational aids to use FP Services.
Past 2 decades increased primary education , lowsecondary education.
Literacy rate 53% (poorest/lowest rate)
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CURRENT SOCIO-ECONOMIC FACTORS
Low Participation of Women in Society: maledominated societyimpedes women to use FPservices.
RH and FP Survey 2003, one in three women was
not allowed to leave her home alone and 42% ofwomen who were able to go to health centers ontheir own were using contraception compared tohalf that proportion. 21%, who were not allowed
to go to these facilities at all. Pakistan has the highest gender gap in labor
force: women employment (19% from 13%).
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PROGRAM SHORTCOMINGS The Population Policy (2002) was strong in principles but frail in
application. No Proper planning before starting new programs.
Instead of introducing new programs and addressing latest issues
only old plans were reinforced.
Expansion ofFP services remained restricted to urban areas. Use
of contraceptives remained confined to urban areas throughorganizations such as Key and Greenstar Social Marketing.
Lack of Understanding of Population Issues: Politicians,
bureaucrats and other organizations have rarely considered
population a huge issue.
Other public-officials hesitate from even discussing it due to
religious pressures.
Provinces often support population growth to get handed with
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RECOMMENDATIONS
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FEMALE EDUCATION
Without making education accessible to all
corners of the society; particularly women
CPR of global standards cant be achieved in
the long run. Women education can lead toPakistans transformation from agrarian
society to an industrialized base where gender
roles, abilities and powers will be workedmore imperatively leading to better
implementation of FP policies and RH services.
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ROLE OF STAKEHOLDERS
The economic and finance partners, including theMinistry of Finance who need to understand thateconomic growth is directly proportional to betterFP services.
The health partners: Improving FP and RH servicesby working together and putting organizationalefforts would further helpprivate andpublicproviders of health services in their own goals.
International Community and Donors need to
emphasize on FP services along with other medicalaids as it can help reducing those medical issues inthe future. Furthermore, they must use thisopportunity to help Pakistan when it eagerly wants
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OWNERSHIP TO STRENGTHEN PROGRAM
GOVERNANCE: FP services in Pakistan can onlyimprove if responsibilities are fully owned by people,organizations and authorities.
SERVICE DELIVERY of family planning services at allhealth outlets; with population welfare outlets playing
a complementary and specialized role. COORDINATION: Strong body to steer, assist and
coordinate the role of the private and not-for-profitsector.
ACCESS & EQUITY: Maximum number of NGOs andCBOs providing services in areas whereunderprivileged, hard to reach populations are located.
Strong MONITORING and oversight role at the centerbut withfull participation of provinces.
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KEY PAPER
Karen Hardee, Elizabeth Leahy.
Population, Fertility, and Family
Planning in Pakistan: A Program in
Stagnation. Population Action
International.October 2008;3(3)
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Working toward success
in family planning
programming is partscience and part art.
(http://www.populationreports.org/j57/j57.pdf)
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