The Sialkot Experience

Abstract

Family planning as a national governmental activity was greatly expanded in Pakistan in 1965. During the 1965-1969 Third Five-Year Plan an attempt was made to provide contraceptive information and services to married women in the reproductive ages and thereby reduce the crude birth rate from 50 to 40 per thousand at the end of the plan period. To achieve these interrelated goals of fostering contraceptive practice and reducing fertility a cadre of 41000 family planning program personnel was recruited. In the main these were traditional midwives or who worked part-time in the program. Their function was to disseminate contraceptive information and supplies and to refer clients for IUD insertions. The dais were supervised by a corps of family planning officers and other administrative training and inspection personnel. Near the end of the plan period it became apparent that the existing field structure was inadequate to achieve the goals of contraceptive practice and fertility reduction. Some success was noted in the spread of contraceptive knowledge (United Nations 1969). A number of problems however limited the effectiveness of the program among them the high rate of turnover of dais limitations in using illiterate women with low social standing as the main field motivators the failure to involve males in family planning the emphasis upon initial acceptance of contraception without provision for follow-up to sustain continued use and the reliance on the IUD as the main program method (Wajihuddin 1971). Studies on the effects of the program indicated declines in fertility among older high-parity women. The populations low levels of knowledge of both contraceptive methods and sources of services and their limited contact with program personnel attested to the programs inability to reach a significant proportion of the population. Levels of current and ever-use of contraception were found to be low - 4 percent and 9 percent respectively for East (Bangladesh) and West Pakistan combined (Pakistan Family Planning Council 1971). These shortcomings led to the introduction at the end of 1969 on a trial basis of a revised pattern of field activity in which a small number of full-time literate male and female field workers offered contraceptive services to all eligible married couples in a given geographic area. Introduced initially in a single district the new field structure was extended to seven additional areas by March 1972 and has served as a model for the national program. An examination of the performance of the new structure in the initial district can provide useful information on the program in Pakistan and present an alternative delivery system model for other countries. The present paper is an analysis of the operation of the project from its inception in December 1969 to October 1971. (excerpt)