Falah programme claims to have found the way to revitalise family planning in Pakistan after consolidating successful results in the conclusion to their four-year old programme that was executed in 15 districts.

Pakistan suffers with some of the highest fertility and maternal mortality rates to date in the world so Falah’s claim is a significant one. “Through Falah, we were able to save lives of 3,000 mothers by encouraging birth spacing,” explained chief of party, Falah programme, at the Population Council.

Repeated pregnancies, which are often unwanted, become the biggest causes of maternal mortality rate, so according to the Falah strategy, giving women control over when they get pregnant can help prevent many fatalities.

“The death of a mother is a human tragedy because each death affects an entire family and has severe social repercussions,” said Dr. Mir, adding, “So how do we save mothers lives? By giving families the ability to plan their families better. There is a discrepancy in wanted and unwanted pregnancies and we can lower pregnancy risks through family planning,” he explained.

According to figures given by Pakistan Demographic Health Survey, 25 percent of women of reproductive age constitute the unmet need for contraceptives in Pakistan.

The programme addresses this through supporting the concept of birth spacing as necessary for the child and mother’s health and making family planning a health subject rather than a population welfare subject.

The programme also extensively trained health personnel on family planning and ensured availability of contraceptives in their 15 test districts.

Realistic?

With an extensive budget of 60 million dollars for the project provided by USAID (as per the USAID website), Falah was able to address the many problems faced by population welfare and health departments in their selected districts.

“Falah has shown that the birth spacing model works in ensuring the well being of families and needs to be scaled up to help Pakistan achieve the Millennium Development Goals,” asserted Dr. Ali Mir.

At a point when provinces and the center are developing their population policies, Falah’s claim is worth evaluating.

While Falah’s results might portray a great success, the fact that there is simply not enough funding for population welfare projects in the provinces or at the federal level remains unchanged and the biggest hurdle to developing a family planning policy in the country.

“In our population policy, we are trying to integrate the Falah approach which seeks to combine health departments with population departments so that access to contraceptives and information about family planning increases,” explained Ashfaq Ali Shah, Additional Secretary of Population Department, Karachi.

But he was willing to admit that while the strategy is a useful one, the lack of funds limits implementation: “Unfortunately, our funding is very limited, 70 per cent of our resources go to salaries, remaining 30 per cent go to utilities etc., and the remaining 10 per cent is simply not enough for procurement of contraceptives or training people.”

Chief of the Health Sector Reform Unit, Khyber Pakhtunkhwa, Dr Shabina Raja, voiced similar sentiments. “In the current strategy we are developing, we have put population welfare as a high priority. KP has the highest abortion rates because of lack of contraceptive use since the population welfare department simply did not have sufficient outreach to all areas,” she explained.

But, she added, “since devolution, funding from federal government has been very problematic and we are barely making salaries. We have much in the pipeline but on the ground, not much change can be seen.”

Doctor Aaeisha Qureshi, Deputy Secretary of Population Welfare Department, Punjab, disclosed that the population welfare department is severely under-funded and there are no funds coming from the provincial government. In fact, the development of a population policy is in very initial stages, nowhere close to developing a PC-1.

Inundating contraceptives

“In the 80s, social marketing campaigns by the government made a difference but they were donor dependant and as attention shifted internationally to other issues, the funding waned off,” explained Dr Mir.

And even today, donor interest is inadequate. According to a population welfare official, there is renewed funding for the procurement of contraceptive devices by some foreign donors, the lack of which has been a significant problem.

“However, the contraceptives they are procuring are very limited in variety and that makes couples more reluctant to use them,” the official revealed.

And even the basic assumption that unmet need of contraceptives is the reality of today is questionable. Samia Altaf, a development professional, in her book ‘So much aid, so little development’ explains that historically too, the ‘Contraceptive Inundation Strategy’ was enacted between 1975 and 1980.

She says, “The first assumption was that high population growth rates were a result of the unavailability of contraceptive devices, and the second was that there was a demand for these devices by eligible couples.”

These are both assumptions that Falah is making, however as Altaf goes on to point out such family planning plans that inundated contraceptives did not lead to results: “…they were not particularly successful at the time in decreasing or even slowing the rate of population growth. This rate in fact peaked during the life of these programs…”

Altaf pointed out the fundamental problem with programmes like Falah. “The Falah programme is completely out-of-context with the implementation reality of Pakistan. They have training modules where they train officials of government of Pakistan on issues of family planning but they all move to other departments or become irrelevant because there are more pressing issues,” she said.

“USAID and such organisations can take up such frivolous issues all they want but the fundamental problems that there aren’t jobs, basic health facilities are messing and that a woman will give birth to as many children as she has to finally have a surviving male child in a society with very high infant mortality rates is not going to change and these programs will not work,” she summarised.