Dr. Sajid Ahmad, Chief EditorMr. Amanullah Bhatti Ms. Azra AzizMs. Aysha Sheraz Mr. Zafar ZahirMr. Ali Anwar Buriro Mr. Faateh ud dinMs. Rabia Zafar Ms. Saima Asghar

RESEARCH BRIEFS& NEWS

Following the revival of the NIPS Quarterly Newsletter, this is the second issue thatannounces the successful completion of the in-depth analysis of the 2006-07 PDHS data.This is a great achievement of NIPS researchers towards a breakthrough in applied research.Although NIPS has been involved in carrying out descriptive research since long; providinginformation about population and health situation in Pakistan, it is the first time that In-depthAnalysis was carried out. The most satisfying factor is that all the researchers of NIPScontributed in it. A total of seven papers were written and I take pride in stating that they havebeen published in the form of a book. Efforts of Syed Mubashir Ali, ConsultantABT/USAID, are fully acknowledged for guiding the researchers to accomplish this cherishedtask.The main focus of the analysis is on Women and Children's Health in association withdifferent social, economic, demographic and other possible influencing factors. The detailedfindings presented in these research papers will be guiding light for all stakeholders especiallypolicy makers to assess the population needs and target right areas while implementing theirprojects or plans; as need based and targeted allocation of resources is cost effective as well asresult oriented.Population Association of Pakistan honoured NIPS by allocating an exclusive session forpresentation of all seven papers. In addition to this, two more papers were presented by SeniorFellow Mrs. Azra Aziz in the last PAP conference. I also extend my gratitude to Dr. SaeedShafqat, President PAP and Ex-Executive Director NIPS and Mr. Mehboob Sultan formerDirector NIPS, who were instrumental in accommodating NIPS in the proceedings of thePAP conference, at a very short notice.Prof. Gavin Jones of Australian National University, graciously accepted NIPS invitation andattended the presentation on the working of NIPS as well as future research plans. He haskindly consented to give his input on the papers currently being worked upon by NIPSresearchers.In a country like Pakistan where resources are scarce, the importance of research focusing onthe needs of population; considering their perceptions, culture and social norms will be ofgreat value for cost effective development strategies. Impact oriented and population needbased studies in all development sectors will be one of our primary agenda for future goals.Three studies which were started last year are meeting the timelines set for these activities.“Islam and Family Planning - Perceptions and Practises”, a pilot study in Sialkot and ChakwalDistricts; after the completion of data analysis, is in the phase of report writing. Similarlyreport writing is actively in progress for the studies “Evaluation of Regional TrainingInstitutes” and “Evaluation of Contraceptive Surgery Cases (CSc) & Family Planning (FP)Services of Reproductive Health Services B Centers”. Final report of Gilgit BaltistanDemographic and Health Survey (GBDHS) has been printed and a dissemination seminar hasbeen organized in May, 2010 in Gilgit. The seminar was attended by a wide variety of peopleincluding researchers, academicians, and representatives of NGO's working in populationrelated and social activities and the government functionaries. The seminar was chaired by theGovernor Gilgit Baltistan.

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The hungry world cannot be fed unless thegrowth of its resources and growth of itspopulation come into balance. Each man andwoman and each nation must make decisionsof conscience and policy in the face of thisproblem.

Lyndon B. Johnson36th American President

Issue No. 9, March 2010

Issue No. 9, March 2010

1 Women & Children's Health - An In-DepthAnalysis of Pakistan Demographic HealthSurvey

2 Findings of Gilgit Baltistan Demographicand Health Survey

3 Islam and Family Planning-Perceptions andPractices; A pilot study in Sialkot andChakwal districts

4 Evaluation of Regional Training Institutes

5 Evaluation of Contraceptive Surgery Cases(CSc) and Family Planning (FP) Services ofReproductive Health Services B Centers

6 Training Workshop on In-depth Analysis ofQuantitative and Qualitative Data

7 Seminars/Lectures on:

“Future Research agenda forReproductive Health under ChangingParadigm” (Dr.Tauseef Ahmed 18November 2009)

“Reproductive Health Behavior ofMuslim Women: Lessons for Pakistan”(Dr. Mehtab Karim 18 January 2010)

8 Dissemination Seminar of “PerformanceEvaluation of Male Mobilizers”

9 Translation of PDHS Findings in Nationaland different Regional languages

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In this Issue

H # 485, St # 09, F-10/2,Islamabad, Pakistan. Ph: +92-51-9260336

Web: www.nips.org.pk, E-mail: info@nips.org.pk

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Forty Three Percent of the population in Pakistan isilliterate.

