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Tauseef Ahmed PhD Country Representative
Pathfinder International
Pakistan Field Office, Islamabad
Mobilizing Religious Leaders for FP and MNCH in Pakistan
Dakar November 2011
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CONTENTS • Facts and Evidence Support
• The Realization
• Project Goal
• Measures and Steps
• Process
• Outputs
• Immediate Results
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People everywhere have
the right and opportunity to live a healthy
reproductive life
Outcome
Pioneering and advocating
Building capacity and creating innovations
Valuing communities’ roles
Approach Areas of Involvement
Contraception
Maternal & Newborn Health
HIV and AIDS
Adolescents
Abortion & Postabortion Care
Advocacy
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CPR Trend in Pakistan
FP is not growing as evidenced by the stagnating CPR
0
5
10
15
20
25
30
35
1984-85PCPS 1990/91/PDHS 1994/95PCPS 2000/01/PRHFPS 2006/07/PDHS
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Proportion of Couples by Status of Contraception Use
51.3
29.6
19.2
Never used
P ast User
C urrentlyus ing
2006/2007 P DHS
Over half have never used contraceptives- almost 20% of ever users have dropped out
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Reason for Not Intending to Use Contraception 2006-07 Reasons Percent of women
Fertility-related reasons Infrequent sex/no sex Menopausal/had hysterectomy Infertile/can’t get pregnant Up to God Wants more children
4.2 6.0
14.5
28.4 2.9
Method-related reasons Health concerns Fear of side effects
3.6 5.4
Opposition to use Respondent opposed Husband opposed Religious prohibition
7.7 9.9 5.0
50 percent do not intend to use Mostly on Religious Grounds
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Barriers
• FP is understood as limiting family size
• The message Not Acceptable by many on religious, economic and social grounds
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Fertility Preferences
Another soon, 21
Another later, 20
No more, 43
Sterlized, 8
Declared infecund, 3
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The Realization • Realization in the Bureaucracy
– Religious Leaders influence play important role
– Political Will to Engage Religious Leaders (RLs)
• Ongoing activities by public sector (25000 RLs) – assumption RLs to take own initiative but did not
• Realization among RLs – to contribute towards social development
• Serious bias among doctors that FP not supported by religion
• Project developed by ESD in June 2009
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PROJECT GOAL
Active mobilization of religious leaders to support family planning through enhancing spacing among pregnancies and improving
maternal health
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Planning
• Identifying champions and building alliances
• Development of Material and Endorsement from Religious Institutions
• Fostering partnerships to build local ownership and sustainability
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Implementation
• Capacity building
• Conduct training workshop (s) for Religious leaders using cascade training of trainers followed by step-down training
• Outreach services to disseminate health messages and supporting fatwas
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Muslim Sects in Pakistan
Sunni - Daobandi Sunni - Berailvee
Shia Ahle Hadith
Members - Council of Islamic Ideology
Proportion wise no authentic figures exist. Sunni around 90 %
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Implementation • Organizational support
– Core Group, Subgroups - Curriculum and Training • Bureaucrats, Academicians, Senior Religious Leaders all sects
• Development of Compendium and Curriculum – consensus and inclusion of material and evidence
from the Life of Holy Prophet and Islamic History
– Integration of family planning into maternal, neonatal and child health services
• Availability of TA from ESD – tremendous help material, resources, guidance
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Process • Compile Fatawa in support of RH/FP/ MNCH
• Obtain endorsement of religious material from heads of religious sects and Institutions
• Consensus development among RLs – HTSP approach readily accepted by all stakeholders
including RLs
– FP (for spacing) in line with Islamic precepts
– FP seen integrated as part of maternal child health
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Active Engagement of RLs
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Process • Established a forum to engage RLs & to address
misconceptions – Contribution in material development – ownership
– Planning process – Training Plan and Scale up
– Development of their role and responsibilities
• Breaking the barriers / isolation – bureaucrats working with religious leaders
• Sense of social responsibility to social change
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Turning Points
Two Core Sore Issues Resolved • Linking Size with sustenance of family
• Limiting family size to two
Paradigm Shift to Birth Spacing Acceptable Availability of alternative model
– Grounded in health of mother
– Focus on spacing
– Support subject to continuity of fecundability
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Emerging Issues Black Box
• How does Contraceptive Technology works
“Contraception equivalent to killing of fetus “
(Contraception related to abortion)
• Culture practices misunderstood for religious responsibilities
• Top religious leadership MUST approve first
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Outputs • Trained District Trainers – 86 from 25 districts
• MAJOR CHANGE – RLs acknowledge their role based on ignorance
– RL willingness to promote family planning
– RL willingness to promote HTSP through meetings and sermons
– RL willingness to train other RLs to expand the circle
• SCALE UP - Step Down Training 2000 RLs in 22 districts ( more in process)
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PIONEERS AND CHAMPIONS Across all Sects
Pioneering and advocating
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Champions to Media
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Immediate Results Community Level Meetings and Dissemination by Religious Leaders
Feel the Change in Making
FP Adoption by RLs
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ENGAGE RLs to START A CHANGE
THANK YOU