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Pakistan

Articles by Pakistan

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

FPAP staff conducts an Awareness Raising Session on Reproductive Health
11 March 2022

Responding with Essential SRHR Provision and New Delivery (RESPOND)

The Responding with Essential SRHR Provision and New Delivery mechanisms (RESPOND) project aims to restore services, particularly to marginalized populations such as young people, people living in poverty, and people with disabilities, which have been impacted by COVID-19. This two-year project is being implemented jointly by IPPF and Marie Stopes International across 22 countries in the Asia Pacific region, funded by the Australian Department of Foreign Affairs and Trade. IPPF is supporting Member Associations to implement RESPOND-funded activities in Cambodia, Laos, Indonesia, Philippines, Bhutan, Sri Lanka, Pakistan, Nepal, Bangladesh, Maldives, Papua New Guinea, and the Pacific Islands. The ultimate outcome of the RESPOND project is to ensure populations affected by the COVID-19 pandemic in the Asia Pacific region have enhanced SRHR. Case study: Serving Afghan refugees in Pakistan UNHCR recorded approximately 1.4 million Afghan refugees in Pakistan in 2021, with 30,000 arriving in August alone as the Taliban took control in Afghanistan. The Pakistani government's capacity to respond to this humanitarian crisis remains limited given the scale of need. Living conditions in many camps are poor, with overcrowding a major challenge. Pervasive gender inequality and a de-prioritisation of sexual and reproductive health (SRH) care mean that women and girls are particularly vulnerable, and at heightened risk of illness and death from preventable causes including unsafe abortions and maternal complications. With support from the Australian government, IPPF is addressing SRH needs through the RESPOND program. This program, running across 19 countries where IPPF has a presence, aims to serve 13,440 Afghan refugees in Pakistan over two years (2021-2023). 

A woman smiles during a youth session
13 January 2022

Pakistan: Reaching young people with sexual health services

An estimated 64% of Pakistan’s population is under the age of 30, and the country now has more young people than it has in its history. In light of this, it is important that policies are in place that can effectively respond to the needs of Pakistani youth.  While government policies are increasingly considering youth but in areas such as sexual and reproductive health and rights (SRHR), policies remain virtually non-existent. The sexual reproductive health of young people continues to be a taboo due to existing and widely entrenched cultural, social, and religious belief that young people – particularly those who are unmarried – have no need for SRHR information and services. Multi-approach techniques for youth Young people not only need access to comprehensive SRHR information but also services that cater to their needs. Through the WISH program*, IPPF’s Member Association R-FPAP has implemented many different approaches to reach young people with SRHR information and services. Through these approaches the programme was able to reach 8.3% of youth (of the total clients served) between January 2019 and August 2021, increasing from 2.5% in the first quarter of the programme, reaching a high of 10.2% in the second to last quarter (+7.7%).  Further, there was a 203% increase in total SRHR services provided to youth under 20 between 2018 (pre-WISH) and 2021. 

women at clinic receives contraception - Pakistan

“I have a three-year-old and want to wait a few years before I have another child"

At the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP), mothers and daughters-in-laws wait for a consultation for affordable treatment and medication. At the FHMC, patients are charged only 50 Rupees (0.22 GBP) for a consultation. This is a fraction of what they would pay at a private clinic and less than the cost of travelling to the nearest government hospital. The clinic also has a ‘no-refusal policy’ to ensure those who cannot afford to pay the fee can still receive the care they need. Around 50 patients visit the clinic every day.  For 26-year-old Sehrish Hamid, the clinic is providing essential healthcare services, she is unable to afford elsewhere. “My husband sells scrap metal off a cart and we often struggle to make ends meet,” she says.  In the past, Sehrish frequently got urinary tract infections but could rarely afford to visit a doctor. A few weeks back, a social organizer from the WISH project visited her house and told her about the FHMC, where she was able to get affordable treatment and medication. “The staff here are friendly, and the doctor gives time and attention to each patient. In the past, no doctor took out the time to talk to me about hygiene and explain how recurring infections can be prevented,” she says.  The FHMC operates as a ‘one stop clinic’ offering a range of health services including family planning and screening for cervical cancer and counselling for Sexual Gender Based Violence (SGBV). Many, such as Sehrish come to clinic for one reason but also end up choosing to take up of family planning services.  “I have a three-year-old and want to wait a few years before I have another child. When I came to the clinic, I also found out about family planning methods. I had a lot of questions and concerns that were addressed and allowed me to make a decision about which contraceptives to use,” Sehrish says. 

