Sumera Naz, Najma Javaid.
Gaps regarding male involvement in family planning in pakistan.
Pak J Med Res Jan ;54(2):38-9.
According to WHO “family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births”. This desire is achieved through the use of contraceptive methods. In Pakistan, family planning program was started in mid-1960s and they have tried many initiatives and policies but yet the current contraceptive prevalence rates (CPR) stands at 35%, reflecting around 0.5% annual increase since the start of the family planning programs in 19641. One of the Millennium Development Goal is to increase the CPR to 55% by 2015 2 (planning commission 2010), however, the Pakistan Demographic and Health Survey (PDHS) 2012-13 reported that the CPR is 35%3. This figure is much lower than the CPR of neighbouring countries like India (48%), Bangladesh (58%) and Srilanka (70%) 4. The fertility rate in Pakistan is 4.7, infant mortality rate is 74/1000 live births (MDG target is 52/1000 live births) and maternal mortality rate is 3.8% against the target of 2.1%. All these figures show that Pakistan is off tract on all indicators5. Mile stones of Millennium Development Goals regarding family planning and mother and child health cannot be achieved until males not only understand but also adopt modern family planning methods. One study reported that only 26% married women use modern contraceptive methods despite the fact that contraceptive methods and services are frequently geared toward women3. There are two aspects of male involvement in family planning, first whether men accept and support their spouse’s requirement, choices and rights in fertility regulations, and second are the contraceptive use and sexual behaviour of men6. In Pakistan, poverty, illiteracy, high mortality, beliefs, low women empowerment and poor health services together with the high population growth rate of around 3.5% poses great challenges in promoting the practice of family planning. Pakistani families are possessive and slow to adopt family planning practices as compared to the neighbouring countries7. In the male dominated Pakistani society where women are subordinate to men, it is evident from literature that the husband’s agreement is the most dominant contributors to acceptance of the family planning method not only in rural but also in urban areas, also the decision making power of the husband or his mother is very critical for family planning outcomes8. Following are the gaps inactive involvement of men in family planning in Pakistan. Men’s views on family planning are not known due to lacking data on men. Where ever data on men is collected, it is scarce and collected through small projects. Pakistan Demographic Health Surveys (PDHS) provides ample data on family planning and reproductive health on women of reproductive age but information on men is missing. Men’s role in family planning and reproductive health is ignored by the family planning programs and most contraceptive methods are designed for women only like pills, injections, intra-uterine device (IUDs). The family planning program activities and policies are focused on women. Family planning field service delivery systems are female based, field workers are women and their clients are also women. Therefore the opportunity for males to access family planning information and services from the family planning providers is almost negligible. Culturally defined gender roles are also hindering men’s participation in family planning along with lack of communication between couples on issues related to fertility and family planning. Most data suggests that couples of reproductive age groups are mainly using contraceptive methods of female use. Reliance of males on traditional and temporary methods like withdrawal and condoms was high 15 years back and recent data is also supports the same trend9. Vasectomy is still the least publicized contraceptive preference in Pakistan10. Although large-scale surveys on men and reproductive health would be useful, there is a particular need for anthropological studies to provide insight into complex issues such as how men and women negotiate contraceptive use, the reproductive health issues faced by these men, their preferred sources of family planning information, and ways through which men may be delaying fertility. Literature suggests that to determine the success of family planning program regarding male involvement there are four outcome indicators. i) increased use of contraceptives ii) increased current contraceptive use iii) correct use of contraceptives iv) decreased unmet needs. While intermediate predictors are to increase knowledge of males and increase communication between the partners11. Regarding these outcome indicators data from Pakistan is not enough to show the success rate of family planning program regarding male involvement. Although few studies in small and selected populations are available but larger national studies involving men of all socioeconomic and cultural groups are required to understand the issue and need.
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