Net Enrolment Rate is 57 percent.

More than 37 percent schools up to elementary levelare without boundary wall.

Almost 34 percent elementary level schools arewithout drinking water facility.

Around 60 percent schools are without electricity.

Infant mortality rate, per 1000, in Pakistan is 65.

Mortality Rate under 5, per 1000, is 95.

Population per Doctor is 1183.

Population per Dentist is 16914.

Labor Force is 55.8 million.

Employed Labor is 52.7 million.

Un-employed Labor Force is 3.0 million.

Source: Economic Survey 2009-10

Do You Know?1. Eradicate extreme poverty and hunger.2. Achieve universal primary education.3. Promote gender equality and empower

women.4. Reduce child mortality.5. Improve maternal health.6. Combat HIV/ AIDS, Malaria and other

diseases.7. Ensure environmental sustainability.8. Develop a global partnership for

development.

The 2006-07 Pakistan Demographic andHealth Survey (PDHS) was designed to providedata for monitoring the population and healthsituation in Pakistan. The Objective of thesurvey was to provide up-to-date informationon fertility, family planning, childhoodmortality, infant and child feeding practices,maternal and child health, maternal mortalityand HIV/ AIDS- related knowledge andbehavior.

NIPS staff remained involved in carrying outresearch since long. In order to make thisresearch more meaningful, realistic, andapplied; an in-depth analysis of 2006-07 PDHSdata was carried out by NIPS researchers withthe suppor t of, Syed Mubashir Ali(ABT/USAID), Dr. William Winfrey & Ms.Sarah Bradley from Macro International .

This book comprises seven papers whichrepresent women and children's health in thiscountry. The findings of these papers are notonly interesting but also revealing. Thesethought provoking findings will open avenuesfor researchers, and will surely be useful forfuture planning .

The consequences of unintended pregnancyare of particular concern in Pakistan becauselevels of unintended pregnancy have risen inrecent years. Overall 24 percent of births in thefive years period preceding the PDHS 2006-07were not wanted at the time of conception with13 percent wanted later and 11 percent birthsnot wanted at all.

Unintended Pregnancy and Antenatal Carein Pakistan

AJK-Demographic and Health Survey 2010;Evaluation and Assessment of quality of Careof Family Welfare Centers; and a study ofExisting Status of Population Education at Pre-service level; will be our upcoming projects.

Human resource development and capacitybuilding has always been top priority of NIPS.Considering this aspect of vital importance aTraining workshop on In-depth Analysis ofQuantitative and Qualitative Data was arrangedfrom 20-26 October 2009. Seminar series isanother noticeable achievement; seminarlectures on Reproductive Health focusing onFuture Research Agenda for ReproductiveHealth under Changing Paradigm” and“Reproductive Health Behavior of MuslimWomen” were organized. The policy makers,academicians, NGO sector and donor agenciesattended these seminars.

To build the capacity of our researchers andstrengthen their current skills trainings on;Office Communication ski lls, OfficeManagement and Time keeping, Project Cycleand Data Analysis are planned in upcomingquarter.

Finally I would like to appreciate the supportreceived from UNFPA and USAID for theircooperation in achieving these objectives.

This issue furnishes the highlights of theactivities carried out from October 2009 toMarch 2010.

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The objective of this paper was to explore therelationship between unintended pregnancy(both unwanted and mistimed) and use ofantenatal care among women in Pakistan. Theresearch question was; Are women withplanned pregnancy more likely to receiveantenatal care (ANC) than women withunintended pregnancy (unwanted andmistimed)? This issue is examined from thesocio-economic and demographic perspectives.

The analysis was based on simple cross-tabulation in the form of bivariate tables andthe OLS Multiple Regression analysis. Theregression results revealed that women withunwanted pregnancies were significantly andpositively associated with number of ANCvisits. However, the analysis did not show asignificant impact of mistimed pregnancy onthe number of ANC visits. In case of plannedpregnancies, women were found less likely toreceive antenatal care visits than women withunintended pregnancies. Impact of othervariables; including Parity of women, Mother'seducation, Wealth status, Working tatus andregion of residence on ANC was also analyzed.

he determined effects of social anddemographic factors on ANC will be of greatconcern for Policy makers and programplanners in setting their path to promoteutilization of ANC.

Pakistan faces high child and maternal mortalityand high population growth (WHO 2008).According to PDHS 2006-07, 1 in 89 womendie of maternal causes with a mortality ratio of276 per 100,000 live births. Realizing thesensitivity of the issue this research paper wasaimed to present; the levels of maternalmortality and how they vary between provincesand between rural and urban areas; also todescribe the causes of maternal deaths and therole of the three delays in the causation ofmaternal mortality and examine the individual-level and contextual risk factors associated withmaternal mortality.

