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<li id="toc-Beginnings" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Beginnings"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.1</span> <span>Beginnings</span> </div> </a> <ul id="toc-Beginnings-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Family_planning_policy_in_the_1960s" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Family_planning_policy_in_the_1960s"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.2</span> <span>Family planning policy in the 1960s</span> </div> </a> <ul id="toc-Family_planning_policy_in_the_1960s-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Family_planning_amid_political_turmoil" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Family_planning_amid_political_turmoil"> <div class="vector-toc-text"> <span class="vector-toc-numb">1.3</span> <span>Family planning amid political turmoil</span> </div> </a> <ul id="toc-Family_planning_amid_political_turmoil-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Rural_and_Urban_Healthcare_Disparities_That_Contribute_to_Pakistan’s_High_Child_Mortality_Rate" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Rural_and_Urban_Healthcare_Disparities_That_Contribute_to_Pakistan’s_High_Child_Mortality_Rate"> <div class="vector-toc-text"> <span class="vector-toc-numb">2</span> <span>Rural and Urban Healthcare Disparities That Contribute to Pakistan’s High Child Mortality Rate</span> </div> </a> <ul id="toc-Rural_and_Urban_Healthcare_Disparities_That_Contribute_to_Pakistan’s_High_Child_Mortality_Rate-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Religious_influences" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Religious_influences"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Religious influences</span> </div> </a> <ul id="toc-Religious_influences-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Current_contraceptive_use" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Current_contraceptive_use"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Current contraceptive use</span> </div> </a> <ul id="toc-Current_contraceptive_use-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Current_policy" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Current_policy"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Current policy</span> </div> </a> <ul id="toc-Current_policy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Family_planning_in_2000s" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Family_planning_in_2000s"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Family planning in 2000s</span> </div> </a> <ul id="toc-Family_planning_in_2000s-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Family_planning_after_2010" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Family_planning_after_2010"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Family planning after 2010</span> </div> </a> <ul id="toc-Family_planning_after_2010-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Community_Health_Workers" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Community_Health_Workers"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Community Health Workers</span> </div> </a> <ul id="toc-Community_Health_Workers-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Notes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Notes"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Notes</span> </div> </a> <ul id="toc-Notes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc 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src="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Maapay_tay_Kaka.jpg/220px-Maapay_tay_Kaka.jpg" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Maapay_tay_Kaka.jpg/330px-Maapay_tay_Kaka.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/3d/Maapay_tay_Kaka.jpg/440px-Maapay_tay_Kaka.jpg 2x" data-file-width="3000" data-file-height="4000" /></a><figcaption>"Tabber", a stone monument at <a href="/wiki/Pakistan_Institute_of_Medical_Sciences" title="Pakistan Institute of Medical Sciences">PIMS</a>, Islamabad. The two taller stones represent parenthood while the smaller one represents a single child.</figcaption></figure> <p>Even though there is considerable demand for <b><a href="/wiki/Family_planning" title="Family planning">family planning</a></b> in <a href="/wiki/Pakistan" title="Pakistan">Pakistan</a>, the adoption of family planning has been hampered by government neglect, lack of services and misconceptions. <a href="/wiki/Demographics" class="mw-redirect" title="Demographics">Demographics</a> play a large role in <a href="/wiki/Pakistan" title="Pakistan">Pakistan</a>'s development and security since the change from military rule to civilian leadership.<sup id="cite_ref-hardee_1-0" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Challenges to Pakistani's well-being, opportunities for <a href="/wiki/Education" title="Education">education</a> and employment, and access to <a href="/wiki/Health_care" title="Health care">health care</a> are escalated due to the country's continuously-growing population.<sup id="cite_ref-hardee_1-1" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> It was estimated in 2005 that Pakistan's population totaled 151 million; a number which grows 1.9 percent annually, equaling a 2.9 million population growth per year.<sup id="cite_ref-debating_2-0" class="reference"><a href="#cite_note-debating-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Though Pakistan's fertility rates still exceed those of neighboring South Asian countries with a total fertility rate at 4.1 (3.3 children in urban settings and 4.5 children in rural areas) and <a href="/wiki/Contraception" class="mw-redirect" title="Contraception">contraception</a> use is lower than 35 percent, approximately one-fourth of Pakistani women wish to either delay the birth of their next child or end childbearing altogether.<sup id="cite_ref-hardee_1-2" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>According to Dr. Ansar Ali Khan, an advisor of <a href="/wiki/Reproductive_health" class="mw-redirect" title="Reproductive health">reproductive health</a> to the <a href="/wiki/United_Nations_Population_Fund" title="United Nations Population Fund">United Nations Population Fund</a> in Pakistan, "A combination of factors like non-availability of services, baseless traditional beliefs and misconception play a big role."<sup id="cite_ref-debating_2-1" class="reference"><a href="#cite_note-debating-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> In addition, Ali Khan stated that "a fairly large number of the population believes the use of artificial contraceptives for <a href="/wiki/Family_planning" title="Family planning">family planning</a> is against nature and also against <a href="/wiki/Islam" title="Islam">Islam</a>."