Iram Yasir

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https://doi.org/10.55282/imj.ed67

The contraceptive prevalence rate (CPR) is the percentage of women of reproductive age, which is between 15-49 years, and who are currently using or have access to contraceptives.¹ It is an important indicator of the level of contraceptive use within a population. In Pakistan, this rate has seen little improvement, especially when compared to regional peers like Bangladesh and India, both of which have made significant strides in family planning.

Despite decades of family planning initiatives, Pakistan’s contraceptive prevalence rate (CPR) has remained stubbornly low, hovering around 34% in 2017-2018. Since 2005, there has been little change in the fertility rate with a woman bearing an average of 3.6 births over their reproductive life span.² As CPR is a significant key demographic and health indicator, its stagnation warrants to readdress structural and sociocultural barriers involved. The population issue is a holistic problem encompassing the issue of poverty, education, economic growth, health, environment, etc.³ As we take low CPR in a broader socio-economic framework, more robust and intersectional understanding is required to design effective and culturally sensitive interventions, keeping in view the complexity and bidirectionality.

It has been reported that there has been a diminished contraceptives inflows since 2016, insufficient funding, and procurement delays by the federal and provincial governments due to several reasons.⁴ This points to systemic issues in governance and accountability. There needs to be stronger intersectoral coordination and investment in Health system to ensure regular contraceptive supplies. The foremost reason for low contraceptive prevalence being a weak outreach system at the grass-root level, limited community participation, and absence of an identification mechanism for the reproductive age groups, especially married women of reproductive age group and pregnant women in the vicinity. Population welfare program at the district level has no active mechanism of identifying the pregnant women essentially in need of assistance and counselling and also willing to accept the advice for birth spacing and family planning. Investment in LHW program with data driven planning along with community mobilization can help to bridge the gap. Affordability, non-availability of contraceptives more so in a rural setting, and poverty are very strong determinants for low CPR in the country.⁵ Social marketing and mobile clinics can help improve the situation.

Misinformation and lack of awareness about contraception remain widespread, particularly in rural areas where family planning services are often scarce. Deep-seated cultural and religious beliefs further hinder contraceptive use, as misconceptions regarding religious prohibitions continue to discourage many from seeking birth control options.⁶ Moreover, gender inequality limits women’s autonomy over reproductive health decisions, with many relying on male family members for approval, which is often not forthcoming.⁷ Women education, women empowerment and addressing qualitative dimensions behind widespread myths, misconceptions about contraceptives and religious beliefs all play significant role.

The implications of a stagnant CPR extend beyond individual families. A stagnant CPR directly contributes to a higher Total Fertility Rate (TFR), exacerbating Pakistan’s already high population growth. High maternal and infant mortality rates persist due to unplanned pregnancies and inadequate prenatal care increasing the burden on already overstretched maternal and child health services. Moreover, without effective family planning, women are less likely to participate in the workforce or pursue education, limiting gender equity and economic productivity. Over-population continues to strain Pakistan’s already struggling economy, worsening unemployment, food insecurity, and environmental degradation. Without intervention, the country risks facing an unsustainable future, where limited resources fail to meet the needs of a growing population.⁸ Low CPR directly affects Pakistan’s ability to achieve multiple Sustainable Development Goals.

The Supreme Court has advised the Federal government to establish a Federal Task Force FTF comprising the Prime Minister and the Chief Ministers of all four provinces, to address the issue of rising population growth. Despite these recommendations, the progress on implementing the FTF’s decision by both provincial and federal agencies has been hindered by weak coordination.

Pakistan has already fallen short of fulfilling its international obligations made at FP—2020 forum in July 2012. This shortcoming reflects administrative lapses, negligence and failure on the part of responsible authorities. The sustainability of Supreme Court-endorsed Federal Task Force, which was also ratified by the Council of Common interest should be secured through legislative backing by the Parliament.

While task forces are generally formed to meet short term goals, the objectives assigned to the FTF require long-term commitment. Legally the Supreme Court has provided a framework for such a federal level body. Pakistan had committed to strengthening its National Task Force or National population Commission to drive consensus on policy and improve family planning initiative across the country.

To ensure long-term stability and support, it would be prudent to institutionalize the commission through permanent legal measures, similar to structure such as the National Commission on women. Revisiting its mandate and establishing it as a permanent institution, aligned with updated administrative rules, would help in shaping national policies for population welfare, regularly evaluating program performance, securing political and financial backing, encouraging public-private partnerships, and ensuring efficient coordination among federal, provincial and district level.

High population growth rate of Pakistan demands integrated efforts in the country, through an effective governance structure, accountability, community participation, and connectivity at all government levels. Family planning must become a national priority, backed by strong political commitment and increased investment. The time to act is now ensuring a healthier, more sustainable future for generations to come.⁹

How to Cite This:

Yasir I. Breaking the Stalemate: Addressing Pakistan’s Stagnant Contraceptive Prevalence Rate. Isra Med J. 2024; 17(1): 1-2. <a “href=”https://doi.org/10.55282/imj.ed-67″>https://doi.org/10.55282/imj.ed67

This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.