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Maternal Mortality

The primary objective of this paper was; toidentify the important risk factors associatedwith maternal mortality in Pakistan, includingbiological and socio-economic risk. In addition,the effect of community- level variables (suchas accessibility of healthcare, transport, andtelecommunication) on the risk of maternalmortality was also estimated.

Keeping the data constraints in view, a nestedcase-control study was designed. Unadjustedand adjusted odds ratios (OR) were estimated toidentify the important risk factors associatedwith maternal mortality in Pakistan.

The findings showed that MMR wassignificantly higher; in the rural areas (320)compared to urban areas (177), and also in theprovince of Balochistan (765, compared to227,311 and 272 in Punjab, Sind and NWFP,respectively).

In the logistic regression model, women’seducation status emerged more important thanthe socio-economic status and the husband'seducation.

Older women (aged 35 years and above) andnulliparous women were at a significantlygreater risk of dying of complications ofpregnancy and childbirth.

Women residing in remote rural villages andhaving no access to transpor t andtelecommunication were more likely to die ofdelivery complications, whereas womendelivered by a skilled birth attendant incommunity were associated with lower risk ofmaternal mortality.

After controlling the known biological riskfactors (age and parity); community level riskfactors, women education, use of prenatal careand use of family planning services were themajor risk factors retaining their significantassociation with maternal mortality.

The Delay in Decision-Making Processand Maternal Mortality

Women empowerment, emancipation,egalitarian decision making or husband wifesharing decision making is still a daunting taskand needs in-depth investigation. Theobjectives of the paper were;

1). To understand the attitude and approach ofdecision makers in the process of delay

2). To find out the discrepancy between fourdelays

i. Delay in identification of problem bybirth attendants

ii. Delay in decision making by familyand birth attendants

iii. Delay in arranging for transport andreferral to a health facility

iv. Delay in getting emergency care at thefacility level

3). To figure out the margin of errors indecision making

After having done qualitative analysis, threeimportant clusters of issues emerged. Firsttheme was about the approach, second wasabout risk and third one was about theinvolvement, in getting treatment and makingdecision. i) Linear versus simultaneousapproach, ii) Risk taking behavior versusresponsibility taking behavior, iii) Involvementversus detachment. At the end of analysis, theconclusion was very simple, it was all aboutattitude.

Due to development in all spheres of life, some

attitudes were impeded, some attitudesrepresented preference and people consideredtheir values and philosophies correct for them.This study clearly indicated that decisionmaking in Pakistan is driven by attitudes andmindsets.

This research study revealed that similarities inthe behavior of people, regional variability,background characteristics, behavior patterns,cultural norms and values, improving maternalhealth are important issues for policy makers tofocus on.

Social infrastructure and social networkingneeds to be systematically and scientificallyestablished with the coordination andcooperation of family, community and serviceproviders

Tuberculosis (TB) kills one person in every 20seconds; about 95 percent of new TB cases and98 percent of TB deaths occur in poorcountries. In Pakistan the incidence of TB is181 cases per 100,000 population; which isresponsible for 5.1% of the national diseaseburden. Government of Pakistan establishedNational TB control Program (NTP); whichlaunched a National Advocacy Communicationand Social Mobilization (ACSM) Strategy in 40districts to educate approximately 38 percent ofthe population in support of expanding TB-DOTS program.

In order to explore the overall awareness levelsof TB among ever-married women in Pakistanand examine the factors influencing the level ofawareness, this in-depth analysis was carriedout.

Bi-variate and multivariate analysis techniqueswere used to explore the influencing factors andoverall levels of awareness about TB. Theanalysis showed that; although every ninthwoman had heard of TB but hardly one in tenwas having correct knowledge. women withhigher than secondary level of education, thosein the highest wealth quintile and living inNWFP were more likely to possess overallcorrect knowledge compared to those; who hadno education, were in lowest wealth quintile and

Knowledge of Tuberculosis and itsCorrelates among Ever-Married Womenin Pakistan

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“He who has health has hope; and he who has hope has everything”(Arabic Proverb)

Women & Children's Health-An In-Depth Analysis of 2006-07 PDHSRemarks from

Executive Director’s Desk

“There is no trust more sacred than the one the world holds with children. There is no dutymore important than ensuring that their rights are respected, that their welfare is protected,that their lives are free from fear and want and that they can grow up in peace”

(Kofi Annan)

Where population size is greater thanavailable resources, or is expandingmore rapidly than the availableresources, there is a tendency towardinternal disorders and violence and,sometimes, disruptive internationalpolicies or violenceNSSM 200 reports

Mankind is looking for food not just onthis planet but on others. Perhaps the timehas now come to put that process intoreverse. Instead of controlling theenvironment for the benefit of thepopulation, maybe we should control thepopulation to ensure the survival of ourenvironment.David Attenborough (Author of The Life ofMammals)

living in Punjab province (OR=2.072, p<0.001;OR=2.568, p<0.001; OR=1.642, p<0.001respectively).

