Family planning behaviour

Currently, it is FP2020 targets on which our four provincial population departments are working. However, data reveals some inadequacy and a lack of urgency in our commitment.

According to Pakistan Demographic and Health Survey (PDHS) 2018 report, the total fertility rate of FATA is 4.8, GB 4.8, KP and Baluchistan 4.0, AJK 3.7, Sindh 3.6, Punjab 3.4 and Islamabad 3.0. These are alarming numbers. Owing to these numbers, Special Assistant to Prime Minister on Health, Dr Zafar Mirza, showed concern over the total fertility situation in the country. He said “one of our greatest national challenges is total fertility (TFR-the average number of children per women of childbearing age). Currently, it is 3.8, which we aim to lower to 2.8 children by 2025 and 2.2 by 2030.”

To reduce the total fertility rate, we have had family planning programs since the 1960s, but the achievement level was less satisfactory with some operational issues at the grass-root level. Historically, it has been subjected to various ideological and political unwillingness. It has been used as a bargaining chip for political settlements between the right- and left-wing politics. It was that unfortunate strife, which did not let the family planning flourish well and bear fruit.

However, at ground level, we are all population actors. Parents did a demographic act and bore a child. Later in life, the child becomes adult and marries. He/she also does demographic acts and paves way for another child and the process goes one to the next generation. Indirectly, it means today, if we have a population explosion, it is solely the subject of individual behaviours.

Studies have shown that attitude and behaviour towards family planning services and methods play a pivotal role. In a grass root level, it is the ‘behaviour’ of the people, which needs to be addressed to make family planning successful. Individual behaviour ensues from the local customs and traditions. However, in Pakistan, the kinship system and ideological adherences are tightened, which do not allow individuals to adopt family planning behaviour. Digging out those factors influence family planning behaviour and are crucial to understanding, which further helps in interventions. It is also consensual that simply providing some information may not work to alter people’s behaviours. Yet, it is one of the factors to change behaviour.

Family planning is a complex area, which is tremendously influenced by tradition, culture, taboos and a feeling of shame to discuss it openly. Other than that, prevailing social norms and peers may have a greater impact on how early and how often to have children. Individuals will conform to these norms at the different social positions in life like age, experiences, sex and culture. Then again, the religious environment in homes may exert more pressures on whether to use contraceptives. In a concluding manner, individuals act in resemblance to those factors, which exert more pressure than others.

In a Pashtun society, it is considered shameful if one has married and don’t have a child after one year. Otherwise, couples are stigmatised for being unhealthy in having productive sex. It is famous proverb “Pehla bacha Mahhaly walon k liye hota ha,” (First child is for villagers). In other words, it means one must have a child in the year after marriage otherwise neighbours start stigmatising the couple. Healthy family planning behaviours need an amelioration from these areas to promote it effectively.

Different factors that will impact an individual’s choice whether to utilise successful family planning include the media, recent developments, life occasions, social policy, laws and general data exchange. Private life occasions, for example, supporting a companion through premature birth, may likewise deliver a stamped behaviour change. People are exposed to a lot of data every day. Certain pictures and thoughts may influence a behaviour change, while others will be filtered and disposed of before the day’s over. Repeated flows of information will have a greater amount of effect than irregular pictures and messages. A well-pitched health campaign may impact a person to embrace new practices, and repeated messages on public transport billboards, TV, and radio may act to strengthen such a behaviour change.

Behaviours should be reinforced if an individual gets some positive feedback from someone whose opinion the person value. However, there are different policy models of incentives which can be adapted to make a successful intervention. For example, in the 1950s, the Indian government introduced an incentive policy for childbearing behaviours. Three groups of people were targeted, which included men and women complying with the government family planning policy, providers of services and promoters. All three groups were awarded for compliance with family planning programs. Bangladesh, despite its farfetched poverty, extended financial support; leading to a dramatic reduction in the population growth.

In a likewise manner, we need laws to intervene in individual behaviour. The UN declared that it was the right of every individual to decide when to have or whether to not have a child. To make women and men freely decide, we need to educate them more, make gender equality more possible, and liberate ourselves from traditional customs and norms.