Rahnuma Family Planning Association of Pakistan (FPAP)
25 September 2020

How a one-stop clinic is making a difference for women in Pakistan

Dr Zarka Riaz sits behind her desk at the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP) in a low-income neighbourhood in Rawalpindi, a city of over two million next to Pakistan’s capital Islamabad. Even on this wet monsoon day, over a dozen women are gathered in the waiting area of the clinic.  “Pakistan is experiencing a population explosion, women, especially those from underprivileged and marginalized sections of society are not able to gain access to contraception they so desperately want and need, to make choices for their families,” says Dr Zarka. Dr Zarka is a gynecologist, with a specialization in family planning. She has been working with FPAP for ten years but started working at this clinic 18 months ago. The family clinic is supported as part of the Women’s Integrated Sexual Health (WISH2ACTION) programme funded by the Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’.  Across the country – Rahnuma-FPAP works through cluster networks. A pioneering model that brings together public and private specialist sexual and reproductive and health centers within a close radius referral network to ensure women and girls can receive life-changing care. Networks use poverty data mapping to ensure that services are targeted to areas where the population needs them most.   "Under WISH we are offering free family planning services, which is extremely important for a low-income area such as this”, explains Dr Zarka.  FPAP works in partnership with government and private clinics, community-based distributors, disability organizations and religious and community leaders as part of the clusters. Local pharmacies are also part of these networks and provide condoms and birth-control pills free of cost.    Dr Zarka observes that a lot of women worry about unintended pregnancies but are not aware of family planning methods available. Pakistan is the world's fifth-most populous country, home to over 220 million people with an annual fertility rate of 3.6 children per couple.  “There are a lot of myths and misconceptions about family planning. In male-dominated societies such as ours, women are often not able to make decisions about their reproductive health, which is why it is essential to engage men and mothers-in-law." Dr Zarka notes that it is becoming increasingly common for women in low-income areas to try to terminate unwanted pregnancies by getting unsafe abortion. “Abortion pills are readily available, and people use the internet to find out ways to abort unwanted pregnancies. However, women often take the wrong dosage and end up with too much bleeding or infections,” she says. “Access to free contraceptives can reduce the need for unsafe abortions, allow women to space their pregnancies and gain autonomy over their health and wellbeing,” she adds. Rahnuma implements the WISH programme across five provinces across the country and through its community awareness work is changing the discourse in Pakistan on family planning and sexual and reproductive health and rights.     

Healthcare worker with combipack.

In pictures: Innovating during COVID-19

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Syed Kamal Shah, Chief Executive Officer of Rahnuma-Family Planning Association of Pakistan (FPAP)
27 April 2020