More congested households (householdswhere 5 and more persons per sleeping room)had significantly lower knowledge about TBand its associated factors and were found athigh-risk due to higher chances of spread of TBamong other member of household.

In this study an effort was made to establish thelinkages of TB control program; especially toestablish a comparison between districts whereACSM activities were carried out and wheresuch activities were not started. The studyrevealed that women living in districts whereACSM activities were not yet started had slightlybetter knowledge than those living in districtswith ACSM activities (OR=1.240, p<0.005). Italso disclosed that majority of women had noknowledge about the duration of treatment ofTB; although NTP was also focusing on theawareness of treatment duration in itscampaign but only one in ten correctlyreported.

The districts having ACSM activities had lowerprevalence of overall correct knowledgecompared to those districts having no ACSMactivities. This finding is a matter of concern forthe managers of program. Public sector, incooperation with private sector, is running anationwide TB-DOTS program since last 10years. It is highly desirable to evaluate anddetermine the level of awareness about it.

The evidence based findings of the paper; onthe factors associated with TB awarenessknowledge; will suggest policy measures forimproved implementation of advocacy,communication, and social mobilizationactivities across Pakistan.

Media Messages Persuading Couples ToUse Contraceptives: An Analysis in TheBack Drop of Socio-Economic Factors

Pakistan has very high growth rate, governmenthas highest priority to reach replacement levelof fertility by 2020. The InternationalInformation Education and Communicationhas been playing a vital role in promotingFamily Planning (FP). This paper was mainlyaimed to compare different electronic media intheir effectiveness to change perception ofwomen in persuading couples for usingcontraceptives and their association with socioeconomic factors.

The dependent variable in this study was;perception of women about effectiveness ofMedia Messages in persuading couples to useFamily Planning; and predictor variables wereRegion, Age, Number of chi ldren,Contraceptive use, Education, Wealth Status,Work Status, Availability of Any Health Serviceand Ownership of Radio and TV.

Analysis was based on three basic Models eachmodel was characterized by differentcombinations of predictors.

The analysis showed that; in Pakistan womenperceived that the Family Planning messagesthrough electronic media were effective inpersuading couples to use contraceptives; somesocio-economic factors were also significantlyaffecting the thinking of women in persuasionof couples to use contraceptives. In Bi-Variateanalysis TV was the most popular medium toexpose to FP messages, whereas female radiolisteners were very small. Multi-Variate analysis;based on logistic regression; found that mediamessages were statistically significant andpositive. Most effective messages of FamilyPlanning in persuading couples were “limitingfamily”, “spacing children”, “maternal andchild health” for both TV and Radio listeners.Radio results were less likely to be significant ascompared to TV and either medium.

The detailed analysis by different socioeconomic factors facilitates and guides thepolicy makers for targeting the right audience.

Effect of Birth Interval and Birth Size onChild Survival in Pakistan

Demographic, Social and EconomicFactors Influencing the Treatment Seekingfr om Health Faci l i t ies for AcuteRespiratory Diseases (ARI) amongPakistani Children

This paper presented the effect of birth spacingand birth size, on child survival controlling thepotentially confounding factors, such asmother's age at birth of child, the order ofbirth, gender composition of children, socialstatus, and place of residence.

The objective of the paper was; to determinethe impact of birth size and birth spacing onchild survival and to analyze the demographicand socio-economic factors affecting thesurvival of children.

This paper revealed that children of small birthsize were 36 percent less likely to survive ascompared to average size. The children havingbirth interval of at least one year or more weretwo times more likely to survive as compared tothe children of less than 12 months interval(OR 2.243 ; 95% CI 1.553 to 3.241).

The neonates having interval of at least 49months were two times more likely to survive ascompared to children having less than 12months interval. Social Status turned out to bethe most significant factor (at p<0.001) that waspositively affecting neonatal and infant survival.The effect of Working Status of Mother onsurvival of neonates was greater (OR 2.129;95% CI 1.650-2.748) than the survival of infant(OR 1.582; 95% CI 1.238-2.021).