<sup id="cite_ref-debating_2-2" class="reference"><a href="#cite_note-debating-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Unlike <a href="/wiki/Family_planning_in_Iran" title="Family planning in Iran">family planning in Iran</a>, a neighboring Islamic republic, Pakistan's <a href="/wiki/Family_planning" title="Family planning">family planning</a> program has been touted to have failed in recent years due to neglect and constant policy changes as a result of political upheaval.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>a<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-boonstra_6-0" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> While 96 percent of married women were reported to know about at least one method of contraception, only half of them had ever used it.<sup id="cite_ref-hardee_1-3" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=1" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1950, Pakistan's population reached 37 million people, making it the world's 13th most populous country.<sup id="cite_ref-hardee_1-4" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Though Pakistan was one of the first Asian countries to begin a family planning program with some help from international donors, fertility has declined slower than in neighboring countries. In 2007, Pakistan had increased in world population ranking to 6th, with over 164 million people and the <a href="/wiki/United_Nations" title="United Nations">United Nations</a> (UN) has projected that in 2050 it will move into 5th place with around 292 million people.<sup id="cite_ref-hardee_1-5" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Beginnings">Beginnings</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=2" title="Edit section: Beginnings"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The Family Planning Association of Pakistan (FPAP), now called "Rahnuma", was founded in Lahore by Saeeda Waheed in 1953.<sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Waheed, a member of the <a href="/wiki/All_Pakistan_Women%27s_Association" title="All Pakistan Women's Association">All Pakistan Women's Association</a>, began advocating for <a href="/wiki/Birth_control" title="Birth control">birth control</a> when her maid died from an attempt to abort her own pregnancy.<sup id="cite_ref-khan_8-0" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> The FPAP was unsuccessful in changing family planning policies until President and military leader <a href="/wiki/Ayub_Khan_(Field_Marshal)" class="mw-redirect" title="Ayub Khan (Field Marshal)">Ayub Khan</a> took interest in the problem of overpopulation in the late 1950s.<sup id="cite_ref-khan_8-1" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Khan spoke at the FPAP's first national seminar in 1959, speaking on the ‘menace over overpopulation'.<sup id="cite_ref-khan_8-2" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Soon after the seminar, the National Board of Family Planning was established as a policy-advising body for the federal government.<sup id="cite_ref-khan_8-3" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Pakistani journalist/researcher Ayesha Khan has suggested various reasons for Ayub Khan's position on population control.<sup id="cite_ref-khan_8-4" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Firstly, religion played a minor role in his government, a position that would change with Pakistan's next leader. Secondly, development ideology during Khan's time of power warned of the economic risks of high population growth rates. Thirdly, it had political utility for a military leader with no popular mandate to his leadership and in need of a development strategy. Lastly, support from international donors.<sup id="cite_ref-khan_8-5" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Family_planning_policy_in_the_1960s">Family planning policy in the 1960s</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=3" title="Edit section: Family planning policy in the 1960s"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Pakistan's first Family Planning Scheme was a part of the country's Third Five Year Plan (1965–1970).<sup id="cite_ref-khan_8-6" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> This scheme became the template for all subsequent family planning strategies. The scheme's goal was to have a vast impact in the shortest time possible, with a reduction of the birth rate from 50 to 40 per 1000 by 1970.<sup id="cite_ref-khan_8-7" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> At the onset of the program, <a href="/wiki/Condoms" class="mw-redirect" title="Condoms">condoms</a> were the most available method of contraception, but by 1966 the <a href="/wiki/Intrauterine_Device" class="mw-redirect" title="Intrauterine Device">Intrauterine Device</a> (IUD) had replaced it has the "corner-stone" of the Scheme. It was said to be "safe, cheap, reversible," and it required "little user action."<sup id="cite_ref-khan_8-8" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Family_planning_amid_political_turmoil">Family planning amid political turmoil</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=4" title="Edit section: Family planning amid political turmoil"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 1969, Ayub Khan was overthrown by the joint action of Islamist parties and the leftist <a href="/wiki/Pakistan_People%27s_Party" title="Pakistan People's Party">Pakistan People's Party</a>.<sup id="cite_ref-khan_8-9" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> His successor <a href="/wiki/Yahya_Khan" title="Yahya Khan">Yahya Khan</a> did little more than watch as a civil war ripped apart East and West Pakistan in 1971. <a href="/wiki/Wajihuddin" title="Wajihuddin">Wajihuddin</a> Ahmed, the Family Planning Commissioner during Yahya Khan's rule, focused on reducing pregnancies in women "rather than meeting contraceptive targets alone" and introducing the pill to Pakistani women.<sup id="cite_ref-khan_8-10" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>In 1971, while the country was split apart and international assistance halted due to army atrocities in Bangladesh, the <a href="/wiki/Pakistan_Peoples_Party" class="mw-redirect" title="Pakistan Peoples Party">Pakistan Peoples Party</a> took power of the Pakistani government.