A couple of years ago, I was traveling in the rural
areas of Sindh Province in Pakistan and met a woman who had six children. Her
resources were so meager that she had to feed her children in shifts — three on
one day, and the other three the next day. It was heart-breaking to see. But it
made me more convinced than ever of the importance of the work my colleagues
and I are doing to provide Pakistani couples with options for healthy spacing
and timing of births.
I live and promote family planning in Pakistan, where
only 26% of married women use a modern method of family planning, dramatically
lower than the 66% who use modern methods in my native Mexico. That’s lower
than all our neighboring countries, except Afghanistan. Yet 20% of married women
say they want contraception but cannot access it.
The Government of Pakistan has
pledged to increase the contraceptive prevalence rate (CPR) for
modern methods from the 26% recorded in the 2012-13
Demographic and Health Survey to 55% by 2020. That would
double the CPR in only eight years.
My job is to help the government reach that goal, but
family planning is a
tough issue in Pakistan. It is difficult to discuss
contraception openly in Pakistani society because of traditional values and the
patriarchal nature of society. Women dare not discuss family planning even in
their own homes. Obstacles to family planning include pressure to have many
children and at least one male child. The pressure can come from the husband,
the mother-in-law, other family members or society at large.
We even face these traditional values inside our own organization,
Pakistan, which is a family planning organization. Sometimes
we hire new employees for the sales team who are shy about contraception, and we
have to spend time developing their confidence. Some leave the job within a few
months after deciding they are not comfortable selling contraceptives. So we
have to find a new person and give them training and confidence-building all
Despite the many obstacles, we are working hard to
change norms around family planning, especially with men. In 2015, we are working
with men to help them understand the benefits of family planning. For example,
DKT sponsors tea parties for men and women to relax and converse about
long-acting reversible contraceptives. We also hold mobile video shows in rural
areas, with separate shows for women and men.
mission of DKT Pakistan, founded
in 2012, is to provide couples with affordable and safe options for family
planning and HIV prevention through social
marketing and social
franchising. We apply a relentless focus on the poor,
the rural and the hard-to-reach.
DKT Pakistan, like the other 20 DKT International programs
around the world, tries to push cultural boundaries, without violating them, in
order to make the greatest impact possible (see our
best TV spots from around the world). Sometimes we
In 2013, we aired a
controversial TV spot featuring the provocative Pakistani model
Mathira playing a newlywed trying to please her husband in the bedroom. It
aired 10 days before being banned by censors. The controversy revealed
over sex. The spot has now been seen millions of times on
YouTube and helped increase DKT’s sales of Josh
other TV spots have also attempted to increase demand
for our products in creative and compelling ways.
Pakistan has built up a social franchising network of 800 midwife-owned
and operated Dhanak clinics in a
little less than three years (Dhanak means rainbow in Urdu). We aim to have 1,200
clinics by the end of 2015. The clinics operate in all parts of Pakistan — from
the deserts of Sindh in the south to the snow-capped Himalayan peaks of the
north. Some of these clinics are as far as an eight-hour drive from the nearest
We are going to remote and rural areas with difficult
access, where many other organizations do not. For example, we are opening
clinics in the provinces of Khyber Pakhtunkhwa and Baluchistan, areas of
Although the 800 Dhanak
clinics are in very different regions and cultural settings, they have a few
things in common:
are located mainly in rural areas, where 65% of Pakistanis live.
share franchising principles, such as standard appearance, signage,
carry out regular quality assurance to ensure that all clinics meet and
maintain high standards of quality.
offer training and refresher training to ensure that their clinical staffs have
the skills they need to provide optimal health care.
provide a full line of reproductive health services and products, most of which
are offered through DKT Pakistan’s parallel social marketing program.
Since the Dhanak
clinics are usually owned and operated by women, the clinics also empower
women and provide a model of entrepreneurial self-sufficiency.
DKT Pakistan has just joined the work led by Aman
Health Care Services under the SUKH Initiative with support from the Bill &
Melinda Gates Foundation and the David and Lucile Packard Foundation with the
goal of increasing modern contraceptive use by 15% among married women in
selected, low-income communities of Karachi.
As its contribution to the SUKH Initiative, DKT will
identify and franchise 80 private sector clinics as Dhanak clinics in low-income urban areas and promote family
planning in the private sector. Due to political and ethnic violence, many
health providers have abandoned their facilities in the selected areas so these
clinics will contribute a great deal to their communities. The first 35 clinics
are expected to be operational in 2015.
In Pakistan, there are many obstacles that stand in
the way of greater acceptance and use of family planning. But Pakistani women
want it, and we are determined to use the vibrancy of the private sector to
offer it to them.