Major boost to reproductive health from UNFPA

The United Nations Population Fund (UNFPA) will spend US $35 million on providing reproductive health care in Pakistan over the next five years, the organisation's representative to the country told IRIN in the capital, Islamabad. Dr Olivier Brasseur announced the funding on Monday, ahead of World Population Day on Friday, when the UNFPA will release its "Pakistan Population Assessment 2003" report. Brasseur said most of the money would be targeted at two main issues identified in the document - the high level of maternal mortality and high fertility rates. Pakistan has one of the region's highest rates of maternal mortality. UNFPA identified basic health care during pregnancy and birth as priorities for tackling the problem. "We are losing in Pakistan something like 30 to 35 pregnant women a day - every day - because of complications either of pregnancy or delivery. These complications are preventable most of the time," the UN official said. In Pakistan, only 19 percent of births are attended by a skilled medical professional, according to a 2001 UNICEF report. The UNFPA's figures show that deaths from postpartum haemorrhage (bleeding after giving birth) can be reduced from 160 per 100,000 live births to 95 when the mother has access to emergency obstetric care. This is the most frequent cause of maternal mortality in Pakistan. UNFPA aims to increase the number of women having antenatal consultations and medically assisted births. The organisation is also directing its funds to rural districts where health and family planning services are more rare. As well as focusing on maternal mortality, UNFPA intends to target fertility control. "Unfortunately, here in Pakistan women start (having children) too soon, they have too frequent pregnancies and they have too many children," Brasseur said. In addition to the health risks for mothers from high fertility rates, the population increase is a concern for Pakistan as a whole. The Economic Survey of Pakistan 2001-2002 said that 43 percent of Pakistan's 142-million population is under the age of 15. The working population is under increasing pressure as it supports a growing number of children. The report also warns that these under 15s will soon be of an age to have children of their own. In order to prevent a further large-scale expansion of the population, the UNFPA recommends in its report that family planning education should be made a government priority for adolescents. Teenagers will be targeted by UNFPA's own programmes for education and medical services.

Dr Olivier Brasseur, UNFPA country head in Pakistan

Brasseur said simply providing health care facilities and education was not enough. "Who is actually using these existing services? The answer is far, far, far too few. So, what we are going to do is to launch a huge community mobilisation programme to convince family members - and especially women - that they should go to them," he said. Brasseur said the demand for services must be encouraged if progress is to be made: "The reason why we have not been as effective as we would hope is that only the supply side is taken care of, very much less on the demand side." The Population Council's deputy programme manager for Pakistan, Minhaj ul Haque, said that UNFPA's efforts to link isolated people with available services was welcome. He said his own research showed that people usually failed to take up services for practical reasons, rather than due to cultural taboos about sexual health and education. "Maybe people used to think like that. But certainly contraceptive knowledge is high now. I don't think it's like that any more." "The first thing to concentrate on is service delivery - to put more emphasis on access to facilities, especially in rural areas which are very much underserved," Ul Haque said. To this end, the UNFPA, the Pakistani government and the aid agencies DFID and USAID have adopted a strategy they call social marketing. They will use techniques usually more popular in the corporate advertising sector to attract people from target groups to services like contraceptive provision and antenatal care. "So instead of doing marketing for profits, it's marketing for social profit," he explained.