COVID-19 Impact: What we know so far – Pakistan

An interview with Syed Kamal Shah, Chief Executive Officer of Rahnuma-Family Planning Association of Pakistan (FPAP), on the impact of COVID-19. How has Pakistan been affected by the coronavirus/COVID19? The COVID-19 pandemic has wreaked havoc on overall economies worldwide, and has impacted Pakistan’s already trembling economy. It has upended life as we know it.  As we all know, the virus spreads at an alarming rate, and the fallout has spanned the globe, exposing the ill-preparedness of governments, health systems, and social safety networks to respond to the longstanding and emerging needs of people – especially relating to the health and rights of women and girls.  Pakistan currently has the highest number of COVID-19 cases in South Asia – we have more than 6,500 confirmed cases, and with over 140 deaths, it has begun to strain our healthcare systems. The Prime Minister of Pakistan, Imran Khan, has repeatedly raised his concerns that Pakistan's health system will not be able to bear the load in case of a rapid increase of the virus here. Right after the pandemic surfaced, Pakistan took stringent measures, which has enabled us to control it from mass spread so far. But during previous months, some laxity was shown when it came to people travelling into the country, as well as the continuation of religious congregations. The lockdown has been extended until 30 April, but the COVID-19 situation is becoming more aggressive day by day. Can you tell us more about your organization, Rahnuma FPAP? Rahnuma Family Planning Association of Pakistan is one of the largest and oldest rights-based civil society organizations working in reproductive health and family planning. We are fully accredited by the government, and our services delivery system is composed of ten fully-equipped Family Health Hospitals, more than 100 Family Health Centers and thousands of Community-Based Distributors and Private Practitioners which benefit a hundred-thousand people annually.  What impact is coronavirus having on sexual and reproductive health (SRH) in Pakistan?   As health systems are increasingly strained, SRH services are often mischaracterized as non-essential or “elective,” and thus de-emphasized in most provinces – with critical consequences. The total focus is on covering the virus and treating the infected. This has illustrated gaps in our existing approach to SRH and family planning. Our one of main challenges is to provide personal protective equipment (PPE), as we have no resources for the purchase of PPE and other supplies.  We may see shortages or non-availability of contraceptives, antiretrovirals for HIV/AIDS and antibiotics to treat sexually transmitted infections, due to disruptions in supply chains. Access to contraceptives has been reduced or limited due to COVID-19 since people are scared to leave their premises, and stoppages of public transport has further added to the mobility restrictions. These impacts may be compounded by the diversion of financial resources to the COVID-19 response, which would take funding away from reproductive health programs and decrease access for patients who rely on free or subsidized care. Likewise, the need for new precautionary equipment, training and protocols will further draw time and resources away from other work, including projects and programs related to SRH. However, we have been providing SRH care at our service delivery points (SDPs) all over Pakistan while ensuring strict protection and safety measures of our service providers and visitors. Which of your services have been the worst hit so far? Our community engagement services and outreach activities have been worse hit, which includes mobilization, training, counselling, community outreach sessions, peer-to-peer-sessions, mobile outreach and door-to-door home visits, and youth engagement channels. However, we are providing SRH counselling through our six dedicated helplines. More than 80% services are targeted towards vulnerable and marginalized sections of society who have been hit hard by this pandemic, including those living with disabilities, HIV/AIDs, women and children, and poorer people. We are working with other stakeholders not to leave them behind and ensure the availability of SRH services despite the pandemic.  Are frontline staff still able to go into the community to deliver services?  Due to the lockdown and a ban on public gathering there is no community activity at large, although all our SDPs in our hospitals and clinics are working as normal, with strict COVID-19 preventive and precautionary measures in place. Frontline staff are, of course, respecting the prevention measures of not going into the field. From day one our staff have also been working with the government and other organizations to raise awareness about complying with the rules on coronavirus prevention. Information banners have been developed and displayed at points where communities can see them, and leaflets have also been distributed to clients.   Despite lockdown, our SDPs are functional and we are also providing counselling and urgent consultation through our free helplines. All staff have been provided with PPE, and other protection tools, and our headquarter and regional staff are working from their homes on roster basis.  What message do you have for people and your staff in Pakistan when it comes to SRH services and coronavirus/COVID-19? The world is going through a period of crisis, but whether we look at it as a crisis or as an opportunity to reshape our thinking depends on us. So use this period as a lesson on how to live life with a concern for all humankind.  Health and safety comes first, therefore personal hygiene should be the top priority and there should be no compromise on it. Practice social distancing, but stay calm and positive. Use prevention measures – as both individuals and service providers at work – in your community and in your homes. Always share information on prevention measures wherever and whenever you can, whether that’s at the service delivery point, work, at home, or with family and friends.  We will pull through it together as we all are one – together we are stronger. We are the Rahnuma FPAP family and we believe in serving people, which for us is not charity, it’s humanity. 

Young women discussing sexual and reproductive health in Pakistan
05 September 2016

How to improve young people’s access to safe abortion - Pakistan: Youth Friendly Spaces

Young people face unique barriers when seeking accurate information about abortion, and in accessing abortion services. This series showcases strategies implemented by IPPF Member Associations that have successfully reduced these barriers and increased young people’s access to abortion information and services. In this short summary from Pakistan, they provide a comprehensive strategy on creating Youth Friendly Spaces, outlining the key steps needed for successful implementation and highlighting key lessons learned to consider in taking this strategy forward. This guide can be used by programme managers and implementers to help design and inform strategies to ensure that young people are enabled to access the necessary support and services they need in the event of an unwanted pregnancy.

hands holding contraceptive pill blister Credits: Graeme Robertson

Pakistan’s contraceptive advertising ban reversal welcomed by IPPF in South Asia

Ms. Anjali Sen, Regional Director, IPPF-South Asia Region said “It comes as a huge relief that Pakistan Electronic Media Regulatory Authority (PEMRA) has decided to reconsider its blanket ban on all advertisements of contraceptives in the electronic media. In the first place, it was an ill-considered order in the backdrop of the fact that Pakistan has the highest population growth, birth and fertility rates among the South Asian countries, including Bangladesh, India, Sri Lanka, the Maldives, Bhutan and Nepal. This blanket ban had raised serious questions because the Contraceptive Prevalence Rate (CPR) for women in reproductive age in Pakistan is an abysmal 35.40, as per 2013 figures. Given the realities of fertility rates and population growth in Pakistan, the Pakistani policy makers must understand that information on contraceptive choices is the key.  From around the world, we have many examples on how a desire for smaller families have led to greater investments in family planning, which have helped transform the age structure and consequently contributed to overall well-being. If the power of media, including the electronic media is harnessed, Pakistan will not stare at a projected 342 million people by 2050. Pakistani policy makers will appreciate that such population explosion will ultimately jeopardize the gains that Pakistan has made over the last few decades. A blanket ban on all contraceptive commercials in electronic media would have been counter-productive and it would have unspeakably harmed Pakistan’s national interest in slowing the population growth. If anything, the state and its agencies should actively facilitate free flow of information on contraceptives and the choices available if Pakistan has to achieve its population and development priorities. As a leading provider and advocates of family planning, South Asia Regional Office of IPPF welcomes PEMRA’s withdrawal of a blanket ban on advertisement of contraceptive products on Pakistani electronic media."

