A CLOSER LOOK:
In the 1960s, Pakistan was at the vanguard of family planning, becoming one of the first countries in the world to develop a national population policy. In the past two decades, however, that initial wave of progress has stalled. Today only one-fourth of married or in-union Pakistani women use modern contraception.
At the 2012 London Summit on Family Planning, Pakistan committed to increasing the contraceptive prevalence rate to 55% by 2020. The obstacles to success are many—political upheaval, social constraints, women’s low status and limited autonomy—yet positive steps are being taken on the national and regional levels.
In the crowded mega-city of Karachi, a new health care program will bring family planning services to one million low-income inhabitants. The Sukh Initiative, which launched in March 2014, will include door-to-door visits from community health workers, 24-hour telephone information lines, postpartum care and counseling in neighborhood clinics, a peer-to-peer awareness campaign, and life skills training for young people. This innovative urban program is a joint partnership between three private foundations—the Pakistan-based Aman Foundation, the Bill & Melinda Gates Foundation and the David and Lucile Packard Foundation—and is implemented by the Karachi-based Aman Health Care Services. The Sukh Initiative is also working closely with the government of Sindh province and other stakeholders to create an enabling environment for family planning.
At the opposite end of the country, in Khyber Pakhtunkhwa province, 110 new Family Welfare Centers are bringing reproductive health care to rural villages. Ministers have begun drafting a bold new population policy for the province, with the goal of doubling contraceptive use in the next 20 years. And next door in Punjab province, a 2013 Population Council study revealed startlingly high levels of enthusiasm for family planning. More than 82% of men and 88% of women expressed approval of contraception, and both men and women told interviewers that they wanted greater access to modern methods.
A jewel in Pakistan’s health care landscape is the Lady Health Worker (LHW) program. This army of 100,000 community health workers provides essential frontline services to millions of women and children, dispensing contraceptives, immunizations and other primary care. The workload on the LHWs has increased enormously in recent years, thus one of Pakistan’s FP2020 goals is to re-focus priority on the family planning aspect of the program. The government of Sindh province has begun the process, working with the Population Council to develop a comprehensive new training program.
Another bright spot in Pakistan is the new Logistics Modeling Information System (LMIS), implemented with the assistance of the
USAID | DELIVER project. LMIS is a web-based system for procurement management, and is part of a whole suite of modernizations USAID has brought to the contraceptive supply chain: barcoding, automated inventory control systems, data visualization and automation of procurement activities. The system has been rolled out nationwide, and health managers in all 143 local districts were able to use it for their 2013–2014 forecasting. Three provincial governments—Sindh, Punjab and Khyber Pakhtunkhwa—have committed more than US$75 million in financing for the next five years.
Pakistan overhauled its constitution in 2010, with the result that responsibility for health policy was shifted from the federal government to the individual provinces. One of Pakistan’s FP2020 commitments was to ensure that each province included contraception in its Essential Health Services Package (EHSP); this was achieved in 2013. In January 2014, it was announced that a new National Task Force on Population Welfare would be created at the federal level to help coordinate reproductive health efforts across all provinces.
7. http://dhsprogram.com/publications/publication- fr290-dhs-final-reports.cfm