title: Family planning in Pakistan: applying what we have learned.
abstract: Despite six decades of government and private sector programs, CPR in Pakistan is among the lowest in the region. This article reviews published and grey literature to understand why despite sufficient time and usually sufficient funding, CPR remains low in Pakistan. This paper looks beyond the usual factors of quality of services, coverage and supplies and management issues to examine how family planning may be improved in Pakistan. Based on analysis of the Pakistan Demographic Health Survey 2006-7, the public sector provides around a third of FP services, while NGOs and private providers another 15%. More than half of all family planning users buy their methods directly from stores. Within the government, the services cost 5-8 fold more than the private sector. Nearly a fifth of pregnancies end in an abortion suggesting the role of abortions as a key FP method. This together with a high unmet need pose the question: why is there such low uptake of FP services in the country. To explain this lack of uptake, we explore the limitations of the public sector in providing services, the lack of effect of religious beliefs, of abundant, yet misdirected funding and gaps in demand creation. The increasing role of NGOs and donors in filling the void left by the public sector is discussed. Suggestions are provided about improving public and private sector services including better information gathering and use in defining needs, measuring results and creating demand for FP.
authors.affiliation: Research and Development Solutions, Islamabad. adnan@resdev.org
authors.forename: Adnan Ahmad
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khan
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Wajiha
authors.initials: W
authors.lastname: Javed
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Hasan Bin
authors.initials: HB
authors.lastname: Hamza
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Mejzgaan
authors.initials: M
authors.lastname: Orakzai
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Aliya
authors.initials: A
authors.lastname: Ansari
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Khadija
authors.initials: K
authors.lastname: Abbas
mesh_terms: D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration*; D006801:Humans; D010154:Pakistan; D012736:Sex Education / Q000458:organization & administration*