Rahnuma-Family Planning Association of Pakistan

Rahnuma Family Planning Association of Pakistan (R-FPAP) is one of the largest and oldest rights-based civil society organizations in Pakistan providing reproductive health and contraceptive care. 

R-FPAP is recognized both nationally and internationally as an advocate and service provider for reproductive healthcare and SGBV. Furthermore it has distinction to collaborate with all major national and international development agencies (INGOs, UN Systems, Public sector, government institutions). R-FPAP is devoted to eliminate and alleviate the sufferings of marginalized and vulnerable sections of society through integrated and concentrated social uplift efforts in the broader areas of RH and FP. Rahnuma-FPAP RH & FP based services delivery apparatus is composed of 10 fully equipped Family Health Hospitals, 130+ Family Health Centres, 80+ youth resource Centres, 2000+ CBDs and a network of private providers. During 2020, FPAP served 17 million SRH&R services while covering more than six million clients. Our SDPs provide FP, SRH, post abortion care, HIV & AIDS, STI/RTI, Gynaecology, Obstetrics, Urology, Sub-fertility, Specialized SRH, SRH- Paediatrics, Other SRH and Contraceptive Services

Contributions of R-FPAP are recognized by Government of Pakistan through its quarterly performance report issued by Pakistan Bureau of Statistics, under Planning Division (www.PBS.gov.pak).

SPRINT
26 April 2022

SPRINT: Sexual and reproductive health in crisis and post-crisis situations

  The SPRINT Initiative provides one of the most important aspects of humanitarian assistance that is often forgotten when disaster and conflicts strike: access to essential life-saving sexual and reproductive health services. We build capacity of humanitarian workers to deliver essential life-saving sexual and reproductive health services in crisis and post-crisis situations through the delivery of the Minimum Initial Service Package (MISP) for reproductive health in emergencies.   Through funding from the Australian Government's Department of Foreign Affairs and Trade (DFAT), our SPRINT Initiative has brought sexual and reproductive health to the humanitarian agenda, increased capacity and responded to a number of humanitarian emergencies. Australia has funded the SPRINT initiative since 2007. Since then, the SPRINT initiative has responded to 105 humanitarian crises and worked with partners in 99 countries. SPRINT has reached over 1,138,175 people, delivering 2,133,141 crucial SRH services, and continues to respond to ongoing emergencies. In each priority country, we work with an IPPF Member Association to coordinate and implement life-saving sexual and reproductive activities. Through these partnerships, SPRINT helps strengthen the enabling environment, improve national capacity and provide lifesaving services during times of crisis. You can read more about IPPF Humanitarian’s Programme here. Australia's location in the Indo-Pacific provides DFAT with a unique perspective on humanitarian action. Australia is committed to helping partner governments manage crisis response themselves. This is done through building the capacity of the national government and civil society to be able to respond to disaster. DFAT also works with experienced international partners to prepare for and respond to disasters, including other donors, United Nations agencies, the International Red Cross and Red Crescent Movement and non-government organisations.          

FPAP staff conducts an Awareness Raising Session on Reproductive Health
11 March 2022

Responding with Essential SRHR Provision and New Delivery (RESPOND)

The Responding with Essential SRHR Provision and New Delivery mechanisms (RESPOND) project aims to restore services, particularly to marginalized populations such as young people, people living in poverty, and people with disabilities, which have been impacted by COVID-19. This two-year project is being implemented jointly by IPPF and Marie Stopes International across 22 countries in the Asia Pacific region, funded by the Australian Department of Foreign Affairs and Trade. IPPF is supporting Member Associations to implement RESPOND-funded activities in Cambodia, Laos, Indonesia, Philippines, Bhutan, Sri Lanka, Pakistan, Nepal, Bangladesh, Maldives, Papua New Guinea, and the Pacific Islands. The ultimate outcome of the RESPOND project is to ensure populations affected by the COVID-19 pandemic in the Asia Pacific region have enhanced SRHR. Case study: Serving Afghan refugees in Pakistan UNHCR recorded approximately 1.4 million Afghan refugees in Pakistan in 2021, with 30,000 arriving in August alone as the Taliban took control in Afghanistan. The Pakistani government's capacity to respond to this humanitarian crisis remains limited given the scale of need. Living conditions in many camps are poor, with overcrowding a major challenge. Pervasive gender inequality and a de-prioritisation of sexual and reproductive health (SRH) care mean that women and girls are particularly vulnerable, and at heightened risk of illness and death from preventable causes including unsafe abortions and maternal complications. With support from the Australian government, IPPF is addressing SRH needs through the RESPOND program. This program, running across 19 countries where IPPF has a presence, aims to serve 13,440 Afghan refugees in Pakistan over two years (2021-2023). 

