SOME SELECTED RESEARCH ASSIGNMENTS UNDERTAKEN BY RAHNUMA FAMILY PLANNING ASSOCIATION OF PAKISTAN (R-FPAP)
1. The Dai Study. 1969
The 4 years study project was designed with two sets of research objectives: One set included the measurement of the level of knowledge possessed by dais (traditional birth attendants) concerning various aspects of family planning; their awareness of and identification with the role of an active family planning worker; their own conceptualization of the theory and functions of family planning; and their attitudes towards family planning. The second set of research objectives included the testing of differences in the attitudes, knowledge and role identification of the sample of dais after having been exposed to a series of lectures and demonstrations given by experts on the need, theory and techniques of family planning services. The study also aimed at increasing motivation of dais to work as family planning workers. This project provided the model for training a pool of traditional birth attendants (dais) for improved access to family planning services at grassroots level.
2. A Follow-Up Study of Vasectomized Clients in Three Towns of the Punjab. 1975.
The universe of the study was constituted of all cases of individuals that were vasectomised in the three districts of Multan, Lyallpur (now known as Faisalabad) and Lahore. A total of 34214 cases were reported in the record of the Provincial Population Planning Board (Punjab) for the period 1698-1969. The sample of 425 cases selected from study districts was included in follow up study. The major objectives of the follow-up study were: i) To study practices and attitudes of the clients in relation to family planning before being vasectomized, ii) To study the post operation marital relations, iii) To find out the relationship between reactions to undergoing vasectomy and various structural attributes of clients, and iv) To study the post operation complications in relation to the pre-operational fear and to understand various social and economic characteristics of the clients. Findings of this follow-up study helped organization in better provision of vasectomy services to its clients.
3. A Study of Male Motivation for Family Planning. 1980.
The study was designed as a first step for a systematic exploration of this intricate area. The study was concerned with the pattern of attitudes, beliefs and practices of selected group of males (100 male users of family planning methods, 100 male non-users of family planning methods, and 100 vasectomized males) to discover the basis of acceptance and rejection of family planning methods. The study was designed with the purpose: i) To formulate implications of the information obtained for the current motivational efforts by R-FPAP for family planning, and ii) To suggest lines of future research in the field. Following were the main objectives of the study: i) To find out what type of men have what motivations for small families and what motivation against them with special reference to the use of family planning method, ii) To utilize findings of the study to develop effective communication materials for promotion of family planning amongst men and educating them for clearing their doubts regarding their ideas against small family norms, and iii) To utilize the knowledge gained from this study to highlight small family norms in training sessions. Findings of this research study encouraged organization towards induction of male motivators in its system and developing men-focused communication material for the promotion of family planning amongst men.
4. Bench Mark Survey of the Girl Child. 1992.
In Pakistan, like other countries of the third world, the girl child has a lower status, and enjoys fever rights, opportunities and benefits of childhood. Keeping in perspective the social and economic conditions of women in our country, the aim of this study was to provide basis for future projects to be undertaken for the uplift of the girl child. The study offered insight into existing knowledge, attitudes and practices about Pakistani girl child of the lower-middle income urban areas and the rural areas. The broad objective of the study were: i) To conduct a bench-mark survey on the existing situation of the girl child, which would form the basis for subsequent project directed to uplift of young girls, ii) To determine how many of the basic needs, in the sphere of health, education, environment, recreation, & nutrition, of the girl child aged 14-20 years are being met with the aim of doing ground work for initiating a programme for the improvement in the condition of the girl child. Since then, combating child and young age marriages has been the integral component of organizations' thematic area 'Adolescent'.
5. A Study on Rumors and Misconceptions Regarding Family Planning in (Peri-Urban & Rural) Lahore and (Rural) Gujranwala. 1993.
The rumors and misconceptions surrounding family planning and its related aspects are thought to be a major constraint in increasing the contraceptive prevalence rate (CPR). For this reason, R-FPAP wanted to explore the incorrect beliefs and misgivings about family planning in general and contraceptive methods in particular. Very little research was done on this subject in Pakistan and this was a pioneer effort in qualitative research that provided useful insight to policy makers and service providers.
