Abdullah Khan
Secretary Population Balochistan
Morbidity, hunger, disease and death are words unfamiliar in no ways to Balochistan. Sometimes it is nature induced disasters, triggered either by monsoon, floods, earthquakes or landslides, and at other times, in fact with a high frequency, it is the man-induced disasters unleashed by lack of planning, mismanagement, corruption, lack of political sagaciousness, foresight, so on and so forth.
At the core of foregoing crises is unbridled population growth in the province that has the potential to eat at the very roots of the society. The traditional approach of viewing population growth in Balochistan with the policy makers is to draw a comparison between the population and vast mineral wealth, landscape, and the resources of Balochistan. The originates from a purely political standpoint where National Finance Commission (NFC) grants a heavy weightage, 82.98%, to the population for a share in the divisible pool. Hence, casting a deep dark shadow on the consequences of population growth on the women, children and their basic human rights. In fact, the human rights-based approach to family planning is a systematic process to ensure that attention to human rights principles pertaining to family planning is rooted in all program phases (UNFPA).
A cursory glance at the data shows that the population of the province in 1951 was 1.2 million, which has grown to 14.89 million in 2023; reflecting a more than tenfold increase. The population in urban areas, in 2017, was 28% against 72% rural, which has become 31% in 2023 against 69% rural. The worse law and order, unemployment intermittent draught and climate change adverse effects are the factors pushing the rural population to shift to urban areas, thus another heavy challenge for the government to deal with.
Studies show that lack of reproductive health (RH) and family planning (FP) results in poor health indicators, such as high maternal mortality rate, child mortality, infant mortality, and malnutrition. There is a vicious cycle of high child mortality and lack of family planning leading to high fertility rates and maternal deaths. High child mortality is not only a cause but also a consequence of a lack of family planning. This vicious cycle can be broken by adopting family planning.
As a consequence, as many as 298 mothers die in 100,000 live births in Balochistan, 1100 women die annually due to pregnancy-related causes, 29,000 children(age under 5) die annually, 40% of the Children are underweight, 16% suffer from wasting, around 52% suffer from stunting. Moreover, approximately half of the mothers and children are deficient in vitamin A, zinc, and anemia (NNS – 2019 & PDHS 2017 -18). There are other factors too, but one of the major causes is the lack of reproductive health and family planning services.
Addressing the rapid population growth and demographic transitions while responding to prevalent anti-family planning arguments, it is crucial to recognize that the province of Balochistan grapples with a pressing issue of water scarcity. We should not be complacent with the abundance of other natural resources; water stands as the most invaluable and irreplaceable of them all. The water table, in the last two to three decades, has gone to an alarming low level. The reasons are persistent drought for more than a decade, the influx of Afghan refugees after the USSR intervention in Afghanistan, excessive groundwater mining, and mismanagement of water for irrigation and agriculture development. The situation is going to be even worse owing to the introduction of cheap solar technology, which makes me recall the book, the Plundered Planet by Paul Collier, Professor of Development Economics and Public Policy at Oxford University wherein he expounds the formula: Natural Resource + Technology – Regulation = Plunder, and in our case, the cheap solar tube well technology is causing water plunder, which is sure to result into the tragedy of the commons. So, we need to plan and balance the population and natural resources, particularly water, in order to attain sustainable development.
Given the dismal situation at hand, Balochistan requires an approach to address the issue of population growth that is unique and all-encompassing. The core mandate of reproductive health services lies with the Population Welfare Department. However, to increase the contraceptive prevalence rate from a current 19 percent to the maximum, a coordinated and multi-sectoral approach is required to work in unison to protect the lives of the mothers and newborns. The family planning programme needs to be recognized as a basic human right with universal availability of contraceptives at ease. The eligible couples should not worry about which method to choose and where to avail contraception from. Access to free contraception should not be an issue for the eligible couples as it has been noted that despite having a desire, the lack of access to contraceptives fails the objective of family planning.
In this regard, functional integration of all the departments focused on reproductive health will be of great help to improve the access. Therefore, PWD has planned to shift the Family Welfare Centres (FWCs) to the health facility, viz district headquarters hospitals (DHQs), RHCs, and even the Basic Health Units (BHUs) providing space availability, which is likely to result in balancing the demand and supply gap.
Moreover; the Lady Health Workers (LHWs), about 7000 in number, is a very potential institutional arrangement being engaged. The Population Welfare Department has introduced a new concept of community-based Family Welfare Workers (CBFWWs), going to be hired on a contract basis, primarily to cover the LHWs uncovered areas in the province. Another potential force is the Community Mid-Wives (CMWs), trained under the MNCH program for ensuring Basic EmONC Services, who will be mobilized for demand generation and providing Postpartum Family Planning(PPFP).
The PPFP is defined as the start of a modern method of contraception as soon as possible after childbirth and the continued use of this or another method for at least two years for optimal timing and spacing of pregnancies (WHO). The Population Welfare Department, in technical support of Pathfinder International, has developed and approved the Postpartum Family Planning (PPFP) & Post Abortion Family Planning (PAFP) Policy, which aims at embedding family planning in all the health facilities and private hospitals where deliveries are conducted so that unwanted pregnancies are prevented for the safety of the women and the children.
Above all, family planning is a promotional health strategy where service providers have to generate a demand for the contraception to draw the attention and interest of clients/eligible couples for adopting any family planning method. In this regard, community mobilization and awareness are key components that can change the perception and approach towards the objectives of family planning. The media involvement in awareness and demand creation has also been well planned. For behaviour change, it has been planned to recruit a large number of social organizers to be deployed to engage men in family planning. Moreover; the education department has advocated to include RH/FP-related topics in the curriculum and textbooks.
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