A woman smiles during a youth session
13 January 2022

Pakistan: Reaching young people with sexual health services

An estimated 64% of Pakistan’s population is under the age of 30, and the country now has more young people than it has in its history. In light of this, it is important that policies are in place that can effectively respond to the needs of Pakistani youth.  While government policies are increasingly considering youth but in areas such as sexual and reproductive health and rights (SRHR), policies remain virtually non-existent. The sexual reproductive health of young people continues to be a taboo due to existing and widely entrenched cultural, social, and religious belief that young people – particularly those who are unmarried – have no need for SRHR information and services. Multi-approach techniques for youth Young people not only need access to comprehensive SRHR information but also services that cater to their needs. Through the WISH program*, IPPF’s Member Association R-FPAP has implemented many different approaches to reach young people with SRHR information and services. Through these approaches the programme was able to reach 8.3% of youth (of the total clients served) between January 2019 and August 2021, increasing from 2.5% in the first quarter of the programme, reaching a high of 10.2% in the second to last quarter (+7.7%).  Further, there was a 203% increase in total SRHR services provided to youth under 20 between 2018 (pre-WISH) and 2021. 

women at clinic receives contraception - Pakistan

“I have a three-year-old and want to wait a few years before I have another child"

At the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP), mothers and daughters-in-laws wait for a consultation for affordable treatment and medication. At the FHMC, patients are charged only 50 Rupees (0.22 GBP) for a consultation. This is a fraction of what they would pay at a private clinic and less than the cost of travelling to the nearest government hospital. The clinic also has a ‘no-refusal policy’ to ensure those who cannot afford to pay the fee can still receive the care they need. Around 50 patients visit the clinic every day.  For 26-year-old Sehrish Hamid, the clinic is providing essential healthcare services, she is unable to afford elsewhere. “My husband sells scrap metal off a cart and we often struggle to make ends meet,” she says.  In the past, Sehrish frequently got urinary tract infections but could rarely afford to visit a doctor. A few weeks back, a social organizer from the WISH project visited her house and told her about the FHMC, where she was able to get affordable treatment and medication. “The staff here are friendly, and the doctor gives time and attention to each patient. In the past, no doctor took out the time to talk to me about hygiene and explain how recurring infections can be prevented,” she says.  The FHMC operates as a ‘one stop clinic’ offering a range of health services including family planning and screening for cervical cancer and counselling for Sexual Gender Based Violence (SGBV). Many, such as Sehrish come to clinic for one reason but also end up choosing to take up of family planning services.  “I have a three-year-old and want to wait a few years before I have another child. When I came to the clinic, I also found out about family planning methods. I had a lot of questions and concerns that were addressed and allowed me to make a decision about which contraceptives to use,” Sehrish says. 

Rahnuma Family Planning Association of Pakistan (FPAP)
25 September 2020

How a one-stop clinic is making a difference for women in Pakistan

Dr Zarka Riaz sits behind her desk at the Family Health Model Clinic (FHMC) set up by Rahnuma Family Planning Association of Pakistan (FPAP) in a low-income neighbourhood in Rawalpindi, a city of over two million next to Pakistan’s capital Islamabad. Even on this wet monsoon day, over a dozen women are gathered in the waiting area of the clinic.  “Pakistan is experiencing a population explosion, women, especially those from underprivileged and marginalized sections of society are not able to gain access to contraception they so desperately want and need, to make choices for their families,” says Dr Zarka. Dr Zarka is a gynecologist, with a specialization in family planning. She has been working with FPAP for ten years but started working at this clinic 18 months ago. The family clinic is supported as part of the Women’s Integrated Sexual Health (WISH2ACTION) programme funded by the Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’.  Across the country – Rahnuma-FPAP works through cluster networks. A pioneering model that brings together public and private specialist sexual and reproductive and health centers within a close radius referral network to ensure women and girls can receive life-changing care. Networks use poverty data mapping to ensure that services are targeted to areas where the population needs them most.   "Under WISH we are offering free family planning services, which is extremely important for a low-income area such as this”, explains Dr Zarka.  FPAP works in partnership with government and private clinics, community-based distributors, disability organizations and religious and community leaders as part of the clusters. Local pharmacies are also part of these networks and provide condoms and birth-control pills free of cost.    Dr Zarka observes that a lot of women worry about unintended pregnancies but are not aware of family planning methods available. Pakistan is the world's fifth-most populous country, home to over 220 million people with an annual fertility rate of 3.6 children per couple.  “There are a lot of myths and misconceptions about family planning. In male-dominated societies such as ours, women are often not able to make decisions about their reproductive health, which is why it is essential to engage men and mothers-in-law." Dr Zarka notes that it is becoming increasingly common for women in low-income areas to try to terminate unwanted pregnancies by getting unsafe abortion. “Abortion pills are readily available, and people use the internet to find out ways to abort unwanted pregnancies. However, women often take the wrong dosage and end up with too much bleeding or infections,” she says. “Access to free contraceptives can reduce the need for unsafe abortions, allow women to space their pregnancies and gain autonomy over their health and wellbeing,” she adds. Rahnuma implements the WISH programme across five provinces across the country and through its community awareness work is changing the discourse in Pakistan on family planning and sexual and reproductive health and rights.     

