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Women in rural Pakistan champion the cause of population planning

By Farahnaz Zahidi Published: July 11, 2015

Benazir With the government lagging behind, women in villages of Pakistan are working for population planning. PHOTO COURTESY: SHIRKATGAH

KARACHI: Her father earns a meager Rs4000 a month as a gate keeper in the village school. Yet, this 18-year-old girl, whose biggest dream in life is to have her own computer, choses to do social work free of charge. “Anything that will help my people,” she says. She visits every home in the tiny village of Allan Chandio in district Shaheed Benazirabad, Sindh, convincing them to practice family planning (FP) and allowing their daughters to study so that they can make informed decisions about their lives. “I even visit my uncles,” says Benazir Chandio with a broad smile. She does this in a culture where issues like contraception are brushed under the carpet. “They say you are too young to be teaching us. I reply that if God has given me more awareness than you, then I have every reason to teach you.” Benazir, who has been given a well-deserved place in Shirkatgah’s “Building Momentum – Strengthening Champions” initiative, convinced two families to delay the weddings of their very young daughters. “Postponing those weddings for two years gave those girls some time to get ready for marriage and motherhood,” she says, and shares with pride that one of those girls recently gave birth to a baby girl at the right time. For women in her village, having anywhere between eight to 12 children is a norm. But she feels that with counseling, villagers are getting convinced to plan their families. Standing at number six among the world’s most populous nations, Pakistan needs more such girls. In absence of satisfactory performance from the government, the onus to cause a change has fallen on the civil society. Read: Addressing the baby boom: Women’s reproductive health an urgent issue Experts like Country Director Population Council Zeba Sathar express dissatisfaction over Pakistan’s success in FP. “Pakistan’s performance in lowering its fertility is indeed dismal; while we had some success in the 90s, the last 15 years have been a virtual standstill,” says Sathar. According to the Pakistan Economic Survey 2014-15, Pakistan’s estimated population is over 191.71 million. While there seems a definite decline in Pakistan’s population growth rate (1.49 per cent in 2014, according to CIA’s World Fact Book), there is much to be done. At the 2012 London Summit on Family Planning, Pakistan had committed to increase the contraceptive prevalence rate to 55 per cent by 2020. Five years short of 2020, the world looks on to see if the commitment will be honoured. “Pakistan’s pledge at the London Summit is an opportunity, perhaps the last, to actually ratchet up efforts, drum up the political will and redesign the programs to accelerate family planning in Pakistan,” says Sathar. Dr Azra Ahsan, technical consultant to the National committee for Maternal and Neonatal Health (NCMNH), says that health care providers need to be convinced first. “When they are not on board, how can we convince patients? What our medical students are taught is not relevant to ground realities. We know more about endoscopic and robotic surgeries, but our medical graduates don’t know about maternal health or public health policies.” Ahsan adds that every health care provider should be trained to guide patients in FP. “Why is it just the gynecologist’s job? Between being referred from one specialist to another, patients slip away,” says Ahsan, and suggests that The World Health Organization’s (WHO) medical eligibility criteria (MEC) wheel should be on every doctor’s table. “It is such a simple guide advising which contraceptive is advisable for whom.” Dr Farid Midhet, demographer and Country director Jhpiego, feels that one factor could be the general instability on many fronts in the country. “We are struggling with the same issues since the last two decades.” One thing that could work, according to Midhet, is integrating population planning into the public health system. Talking about unmet needs of contraceptives, he says that the use of traditional methods of contraception have gone up by ten per cent, citing the latest PDHS results. However, traditional methods in his opinion are not reliable enough. “A Population Council Pakistan research on Barriers to Contraceptive Use, 2013, shows that contrary to popular belief, neither religion nor male dominance are the main reasons for unmet need. Supply is the main factor here,” he says, adding that if supply is steady and is accompanied by counseling, use of contraceptives in Pakistan can go up by 50 per cent safely. Sharing research showing the gap between what women want and the four million unwanted and mistimed pregnancies that are happening annually, Sathar says, “Two million of these end up in abortions, which could be avoided by better family planning programs.” The aforementioned Population Council study confirms what most experts say – that Punjab is way ahead other provinces in terms of reaching developmental goals, including FP. “Punjab is the only province that may abide by its commitments in this regard. It is initiating the post-partum contraception program, which will be putting to use new technology,” says Midhet, adding that in comparison, Sindh faces more serious issues like lack of implementation of policies, corruption and shoddy governance. Read: One death too many: One death in childbirth every 37 minutes “The provinces are ready to play their role and have set ambitious goals for 2020,” says Sathar, expressing hope that the provincial governments now realize that they must set family planning as a priority. “While there are improvements in the budget lines for contraceptives (previously supplied by donors), funds and priority still lag behind.” Conflict and insecurity has affected more than just health initiatives, with mental illnesses on the rise in Pakistan, especially in women, says Dr Rukhsana Ansari from Indus Hospital, Karachi. “It has a close link with inflation and poverty. Too many children exacerbate women’s problems,” she says, adding that mothers from underprivileged backgrounds suffer from nutritional deficiencies, muscular and skeletal diseases and sleep deprivation. In turn, the children they give birth to are also malnourished. Mothers feel frustrated when they cannot go back to work because of their small children dependent on them, in situations where earning could alleviate their miseries. “If at all women chose to use contraception, the decision is not theirs. It is either the husband or the mother-in-law who decides.” Mehnaz 1 If the Lady Health Worker (LHW) program is re-focused on FP, it could yield results. Mehnaz is one such promising LHW. She has succeeded in convincing most households in the village of Kahazana Dheri, District Mardan, in Khyber-Pakhtunkhwa, to use contraceptives. “I can safely say that now at least half of the couples in our village are using contraception,” says the 36-years-old woman, another one of the Shirkatgah Champions. Yet, the obstacles are many. “Our area was devastated by the 2010 floods. Additionally, incidences of terrorism affect everything – when roads and bridges are blown off in bomb attacks, how will contraceptives reach small health facilities? People lose jobs in conflict areas. For an unemployed man, feeding his family becomes priority instead of buying contraceptives.” Published in The Express Tribune, July 11th, 2015. http://tribune.com.pk/story/918815/women-in-rural-pakistan-champion-the-cause-of-population-planning/