6. Sexuality and Reproductive Health Knowledge and Attitudes. 1999.
Sexuality and reproductive health knowledge and attitudes study survey was proposed with following objectives: i) Assess the extent of information and knowledge about reproductive and sexual health, ii) Assess the existing attitude towards human sexuality, and iii) Assess couple communication on sexual and reproductive health. The findings of this study lead to a general conclusion that the knowledge about sexuality in the sample exists at a much lower level than desired for healthy attitudes and practices towards this very significant aspect of human life. Findings of this survey suggested R-FPAP for developing more practical BCC and IEC material on SH&RH for its clients. This study also provided adequate evidence to develop new and strengthen on-going programs and projects on SH&RH.
7. Baseline Survey of 49 Locations. 1999.
The R-FPAP with the cooperation of the UNICEF, the UNESCO, the UNFPA and the WHO published basic information on preventive and promotive health aspects as a contribution to the global call for 'Health for All'- the year 2000. The information includes mother and child care, immunization, birth-spacing and other essential elements. The R-FPAP started a project for dissemination of the messages through its network, thus supporting the government efforts in creating awareness on health issues and utilization of health facilities. A project 'Facts for Life Macro Work Unit Project', undertaken by R-FPAP disseminated knowledge on preventive health care practices through its network at 49 locations (at that time) directly covering one million people. The community profile comprising of researched material was developed with objectives: i) Assess the awareness of key health problems affecting children and women in the county; ii) Assess knowledge of actions required to address key health problems of children and women; iii) Assess household caring practices for children and women in the areas of health, nutrition, hygiene, sanitation; and iv) Assess present practices of utilizing health services (government/private sector) like immunization, pre/post-natal health care etc.
8: Sexual Negotiation: An Inquiry on Empowerment of Women. 2007.
The pilot project, first of its kind in Pakistan, was initiated with an aim to understand the relationship between sexual behavior and gender meanings vis-à-vis the negotiation of safer sex practices among women. It also focused on empowering women in order to protect them from HIV/AIDS and other STIs. The project primarily conceived to test tools and techniques of making women aware about their bodies and sexual reproductive rights and empowering them with courage and confidence to ensure consensual and safe sex. The project also aimed at critically addressing the following questions: i) Can a woman really be sexually assertive?, ii) Can she ever think of differing from the concept of mutual fidelity when she has been socialized and brought up on the principle that husband is 'god'?, iii) Can a woman ensure safe sex by suggesting that sexual partner wear a condom when the very suggestion of condom implies infidelity that could threaten her personal security and destroy the relationship?, and iv) Further, if the women did have sex using a condom, how would she be able to prove that she is fertile and can bear a son?. This descriptive study encouraged organization in further discourse on female health by research including discussions at various tiers and reaching especially the unreached. Support from IPPF and donor community was obtained on the basis of these preliminary findings for continued and increased support on women's empowerment to overcome a lot of stigma, shame and guilt associated with sexuality, especially women sexual rights.
9. Integration of SH&RH and HIV as One Window Approach- Need for Appropriate Policy in Pakistan. 2007.
Integration of HIV/AIDS services into SH&RH settings can be viewed as a continuum running from an informal to a more formal combination of two or more services. SH&RH-integrated service delivery is highly challenging yet it provides numerous benefits that promote the rationale for the linkage between the SH&RH and HIV/AIDS. Final draft of the National HIV and AIDS Policy (2007) stipulates the integration of HIV/AIDS initiatives and awareness into existing programs, showing some definite commitment in this regard. Research under consideration suggested integration at the policy level, program level, service site level, and client and community level. This paper also emphasized on incorporating integration strategy in the health system policy for putting it into action in the operational programs for service delivery and need to establish and strengthen public-private partnership in carrying forward the agenda of protecting people from HIV/AIDS epidemic that knows no boarders.