Healthcare worker with combipack.

In pictures: Innovating during COVID-19

Women around the world have faced multiple barriers to accessing safe abortion care during the COVID-19 pandemic including the de-prioritization of sexual and reproductive healthcare, overwhelmed health systems and restrictions on movement. The COVID-19 crisis has sparked innovation among IPPF Member Associations who responded swiftly by developing new approaches to reach women with safe abortion care including telemedicine and home-based provision of medical abortion. Strong evidence generated from this work supports the continuation and strengthening of these approaches beyond the end of the pandemic. Cameroon Cameroon National Planning Association for Family Welfare (CAMNAFAW) To ensure that quality abortion care can be provided to women during travel restrictions, CAMNAFAW’s service providers travel to partner clinics in underserved areas and to clients’ homes to provide medical and surgical abortion care. This model of taking safe abortion care closer to women will continue even with easing of travel restrictions, as this has been found to be an effective and acceptable approach to increasing access.Photo: IPPF/Xaume Olleros/Cameroon Share on Twitter Share on Facebook Share via WhatsApp Share via Email Guinea Association Guinéenne pour le Bien-Etre Familial (AGBEF) Building on lessons learned during the Ebola crisis in Guinea, AGBEF quickly took measures to prevent infection in its clinics to continue providing sexual and reproductive healthcare, including surgical and medical abortion, in a safe environment. AGBEF donated protective materials to communities, including hand-washing stations, face masks and antibacterial gel, alongside messaging on infection prevention. This community visibility reassures clients they can safely attend AGBEF clinics for abortion and contraceptive care.Photo: AGBEF/Guinea Share on Twitter Share on Facebook Share via WhatsApp Share via Email India Family Planning Association of India (FPA India) FPA India and partners advocated to have sexual and reproductive healthcare, including abortion, recognized as essential by the government, which meant FPA India could continue healthcare delivery during the national lockdown. To reduce in-person clinic visits, FPA India established teleconsultation and counselling for abortion care, and is continuing to provide in-clinic care for both medical and surgical abortion. Photo: IPPF/Alison Joyce/India Share on Twitter Share on Facebook Share via WhatsApp Share via Email Nepal Family Planning Association of Nepal (FPAN) FPAN and partners advocated for interim approval of home provision of medical abortion and telemedicine for abortion counselling during COVID-19. FPAN is now implementing these approaches, ensuring continued access to abortion care in Nepal, where many people live in remote locations with limited mobility, which has been further restricted by COVID-19 lockdowns. Photo: FPAN/Nepal Share on Twitter Share on Facebook Share via WhatsApp Share via Email Pakistan Rahnuma – Family Planning Association of Pakistan (Rahnuma-FPAP) Rahnuma-FPAP and partners successfully advocated for the government to class sexual and reproductive healthcare as ‘essential’, which enabled the team to continue providing post-abortion care during the pandemic. Rahnuma-FPAP expanded its telemedicine and home-based provision for menstrual regulation counselling and post-abortion care. These new approaches have ensured continued access to services for clients unable to reach clinics.Photo: Rahnuma-FPAP/Pakistan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Palestine Palestinian Family Planning and Protection Association (PFPPA) In response to the government-mandated closure of its clinics, PFPPA quickly established a toll-free call centre which provides consultations, counselling, referrals and follow-up, including consultation for abortion care through a harm reduction approach, ensuring that women are provided with accurate information. Due to its success, PFPPA is exploring options for continuing this healthcare delivery model beyond the pandemic, with the aim of keeping it free of charge for users.Photo: SAAF/Samar Hazboun/Palestine Share on Twitter Share on Facebook Share via WhatsApp Share via Email Sudan Sudan Family Planning Association (SFPA) Following a nation-wide shutdown in April, SFPA  established  a call centre to increase access to healthcare, including abortion and contraceptive counselling and referrals.  An unexpected outcome of the new call centre is that it has reached an increased number of young women who regularly call to discuss their reproductive health and rights. SFPA  is working  towards institutionalizing this model for continuation beyond the pandemic.Photo: SFPA/Sudan Share on Twitter Share on Facebook Share via WhatsApp Share via Email Togo Association Togolaise pour le Bien-Etre Familial (ATBEF) ATBEF adapted its mobile application ‘Infos Ado Jeunes’, adding a toll-free teleconsultation service for young clients to use to access abortion consultations and pre- and post-abortion counselling. This app has given young clients ongoing access to care when they face challenges travelling to clinics. It has also eased overall client flow in clinics at a time when social distancing is being implemented.Photo: ATBEF/Togo Share on Twitter Share on Facebook Share via WhatsApp Share via Email

