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KARACHI:
National Commission on Maternal and Neonatal Health (NCMNH) in
collaboration with Association for Mothers and Neonates (AMAN) and
Greenstar Social Marketing organized a meeting on “Update on
Contraception” to celebrate the World Population Day at JPMC on July
10th 2010. The meeting was largely attended by obstetricians and
gynaecologists besides nurses. Addressing the participants Dr. Navaid
Ali Chief Executive Officer of Greenstar Social Marketing said that
proper nutrition, birth spacing and skilled birth attendants can play a
vital role in reducing maternal and neonatal, child mortality. Pakistan
has a population of one hundred seventy million being the sixth country
with the largest population. If this population is productive and
educative, it can be a strength.
Dr. Navaid Ali CEO Greenstar Social Marketing responding
to questions during the panel discussion in a seminar on “Update on
Contraception” organized on World Population Day at JPMC. Also sitting
on the dais other panelists are from (L to R) Prof.Sadiqa Jafary, Mrs.
Imtiaz Kamal and Prof. Shahida Zaidi.
If we look at our GDP we are at no. 27 among the 160 Nations but if we
take into consideration the purchasing power and per capita income our
ranking is one hundred thirty one because most of our population is
neither educated nor productive. We need to make investment in Health
and Education. We have very high maternal mortality, child mortality as
well as infant mortality. These figures reflect the future of nations.
Proper nutrition, birth spacing and skilled birth attendants can help
reduce maternal and neonatal mortality. If the women go on producing a
child every year, it will certainly affect their health as well. Hence
birth spacing is extremely important. It is possible and we have the
resources. Post Partum intrauterine contraceptive device insertion
should be practiced and these services should be available in health
care facilities. This is the right time for counseling of the couple
when they are most receptive. If we practice antenatal counseling we can
turn around this situation. We will have the first workshop on post
partum IUCD insertion during this meeting and if it is successful, we
can go to other cities as well. Dr.Navaid Ali commended the initiative
taken by NCMNH, Prof. Sadiqa Jafary and Dr. Sadiah Ahsan in this regard
and offered services of Greenstar Social Marketing in all such
activities in future as well.
Prof. Sadiqa Jafary was the next speaker who gave facts and figures
about maternal mortality, infant and neonatal mortality and the progress
Pakistan has made so far in these sectors using the latest information
technology with multimedia. Starting from 1970, Pakistan she said had
very low child health services and the number of educated girls. We had
under five mortality of over two hundred per thousand live births and
education of girls was 0.40%.Only 11% of children were enrolled in
primary schools. With the passage of time under five mortality has
reduced and education of girl children has also improved. In the Year
2000, under five mortality had reduced to 10% from 18% and 38% of
children were enrolled in the primary schools.
Group Picture shows
Dr. Navaid Ali CEO, Greenstar Social Marketing (GSM), Dr. Farukh Farooqi,
Deputy Manager Health Services & others at the World Population Day
Seminar held at Jinnah Post Graduate Medical Centre (JPMC), Karachi as a
joint venture of NCMNH, AMAN and Greenstar Social Marketing (GSM).
On the economic side too we have made some progress. In 1975 our income
was US$ 380/- per person which in 2005 has increased to US$ 2,320/-
Despite the fact that income per person has increased but three out of
five people are living below the poverty line. This affects economic
development and country’s stability. We need to improve reproductive
health services, improve health of mothers and children and make
concerted efforts to reduce poverty. In Pakistan women make up of one
third of labour force. Studies have shown that women wish to have up to
three children and the couple making a five member family. However, our
total fertility rate average is four children if we look at the whole
population but in fact the married women have six children per couple.
This is despite the fact that women desire to have small family size.
Giving a comparative study with Bangladesh Prof. Sadiqa Jafary said that
since 1973 they have made lot of progress. In 2008 they had 2.83
children per women as compared to 4.1 children in Pakistan. If we
compare Pakistan with Iran and Indonesia, Iran has also made tremendous
progress. They have two children per women as compared to four in
Pakistan and 2.5 in Indonesia. Iran could achieve that because free
services are made available to all the married couples.
