Family Planning in Pakistan: Unraveling the complexities

• Author / Creator

  Ataullahjan, Anushka

• With a population of 207 million, Pakistan is the sixth most populous country in the world. Recognizing uncontrolled population growth as a threat to economic prosperity and development, the Pakistani Family Planning Program has sought to increase the awareness and use of contraceptives. However, increasing uptake of family planning methods has proved to be difficult. In 2013, after nearly 60 years of effort, only 35% of eligible users reported using a contraceptive, with a mere 26% using a modern method. A large body of literature has sought to explain the low prevalence of contraceptive use in the country. Primarily focused on the failure of delivery of family planning services, and mostly using the survey methodology, these studies have operated under the assumption that increasing knowledge and access will address the reluctance to use contraceptives. This approach, I argue, oversimplifies the many and complex considerations that influence family planning use. Missing from the family planning discourse in Pakistan today is a nuanced analysis of the beliefs and values that underlie family size and notion of fertility control. Specifically missing is an understanding of the ideologies, values and practices underlying birth control in a context characterised by religious conservatism, strong patriarchal values, fragility, an unresponsive health care system, poor governance and prolonged low-level conflict. My dissertation seeks to fill this gap in our knowledge. It does so by exploring:1) the influence of Islamic beliefs and practices on fertility control and choice; 2) whether fertility is considered within the locus of individual control and what values form the basis of this judgment; 3) what ideological, socioeconomic class, security, or logistical considerations determine how fertility choices are made; 4) how fertility behaviour is regulated through identity and community belonging, and 5) who is included in fertility decision-making and how responsibility is allocated.I conducted a critical ethnography in a village in Khyber Pakhtunkhwa, Pakistan. Over the course of 13 months I conducted 242 observations of daily life, 109 informal interviews and 197 in-depth interviews with 76 participants (41 women and 35 men). Each participant was interviewed a minimum of two times. Interviews were audio recorded and transcribed. Data were analysed using a latent content analysis approach guided by my research objectives.The data demonstrate that fertility decisions in my field site are situated in complex historical, socioeconomic, and geopolitical landscapes. The first paper unpacks family size ideals. It illustrates that large family sizes are a response to precarity of life in a context characterised by economic deprivation, violence, and insecurity. My second paper explores how regional and global geopolitics contribute to anxiety about fertility control. The third paper focuses on the complex role of Islam on family planning decision-making. It describes how respondents engage with and negotiate their religious beliefs to reconcile their contraceptive use. The fourth and final paper challenges biomedical approaches to the body and calls for a culturally situated understanding of contraceptive side effects. By centering the voices of the respondents, this work brings into focus “subaltern” voices which Pakistan’s family planning discourse has tended to neglect. I demonstrate that a large failing of the Pakistani Family Planning Program is its focus on increasing contraceptive prevalence while overlooking the upstream structural issues that create a preference for specific reproductive strategies. Overall, my dissertation is a call to Pakistani family-planning programmers and policy makers to centre the voices and concerns of their citizens.

• Subjects / Keywords

  • fertility
  • family planning,
  • Pakistan
  • Pakhtun

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3B854065

• License

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