At the end of this month, the population of the world reaches 7 billion. With the population of Pakistan standing at 174 million (officially) and growing rapidly, and with the highest unmet needs for healthy timing and spacing of pregnancies (HTSP) occurring in isolated rural areas, how do we approach this phenomenon? That was the question raised by Dr. Mohsina Bilgrami, Managing Director of Marie Stopes Society, at a collective review of Pakistan’s reproductive health sector by private, public and international experts in the field. The event was organized by Marie Stopes Society and its sister company Contraceptive Social Marketing, and featured half a day of presentations and discussions by leading experts and specialists.
It was mentioned that although the average number of children per woman in Pakistan has reduced from 6.7 to 4.1 between the 1970s and present day, women are still having one more child than they planned or desired to have. Participants referenced the significantly low usage of contraception in Pakistan’s rural areas, correlated to the level of isolation and poverty of the area. At the same time, they cited research that indicates that 25% of couples who want HTSP services are not receiving them, for a variety of reasons. Dr. Bilgrami argued that if the sector targets this cohort and strategizes around the barriers to access to services, they could bring about significant, positive impact in maintaining a healthy balance between Pakistan’s population and its resources.
Discussions explored strategies to promote and improve access to contraception, specifically with relation to the role of the private and public sector in a post-devolution context, and the role of social marketing in bringing about attitudinal and behavior change. Participants agreed that there is collaboration between private institutions and the government in leveraging initiatives and bridging gaps, with potential for more. Dr. Zeba Sathar, Country Director of Population Council, stressed the importance of training and capacity-building of mid-level service providers (such as Lady Health Workers and Midwives) in providing modern contraceptive measures, as a key intervention in reducing unmet needs in rural areas. Dr. Asad Hafeez, former Director General of the now devolved Ministry of Health, spoke about the impact of the 18th Amendment on reproductive health, and stated that devolution presents the potential for positive change in the long term if all private and public players prepare themselves appropriately and weather the pains of the transition.
While the collaboration and institution-strengthening between the public and private sector is improving the supply side of HTSP products and services, social marketing is addressing the attitudes, beliefs and values that make up the demand side. Mr. Babar T. Shaikh, Health Systems Specialist, explained that social marketing applies the principles of commercial marketing to promote healthy behavior in a target audience, so that it voluntarily accepts, abandons or modifies its behavior for its own advantage. He explained that social marketing has been successful in institutionalizing HTSP services in the urban private sector, and should be scaled up to address the gaps in Pakistan today.
The event concluded with a message of hope and optimism from Mr. Dana Hovig, CEO of Marie Stopes International. Mr. Hovig recounted his time living in Pakistan in the mid-90s and how the country made a deep and lasting place in his heart. He commended the leaders in the reproductive health sector, notably the women, for all their successful accomplishments over the years in providing choices to women, and their unending dedication to this cause. Mr. Hovig shared a promise he had made at the turn of the millennium to baby girls in Pakistan: that by 2020, they would have the same choices in reproductive health as women in the developed world. He expressed a firm belief that this is a promise that is possible to deliver if the people in this field continue working with the same level of passion and commitment.