Our current population is 170 million which will increase to 459 million
in 2050 if we have this fertility rate of four children. However, if we
can reduce it to two children, our expected population will be 335
million. She was of the view that efforts should be made to ensure that
we reduce our fertility rate to three children per women. Our fertility
rate should continue to decline as we cannot afford this population
growth. Currently only 22% of our women use modern family planning
methods. Again in urban 30% of women use this while in rural areas it is
only 18%. We must put more emphasis on providing these services in rural
areas. Many women would like to practice these modern family planning
methods but they cannot due to various reasons. The number of women with
unmet family planning needs is about 25%.Again it is much more in the
poor i.e. 31% and about 20% in the affluent class. Studies have shown
that one out of every three pregnancies is unplanned. We have high
fertility rate and this population growth is a strain on national
economy. High risk of birth, pregnancy is directly related to unsafe
abortions, maternal deaths, disability and family struggle. It is
estimated that about nine hundred thousand abortions are performed in
Pakistan every year and majority of these are unsafe abortions. About
65% of these abortions are in women over thirty years of age and 80% of
these women have more than three children. Majority of these women are
married who go for abortions.
Continuing Prof. Sadiqa Jafary said that when it was investigated why
these women go for abortion rather than practicing modern family
planning methods, it was revealed that many of them are not convinced
that these contraceptive methods are effective. Some fear of their side
effects, then resistance from husband, too high cost coupled with
inadequate services were mentioned as some other reasons. If these women
start using modern family planning methods, it will significantly reduce
the number of abortions. From religious point of view abortion is
permitted before one hundred twenty days to save the life of the women
and provide them necessary treatment. Investment in family planning will
save lot of expenses on maternal health, education, water and
sanitation, TB and immunization etc. She concluded her presentation by
suggesting that government should expand reproductive health services,
improve abortion related services to save women. Improve children
enrollment in schools and create more jobs for improvement of the
economy. Simple cost effective services, she felt would improve women’s
health; reduce poverty which will ensure stable prosperous Nation.
This was followed by a panel discussion. Members of the panel included
Prof.Sadiqa Jafary, Mrs. Imtiaz Kamal, Dr. Naveed Ali and Prof. Shahida
Zaidi. Participating in the discussion Dr.Azra Ahsan said that where we
have patients, there are no reproductive health services and where
services are available, there are no patients. Family Planning clinics
in public hospitals close after 2.00 PM. Mrs. Imtiaz Kamal said that
neither faculty members were teaching family planning or reproductive
health to medical students nor this is an examination subject. Prof.
Shahida Zaidi said that we must offer safe abortion and promote family
planning. We need to promote integration of services. Post partum IUCD
insertion should be promoted.
Prof. Jahan Ara Pal speaking on the occasion said that Pakistan has made
tremendous progress and we should not feel shy in admitting it. We have
many intelligent people and using their expertise, we can do a lot. We
have not included men and while planning our population man should be
targeted. It is not only the healthcare professionals alone but each
individual has to take care of reproductive health and promote its
positive aspects. Teachers should also teach reproductive health and
family planning. They can give advice and what we the seniors have not
done, the youngsters can do. Public health education through media
should be intensified. Speaking about abortion and termination of
pregnancy, she quoted Caliph Hazrat Ali who when approached by some
people, had approved these practices. In order to save the mother and
provide treatment, pregnancy can be terminated before one hundred twenty
days. Doctors should discuss reproductive health with the patients.
Replying to a question Dr. Navaid Ali CEO of Greenstar Social Marketing
said that more than eight thousand clinics all over the country have
been identified which are providing these services. There are three
million couples in urban areas and six million couples in rural areas
with unmet family planning needs. We have introduced mobile service
units; have assumed control of ten basic health units in Sindh province
where we will provide all these services. We wish that institutions like
JPMC teach the students. We will be too glad to collaborate with medical
institutions, healthcare facilities all over the country to arrange
seminars, training workshops. We wish to involve the key opinion leaders
in our efforts and it was with this objective in mind that we are
collaborating with these NGOs.