<sup id="cite_ref-khan_8-11" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Its leader, <a href="/wiki/Zulfiqar_Ali_Bhutto" class="mw-redirect" title="Zulfiqar Ali Bhutto">Zulfiqar Ali Bhutto</a>, needed to gain legitimacy and popularity by taking an anti-American, anti-capitalist, and anti-Ayub Khan-stance. However, Bhutto found that he could not fund many of his socialist promises, and so allowed economic assistance from <a href="/wiki/USAID" class="mw-redirect" title="USAID">USAID</a>. Over the 15-year span of 1964-1979, USAID "spent over $30 million on Pakistan's population programme; during 1965–75 US AID provided 40% of total programme inputs."<sup id="cite_ref-khan_8-12" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> However, due to extreme and unrealistic goals,<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Vagueness" title="Wikipedia:Vagueness"><span title="This information is too vague. (September 2011)">vague</span></a></i>]</sup> the USAID program was highly ineffective.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (September 2011)">citation needed</span></a></i>]</sup> </p><p>In 1977 Bhutto's Chief of Army Staff, General <a href="/wiki/Zia_ul-Haq" class="mw-redirect" title="Zia ul-Haq">Zia ul-Haq</a>, deposed the leader and declared martial law.<sup id="cite_ref-khan_8-13" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Zia differed from his predecessors in that he "made the religious-right-wing his political ideology." He had used the religious lobbies and conservative middle-classes as support for his take-over. In a move looking to counter Bhutto's government and as a gesture to his religious constituency, Zia froze the existing family planning program and banned publicity for family planning activities. Zia enforced strict laws against adultery (punishable by death), <a href="/wiki/Rape" title="Rape">rape</a>, intoxication, and theft. USAID funding was suspended, and Pakistan became alienated "from the Western powers that Ayub Khan had so carefully cultivated."<sup id="cite_ref-khan_8-14" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Near the end of Zia's era of power, family planning and population control became tied to the <a href="/wiki/Ministry_of_Health_(Pakistan)" class="mw-redirect" title="Ministry of Health (Pakistan)">Ministry of Health (Pakistan)</a>. Unfortunately, the program has remained fairly unchanged over the past 35 years due to implementation problems involving over-centralization, lack of coordination, and structural flaws.<sup id="cite_ref-khan_8-15" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Rural_and_Urban_Healthcare_Disparities_That_Contribute_to_Pakistan’s_High_Child_Mortality_Rate"><span id="Rural_and_Urban_Healthcare_Disparities_That_Contribute_to_Pakistan.E2.80.99s_High_Child_Mortality_Rate"></span>Rural and Urban Healthcare Disparities That Contribute to Pakistan’s High Child Mortality Rate</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=5" title="Edit section: Rural and Urban Healthcare Disparities That Contribute to Pakistan’s High Child Mortality Rate"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One of Pakistan's largest problems is its rapidly expanding population and their limited access to necessary essentials such as readily available healthcare, doctor's, and basic sexual education.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Although the nation has recently been making active efforts to adhere to the United Nations <a href="/wiki/Millennium_Development_Goals" title="Millennium Development Goals">Millennium Development Goals</a><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> that aims to reduce global infant mortality by two-thirds, their efforts have fallen short as a large population of the Islamic Republic of Pakistan resides in rural areas where the nation's efforts have rarely been seen. The accompanying concerns of this crisis have resulted in extremely high neonatal, infant and child mortality rates. According to the UN Inter-agency Group for Child Mortality Estimation, Pakistan's rates of child mortality (neonatal mortality rate: 44.2; infant mortality rate: 61.2; child under 5 mortality rate: 74.9)<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> nearly double the worldwide average (neonatal mortality rate: 18; infant mortality rate: 29.4; child under 5 mortality rate: 39.1)<sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> set by UNICEF Global. </p> <div class="mw-heading mw-heading2"><h2 id="Religious_influences">Religious influences</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=6" title="Edit section: Religious influences"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Religious_views_on_birth_control" class="mw-redirect" title="Religious views on birth control">Religious views on birth control</a></div> <p><a href="/wiki/Muslim" class="mw-redirect" title="Muslim">Muslim</a> populations are incredibly diverse, varying by race, language, and degree of religious conservatism.<sup id="cite_ref-rf_13-0" class="reference"><a href="#cite_note-rf-13"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Some populations are part of countries run by Islamic law, while others live under secular governments.<sup id="cite_ref-rf_13-1" class="reference"><a href="#cite_note-rf-13"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> In Pakistan, extremely conservative Islamic beliefs predominate in many parts of the country, in which <a href="/wiki/Purdah" title="Purdah">purdah</a> restricts women to their homes unless chaperoned by a male relative.<sup id="cite_ref-boonstra_6-1" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Additionally, levels of schooling are very low in Pakistan, allowing men to have more power in decision-making.<sup id="cite_ref-boonstra_6-2" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>When Ayub Khan resigned in 1969, religious demonstrators attempted to discredit the leader morally using the slogan "Family planning, for those who want free sex!"<sup id="cite_ref-khan_8-16" class="reference"><a href="#cite_note-khan-8"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> This ideology is still present in Pakistan, as the organized religious party opposes family planning because it is un-Islamic.<sup id="cite_ref-boonstra_6-3" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Though Pakistani couples commonly cite religious reasons for avoiding birth control, there is not one definitive agreement about family planning and contraception in Islam.<sup id="cite_ref-boonstra_6-4" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> In Pakistan, many local religious figures are supportive of family planning and have begun discussions in their communities in order to promote the health of women and children.