Reproductive health: ‘Healthy mothers mean a healthy nation’

Published: September 12, 2014

Research shows that when a mother dies, the children that are left behind are more likely to grow into adults with psychological issues. PHOTO: SHIRKATGAH

KARACHI: If you ask me what the government is doing about maternal and reproductive health of women and family planning, my answer will be ‘nothing’, said Planning Commission of Pakistan population section chief Shahzad Malik.

Malik – along with members of provincial assemblies, government officials, gender activists and members of civil society – said this at an event held at the Beach Luxury hotel on Wednesday. Organised by the Shirkatgah Women’s Resource Centre, ‘Next Steps: Achieving universal access to sexual and reproductive health and rights through a coherent post-2015 framework’ was a national consultation with stakeholders.

The discourse remains relevant as ever, with an estimated 30,000 women dying every year due to birth-related mishaps. While Maternal Mortality Rate (MMR) in Pakistan may have improved – dropping from 490 in 1990 to 260 in 2010 – a lot still needs to be done. MMR is the number of women per 100,000 live births who die of pregnancy and childbirth related complications. A staggering number of abortions – somewhere between 800,000 and 900,000 – are carried out in Pakistan every year, and most of them classified as unsafe abortions. Lack of contraceptive facilities and absence of timely family planning are the major reasons, as most women getting abortions are married women getting rid of an unwanted pregnancy.

Representatives from each province shared their experiences and problems. Balochistan’s representation was sorely missing as the speakers could not make it to the event. However, some jarring issues came to the fore in the discussions, such as the fact pointed out by moderator Imran Shirvanee. “Only two political parties bothered to talk to health experts when designing the public health manifesto, before the 2013 general elections,” said Shirvanee, refusing to divulge the names of the parties.

Punjab MPA Dr Najma Afzal Khan shared information about positive reproductive health initiatives and headways made in the province of Punjab. “The Punjab chief minister is committed to improving maternal health,” she said.

