March 12th, 2009 | Posted in Reproductive Health
by Jay Gribble, vice president, International Programs
I was recently looking at use of family planning methods in Pakistan. According to the recent Pakistan Demographic and Health Survey 2006-07, almost 30 percent of married women of reproductive age (ages 15 to 49) use some form of family planning—either a traditional or modern method. Recent surveys indicate that use of family planning methods has hovered around 30 percent for almost a decade
But what does this “30 percent” mean? So often, officials use aggregate numbers as the basis for decisions about policies and programs. But there are many ways to look at what that “30 percent” represents—and many of them could provide valuable insight into how to better serve the reproductive health needs of Pakistani women and couples. Let’s take a look at a few of them.
We can consider how the “30 percent” breaks down by type of contraceptive method use. Of the 30 percent of women who use a family planning method, 8 percent use a traditional method and 22 percent use a modern method. If we considered only the group of women who report using any form of family planning, over a quarter (8/30) of them have opted to use a relatively ineffective methods—rhythm and withdrawal are the two most common traditional methods used. When we look at the use of modern methods, the most popular choice is female sterilization. Eight percent of all married women ages 15 to 49 have chosen sterilization; but when considering only women who are using family planning, over a quarter of women have chose sterilization. Condoms are also a popular method and are the choice of 7 percent of all married women ages 15 to 49 ( and the choice of 23 percent of women who use any form of family planning). However, inconsistent use of condoms can lead to unplanned pregnancies. So what does method mix tell us about family planning in Pakistan? It says that not too many women use effective contraception until they are ready to end childbearing. Few women use modern methods for the purpose of spacing pregnancies, which contributes to better health for both mothers and children.
Another way to look at the “30 percent” is based on the number of children that a woman already has. In many parts of the world, women use contraception for years after marriage, choosing to start a family when they are ready. In Pakistan, less than 1 percent of women who have no children use family planning. It isn’t until women have three or more children that they really begin to think about family planning. After having five or more children, women opt for sterilization. Most Pakistani women are not using family planning to space pregnancies; if anything, they are using it so that they don’t ever get pregnant again.
Finally, one of the most important ways of looking at the “30 percent” is by wealth group. It’s very common for a larger percentage of wealthier women to use family planning than poor women, which is also the case in Pakistan. Among the poor, almost 16 percent use family planning, while 43 percent of women the wealthiest group are using contraception. Among the poor who are using any form of family planning, almost half are sterilized and one third uses another modern method. But the fact that 84 percent of poor women are not using any form of family planning is a very important piece of information to know. Among the wealthy, 31 percent use modern methods and 12 percent rely on ineffective traditional methods. Again, the national average of “30 percent” hides this important variation.
Given what we know about high fertility and poverty, we should be thinking more about how to make family planning more accessible to the poor. While the “30 percent” leaves room for improvement, the fact that 84 percent of Pakistan’s poorest women are not using any form of family planning suggests that something must to change.
Averages are useful for comparisons, but remember to scratch the surface and see what’s really going on.