<sup id="cite_ref-boonstra_6-5" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Although many public health specialists feel that religion plays a major role in resistance to the use of FP in Pakistan, the Pakistan Demographic and Health Survey of 2006-7 showed that religious reasons accounted for only 9% of FP non-use. In fact, many NGOs have implemented interventions where they have worked with local or national clergy. Islamabad based think tank <a rel="nofollow" class="external text" href="http://www.resdev.org">Research and Development Solutions</a> reports that there is no quantitative evidence that any of these interventions have resulted in an increase in CPR in these communities. </p> <div class="mw-heading mw-heading2"><h2 id="Current_contraceptive_use">Current contraceptive use</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=7" title="Edit section: Current contraceptive use"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Historically, political strife and cultural restrictions on women constraining their empowerment have hampered implementation of family planning strategies throughout the country.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-hardee_1-6" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Most women who say they do not want any more children or would like to wait a period of time before their next pregnancy do not have the contraceptive resources available to them in order to do so.<sup id="cite_ref-hardee_1-7" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> One-fourth of married women are estimated to have an unmet need.<sup id="cite_ref-hardee_1-8" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> In the 1990s, women increasingly reported to wanting fewer children, and 24 percent of recent births were reported to be unwanted or mistimed.<sup id="cite_ref-hardee_1-9" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-boonstra_6-6" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The rate of <a href="/wiki/Unwanted_pregnancies" class="mw-redirect" title="Unwanted pregnancies">unwanted pregnancies</a> is higher for women living in poor or rural environments; this is especially important since two-thirds of women live in rural areas.<sup id="cite_ref-hardee_1-10" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> While only 22 percent of pregnant married women report being currently using a modern method of birth control and 8 percent reported to be using a traditional method, lack of widespread contraceptive use could be due to the lack breadth of the current family planning program.<sup id="cite_ref-hardee_1-11" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-boonstra_6-7" class="reference"><a href="#cite_note-boonstra-6"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The most commonly reported reasons for married women electing not to use family planning methods include the belief that fertility should be determined by God (28 percent); opposition to use by the woman, her husband, others or a perceived religious prohibition (23 percent); infertility (15 percent); and concerns about health, side effects or the cost of family planning (12 percent).<sup id="cite_ref-hardee_1-12" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>The first abortion penal code (Article 312) of this region dates back to 1860, during British colonial rule which stipulated that unless an abortion was to "save a woman's life," it was expressly illegal and punishable by law, and the same applied for (self)induced miscarriages.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> In 1990, the penal code was provisionally adapted in order to better reflect Islamic Law, and finally was made permanent in 1997. According to this change in the abortion law, preservation of "the physical and mental health" of a woman, early on in the pregnancy, also became legal grounds for a permissible abortion.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Unfortunately, however the interpretation of necessary treatment required by a woman for an abortion to be performed is vague, and despite the legality, health professionals in Pakistan felt abortion was "immoral, contrary to religion and illegal," especially according to female paramedics when compared to doctors and gynaecologists.<sup id="cite_ref-popcouncil.org_18-0" class="reference"><a href="#cite_note-popcouncil.org-18"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> However, the female paramedics had a more lenient attitude when it came to a question of whether an abortion was justified: to save a mother's life, when the fetus was either abnormal or when a woman was raped; whereas the gynaecologists and doctors felt it was less permissible to perform, especially in the case of rapes.<sup id="cite_ref-popcouncil.org_18-1" class="reference"><a href="#cite_note-popcouncil.org-18"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Unfortunately, health care professionals do not wish to perform abortions either due to their own religious leanings, ethical stances or fear of stigmatization.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><p>When a comparison of the private sector and public sector was made with regards to abortion and <a href="/wiki/Post-abortion_care" title="Post-abortion care">post-abortion care</a> provided, it was noted that the private sector performed more abortions and took on double the case-load of post-abortion care, as opposed to the public sector.<sup id="cite_ref-popcouncil.org_18-2" class="reference"><a href="#cite_note-popcouncil.org-18"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Therefore, it currently plays an important role in the provision of care of patients undergoing abortions. Due to a lack of access (especially in the rural areas), no clarity (dearth of awareness, understanding and education), fear of legal persecution (especially in the public sector), an inability of health care professionals to interpret the law, as well as a form of FP, women are often forced to seek abortion by untrained providers.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> According to an indirect estimation method, applied to the 2002 national data on abortions and its related complications in Pakistan, 1 in every 7 pregnancy terminates in an abortion.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>Extending beyond the reach of family planning and contraceptive methods is the issue of women's sexual and reproductive health. According to the <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> and <a href="/wiki/Population_Action_International" title="Population Action International">Population Action International</a>, as of 2007, "only 16 percent of women receive at least four antenatal care visits during pregnancy, fewer than one-third of births are attended by skilled health personnel, and the maternal mortality ratio, at 320 maternal deaths per 100,000 live births, remains high."