The results showed that among all thepredictors birth interval was the mostsignificant factor affecting the survival ofchildren. Child survival could be increased if allbirths would have at least two years interval.

The purpose of study was; to determine theassociation between the treatment seeking froma health facility for children suffering from ARIand social, economic, and demographicvariables. Further, the analysis identified the neteffect of these variables on the healthcareseeking behavior.

The analysis of the study revealed that morethan seventy percent of children residing inprovinces of Sind and Punjab had soughttreatment for ARI from a healthcare facility ascompared to Baluchistan and NWFP wherehalf of the children sought treatment.Healthcare Treatment for children wereevaluated and analyzed on the basis of regionof residence, availability of health services,education of mother and father, economicstatus, wealth quintile, number of livingchildren, age of children and social andeconomic dimensions. Women’s education,availability of healthcare services within fiveKm, the effect of economic status and numberof living children were found to be positivelyinfluencing the healthcare seeking behavior forchildren suffering from ARI.

The findings of the paper suggest that thehealth department should improve theavailability and access of health services forpoor and under privileged populationparticularly in rural areas so that morbidity andmortality among children can be reduced.

Advocacy campaign should be designed topromote healthcare seeking behavior.

To improve healthcare utilization among thelower income groups, free medical servicesshould be made available for poor people.Attitudinal change in parents is needed so thatthey seek healthcare for all children butspecifically for those children who sufferedillness with ARI which is one of the majordeadly disease among children.

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NIPS carried out Gilgit Baltistan Demographicand Health Survey (GBDHS) during 2008 tocollect information on diferent demographicand health indicators aiming to; address themonitoring and evaluation needs of populationwelfare and reproductive health programmes,and provision of information to the policymakers to effectively plan and implement futureinterventions.

The study revealed that the age structure of thepopulation was typical of a society with ayouthful population. It showed a pyramidal agestructure due to a large number of children lessthan 15 years of age. Fifty-two percent of thepopulation was in the age group of 15-64 yearsand less than 4 percent were over 65 years ofage.

About half of the total women population wasin the reproductive age group (15-49 years).The fact that this segment has been increasingover the last two decades has major implicationsfor overall population growth.

Education turned out to be an important factorinfluencing individual's attitude and approachon various aspects of life. Majority (77%) ofever-married women in Gilgit Baltistan had noeducation. Despite that, it was encouraging tonote that a significant proportion (39%) of thewomen was engaged in gainful employment.

Total Fertility Rate (TFR) in Gilgit Baltistan was4.6 children per woman for the three yearsperiod preceding the survey; whereas fertilityrate in rural areas (5.1 children per woman) washigher as compared to urban areas (3.8 childrenper woman). Education level of womenbrought about the most conspicuousdifferentials in fertility.

The Children Ever Born (CEB) was almost 3children less among women with highereducation than among uneducated women.

Population Welfare Programme had been ableto create universal awareness about familyplanning methods among married women butthe contraceptive prevalence rate was quite low.The challenge is to ensure continuous use bycur rent users and increase exist ingContraceptive Prevalence Rate by meeting theunmet need for family planning services alongwith sustaining the demand of family planningservices by new entrants in the reproductive agegroup.

More than one fourth of the married womenwere using a method of family planning; use ofany method was highest (48%) among womenwith higher level of education.

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Among the users of family planning method 27percent were using a modern contraceptivemethod, among them 71 percent were relyingon public sector institutions for family planningservices.

Within the public sector; the most importantsources of family planning services weregovernment hospitals and Reproductive HealthServices Centers (RHSC). Family WelfareCenters (FWCs) were the major sources forservice delivery under the Ministry ofPopulation Welfare but only 23 percent ofwomen visited FWCs, followed by Lady HealthWorkers being another important source atgrass root level.

The health indicators showed encouragingpicture; it was observed that about 61 percentof the women received prenatal care from askilled health professional; majority of themcontacted a doctor for antenatal checkup,followed by a nurse/mid wife/LHV.

“

”(Robert Alan)

Good health is one of the most important ingredients for a happy and productivelife. And yet, many people do not have access to health care and live in conditionsthat spread disease

Gilgit Baltistan Demographic and Health Survey 2008

Current FertilityASFR Urban Rural All Areas

58.2201.1267.1204.7119.450.220.64.614.1

66.2219.2279.5218.2143.1

61.726.35.074.5

44.5171.7245.7181.1

73.227.48.03.763.3

15 - 1920 - 2425 - 2930 - 3435 - 3940 - 4445 - 49TFRPDHS

2006-07

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60

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Anytraditionalmethod

CPR by Background of Women

D e m o c r a c y c a n n o t s u r v i veoverpopulation. Human dignitycannot survive it. Convenience anddecency cannot survive it. As you putmore and more people into the world,the value of life not only declines, itdisappears. It doesn't matter ifsomeone dies. The more people thereare, the less one individual matters.