10. Improving Access to Quality SH&RH Services in Government Sector. 2007.
Sexual and reproductive health programmes have five major components: maternal and newborn health; family planning; prevention of unsafe PAC/MRs; management of RTIs and STIs including HIV/AIDS; and promotion of sexual health. In public sector of Pakistan, these services are available in an organized manner in teaching hospitals and to some extent at district headquarter hospitals. Rudimentary services are being provided by lady health visitors in domiciliary setting, however universal access is lacking. This research study strongly proposed to ensure improved access to SH&RH services as the integration of SH&RH services with general health services along with targeting the marginalized groups and strengthening the accountability at all levels. R-FPAP's learning from this study resulted in ensuring SH&RH integration in almost all its core programs.
11. Social and Networks Analysis on High Risk Group and the Coverage of Services and Providers (NGOs) in Quetta, Balochistan. 2007.
The KAP study was a milestone for a services delivery project aiming to provide quality sexual and reproductive health and primary health care services for High Risk Group in Quetta was a joint effort of UNFPA, FPAP and a local NGO (Voice). The project was designed to reduce heterosexual transmission of HIV/AIDS through improvement in the health seeking behavior of High Risk Groups and to provide them access to quality information and health care services. The study survey was particularly intended to help design, clarify and prioritize appropriate interventions for High Risk Group in Quetta.
12. Study Report- Child Marriage in Pakistan- A Taboo. 2007.
This report was developed on the basis of secondary material search and was not a primary data based study rather it was more seen as archive of all the material on the subject and a compilation of relevant aspects of the issue. There seem to be a dearth of material on early marriages in Pakistan. The topic is largely un-researched and even ignored. As early marriages are unregistered, their prevalence is hard to determine quantitatively. However, it is unquestionable that the custom of child marriage is widely prevalent in throughout Pakistan. Literature review carried out provided strong rationale for developing a three years project in 2008 titled, 'Women as compensation: reaching the survivors of coerced marriages and violence in Pakistan'. This project provided adequate foundation for advocating with decision and policy makers for the amendment in the child marriage restraint act 1929 in addition to other outstanding outcomes of one of the most innovative and successful project of R-FPAP.
13. Sexual Behavior of Hijras and their knowledge of HIV/AIDS. 2007.
The study was undertaken with 300 hijras to: i) Assess risk behaviors including number and type of sex partners (commercial, regular, non-paying), ii) Assess the knowledge of STI, HIV/AIDS and perceptions of related self risks, and iii) Assess condom, drug and substance use.
14. Sexual Behavior/ Practices and Psychological States Among High Risk Group of Lahore. 2008.
In Pakistan no study of the psychological profile of sex workers had been conducted before this study was envisaged to gain an insight into the sexual behavior, knowledge about sexually transmitted infections, including HIV, and psychological health of sizeable key population of Pakistan. The objectives defined were: i) To analyze sexual behavior and practices of High Risk Group (High Risk Groups) of Lahore, ii) To assess High Risk Group,s knowledge about STIs including HIV and AIDS, iii) To measure the prevalence of depression and level of self-esteem among High Risk Groups, iv) Condom use among High Risk Groups, and v) Risk perceptions to HIV. Analytical findings of this cross sectional descriptive study were extremely useful in developing more suitable health service interventions and risk mitigation strategies for key population. R-FPAP succeeded in continuation of interventions through different projects that helped reduce vulnerability of High Risk Groups to HIV infections by creating a social, legal and economic environment in which prevention is possible. Organization managed to extent its intervention to High Risk Groups of Quetta and Faisalabad districts.