<sup id="cite_ref-hardee_1-13" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Current_policy">Current policy</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=8" title="Edit section: Current policy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dating from 2002, Pakistan's current family planning policy reflects the government's concern with rising population trends and poverty. The policy's goals include reducing population growth (from 2.1 percent in 2002 to 1.3 by 2020), reducing fertility through voluntary family planning (from 4 births per woman in 2004 to 2.1 births per woman by 2020), and as a signatory to the Programme of Action developed at the <a href="/wiki/International_Conference_on_Population_and_Development" title="International Conference on Population and Development">International Conference on Population and Development</a> in Cairo in 1994, Pakistan pledged to provide universal access to family planning by 2010.<sup id="cite_ref-hardee_1-14" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Also in Pakistan's Poverty Reduction Strategy Paper is the objective of increasing contraceptive use 57 percent by 2012.<sup id="cite_ref-hardee_1-15" class="reference"><a href="#cite_note-hardee-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> At present there is no federal ministry of health or population welfare and therefore no, population policy. However, at the time of writing, Khyber Pakhtunkhwa, Sindh and Punjab are working on individual Health and Population strategies. An analysis of this policy showed that while the Government of Pakistan spent US$652 million funds under this policy between 2000 and 2009 (UNFPA), there was hardly any change in CPR which was 30% in 2000 and remained unchanged in 2006. It is also important to note that other elements of population development such as education, capacity building, economic development, climate etc. were notably absent from this policy.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> </p><p>In 2009 the Ministry of Population sought to revise the Population Policy. However, under the 18th Amendment to the Constitution, the Ministry was devolved and its responsibilities were shifted to Provincial Population Welfare Departments. In 2013 some of the provinces - notably Punjab - reported that they were developing their own population policies. </p> <div class="mw-heading mw-heading2"><h2 id="Family_planning_in_2000s">Family planning in 2000s</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=9" title="Edit section: Family planning in 2000s"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2006–07, the Pakistan Demographic Health Survey of Pakistan (PDHS 2006-7) showed that approximately 30% of married women of reproductive age (MWRA) were using some form of Family Planning. Of these 8% used a traditional and 22% used a modern method. Approximately 25% had an unmet for Family Planning, of this around 2/3rd was for limiting and the rest for spacing. These translate into 7 million FP (Family Planning) users, 5 million users of modern methods and 6 million with an unmet need. Since a large number of modern method users are sterilized and received the service in a previous year, the actual number women availing any FP service were just under 3 million or less than half of those with an unmet need.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> The DHS also dispelled the popular notion that religious reasons keep families from using family planning. In the DHS less than 10% of FP nonusers cited a religious reason for their non-use. </p><p>Using data from the PDHS 2006-7, approximately 35% of FP users received their FP services from the public sector, 12% from NGOs and private providers and the overwhelming 52% bought their methods over the counter from shops, making FP services largely subject to market forces. The government spends on average around Rs. 4 billion (US$42 million) a year on FP but nearly 90% of this goes towards salaries and overheads and commodities account for 7-14% of these funds.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Since the PDHS 2006-7, operations of NGOs have increased but it appears that according to the supply data there has been no increase in supply of FP commodities<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> and that entry of the NGO Marie Stopes Society into FP services has displaced clients from other private sector, perhaps those that previously self procured commodities. Additionally, it appears that the if the amount of commodities that are being reported by the Pakistan Bureau of Statistics in its "Annual Contraceptive Prevalence Reports" is accurate, the overall increase in population may mean that the CPR for modern methods may have actually declined. Even when one adjusts for underreporting for private sector and NGO services, it is likely that the current CPR may actually be unchanged from the PDHS 2006-7. A more accurate picture will emerge with the release of the data from the Pakistan Demographic and Health Survey 2012. </p> <div class="mw-heading mw-heading2"><h2 id="Family_planning_after_2010">Family planning after 2010</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=10" title="Edit section: Family planning after 2010"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A brief version of the Pakistan Demographic and Health Survey 2012 was released in October 2013. It showed that the overall CPR had climbed to 33.4% of which approximately 25% was from modern methods. In essence it showed that the overall increase in CPR since the previous DHS had been around 1% per annum overall and around 0.5% in modern methods. Extrapolating these results to estimated populations suggest that there are 8.8 million users of any FP, 5.5 million users of modern methods and 3.65 million women who avail FP services in any given year. Thus only around 14% of all married women of reproductive age (MWRA) access FP services in a given year. This represents an increase of 700,000 users since the last DHS; around 2/3 of this difference may be attributed to increased population and nearly all these were supplied by NGOs.<sup id="cite_ref-resdev.org_28-0" class="reference"><a href="#cite_note-resdev.org-28"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p><p>The preliminary DHS report does not report sources of FP services but analysis of government's contraceptive prevalence report suggests that 44% avail public sector services and that the role of NGOs has increased from 11% in 2006-7 to around 40%. The total change in users of FP services between 2006 and 2012 was around 700,000 women. This is exactly equal to the increase in number of women served by NGOs (supported by donors such as USAID, DFID, KfW, GIZ, David and Lucile Packard Foundation etc.); while the overall quantum services by the Government and those that self procure commodities from stores remained the same.