(1920-1992) AmericanWriter & HumanistIsaac Asimov

After the inception of Regional TrainingInstitutes (RTIs) an evaluative study entitled“Assessment of Trainings and AccreditationSystem of RTIs of the Ministry of PopulationWelfare” was carried out by NIPS in 2007. Thisstudy focused on capacity of teaching faculty,training resources, teaching methodology andnumber of trainees in a class room. The studyexhibited some weak areas; many RTIs wereusing the blackboards, library arrangementswere not up to mark and limited use of audio-video films. Examination system of many ofthe RTIs was not up to date. Exams wereconducted on hand written questionsapproach. The other main issues identifiedwere; insufficient stipend to the trainees, lesserstaff strength, poor efficiency of staff andtraining infrastructure.

Keeping in view the preceding study, Ministryof Population Welfare approached NIPS toconduct another study “Evaluation of RegionalTraining Institutes”. The main objectives of thestudy were to; Evaluate the Training Capacityof Trainers, Carry out Situation Analysis ofRTIs,

Place of delivery is vitally important for thehealth of mothers and the newborns. Thefindings showed that the home based deliverieswere very high (61%). This practice was morecommon amongst older age women and thosehaving more than 4 children. Majority (74%) ofthe women did not have a checkup after theirlast delivery. It was discouraging to note thatcomplete vaccination was given to only onethird of the children aged 12-23 months.

The prevalence of all types of diarrheal diseaseswas 22 percent among children under five yearsof age during two weeks preceding the survey;whereas about 57 percent of them were takento a health facility/ provider for treatment.Overall only 16 percent of the children belowthree years of age were found to be exclusivelybreastfed. Children of young mothers andchildren living in rural areas were more likely tohave exclusive breastfeeding.In Gilgit Baltistan, every eighth womanreported that she had heard of AIDS. The dataindicated that majority of women aged 15-49years lack accurate knowledge about variousmodes of AIDS virus transmission. Only fourpercent women correctly believed that a personcould not get infected by sharing food with aperson who has AIDS; while 10 percent of thewomen had the correct information; that HIVcan be transmitted from mother to child duringpregnancy.The GBDHS 2008 revealed very useful data onvarious indicators based on the informationrelated to demographic, family planning andhealth of mother and child. A reader of themain report can benefit from a detailed analysispresented in different chapters; which will beparticularly useful for researchers as well asother stakeholders involved in reproductivehealth and family planning in Pakistan.

In Pakistan, generally prevailing perceptionsand practices have been linked with Islamicteachings. Majority of the people in Pakistanlive in rural areas where literacy rate is low andhence they adhere to age, old traditions andIslamic values. Thus, a need was felt to conductan empirical study to investigate theperceptions and practices of general public aswell as religious leaders in context of Islamicvalues.

Aiming to answer the related issues of “Islamand Family Planning”, a pilot study has beencarried out in Districts of Sialkot and Chakwalby National Institute of Population Studies.The Objectives of the study were to; Investigatethe prevailing knowledge of family planning incontext of Islam in general public; Collectinformation on extent of perception andawareness of religious leaders about Islam andfamily planning; Discover existing role ofreligious leaders in communicating familyplanning knowledge to their communities;assess the possibility of advocacy for familyplanning through religious leaders.

Pakistan has rapid population growth thatmanifests serious implications for the socio-economic development of the country. Islamhas never opposed to what is good to man; andAllah has enabled man to distinguish betweenthe useful and harmful; and to follow the paththat would assure him happiness. Despite thefact that Family Planning is allowed in Islam andthe coitus interruptus was permitted absolutely

vidence from a study (PDHS, 2007)showed that; from among other factors religionwas cited by a substantive number of womenfor not using Family Planning methods inPakistan.

Realizing the role of Islamic Teachings inadoptions of Family Planning Practices; diverseve rs ions , in ter pr eta t ion s and evenmisconceptions; the United Nations undertooksome efforts to address the issue; including

being the most Prominentactivities. Islamic countries generally endorsedthe “Programme of Action” of the conferencebut with the reservation that they wouldinterpret and adopt its recommendations inaccordance with Islam.

In continuation of the UN's Initiative, Ministryof Population Welfare Pakistan organized amega event of International UllemaConference in 2005 to ponder upon variousaspects of “Islam and Family Planning”inwhich Ullemas of 21 countries discussedimportant issues concerning population anddevelopment.