Syed Kamal Shah, Chief Executive Officer of Rahnuma-Family Planning Association of Pakistan (FPAP)
27 April 2020

COVID-19 Impact: What we know so far – Pakistan

An interview with Syed Kamal Shah, Chief Executive Officer of Rahnuma-Family Planning Association of Pakistan (FPAP), on the impact of COVID-19. How has Pakistan been affected by the coronavirus/COVID19? The COVID-19 pandemic has wreaked havoc on overall economies worldwide, and has impacted Pakistan’s already trembling economy. It has upended life as we know it.  As we all know, the virus spreads at an alarming rate, and the fallout has spanned the globe, exposing the ill-preparedness of governments, health systems, and social safety networks to respond to the longstanding and emerging needs of people – especially relating to the health and rights of women and girls.  Pakistan currently has the highest number of COVID-19 cases in South Asia – we have more than 6,500 confirmed cases, and with over 140 deaths, it has begun to strain our healthcare systems. The Prime Minister of Pakistan, Imran Khan, has repeatedly raised his concerns that Pakistan's health system will not be able to bear the load in case of a rapid increase of the virus here. Right after the pandemic surfaced, Pakistan took stringent measures, which has enabled us to control it from mass spread so far. But during previous months, some laxity was shown when it came to people travelling into the country, as well as the continuation of religious congregations. The lockdown has been extended until 30 April, but the COVID-19 situation is becoming more aggressive day by day. Can you tell us more about your organization, Rahnuma FPAP? Rahnuma Family Planning Association of Pakistan is one of the largest and oldest rights-based civil society organizations working in reproductive health and family planning. We are fully accredited by the government, and our services delivery system is composed of ten fully-equipped Family Health Hospitals, more than 100 Family Health Centers and thousands of Community-Based Distributors and Private Practitioners which benefit a hundred-thousand people annually.  What impact is coronavirus having on sexual and reproductive health (SRH) in Pakistan?   As health systems are increasingly strained, SRH services are often mischaracterized as non-essential or “elective,” and thus de-emphasized in most provinces – with critical consequences. The total focus is on covering the virus and treating the infected. This has illustrated gaps in our existing approach to SRH and family planning. Our one of main challenges is to provide personal protective equipment (PPE), as we have no resources for the purchase of PPE and other supplies.  We may see shortages or non-availability of contraceptives, antiretrovirals for HIV/AIDS and antibiotics to treat sexually transmitted infections, due to disruptions in supply chains. Access to contraceptives has been reduced or limited due to COVID-19 since people are scared to leave their premises, and stoppages of public transport has further added to the mobility restrictions. These impacts may be compounded by the diversion of financial resources to the COVID-19 response, which would take funding away from reproductive health programs and decrease access for patients who rely on free or subsidized care. Likewise, the need for new precautionary equipment, training and protocols will further draw time and resources away from other work, including projects and programs related to SRH. However, we have been providing SRH care at our service delivery points (SDPs) all over Pakistan while ensuring strict protection and safety measures of our service providers and visitors. Which of your services have been the worst hit so far? Our community engagement services and outreach activities have been worse hit, which includes mobilization, training, counselling, community outreach sessions, peer-to-peer-sessions, mobile outreach and door-to-door home visits, and youth engagement channels. However, we are providing SRH counselling through our six dedicated helplines. More than 80% services are targeted towards vulnerable and marginalized sections of society who have been hit hard by this pandemic, including those living with disabilities, HIV/AIDs, women and children, and poorer people. We are working with other stakeholders not to leave them behind and ensure the availability of SRH services despite the pandemic.  Are frontline staff still able to go into the community to deliver services?  Due to the lockdown and a ban on public gathering there is no community activity at large, although all our SDPs in our hospitals and clinics are working as normal, with strict COVID-19 preventive and precautionary measures in place. Frontline staff are, of course, respecting the prevention measures of not going into the field. From day one our staff have also been working with the government and other organizations to raise awareness about complying with the rules on coronavirus prevention. Information banners have been developed and displayed at points where communities can see them, and leaflets have also been distributed to clients.   Despite lockdown, our SDPs are functional and we are also providing counselling and urgent consultation through our free helplines. All staff have been provided with PPE, and other protection tools, and our headquarter and regional staff are working from their homes on roster basis.  What message do you have for people and your staff in Pakistan when it comes to SRH services and coronavirus/COVID-19? The world is going through a period of crisis, but whether we look at it as a crisis or as an opportunity to reshape our thinking depends on us. So use this period as a lesson on how to live life with a concern for all humankind.  Health and safety comes first, therefore personal hygiene should be the top priority and there should be no compromise on it. Practice social distancing, but stay calm and positive. Use prevention measures – as both individuals and service providers at work – in your community and in your homes. Always share information on prevention measures wherever and whenever you can, whether that’s at the service delivery point, work, at home, or with family and friends.  We will pull through it together as we all are one – together we are stronger. We are the Rahnuma FPAP family and we believe in serving people, which for us is not charity, it’s humanity. 

