KARACHI – Health experts at Aga Khan University Hospital (AKUH) have said that when it comes to success in family planning, population constraint and maternal and child morbidity Pakistan was still significantly lagging behind some of its neighbours.
They stated this while speaking at a two-day ‘Advocacy seminar on family planning and reproductive health’ held at the AKUH here on Tuesday.
However, they said, some improvement were also made in some fields as total fertility rate, meaning the number of children per woman on average, had declined to float around 3.6, down from almost six despite family planning was almost always viewed with skepticism in the country.
Diverse range of perceptions and policies were highlighted and discussed at the seminar as local and international experts from Indonesia, India, Nepal and Bangladesh spoke on the topic.
The said that although maternal and child morbidity had also declined in the country but remained in the high range and according to WHO estimates in 2011, infant mortality was 65.1 per 1,000 live births compared to 90 per 1,000 in 1999, whereas maternal mortality ratio stands at 276 per 100,000 in 2011 from 450 in 1999.
The experts said that the major chunk of the improvement begun when policy makers pegged family planning to healthy mothers producing healthy babies.
Country Director for Pakistan Population Council Dr Zeba Sathar said that for decades Pakistan’s policy makers pitched the ‘Bachay do hi achay’ campaign that proved counterproductive, adding that there has been no opposition since family planning has been linked to maternal and child morbidity.
Chairperson of the Department of Paediatrics and Child Health at AKU Dr Anita Zaidi said that some mothers were so malnourished in the country that they did not have the reserves to nourish their child.
She argued that family planning was not just about population control rather it was about wanting healthy mothers and healthy children and Infant mortality, meaning a child dying within the first year of life was also at a disturbing rate in Pakistan. Worse still, she said that about two thirds of infant mortalities were within the first month of life.
“If a mother is malnourished her baby is more than likely born with low birth weight, less than 2.5 kilogrammes, leaving them highly susceptible to infection and inability to keep their body warm. Twenty five to 30 per cent of children are born of low birth weight in urban Pakistan whereas in rural areas it is about 40 per cent,” Zaidi added.
Associate professor and Head Population and Reproductive Health Programme at AKU Dr Sarah Saleem said that country’s population had officially crossed 182 million and had doubled at least twice since its independence.
“In 1950, the country was measured 13th largest in terms of population with about 37 million people while by 2007, the population swelled to 164 million taking Pakistan to the sixth place.” She added.
She warned that if the country continued at the same rate, by 2050 Pakistan’s population was expected to exceed 292 million and would be in fifth place, after India, China, United States and Indonesia.
According to Experts warned that decisive action must be taken before the country’s robust population becomes a huge economic and social burden.
Even then, according to Population Council’s Dr Sathar, it will take another 10 to 15 years before Pakistan can stabilise its population.
He said that Muslim neighbour Indonesia also came across similar obstacles during its initial ‘population control’ policy and their campaign ‘Dua Anak Cukup’ or ‘Two children are enough’ was later changed to ‘Having two children is better than mourning two children’ achieved wider acceptance.
Speaking at the seminar, Chairperson of the Department of Public Health and the Centre for Reproductive Health, Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Indonesia, Prof Siswanto Agus Wilopo said that family planning was not about limiting children but rather about improving their health’.
Comparing the religious aspect of family planning, Prof Wilopo said that family planning was consistent with the teaching of Islam and the Quran.
Quoting an excerpt from the Holy Book he said that the Quran says women should breastfeed their children for at least two years, adding that medically if a woman was breastfeeding for two years it will biologically impact her ability to conceive.
The experts also recommend two years as the period for ‘child spacing’.
They said that girls and women’s education also plays a vital role and educating a woman was educating a household, adding that if woman was educated she would be empowered to control her fertility and contribute to her family’s wellbeing on a micro level as well as the nation’s prosperity at the macro level.
Meanwhile, they said, there were also families in Pakistan who wanted to use contraceptives but had no access to them and this ‘unmet’ need constituted 25 per cent of women, and if met it could help lift the use of contraceptives to 60 per cent.
The experts said that it was barely 20 years since policy makers in Pakistan had paid serious attention to the issue while Bangladesh’s health indicators specifically maternal, child and infant mortality were impressive despite a larger population at the time of its independence in 1971.
Director for Health Programme BRAC Centre in Dhaka Dr Koasar Afsana said that Bangladesh had created an example in the world with its success in family planning.
He said from a population with 75 million in 1972 the population doubled in 2010 with an impressive improvement in age specific fertility rate as well as use of contraceptives.
Dr Afsana said that India had witnessed a paradigm shift to focusing on ‘birth spacing’ as well and Bangladeshis were also being encouraged to delay in marrying young girls and control their fertility rate as well.
Speaking on the strategies in India Country Director for JHPIEGO, New Delhi Dr Bulbul Sood said that, there were strategies to address the unmet need including strengthening postpartum family planning with introducing postpartum IUCD services. Keeping in mind that 60 per cent of our population was below 30 years of age, youth icon Shahzad Roy started off the seminar with a performance advocating family planning.