My name is Dr. Samina Afzal and I am working as Head of Department, Surgical Services at Greenstar Social Marketing, Pakistan. I have been associated with Greenstar for over nine years now. At Greenstar, we take pride in providing quality family planning services, with our share only second to the services offered by Government.
I belong to a country having population in excess of 18 million with maternal mortality ratio of 260 per 100,000 live births, infant mortality rate of 69 per 1000 live births and neonatal mortality rate of 42 per 1000 live births (UNICEF). We are ranked at 26 in the world when it comes to mortality of children under 5 years of age (UNICEF). From 1990 till 2012, Pakistan’s population has grown at a rate of 2.2 % and from 2012 till 2030, the projected growth rate of the country is 1.4 % (UNICEF).
The purpose of mentioning these indicators is to document the state of public health emergency Pakistan is in. Even if the commitment of the Government made at Millennium Development Goals in 2000 is kept aside, we stand at boiling point when we review our indicators. Women and children are dying for reasons which are preventable.
Pakistan is a country with complex and varied demographics. A strategy appropriate for one region is simply inappropriate for the other. Similarly, the indicators mentioned above are quite different in different parts of the country. There is a large variance among different provinces, urban – rural settings, education of inhabitants and socio-economic status. An example can be extracted from the status of polio campaigns in the country. In many parts of the country polio campaign has been successful while in some parts it is not successful. Will of Government is there and it has deputed all its resources uniformly but due to attitudes of the communities, it is virtually impossible to administer the vaccine to the children thus resulting in failure to stop the transmission.
In Pakistan, the word abortion is a taboo. Even educated and well informed people associate this word with induced abortion. Women are not taken to appropriate health care professionals even if a genuine need arises for a medical abortion – thus exposing the women to sepsis and other fatal complications. In my experience, in numerous instances, once a woman does have an abortion she comes back with the same problem within a few months. This is because she is not given an appropriate method of contraception.
Keeping these things in view I advocate a three pronged strategy. To tackle the mindset of the community, we need to create acceptance through behavioral change communication. We have replaced the word abortion with miscarriage when we communicate with our stakeholders.
Secondly, we need to focus on equity rather than equality. We should depute our resources more where there is need. Greenstar has made a list of Districts where it needs to focus in the coming years based on family planning need of the regions.
Thirdly, there is need for effective public private partnership. It is observed that at easily accessible areas there is the presence of many organizations resulting in a duplication of resources while their presence in some areas is virtually non-existent. Organizations can work in harmony making use of each others’ strengths thus reaching those who need the services.
With these suggestions I end my blog. Your feedback and suggestions are welcomed.
Dr. Samina Afzal
Greenstar Social Marketing