Young women discussing sexual and reproductive health in Pakistan
05 September 2016

How to improve young people’s access to safe abortion - Pakistan: Youth Friendly Spaces

Young people face unique barriers when seeking accurate information about abortion, and in accessing abortion services. This series showcases strategies implemented by IPPF Member Associations that have successfully reduced these barriers and increased young people’s access to abortion information and services. In this short summary from Pakistan, they provide a comprehensive strategy on creating Youth Friendly Spaces, outlining the key steps needed for successful implementation and highlighting key lessons learned to consider in taking this strategy forward. This guide can be used by programme managers and implementers to help design and inform strategies to ensure that young people are enabled to access the necessary support and services they need in the event of an unwanted pregnancy.

hands holding contraceptive pill blister Credits: Graeme Robertson

Pakistan’s contraceptive advertising ban reversal welcomed by IPPF in South Asia

Ms. Anjali Sen, Regional Director, IPPF-South Asia Region said “It comes as a huge relief that Pakistan Electronic Media Regulatory Authority (PEMRA) has decided to reconsider its blanket ban on all advertisements of contraceptives in the electronic media. In the first place, it was an ill-considered order in the backdrop of the fact that Pakistan has the highest population growth, birth and fertility rates among the South Asian countries, including Bangladesh, India, Sri Lanka, the Maldives, Bhutan and Nepal. This blanket ban had raised serious questions because the Contraceptive Prevalence Rate (CPR) for women in reproductive age in Pakistan is an abysmal 35.40, as per 2013 figures. Given the realities of fertility rates and population growth in Pakistan, the Pakistani policy makers must understand that information on contraceptive choices is the key.  From around the world, we have many examples on how a desire for smaller families have led to greater investments in family planning, which have helped transform the age structure and consequently contributed to overall well-being. If the power of media, including the electronic media is harnessed, Pakistan will not stare at a projected 342 million people by 2050. Pakistani policy makers will appreciate that such population explosion will ultimately jeopardize the gains that Pakistan has made over the last few decades. A blanket ban on all contraceptive commercials in electronic media would have been counter-productive and it would have unspeakably harmed Pakistan’s national interest in slowing the population growth. If anything, the state and its agencies should actively facilitate free flow of information on contraceptives and the choices available if Pakistan has to achieve its population and development priorities. As a leading provider and advocates of family planning, South Asia Regional Office of IPPF welcomes PEMRA’s withdrawal of a blanket ban on advertisement of contraceptive products on Pakistani electronic media."

Rahnuma-Family Planning Association of Pakistan

Rahnuma Family Planning Association of Pakistan (R-FPAP) is one of the largest and oldest rights-based civil society organizations in Pakistan providing reproductive health and contraceptive care. 

R-FPAP is recognized both nationally and internationally as an advocate and service provider for reproductive healthcare and SGBV. Furthermore it has distinction to collaborate with all major national and international development agencies (INGOs, UN Systems, Public sector, government institutions). R-FPAP is devoted to eliminate and alleviate the sufferings of marginalized and vulnerable sections of society through integrated and concentrated social uplift efforts in the broader areas of RH and FP. Rahnuma-FPAP RH & FP based services delivery apparatus is composed of 10 fully equipped Family Health Hospitals, 130+ Family Health Centres, 80+ youth resource Centres, 2000+ CBDs and a network of private providers. During 2020, FPAP served 17 million SRH&R services while covering more than six million clients. Our SDPs provide FP, SRH, post abortion care, HIV & AIDS, STI/RTI, Gynaecology, Obstetrics, Urology, Sub-fertility, Specialized SRH, SRH- Paediatrics, Other SRH and Contraceptive Services

Contributions of R-FPAP are recognized by Government of Pakistan through its quarterly performance report issued by Pakistan Bureau of Statistics, under Planning Division (www.PBS.gov.pak).