The gap between findings and policy of family planning in Pakistan

The latest statistics from Pakistan put Research has shown again and again that people in Pakistan are more comfortable with traditional family planning methods such as withdrawal, safe days and condom (PDHS 1990, 2006-07). These three methods account for almost half of the contraceptive usage in Pakistan (14.5 percent women use either of the three methods while CPR is 29.6 percent).

Non hormonal methods such as withdrawal is the one of the most favorite among most married men and women of the country (Casterline, Sathar and Haque 2001) just because it is free, readily available and has no side effects. The caveats are higher failure rate than hormonal or other barrier methods and dependency upon husband's cooperation to use. I personally consider withdrawal superior over condom and safe days method. For condom usage access (including geographic, financial, social and personal) still remains a barrier, cumbersome to use when sex is a quick act in a room shared with family members, requires storage and disposal after usage both of which may violate privacy for couples in country like ours where most people share sleeping areas with others.

Hormonal methods including pills, injectables and IUD which are considered the best also have the worst side affects. Fear of actual and perceived side effects lead to non use and discontinuation of contraception. Based on my personal conversations with colleagues who are involved in family planning research I learnt that withdrawal and condoms are the most favorite and the very same people who promote (in whatever way) hormonal methods would not consider those methods for themselves. A quick look at the latest PDHS data also shows that contrary to the expectation, the users of withdrawal and condoms are more educated, urban and more resourceful than users of injectable and pills. My point is that if people learn how to use traditional methods (Withdrawal, safe days, LAM) and modern methods at the same time, they would most probably go for the latter, unless they have completed their desired family size--for which they would prefer female sterilization.

Despite such findings, it is baffling to know that the emphasis of our government is always on promoting the so called modern (mostly hormonal) contraceptive methods, all in the name of effectiveness. I agree that effectiveness should be important, but in the scenario where accessibility and non-existence of side effects support natural methods and many would rather take chances of pregnancy rather than using a modern family planning method. I think in such cases the benefits of modern methods are seriously undermined where people are willing to go as far as induced abortion due to lack of use. (Please note that in Pakistan almost a million abortions are conducted every year)