<sup id="cite_ref-resdev.org_28-1" class="reference"><a href="#cite_note-resdev.org-28"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Community_Health_Workers">Community Health Workers</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=11" title="Edit section: Community Health Workers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the 1990s, two agencies in Pakistan started village-based community health worker programs in Pakistan. The Ministry of Population Welfare started planning a program in 1992 based on a similar program in <a href="/wiki/Bangladesh" title="Bangladesh">Bangladesh</a>. This program recruited married women, with at least 10 years of schooling, that lived in rural areas, and trained them to provide <a href="/wiki/Family_planning" title="Family planning">family planning</a> services to their communities. The aim of these services was to reduce the fertility rate and slow population growth. The <a href="/wiki/Ministry_of_Health_(Pakistan)" class="mw-redirect" title="Ministry of Health (Pakistan)">Ministry of Health (Pakistan)</a> started a similar program in 1994 called "lady health workers." This program emphasized maternal and child health, and also delivered family planning services. Both groups of women provide door to door health and family planning services, supplied with oral and injectable contraceptives and condoms to distribute to their communities. One study in 2002 showed that in areas with 2 or more community-based workers there was a 7% increase in the use of modern, reversible contraceptive methods.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> An evaluation of the lady health worker program showed only a marginal improvement in FP among <a href="/wiki/Health_indicators" class="mw-redirect" title="Health indicators">health indicators</a> the populations served of around 5-6%.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> In 2006 there were 96,000 lady health workers.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=12" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Human_population_planning" title="Human population planning">Human population planning</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="Notes">Notes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=13" title="Edit section: Notes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-lower-alpha"> <div class="mw-references-wrap"><ol class="references"> <li id="cite_note-5"><span class="mw-cite-backlink"><b><a href="#cite_ref-5">^</a></b></span> <span class="reference-text">Pakistan has more <a href="/wiki/Arable_land" title="Arable land">arable land</a> than Iran which has more dry and mountainous territory, which is unsupportive for such a large scale of <a href="/wiki/Agricultural_productivity" title="Agricultural productivity">agricultural productivity</a>. Like other species, <a href="/wiki/Human_population_growth" class="mw-redirect" title="Human population growth">human population growth</a> depends on the amount of food availability in the area they inhabit.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> See <a href="/wiki/Carrying_capacity" title="Carrying capacity">carrying capacity</a>.</span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=14" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239543626"><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-hardee-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-hardee_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-hardee_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-hardee_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-hardee_1-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-hardee_1-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-hardee_1-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-hardee_1-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-hardee_1-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-hardee_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-hardee_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-hardee_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-hardee_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-hardee_1-12"><sup><i><b>m</b></i></sup></a> <a href="#cite_ref-hardee_1-13"><sup><i><b>n</b></i></sup></a> <a href="#cite_ref-hardee_1-14"><sup><i><b>o</b></i></sup></a> <a href="#cite_ref-hardee_1-15"><sup><i><b>p</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFHardee_KarenLeahy_Elizabeth2007" class="citation journal cs1">Hardee Karen; Leahy Elizabeth (2007). "Population, Fertility and Family Planning in Pakistan: A Program in Stagnation". <i>Population Action International</i>. <b>4</b> (1): 1–12.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Population+Action+International&rft.atitle=Population%2C+Fertility+and+Family+Planning+in+Pakistan%3A+A+Program+in+Stagnation&rft.volume=4&rft.issue=1&rft.pages=1-12&rft.date=2007&rft.au=Hardee+Karen&rft.au=Leahy+Elizabeth&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFamily+planning+in+Pakistan" class="Z3988"></span></span> </li> <li id="cite_note-debating-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-debating_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-debating_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-debating_2-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text">"Pakistan: Debating Islam and family planning." IRIN. 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Family Planning in Pakistan: Applying What We Have Learned. JPMA April 2013"</a> <span class="cs1-format">(PDF)</span>. Archived from <a rel="nofollow" class="external text" href="http://jpma.org.pk/PdfDownload/supplement_112.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 30 January 2022<span class="reference-accessdate">. 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Changes in CPR between Pakistan DHS 2006 and 2012</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20141017025154/http://resdev.org/files/policy_brief/43/Policy%20Brief%2043%20-%20Differences%20between%20PDHS%202006-7%20and%202012-13.pdf">Archived</a> 2014-10-17 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a>.</span> </li> <li id="cite_note-29"><span class="mw-cite-backlink"><b><a href="#cite_ref-29">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFSultanClelandAli2002" class="citation journal cs1">Sultan M, Cleland JG, Ali MM (2002). