The unchecked and rapid rise in population poses the biggest threat to the state’s plans to achieve self-sufficiency in different human development indicators, as noted by the Pakistan Bureau of Statistics.
In its latest report titled ‘Contraceptive Performance Report 2019-20’ that was released on Monday, the Pakistan Bureau of Statistics (PBS) stated that unchecked population growth in Pakistan is one of the serious challenges that the country is facing. The major causes of this continuing surge are high fertility rates, ignorance of modern contraceptive measures, religious taboos (particularly in the rural areas), preference for sons, the need for more earning hands, early marriages, avoiding family planning measures, and people’s beliefs about family planning about being ‘contrary to Islamic teaching’.
The report revealed that on average, Pakistani couples have one unwanted child. Furthermore, the contraceptives’ supply-side factors (including poor’s access to family planning services, lack of counseling and technical knowledge of unmotivated providers, and insufficiency of availability of affordable modern methods) are the major obstacles to the uptake of modern contraceptives, rather than the more frequently cited demand-side factors (including husband disapproval and religious opposition).
The comparison of Contraceptive Performance during 2019-20 regarding these departments was made with the previous year 2018-19 at the national and provincial levels. It was observed that this year, the Contraceptive Performance of Population Welfare Departments – in terms of the Contraceptive Performance regarding Couple Years of Protection – has decreased by 24.5 percent, while the Contraceptive Performance of Departments of Health (HF) and the Departments of Health (DoH) have decreased by 6.8 percent and 26.7 percent respectively when compared to the previous year (2018-19).
The Overall Contraceptive Performance of the Population Welfare Departments (PWDs) for the year 2019-20 – in terms of Couple Years of Protection (CYP) – has decreased by -24.5 percent in comparison with the last year 2018-19. The province-wise and region-wise profiles of CYP indicate an increase in Sindh (10.3 percent), and decreases in Punjab (-19.2 percent), Khyber Pakhtunkhwa (-74.1 percent), Balochistan (-19.0 percent), Islamabad (-28 percent), Azad Jammu and Kashmir (-39.4 percent), Gilgit-Baltistan (-13.3 percent) and the Merged Area-KP (former FATA) (-59.9 percent).
Considering a method-wise comparison of PWDs in 2019-20 and 2018-19 – in terms of CYP – a decrease was observed in all the methods such as condoms (-25.4 percent), oral pills (-9.5 percent), injectables (-26.5 percent), IUCDs (-27.4 percent), sterilization/contraceptive surgery (-17 percent), and implants (-16.4 percent).
Outlet-wise contribution – in terms of CYP – during the year 2019-20 as compared with the year 2018-19 showed an increase of 19 percent in RHS-B Centers, 7.8 percent in Male Mobilizers, and 207.6 percent in the FPIH program.
The performance has decreased by -26.5 percent in Family Welfare Centers, -19.7 percent in Reproductive Health Services-A Centers, -22.5 percent in Mobile Service Units, 10.7 percent in PLDs, -26.1 percent in Registered Medical Practitioners, -57.7 percent in hakeems and homeopaths, -37 percent in RTIs, -79.2 percent in counters, and -34.7 percent in others (franchise clinics, etc.)
Overall, the Contraceptive Performance of the Departments of Health (Health Facilities) for the year 2019-20 – in terms of CYP – has decreased by -6.8 percent in comparison with the last year 2018-19. The provincial/regional profile of the Departments of Health (HFs) – in terms of CYP – has shown increases in Sindh (20.2 percent), Balochistan (3.1 percent), and Azad Jammu and Kashmir (830.8 percent), and decreases in Punjab (-11.0 percent), Khyber Pakhtunkhawa (KP) (-40.9 percent), Islamabad (-19.0 percent), the Merged Area-KP (former FATA) (-34.6 percent), and Gilgit-Baltistan (-48.4 percent).
A method-wise comparison of the DoH (HFs) for 2019-20 with 2018-19 in terms of CYP depicted increased injectables (13.0 percent) and implants (86.4 percent) and decreases in condoms (-4.3 percent), oral pills (-26.9 percent), IUCDs (-7.0 percent), and sterilization/contraceptive surgery (-26 percent).
The report noted that the PBS has no mechanism for the on-spot checking of data quality except for asking for a justification for the positive and negative 10 percent change in the current year performance as compared to the previous year performance, and getting the data vetted by the source agencies.
It is proposed that the PBS may carry out random on-spot checking as a third party to ensure data quality at least once in a quarter.
The report also highlighted that there is a lack of coordination between the Provincial Population Welfare Departments and the Departments of Health (Health Facilities and Lady Health Workers) and the non-governmental organizations working in the provinces.
However, Sindh and KP have taken some positive steps and have started coordination meetings that still need to be conducted regularly.
