The Population Programme of Pakistan of which Reproductive Health and Family Planning (RH&FP) are an integral component, has witnessed an appreciable decline in fertility. Yet this fertility transition has been slower when compared to other countries in the region and not accompanied by similar declines in other RH&FP indicators. Contraceptive prevalence, which initially increased in the 90s has plateaued and remains around 35% and unmet need for contraception still stands at 25%.
While demographers and programme implementers quote a number of reasons for this poor performance, one of the important determinants for these adverse RH&FP outcomes remains poverty, especially in the rural settings in the country.
With a high premium on children especially males, households with low incomes still view children as ‘net’ contributors to family income as they begin to engage in economic activities at an early age bringing in small incomes from either the formal or informal sectors. As women in these households continue with unwanted births, the limited assets of these poor households continue to be diluted thus further deepening the household’s level of poverty.
With little disposable income available, a large number of children in the family means that some children get no education, for others it may be delayed or interrupted. In such family settings girls are more likely to be deprived of education since they are expected to help out with household chores or look after the siblings and an investment in their education is seen as a financial loss to the family.
Given this belief system large families also tend to marry off girls at an early age. Young uneducated females know little of family planning and with the existing bias towards early marriage begin to bear children earlier and more frequently as they are unable to exercise any personal choice either in terms of timing the birth of their children or the number of children they should eventually bear.
Frequent child bearing exposes women to poor health that is further aggravated by mal-nourishment and morbidity—all those conditions that lead to high maternal deaths. Unwanted pregnancies decreases women’s productivity to engage in any income generation activities and are constrained in improving the quality of their lives.
Poverty has many dimensions.The poor are deprived of services, resources, opportunities as well as money. Their health, education and a well-defined degree of exclusion all promotes or diminishes their well being and determines the prevalence of poverty.
Poor people feel their powerlessness and insecurity, their vulnerability and more importantly their lack of dignity. Rather than taking decisions and making their own choices they depend on decisions made by others. Their lack of education further deprives them of gainful employment which in most cases is erratic. Their poverty excludes them from the means of escaping it thereby perpetuating the vicious cycle in which their lives are trapped.
For people to break out of their poverty, they need the support of institutions. The state and civil society at large must create a social and economic environment that will provide them the opportunities they need to improve their lives.
Good demographic outcomes eventually depend on sound policies that are well coordinated with other social sectors and most importantly on the political will to bring these policies to fruition.
Shahida,
Good to see you and your ‘fazilana'(no pun intended) article. I think you have highlighted very succinctly the reason family planning programme has not been very successful in Pakistan. Of course, as you have implied, a lack of government commitment and services, are also the factors responsible. The question is: what to do? Poverty will not disappear in foreseeable future. So, poor should keep producing children? While poverty indicators are not much different in India and Bangladesh, government commitment and availability of services have made a big dent in their CPRs and fertility rates. Therefore, I think this fact needs to be highlighted and explained with equal zeal.. . .
Thank you for your comment. Your observation is valid and well taken. Availability of FP services remains at the heart of the issue. Even when these services are available not all the people who ‘need’ these services access them for a number of reasons. There has to be a renewed commitment at all levels to provide not only FP services, but more of these and throughout the public health system. Also these services should be both affordable and of better quality and easily accessible. These efforts need to be further supported through an aggressive communication campaign that focuses on the need to adopt family planning if indeed, we are serious about bringing about a qualitative improvement in the lives of the people