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447209">"Assessment of a New Approach to Family Planning Services in Rural Pakistan"</a>. <i>American Journal of Public Health</i>. <b>92</b> (7): 1168–1172. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.2105%2Fajph.92.7.1168">10.2105/ajph.92.7.1168</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447209">1447209</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/12084703">12084703</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=American+Journal+of+Public+Health&rft.atitle=Assessment+of+a+New+Approach+to+Family+Planning+Services+in+Rural+Pakistan&rft.volume=92&rft.issue=7&rft.pages=1168-1172&rft.date=2002&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1447209%23id-name%3DPMC&rft_id=info%3Apmid%2F12084703&rft_id=info%3Adoi%2F10.2105%2Fajph.92.7.1168&rft.aulast=Sultan&rft.aufirst=M&rft.au=Cleland%2C+JG&rft.au=Ali%2C+MM&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1447209&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFamily+planning+in+Pakistan" class="Z3988"></span></span> </li> <li id="cite_note-30"><span class="mw-cite-backlink"><b><a href="#cite_ref-30">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://web.archive.org/web/20161020230038/http://www.resdev.org/files/policy_brief/15/15.pdf">"Research and Development Solutions Policy Brief Series #15: The Role of Lady Health Workers in Family Planning in Pakistan"</a> <span class="cs1-format">(PDF)</span>. Archived from <a rel="nofollow" class="external text" href="http://resdev.org/files/policy_brief/15/15.pdf">the original</a> <span class="cs1-format">(PDF)</span> on 20 October 2016<span class="reference-accessdate">. Retrieved <span class="nowrap">7 August</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Research+and+Development+Solutions+Policy+Brief+Series+%2315%3A+The+Role+of+Lady+Health+Workers+in+Family+Planning+in+Pakistan.&rft_id=http%3A%2F%2Fresdev.org%2Ffiles%2Fpolicy_brief%2F15%2F15.pdf&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFamily+planning+in+Pakistan" class="Z3988"></span></span> </li> <li id="cite_note-31"><span class="mw-cite-backlink"><b><a href="#cite_ref-31">^</a></b></span> <span class="reference-text">World Health Organization and Global Health Workforce Alliance. Pakistan's Lady Health Worker programme. 2008 <a rel="nofollow" class="external autonumber" href="https://www.who.int/workforcealliance/knowledge/resources/casestudy_pakistan/en/">[1]</a></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=15" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation book cs1"><a rel="nofollow" class="external text" href="https://books.google.com/books?id=Y4ZLAAAAYAAJ"><i>Pakistan Agriculture</i></a>. Finance Industry Publications. 1988.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Pakistan+Agriculture&rft.pub=Finance+Industry+Publications&rft.date=1988&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DY4ZLAAAAYAAJ&rfr_id=info%3Asid%2Fen.wikipedia.org%3AFamily+planning+in+Pakistan" class="Z3988"></span></li></ul> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Family_planning_in_Pakistan&action=edit&section=16" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="http://www.resdev.org/e2pa">Research and Development Solution - Evidence to Policy Action: Briefs on Family Planning</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20210309162814/http://www.resdev.org/e2pa">Archived</a> 2021-03-09 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li> <li><a rel="nofollow" class="external text" href="http://www.fpapak.org">Rahnuma- Family Planning Association of Pakistan</a></li></ul> <div style="clear:both;" class=""></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output 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class="mw-redirect" title="Abortion-rights movements">Abortion-rights movements</a></li> <li><a href="/wiki/Bodily_integrity#Genital_integrity" title="Bodily integrity">Genital integrity</a> <ul><li><a href="/wiki/Circumcision_controversies" title="Circumcision controversies">Circumcision controversy</a></li> <li><a href="/wiki/Intersex_human_rights" title="Intersex human rights">Intersex human rights</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Education</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sex_education" title="Sex education">Sex education</a></li> <li><a href="/wiki/Genetic_counseling" title="Genetic counseling">Genetic counseling</a></li> <li><a href="/wiki/Pre-conception_counseling" title="Pre-conception counseling">Pre-conception counseling</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Family_planning" title="Family planning">Planning</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Voluntary_childlessness" title="Voluntary childlessness">Childfreeness</a>/<a href="/wiki/Childlessness" title="Childlessness">childlessness</a></li> <li><a href="/wiki/Birth_spacing" title="Birth spacing">Birth spacing</a></li> <li><a href="/wiki/Parenting" title="Parenting">Parenting</a> <ul><li><a href="/wiki/Adoption" title="Adoption">adoption</a></li> <li><a href="/wiki/Foster_care" title="Foster care">foster care</a></li></ul></li> <li><a href="/wiki/Sperm_theft" class="mw-redirect" title="Sperm theft">Sperm theft</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Birth_Control" class="mw-redirect" title="Birth Control">Contraception</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hormonal_contraception" title="Hormonal contraception">Hormonal contraception</a></li> <li><a href="/wiki/Male_contraceptive" title="Male contraceptive">Male contraception</a></li> <li><a href="/wiki/Safe_sex" title="Safe sex">Safe sex</a></li> <li><a href="/wiki/Condom" title="Condom">Condom</a></li> <li><a href="/wiki/Intrauterine_device" title="Intrauterine device">Intrauterine device</a></li> <li><a href="/wiki/Sterilization_(medicine)" title="Sterilization (medicine)">Sterilization</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Assisted_reproductive_technology" title="Assisted reproductive technology">Assisted<br />reproduction</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/In_vitro_fertilization" class="mw-redirect" title="In vitro fertilization">In vitro fertilization</a></li> <li><a href="/wiki/Intracytoplasmic_sperm_injection" title="Intracytoplasmic sperm injection">ICSI</a></li> <li>Gamete Cryopreservation <ul><li><a href="/wiki/Oocyte_cryopreservation" title="Oocyte cryopreservation">Egg</a></li> <li><a href="/wiki/Semen_cryopreservation" title="Semen cryopreservation">Sperm</a></li></ul></li> <li><a href="/wiki/Sperm_bank" title="Sperm bank">Sperm bank</a></li> <li><a href="/wiki/Fertility_fraud" title="Fertility fraud">fertility fraud</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sexual_and_reproductive_health" title="Sexual