Family Planning in Asia and the Pacific - International Council on ...

FigureFigure5Percentage change <strong>in</strong> contraceptive method mix over time1991610 3 11117PillIUDInjectionCondom121420071788PillIUDInjectionCondom2330Female sterilizationRhythmWithdrawal2823Female sterilizationRhythmWithdrawalO<strong>the</strong>rO<strong>the</strong>rOverall, <strong>the</strong> trends <strong>in</strong> choice of method <strong>in</strong>dicate thata quarter of women use traditional methods of familyplann<strong>in</strong>g <strong>and</strong> ano<strong>the</strong>r quarter use condoms, mean<strong>in</strong>g thathalf are us<strong>in</strong>g couple-methods of family plann<strong>in</strong>g. Theo<strong>the</strong>r half use female methods, with about a quarter of<strong>the</strong>se choos<strong>in</strong>g permanent methods <strong>and</strong> <strong>the</strong> rema<strong>in</strong><strong>in</strong>gquarter us<strong>in</strong>g o<strong>the</strong>r modern female methods.Source of methodsIn 1991, when fertility decl<strong>in</strong>e had just come <strong>in</strong>to play<strong>and</strong> contraceptive prevalence was at a low 11 per cent, <strong>the</strong>government was <strong>the</strong> major supplier of modern contraceptivemethods: 56 per cent of users received <strong>the</strong>ir method froma government supplier (<strong>in</strong>clud<strong>in</strong>g government hospitals,doctors, cl<strong>in</strong>ics, family welfare centres etc.), while only30 per cent received methods from <strong>the</strong> private sector (seeTable 2). By 2007, while <strong>the</strong> government rema<strong>in</strong>ed <strong>the</strong>supplier for almost half of all contraceptive users, at 48 percent, <strong>the</strong> share of <strong>the</strong> private sector <strong>in</strong>creased by more than10 percentage po<strong>in</strong>ts to 41 per cent, <strong>in</strong>dicat<strong>in</strong>g that more<strong>and</strong> more users were pay<strong>in</strong>g for contraception.In look<strong>in</strong>g at source of method by specific method type, twotrends st<strong>and</strong> out. Over <strong>the</strong> 16-year period, <strong>the</strong> government’sshare <strong>in</strong> <strong>the</strong> supply of <strong>the</strong> pill <strong>in</strong>creased <strong>and</strong> it replaced <strong>the</strong>private sector to become <strong>the</strong> biggest supplier. On <strong>the</strong> o<strong>the</strong>rh<strong>and</strong>, IUDs, which <strong>in</strong> 1991 were supplied primarily by<strong>the</strong> government (81%), were now be<strong>in</strong>g provided equallyby <strong>the</strong> private sector as well. Among <strong>the</strong> o<strong>the</strong>r methods,<strong>the</strong> private sector saw slight <strong>in</strong>creases (correspond<strong>in</strong>g to aslight decrease <strong>in</strong> <strong>the</strong> government’s share) <strong>in</strong> <strong>the</strong> share of<strong>in</strong>jectables <strong>and</strong> female sterilization, while both <strong>the</strong> public<strong>and</strong> private sectors saw <strong>in</strong>creases <strong>in</strong> <strong>the</strong> market share ofcondoms. With<strong>in</strong> <strong>the</strong> private sector, <strong>the</strong> supply of condomsby non-medical stores was responsible for <strong>the</strong> <strong>in</strong>crease <strong>in</strong>market share.Induced abortionsDespite <strong>the</strong> fact that <strong>in</strong>duced abortions are illegal <strong>in</strong>Pakistan, except when performed to save women's lives,a study carried out by <strong>the</strong> Population <strong>Council</strong> estimatedthat 890,000 <strong>in</strong>duced abortions were performed <strong>in</strong> 2002,<strong>and</strong> <strong>the</strong> abortion rate was 29 per 1,000 women aged15-49 (Population <strong>Council</strong>, 2004). This was a mediumestimate; <strong>the</strong> low <strong>and</strong> high estimates were 25 <strong>and</strong> 31 per1,000, respectively. The abortion rate of 29 is most likelyan underestimate of <strong>the</strong> true abortion rate despite be<strong>in</strong>gmoderately high by global st<strong>and</strong>ards. The majority ofsuch abortions are tak<strong>in</strong>g place among married womenwith more than three children. Studies based on <strong>the</strong>sedata also found that a considerable proportion of womenwho <strong>in</strong>duced abortions had tried some method ofcontraception <strong>and</strong> some even reported that <strong>the</strong>y had beenus<strong>in</strong>g contraceptives, albeit <strong>in</strong>effectively, when <strong>the</strong>y becamepregnant (Arif <strong>and</strong> Kamran, 2007).Sathar et al. (2007) estimated measures of total pregnancy<strong>and</strong> unwanted pregnancy to portray <strong>the</strong> broader contextwith<strong>in</strong> which <strong>in</strong>duced abortion was occurr<strong>in</strong>g <strong>and</strong> tomeasure both <strong>the</strong> absolute level of unwanted pregnancy<strong>and</strong> <strong>the</strong> probability that women who experienced anunwanted pregnancy would seek an abortion. Resultsyielded an unwanted pregnancy rate of 77 per 1,000women, which accounted for almost two fifths of allpregnancies. Abortions accounted for almost two fifths of<strong>the</strong>se unwanted pregnancies.Unmet needDespite <strong>the</strong> low use of fertility regulation, more <strong>and</strong> morewomen <strong>in</strong> Pakistan are express<strong>in</strong>g <strong>the</strong> desire to limit orpostpone childbear<strong>in</strong>g. In 1991, 40 per cent of <strong>the</strong> women208