1. Department of Community Health Sciences Peshawar Medical College
Family planning
Department of Community Health Sciences
Peshawar Medical College

2. By the end of the session, students will be able to:
Define Family Planning (FP) and related terms.
Describe the evolution of Family Planning interventions from 1947 to present.
Illustrate vital trends (situational analysis) in health indicators related to Family Planning.
Sensitize the unmet needs of vulnerable population.
List the program shortcomings in Pakistan.

3. FAMILY PLANNING - Definition
“Family planning allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.”
(WHO. Family Planning)

4. Family planning policy in the 1960s
The Family Planning Association of Pakistan (FPAP), now called "Rahnuma", was founded in Lahore by Saeeda Waheed in 1953.
Waheed, a member of the All-Pakistan Women's Association, began advocating for birth control when her maid died from an attempt to abort her own pregnancy.
The FPAP was unsuccessful in changing family planning policies until President and military leader Ayub Khan took interest in the problem of overpopulation in the late 1950s.
Khan spoke at the FPAP's first national seminar in 1959, speaking on the ‘menace over overpopulation'. Soon after the seminar, the National Board of Family Planning was established as a policy-advising body for the federal government.
Family planning policy in the 1960s
Pakistan's first Family Planning Scheme was a part of the country's Third Five Year Plan (1965–1970).This scheme became the template for all subsequent family planning strategies. The scheme's goal was to have a vast impact in the shortest time possible, with a reduction of the birth rate from 50 to 40 per 1000 by At the onset of the program, condoms were the most available method of contraception, but by 1966 the Intrauterine Device (IUD) had replaced it has the "corner-stone" of the Scheme. It was said to be "safe, cheap, reversible," and it required "little user action.“
In , the Pakistan Demographic Health Survey of Pakistan (PDHS ) showed that approximately 30% of married women of reproductive age (MWRA) were using some form of Family Planning. Of these 8% used a traditional and 22% used a modern method.
Reference:
Khan, Ayesha. "Policy-making in Pakistan's population programme." Health and Policy Planning. Volume 11, Number 1, Oxford, 1996.

6. Demographic Survey

9. FERTILITY REGULATION
Contraceptive Prevalence Rate (CPR) is 30% in Pakistan
a figure that has virtually remained the same over the last decade
which is considerably low as compared to other Muslim countries.
Iran has 74 % CPR, Turkey 71%, Morocco 63%, Indonesia 61%, Egypt 60%, Bangladesh 56% and Malaysia, 55%.
SOURCE: Sadiah Ahsan Pal. Family planning: Pakistan still has a long way to go. to- go/

10. Barriers to Family Planning Services….

11. Vulnerable Group – POOR!
Fertility rates in Pakistan vary by women’s education and household wealth status.
Women across all wealth circles desired for lesser childbearing in than 1991, but richer women used contraceptives much more to prevent such cases. This gap of contraception usage has raised alarmingly between women of different wealth status over the past decade.
Unmet needs during 1991 stood better for poor women but lack of contraceptive usage in comparison of desire to limit childbearing takes it to 30% while unmet needs of richer women are practically nonexistent.

12. LACK OF ACCESS
Access to FP services in Pakistan varies from urban to rural areas.
It takes 40 minutes on average to reach a RH facility in urban areas while it takes 96 minutes in rural areas. (1991 DHS)
Distressingly, the amount of poor population in rural areas is far higher causing lack of contraceptive usage and superfluous childbearing

13. QUALITY OF SERVICES
Quality of FP services remains a huge block in the path of applying population policies
Increasing numbers of women have reported fear of side effects and health concerns as their primary reason for not intending to use contraception in the future both in urban and rural areas

14. The National Program for Family Planning & Primary Health Care
Also known as the Lady Health Workers Program (LHWP) was launched in 1994 by the Government of Pakistan.
The Lady Health Worker Model: employment of over 100,000 Lady Health Workers (LHWs).
Recruitment and trainings: First Level of Care Facility (FLCF).
Scope of work: 1 LHW = 1000 person/150 homes.
Supervision and monitoring: Lady Health Supervisors and Field Program Officers

15. Family planning/Contraception-WHO Fact sheet Updated December 2016 (class hand outs)

16. Benefits of family planning / contraception
Family planning/Contraception-WHO Fact sheet Updated December 2016 (class hand outs)
Benefits of family planning / contraception
Preventing pregnancy related health risks in women
Reducing infant mortality
Helping to prevent HIV/AIDS
Empowering people and enhancing education
Reducing adolescent pregnancies
Slowing population growth

17. Global unmet need for contraception
An estimated 225 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception.
Reasons for this include:
Limited choice of methods
Limited access to contraception, particularly among young people, poorer segments of populations, or unmarried people
Fear or experience of side effects
Cultural or religious opposition
Poor quality of available services
Users and providers bias
Gender based barriers

18. Contraceptive methods
Kindly study the class hand outs………

19. Thank you