Dr. Sadiah Ashan Pal’s presentation was on contraception update. She
pointed out that the first family planning clinic was established by
Sangar a midwife in 1916 in United States. She reiterated the figures
earlier presented by Prof. Sadiqa Jafary that almost 40% of pregnancies
worldwide are unplanned, we have maternal mortality rate of 276,
fertility rate of 4.1%, and contraceptive prevalence rate of 30%, only
22% women practice modern family planning services, population with
unmet needs for family planning was 25%. About 8% women have
sterilization, only 2% use oral contraceptive pills, 2% use injections,
7% couples use condoms while other traditional methods of family
planning were being used by 8%. About one lac ninety seven thousand
women are hospitalized for complications of pregnancy every year and we
have one abortion for every five live births. Again 5.6% of maternal
deaths are due to abortion. Almost 51% commence sex two weeks post
abortion and over 30% of them will have repeat abortions.
Speaking about the new developments in modern family planning she said
that we have now contraceptive spray, E2 Pill, male contraception, SPRMs,
Implanon, NUVA Ring, medicated IUS, DMPA in Uniject and Women’s condoms.
Some of these are not yet available in Pakistan and hopefully will be
available in the days to come. Some of the barriers to the use of oral
contraceptive pills include that pill is misunderstood, there are fears,
myths and misperceptions, concerns about body image, and some women are
not aware of the non-contraceptive benefits. As regards fear of weight
gain, it has nothing to do with the pills but since we eat too much,
that is why most women after marriage put on lot of weight. These drugs
are made available at subsidized prices in Pakistan just to promote
their use though these services are much more expensive overseas. The
non-contraceptive benefits of modern family planning methods she said
include decreased blood loss, reduction in osteoporosis; it is good for
skin and hair. Ovarian cancer risk and uterine cancer risk are reduced.
To prevent cancer, we need to promote cessation of smoking, weight
reduction, regular exercise, vaccination and contraception. VTE
association with oral contraceptive pills was over emphasized by the
media which reduced its use and also increased abortion. The pill
fortified with folic acid will decrease NTDs. LARCs and NUVA as well as
patch are expected to be made available in Pakistan soon. Other new
products include indomethacin releasing copper IUCD and copper induced
IUCDs.
Post delivery IUD insertion is an option which can be practiced after
counseling the women. Post partum after four weeks IUD expulsion rate is
3-13%. Late post partum IUD is not recommended. There have been some
developments regarding oral pill for the male but women do not trust men
to pop the pill because it is they who will become pregnant.
Dr. Azra Ahsan spoke about emergency contraception. She pointed out that
contraceptive prevalence rate was 23% in Punjab, 22% in Sindh, 19% in
NWFP and just 3% in Baluchistan. The Contraceptive Prevalence Rate is
less while abortion rate was much higher. Studies have showed that 43%
of married women do not intend to use family planning in the future.
Reasons for opting for abortion have been reported to be family building
preferences. She then referred to various medications and how many
tablets should be used a day which can be continued for three or even
five days. These drugs are effective if taken immediately or as soon as
possible. She also talked about indications for emergency contraception
and said there are no major side effects. ECP can be taken with food or
at bed time when it is more helpful. However, she cautioned that
Emergency Contraception should not be used as a routine contraceptive
method.
Greenstar Social Marketing, it may be mentioned here, has made available
numerous products to promote birth spacing. ECP is recommended in
emergency situations when no contraceptive has been used, in case of
ruptured or forgotten condom, missed oral contraceptive pill, expelled
intrauterine device or failure of the coitus interrupts method. Taken
within twenty four hour it has an efficacy rate of 95%. FEMI-JECT offers
one month contraception. NOVA-JECT offers two months contraception and
this helps even lactating mothers to enjoy benefits of birth spacing.
Megestron offers three months contraception which is much more
convenient and offers reliability. Multiload offers contraception for
five yeas and Safeload can be used for long tern contraception for up to
ten years. Other products made available by Greenstar Social Marketing
include Novodol and NOVA.
Earlier Prof. Tasnim Ahsan Director JPMC in her brief address welcomed
the participants to the meeting and said that this purpose built
facility of auditorium is available for scientific academic activities.
It provides an academic atmosphere and also enables many healthcare
professionals within the campus to participate if they wish. The nominal
rental that is charged is for the maintenance of this facility and to
improve the facilities available. |