15. Socio-Cultural Determinants and Economic Consequences of Unsafe PAC/MR in Pakistan. 2008.
In Pakistan, PAC/MR remains a controversial issue because of social, cultural and religious factors, which often translates into discrimination against and subordination of women. The objectives of the study were: i) Identify socio-cultural barriers, which limit of deny women faced with unwanted or unplanned pregnancies to access quality safe PAC/MR services, and ii) Ascertain the economic consequences of induced PAC/MR. Cross sectional study was carried out in Lahore with pregnant women, and women who have complications of induced PAC/MR as study respondents. Findings of this research study were instrumental in developing advocacy and IEC/BCC tools, and material to key audiences in the form of position papers for generating dissonance with policy makers. This research study was the part of 5 year safe PAC/MR project in South Asia Region in partnership with five member associations of IPPF i.e. Afghanistan, Pakistan, Iran, Sri Lanka, and Maldives. The project aimed to create enabling environment for improved service delivery and enhanced understanding of social and cultural factors that support women's right to access legal PAC/MR services. This study generated regional data on safe and unsafe PAC/MR, an improved understanding of the social barriers that inhibit or hinder women's access to safe PAC/MR services.
16. Baseline Survey and Mapping Exercise for the Projection on Early/Coerced Marriages, Sexual Reproductive Health and Rights and the Custom of Swara in District Swabi and Mardan. 2009.
This baseline study was conducted to document the prevalence, perceptions, attitudes and behaviors of the communities in order to address following main objectives of the project: i) Reduce tolerance for and acceptance of GBV and Swara among the target communities, ii) Generate support for SH&RHR and promote gender equality among stakeholders and partners in Pakistan, iii) Increase access to SH&RHR services to Swara girls/women including their families, and iv) Contribute towards increased knowledge on Islamic teachings relating to SH&RHR, Swara and gender equality. Districts Mardan and Swabi (15 union councils each) were selected primarily to carry out this survey. The main impediments to early/coerced marriages (which is a gradually dying custom), SH&RHR and the custom of Swara in both districts were inadequate health facilities, lack of education and awareness, poor economic status of families, and more importantly socio-cultural constraints. The interest of majority of people in getting knowledge and awareness related to SH&RH to protect themselves from STIs as well as protect women from unwanted pregnancies and subsequent risks of infertility. Project intermediacies developed on the basis of baseline findings provided remarkable guidance during the course of entire duration (3 years) of the project, which not only addressed the issue of early marriages, SH&RHR and the custom of swara at local community level and empowered swara victims but also provided the strong basis for developing BCC and IEC materials and knitting massive advocacy campaigns for the formulation of laws and policies for combating the issue of child/ early age marriages.
17. Demographic Transition in Pakistan- the Imperative of Family Planning in Attaining Fertility Transition: Exploring Future Prospects. 2009.
This critical population sector review was commissioned by R-FPAP to understand the current situation of demographic transition in Pakistan with specific reference to fertility. The objective of the sector review was to analyze all related areas, which come under the impact of the family planning programme. The purpose of this review was to set a stage for informed interaction between Federal Ministries and Provincial Departments of Population Welfare, Health, Education, Social Welfare, Environment, and Finance as a guide to build provincial ownership of population issues. The report includes discussion on demographic transition in Pakistan, importance of examining fertility transition, determinants of fertility decline and reviewing reasons for fertility stagnation in Pakistan; and barriers to contraceptive use, highlighting missed opportunities in absolute numbers. This report is an excellent addition to academic discourse on the subject and provided a starting point for productive discussions among all stakeholders to the benefit of the people especially women of Pakistan.
18. Mapping of Gender-Based Violence (GBV) Service Providers in Flood Affected Areas of Punjab, Sindh and AJK. 2011.
According to UN estimates, approximately 17.2 million people were affected by floods in Pakistan in early 2011. The worst hit districts were: Bagh, Neelum, Layya and Muzaffarabad in AJK; Muzaffargarh, Rajanpur and Dera Ghazi Khan in Punjab; and Dadu in Sindh. The mapping was aimed to find out answers of the following questions: i) Find the number of facilities providing medical, law enforcement (police), shelter, legal aid and psycho-social support available for the survivors of violence, ii) Assess the practices and challenges faced by the service providers involved in the section, iii) Examine the specific services provided by the institutes for the support of women, iv) Know about the capacity building trainings related with GBV and human rights by the staff, particularly on human rights and women's rights, gender base violence and gender sensitization, v) Involving females in handling female cases, vi) Confidentiality and security arrangements for the survivors, and vii) Give recommendations to improve services in the targeted districts. This well-researched mapping shared with UN agencies and other partner organizations supported in streamlining GBV related interventions in selected districts.