“In Punjab, there has definitely been progress,” said Dr Zafar Ikram, provincial coordinator of the Maternal, Neo-natal and Child Health Programme, Punjab. “However, problems such as unmet need of family planning methods persist. Gestational diabetes is on the rise and there is hardly any emphasis on post-menopausal cancer.”

The problems in Khyber-Pakhtunkhwa (KP), as pointed out by MPA Arshad Umerzai, are mostly to do with the security situation. “Also, while the policies of the provincial government in KP may be commendable, a lack of coordination and strained relations between the federal and provincial governments hinders progress.”

Issues related to governance and social and demographic dynamics were also discussed, and recommendations were made to improve the situation. Some of the problems pertaining to funding owe to the confusion that still exists between provincial and the federal governments after the 18th Amendment.

As the participants pointed out, it is time for maternal health to be taken seriously, especially since research shows that when a mother dies, the children that are left behind are more likely to grow into adults with psychological issues. Such issues, experts shared, are likely to fall into extremist behaviour as well.

Published in The Express Tribune, September 12th, 2014.

Hits and misses: Developments indicate better days for women’s rights

By Farahnaz ZahidiPublished: February 23, 2014
http://tribune.com.pk/story/675083/hits-and-misses-developments-indicate-better-days-for-womens-rights/

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Discussing Sindh, experts shared that enrolment of girls in schools is going up and there is an increased focus on funding female literacy projects. PHOTO: FILE

KARACHI:
Somewhere in Pakistan, a woman is struggling to get a CNIC, but NADRA only accepts a biometric system of identification whereby her thumb must be scanned. Her thumbs are too chafed due to constant work in agricultural fields with sickles.
Another woman in Pakistan is sucked into an armed conflict situation. Her son is taken away at a tender age by people she knows will misuse him, but when it comes to the peace process, her opinion is not taken into account. At another location in Pakistan, a jirga of men sits and decides a woman’s fate, while other women who are members of the community cannot share their perspective
The questions and issues are multiple. The achievements, challenges and opportunities in this regard were discussed recently at the one-day Provincial Consultation of Sindh for the State Report on Beijing+20. Held on February 21, it was organised by the National Commission on Status of Women (NCSW), Shirkatgah and Rozan. It aimed at involving all stakeholders including NGOs, parliamentarians and activists.
NCSW is leading the process of compiling the State Report on Beijing Plan for Action, which is an agenda for women’s empowerment. In this, NCSW is being co-facilitated by Shirkatgah and Rozan.
Beneath a whole lot of jargon that development sector professionals typically use, the underlying idea was resounding: what will it take for humanity to realise that salvation, progress and development are all clutched tight in the fist of one single solution – empowering the mother, the daughter, the wife, the sister. It is a little difficult for a journalist to understand what it exactly means by “best practice” and how can a 100 plus people know all the UN resolutions and Pakistan’s legislations regarding women by heart. Yet, the sincerity is obvious in such meets. And a lot of good is coming out of them.
Just talking of Sindh, experts shared that girl-child enrolment in schools is going up. There is an increased focus on funding for female literacy projects, including women with minor disabilities. The Domestic Violence Act and laws pertaining to acid burning, as well as the anti-women practices acts are promising. There is increasing talk of involving women in peace processes as equal stakeholders, even if they are unaware that UN Resolution 1325 requires us to do it. Land allotment schemes are tilting towards including female peasants as small land-holders.
Yet, as discussed in presentations given by the many groups that had been given different topics pertaining to women’s empowerment, there are many ifs and buts. For example, when talking of the encouraging presence of women in the field of media, it was pointed out that the growth of women in this field should not be only horizontal but also vertical, whereby more women in media should be in decision-making key positions. It was discussed that the UN Declaration on the Elimination of Violence against Women stated 20 years ago that “violence against women is an obstacle to the achievement of equality, development and peace”. Much remains to be achieved but it appears that Pakistan is at least on the journey towards a better future for its women.
Published in The Express Tribune, February 23rd, 2014.