Sharing best practice in reproductive health

Despite a high rate of population growth, reproductive health (RH) and family planning services continue to be in demand in both urban and rural communities in Pakistan, health activists told IRIN on Wednesday. "People are aware of reproductive health issues but have lacked access to contraceptive services," Dr Iftikhar Ahmed, programme coordinator of the Pakistan Voluntary Health and Nutrition Association (PVHNA), told IRIN from the southern port city of Karachi. According to government figures, Pakistan had a population of 146 million in 2002, making it the seventh most populous country in the world. At its current rate of growth, Pakistan’s population will double by 2035. PVHNA and the Marie Stopes Society (MSS) of Pakistan, which work to promote reproductive health services, arranged a dissemination meeting on Tuesday to share best practices learned during a five-year reproductive health programme funded by the UK Department for International Development (DFID), which ended this month. Only 28 percent of the Pakistani adult population use contraceptives, making it the lowest rate among Asian countries. However, a 2001 survey of the country's National Institute of Population Studies (NIPS) reported that around one in three women surveyed wanted family planning advice and supplies, including 12.1 percent of women who wished to delay their next pregnancy and 20.9 percent who wanted no more children. Under the RH programme, PVHNA worked in eight districts across Pakistan in the three provinces of Sindh, Balochistan and North West Frontier Province (NWFP), while MSS worked in the Khairpur district of Sindh. MSS revealed that needs assessment research carried out between April and June 2003 in Khairpur found a lack of trained staff to provide Emergency Obstetric Care (EOC) at local health facilities. "Given the shortage of female providers, allowing male doctors to perform surgery [on women] was one way of relieving the constraint on services," Dr Yasmeen Sabeeh Qazi, working with MSS, told participants at the meeting. "However, when the views of the community were sought as to what they considered acceptable, given the sensitivity of the project, the majority felt that in a life or death situation, a male could be allowed to operate on a female," Qazi said, noting, "this indicates a significant change in our social perceptions about RH services." Health professionals noted a distrust of modern methods of contraception, fear of undesirable side-effects, social taboos against the use of family planning and a lack of follow-up services as reasons for such a high level of unmet needs. "Initially the local population was resistant, however, over time through concentrated advocacy, counselling and coordination with government bodies, the [RH] project was well received," Dr Inayat Khawar, working with DFID's reproductive health programme, told IRIN in the Pakistani capital, Islamabad. The 2003 Pakistan Population Assessment report, compiled by the United Nations Population Fund (UNFPA), noted high public awareness on reproductive health issues, particularly family planning. However, the report recommended a comprehensive youth and adolescent reproductive health policy, serving those most in need.