Fertility control in the context of the family and society in Pakistan

This study has examined the functioning of the family planning programme, reasons for the low contraceptive prevalence and sustained high fertility levels in Pakistan. The examination of the status of women in Pakistan has revealed that women have a low level of education (14 per cent) and their participation in the gainful employment (3 per cent) is also very low. Most of them marry early (mean age 17.4 years) and rarely use contraception (current use 9 per cent), factors which lead to high fertility. The blend of both Hindu customs and Islamic values has affected the position of women in Pakistani family and society. However, more important have been religious injunctions that have restricted women from participating in educational, economic, political and social activities, including family planning. Several religious scholars in Pakistan have advocated that a truly Islamic society must be based on complete segregation of the sexes and subordination of women to men. Considerable pressure is exerted by these scholars and local preachers for political decisions limiting an active role for women in the family and society, with motherhood being considered to be the main role for women in Pakistan. Since 1965, a family planning programme has been implemented through variety of strategies. However lack of political support and, in particular, religious resistance are important factors hindering family planning implementation. None of the religious leaders or scholars in Pakistan have ever openly supported the view that family planning is religiously acceptable, and some scholars have always opposed family planning in the country on religious grounds. A multi-sectoral approach to family planning was adopted in 1980 with the family welfare centre (FWC) as the key institution for providing family planning services to a population of around 25,000 in rural and 65,000 in urban areas. The implementation of the new strategy has revealed certain short-comings, such as inadequate coverage and lack of support on the part of the community and other government departments. In urban areas FWCs have a very low profile, whereas in rural areas it is not possible for women to travel to other villages where the centre is located because of norms requiring female seclusion. The assessment of the programme’s impact on fertility levels indicates that a marginal decline in fertility, about one child per woman (from seven in 1965 to six 1985), has been mainly due to rising age at marriage, and only marginally to the use of contraception. Differentials in fertility, after controlling for women's age and age at marriage, are mostly explained by the education levels of women and their husbands with low levels of education associated with higher fertility. Family size norms (around five children per woman), in particular the desire for at least two sons, also support high levels of fertility. These large family size norms are also associated with the low levels of education of women. Women's education is also the most important factor influencing contraceptive use after controlling for the number of living children. Women who have attained primary and secondary education are two-and-a-half and five times respectively more likely to use contraception compared to those who have no education. The study has also documented some cultural values, such as opposition from family elders and son preference, which hinder adoption of family planning. Changes which may affect positively the status of women and acceptance of family planning in Pakistan are: economic development; acceleration of education and employment opportunities for women; increase in age at marriage for women; political commitment for family planning; change in religious influence; and provision of social justice and security for smaller families. It is recognized that such cultural, social and political changes may occur with the development (economic and social) of the country. However, immediate steps to expand the coverage of family planning services through FWCs and health clinics of other government departments and to increase education of women, both of which could be afforded if the government had the political will, would make an impact on reducing high fertility