(mubah), e

International Conference on Population andDevelopment (ICPD)1994, Millennium DevelopmentSummit (2000)

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A total sample of 2398 respondents fromdistrict Sialkot and Chakwal was covered bytrained enumerators of NIPS.

Qualitative and Quantitative methods; based onStructured Questionnaires at Household level,Focus Group Discussions with general publicand In-depth Interviews of religious leaders; asdata collection tools were applied.

The process of data analysis was accomplishedand the report writing is in progress. Thisresearch study aims to provide a detailedscanned views on perceptions, attitudes,practices of Islam and Family Planning in thecontext of prevalent socio-cultural setting. Thestudy will generate reliable information forpolicy makers and planners.

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Evaluation of Regional Training Institutes 2009-10

Assess the Impact of Basic and RefresherTraining on the work efficiency of FamilyWelfare Workers (FWWs) and determine anddecide the future course of action regardingRTIs.

The study adopted quantitative approach with atotal sample of 1646 respondents from 13districts; where RTIs were located; all overPakistan. Different types of Questionnaires/Modules were used for the PerformanceEvaluation of RTIs and Perception of Clientsregarding provision of services. The trainedenumerators interviewed total 13 RTI In-charges, 70 RTI Trainers, 143 Family WelfareWorkers and 1420 clients.

After successful completion of the datacollection and data entry, the analysis of thedata is actively in progress and final report willbe ready shortly.

Islam and Family Planning-Perceptions and Practices; A pilot study inSialkot and Chakwal districts

“The point of population stabilization is to reduce or minimize misery.( )Roger Bengston, founding board member, World Population Balance

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Education is a human right withimmense power to transform. On itsfoundation rest the cornerstones offreedom, democracy and sustainablehuman development.

Kofi Annan

Experience shows that a very populous citycan rarely, if ever, be well governed. To the sizeof states there is a limit, as there is to otherthings (plants, animals, implements), for noneof these retain their natural power when theyare too large or too small

Aristotle, 322 B.C.

In continuation to the series of seminar lectureson; linkages between population growth andsocio economic sector's development,reproductive health, family planning, researchpriorities and population welfare programs andother demographic areas; NIPS launchedanother episode of seminars/lectures on

an exper t ondemographic research and program evaluationhighlighted various issues r

focal institution for coordinating andundertaking research on emerging issues.Eminent social scientists, policy-makers,programme managers and representatives frominternational donor agencies attended theseminar.

The second seminar was organized at NIPS on18 January 2010. During his lecture

; renowned scholar havingample expertise in the fields of demography,reproductive health and family planning;accentuated the indicators of reproductivehealth of women belonging to different Muslimcountries.

from the experiences of other Muslimcountries in improving the reproductive healthstatus of women. Updated Website andComputerized Library of NIPS were alsoinaugurated after the seminar.

“Future Research Agenda for ReproductiveHealth under Changing Paradigm” by Dr.Tausef Ahmed, and “Reproductive HealthBehavior of Muslim Women: Lessons forPakistan” by Dr. Mehtab Karim”-

Dr. Tauseef Ahmed

Dr.Mehtab Karim

elating to national

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T hird par ty eva luat ive s tudy t i t l ed“Performance Evaluation of Male Mobilizers”(PEMM-2008-09) was designed and conductedby National Institute of Population Studies onthe request of Ministry of Population Welfareas a requirement of Planning & DevelopmentDivision. This is the second evaluative surveyon Male Mobilizers which was previouslyknown as “Male Village-Based Family PlanningWorkers”.

for Population Welfare and Mr. Nayyar Agha,Federal Secretary, Ministry of PopulationWelfare on 19 December, 2009 at Avari HotelLahore. Various stakeholders, populationexperts, researchers/professionals, policymakers, and District Population WelfareOfficers/Tehsil Population Welfare Officersattended the seminar.

The Honorable Minister graced the occasionand stated valuable remarks about thewonderful presentation

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She also instructed to translate it in Urdu andthen disseminate all over the country.

The printing process oflanguages has been completed and are

ready to be distributed to Male Mobilizers asadvised.

Pakistan Demographic and Health Survey(PDHS) is the largest household-based survey;providing the estimates, for urban and ruralareas, and each of the four provinces;conducted in Pakistan by National Institute ofPopulation Studies (NIPS). It was the secondsurvey as part of the worldwide Demographicand Health Survey (DHS) project. It providesdetailed information on fertility, familyplanning, infants, child and adult mortality,maternal and child health, nutrition, andknowledge of HIV/AIDS and other sexuallytransmitted InfectionIn order to increase the awareness level ofmasses, NIPS planned to translate PDHS keyfindings in National and four regionallanguages; Punjabi, Sindhi, Pushto and Balochiand its distribution to the respective provinces.

