The Family Planning Program in Pakistan: What Went Wrong?

Pakistan was 1 of the 1st developing countries to adopt an official policy to reduce fertility. Its national family planning program begun in 1965 cost more than 165 million dollars over 15 years and was widely considered to be a model for other nations to follow. Yet by the end of the 1970s it became clear that the program had not worked. Only 5% of married women were using any contraceptive method; 2/3 did not know where they could obtain a method; 70% had never met a family planning program staff member. The crude birthrate (40 per 1000) was the same as in the early 1960s. According to the authors many program reforms which were supposed to have been introduced in the 1970s were never introduced partly a result of administrative problems and internal and external conflict but also partly due to low levels of effective demand. Administrators and donors accepted the figures garnered from service statistics about new acceptors and couple years of protection and assumed that program reforms would clear up problems indicated by the bad news about contraceptive use and continued high fertility which 1st broke in 1969. Observers thus continued to be surprised with the results of the 1975 fertility survey which showed no improvement. The schemes developed by program administrators are now seen to have been based on unrealistic targets and were hampered by inadequate supervision of fieldworkers political interference in staff recruitment inadequate evaluation procedures lack of commitment and motivation of key program staff and most importantly a preoccupation with a supply oriented approach. A considerable unmet need for family planning services remains which has not been converted into effective contraceptive usage partly because of the family dynamics of a male dominated society. Women who bear most of the costs of childbearing may want fewer children while men who receive most of the benefits want more. The cost of having more children may not be great enough to encourage women to face the problem of going against the wishes of husbands or mothers-in-law. The current family planning approach in Pakistan lays stress on changing the attitudes of potential clients about contraception apparently recognizing the lack of effective demand. (summary in FRE)