and reproductive health">Health</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Men%27s_health" title="Men's health">Men's</a></li> <li><a href="/wiki/Women%27s_health" title="Women's health">Women's</a> <ul><li><a href="/wiki/Vulvovaginal_health" class="mw-redirect" title="Vulvovaginal health">vulvovaginal</a></li></ul></li> <li>Research <ul><li><a href="/wiki/Self-report_sexual_risk_behaviors" title="Self-report sexual risk behaviors">self-report sexual risk behaviors</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pregnancy" title="Pregnancy">Pregnancy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Maternal_health" title="Maternal health">Maternal health</a></li> <li><a href="/wiki/Obstetrics" title="Obstetrics">Obstetrics</a></li> <li><a href="/wiki/Unintended_pregnancy" title="Unintended pregnancy">Unintended pregnancy</a></li> <li><a href="/wiki/Childbirth" title="Childbirth">childbirth</a></li> <li><a href="/wiki/Abortion" title="Abortion">Abortion</a></li> <li><a href="/wiki/Pregnancy_options_counseling" title="Pregnancy options counseling">Options counseling</a></li> <li><a href="/wiki/Pregnancy_from_rape" title="Pregnancy from rape">Pregnancy from rape</a></li> <li><a href="/wiki/Pregnant_patients%27_rights" class="mw-redirect" title="Pregnant patients' rights">Pregnant patients' rights</a></li> <li><a href="/wiki/Prenatal_care" title="Prenatal care">Prenatal care</a></li> <li><a href="/wiki/Teenage_pregnancy" title="Teenage pregnancy">Teenage pregnancy</a></li> <li><a href="/wiki/Category:Precocious_puberty_and_pregnancy" title="Category:Precocious puberty and pregnancy">Precocious puberty and pregnancy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Identity</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gender_identity" title="Gender identity">Gender identity</a></li> <li><a href="/wiki/Sexual_orientation" title="Sexual orientation">Sexual orientation</a></li> <li><a href="/wiki/Intersex" title="Intersex">Intersex</a></li> <li><a href="/wiki/Transgender" title="Transgender">Transgender</a></li> <li><a href="/wiki/Genital_modification_and_mutilation" title="Genital modification and mutilation">Genital modification</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Medicine</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Andrology" title="Andrology">Andrology</a></li> <li><a href="/wiki/Reproductive_medicine" title="Reproductive medicine">Genitourinary medicine</a></li> <li><a href="/wiki/Gynaecology" title="Gynaecology">Gynaecology</a></li> <li><a href="/wiki/Obstetrics_and_gynaecology" title="Obstetrics and gynaecology">Obstetrics and gynaecology</a></li> <li><a href="/wiki/Reproductive_endocrinology_and_infertility" title="Reproductive endocrinology and infertility">Reproductive endocrinology and infertility</a></li> <li><a href="/wiki/Sexual_medicine" title="Sexual medicine">Sexual medicine</a></li> <li><a href="/wiki/Transgender_health_care" title="Transgender health care">Transgender health care</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Disorders</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Disorders_of_sex_development" title="Disorders of sex development">Disorders of sex development</a></li> <li><a href="/wiki/Infertility" title="Infertility">Infertility</a></li> <li><a href="/wiki/Reproductive_system_disease" title="Reproductive system disease">Reproductive system disease</a></li> <li><a href="/wiki/Sexual_dysfunction" title="Sexual dysfunction">Sexual dysfunction</a></li> <li><a href="/wiki/Sexually_transmitted_infection" title="Sexually transmitted infection">Sexually transmitted infections</a> <ul><li><a href="/wiki/Sexual_health_clinic" title="Sexual health clinic">clinic</a></li></ul></li> <li><a href="/wiki/Gender_dysphoria" title="Gender dysphoria">Gender dysphoria</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">By country</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/One-child_policy" title="One-child policy">China</a></li> <li><a href="/wiki/Family_planning_in_India" title="Family planning in India">India</a></li> <li><a href="/wiki/Family_planning_in_Iran" title="Family planning in Iran">Iran</a></li> <li><a href="/wiki/Contraception_in_the_Republic_of_Ireland" title="Contraception in the Republic of Ireland">Ireland</a></li> <li><a class="mw-selflink selflink">Pakistan</a></li> <li><a href="/wiki/Responsible_Parenthood_and_Reproductive_Health_Act_of_2012" title="Responsible Parenthood and Reproductive Health Act of 2012">Philippines</a></li> <li><a href="/wiki/Population_planning_in_Singapore" title="Population planning in Singapore">Singapore</a></li> <li>United Kingdom <ul><li><a href="/wiki/Teenage_pregnancy_in_the_United_Kingdom" title="Teenage pregnancy in the United Kingdom">teen</a></li></ul></li> <li><a href="/wiki/Family_planning_in_the_United_States" title="Family planning in the United States">United States</a> <ul><li><a href="/wiki/Teenage_pregnancy_in_the_United_States" title="Teenage pregnancy in the United States">teen pregnancy</a></li> <li><a href="/wiki/Birth_control_in_the_United_States" title="Birth control in the United States">birth control</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">History</th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Birth_control_movement_in_the_United_States" title="Birth control movement in the United States">Birth control movement in the United States</a></li> <li><a href="/wiki/History_of_condoms" title="History of condoms">History of condoms</a></li> <li><a href="/wiki/Social_hygiene_movement" title="Social hygiene movement">Social hygiene movement</a></li> <li><a href="/wiki/Timeline_of_reproductive_rights_legislation" title="Timeline of reproductive rights legislation">Timeline of reproductive rights legislation</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Policy</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/One-child_policy" title="One-child policy">One-child policy</a></li> <li><a href="/wiki/Two-child_policy" title="Two-child policy">Two-child policy</a></li> <li><a href="/wiki/Three-child_policy" title="Three-child policy">Three-child policy</a></li> <li>Financial <ul><li><a href="/wiki/Baby_bonus" title="Baby bonus">baby bonus</a></li> <li><a href="/wiki/Bachelor_tax" title="Bachelor tax">bachelor tax</a></li> <li><a href="/wiki/Child_benefit" title="Child benefit">child benefit</a></li> <li><a href="/wiki/Tax_on_childlessness" title="Tax on childlessness">tax on childlessness</a></li></ul></li> <li><a href="/wiki/Abortion_law" title="Abortion law">Abortion law</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" 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