The main objective of this activity was tocapture the attention of a common man inPakistan towards present status of theircommunities in respect of differentdemographic and health indicators. Sincemajority of the population does not haveunderstanding of English language which isone of the major hindrance to understand thefacts. It will support them in understanding andrealization of the statistics which are directlyinfluencing their lives

The translation activity was started in May 2009.NIPS research staff, M/s Ink Soft, ProfessorBaloch Dean Balochi Language of Universityof Balochistan and National University ofModern Languages (NUML); were mainsources in translation of PDHS key findings.After the completion of printing process,findings have been distributed to respectiveprovinces and departments.

leaflet in Urdu andEnglish

.

8 9

Reproductive Health (RH) services including;preventive obstetric and gynecological services,maternal and child health (MCH) care,consultation and counseling for infertility andfull range of FP methods includingContraceptive Surgery (CS) are provided by theReproductive Health Service Centres (RHSCs).These centres are of two types; the one that arelocated at the premises of governmenthospitals designated as “A” type and the otherthat are run by the Provincial Line Departments(PLDs), different NGOs and private centersdesignated as “B” type.

The Ministry of Population Welfare (MoPW)intends to assess the strength and quality ofservices provided by RHS-B centres to gaugeand strengthen the Public Private Partnership(PPP).

On the request of MoPW, National Institute ofPopulation Studies (NIPS) carried out the studywith the aim to generate suggestions andrecommendations for policy makers. Thespecific objectives were to;

1) Assess the performance of RHS-B centersregarding the CSCs performed and IRC claimspaid by the district office during last one year(July 2008 June 2009);

2) Examine and assess the FP services beingprovided by RHS-B Centres.

The quantitative techniques were used toundertake the study. Four types of structuredquestionnaires were used to collect informationfrom the concerned District PopulationWelfare Officer (DPWO), RHS-B centres'sIncharge regarding Situation Analysis of thecentres and Clients who have used FP servicesand undergone surgeries.

Data was collected at national level by very wellqualified trained field interviewers. Dataanalysis and report writing is in process. Keyfindings will be disseminated as the report isfinalized and printed.

The second round of the trainings for NIPSResearchers was held from October2009 at NIPS; aiming to train them in effectivedemographic survey or research designing andapplied statistical techniques for writingresearch papers.

The training emphasized advance techniquesof in-depth analysis of qualitative andquantitative data, future research agenda androle of research in policy and plan formulation.

The main resource persons for the training wereDr. Faqir Muhammad (

and Dr.Abdul Waheed Chaudhry

.

Chairman Department ofMathematics & Statistics AIOU Islamabad)

(Associate Professor,Quaid-e-Azam University Islamabad) as statisticaland qualitative data analysis experts

S e m i n a r s / L e c t u r e son “Reproductive Health”

Dissemination Seminar of“Performance Evaluation of

Male Mobilizer”

Evaluation of ContraceptiveSurgery Cases and Family Planning

Services of RHS-B Centers

Special lectures on future research agenda androle of research in policy and plan formulationwere also delivered by senior experts; Dr.Tausef Ahmed ( Mr.Abdul Ghaffar Khan (

.

The contents of training included; Priorityresearch agenda for reproductive health, Roleof research in population policy and planformulation, Logistic regression, Ordinal &Multinomial logistic, Path analysis: (ANOVA),Non parametric tests, Analysis & Interpretationof data from FGD and In-depth Interviews.

Freelance Consultant) andDirector General (Projects)

M/o Population Welfare)

Training workshop on In-depthAnalysis of Quantitative and

Qualitative Data ( October 2009)20-26th

“”

Perhaps we cannot prevent this world from being a world in which children aretortured. But we can reduce the number of tortured children

(Albert Camus)

“”

These children and their parents know that getting an education is not only theirright, but a passport to a better future - for the children and for the country

( )Harry Belafonte

Translation of PDHS Findingsin National and different Region

al languages- UNFPA 2009

reproductive healthprogramme andalso pointed outsome importantareas for research.He suggested thatNIPS should be a

The main findingsof final report ofs u r v e y w e r epresented to Dr.Firdous AshiqueA w a n t h eHonorable Minister

and recommendedto ED, NIPS to printa separate booklethighlighting greyareas/ weaknessesf o u n d i n t h eperformance of malemobilizers.

He discussed thevariation in thebehavior of womenliving in differentenvironment andemphasized thatPakistan must learn