19. CROSS-ROADS OF DISABILITY AND SRH:
Sexual and reproductive health needs, and information and services available, to persons with disabilities in Lahore, Pakistan
Rahnuma Family Planning Association of Pakistan (R-FPAP) engaged the Institute of Social Sciences (ISS) to conduct a research study to identify different kinds of sources of SRH information available to PWDs (Persons With Disabilities), identify assistance required and services available to and attained by PWDs to fulfil their SRH needs, and document perceptions, practices and attitudes of service providers, parents or immediate care takers and PWDs themselves, which make them more vulnerable for access to SRH information and services.
The study involved in-depth interviews and focus group discussions with a wide range of stakeholders involved with the rehabilitation and welfare of PWDs, including PWDs themselves, their parents, staff of institutions involved in the education and care of PWDs, SRH and public health experts, physicians, government officials, and disability experts and advocates, assessment of the existing attitudes of service providers regarding PWDs using an attitude scale, and semi-structured interviews of 104 PWDs. A Reference Group consisting of key stakeholders reviewed and made inputs into the research design and instruments, as well as the study report, and participated in the dissemination meeting of the report. The key findings of the study are summarized below.
There is a huge gap between the needs of PWDs for SRH information, counselling and services and the availability of the same to PWDs, both in mainstream institutions like hospitals, as well as institutions dedicated to PWDs. The study identified many myths, misconceptions and unscientific thinking regarding SRH, disability and PWDs (e.g. many PWDs attributed the infertility of a couple, the birth of a disabled child, the determination of the sex of a child, or a person becoming disabled due to Allah), and most PWDs and their teachers declared masturbation sinful and harmful to health. , However, about one-fourth of PWDs, mostly young, provided scientific explanations for most of these SRH myths.
Many staff members of special education had stereotypes of PWDs (e.g. over-sexed, stubborn, argumentative; prefer to interact with/marry persons of their own disability, do not share SRH matters with families). One reason for these stereotypes may be a lack of intimacy between the staff and students of special education institutions. This is also evident in the disciplinary approach adopted by many staff members towards PWDs (separate boys and girls, do not let them be alone, always keep an eye on them, keep them busy, punish them for misbehaviour, etc.), focusing not on the SRH problems faced by PWDs, but the problems faced by staff in dealing with the SRH issues of PWDs.
There was considerable sharing regarding SRH matters between students with disabilities and their family members, as well as their friends and acquaintances (though the latter is considered an unreliable source by many PWDs). The incorrect idea that PWDs do not share SRH matters with family members may be based on the fact that this is more likely to be true of non-disabled children, who are much more independent, and have far greater access to persons outside the family than PWDs. Since most PWDs are greatly dependent on their families, it can be expected that they share SRH matters with them much more frequently than non-disabled persons.
The data clearly shows that sexual harassment takes place in institutions where PWDs live and/or study, that there is a definite increase in the reporting of harassment of PWDs in institutions during the last year, and most cases are dealt with by the staff of the concerned institutions without informing or involving high ups. At the same time we find that most staff members tend to deny the presence of harassment in their own institutions. There is limited awareness of the law regarding sexual harassment, and is limited to punishment for the harasser, without any knowledge for the need for a committee to deal with complaints. There is also a tendency to focus on the victim of harassment but not the perpetrator.
On the whole one finds the prevalence of an exclusive approach regarding PWDs. Most service providers and staff talk about separate facilities for PWDs regarding SRH and other services. There is considerable talk of fixing the impairments and disabilities of PWDs, but little talk of fixing the society which is responsible for impairments and disabilities turning into handicaps, mainstreaming PWDs, or focusing on their constitutional rights.
What is heartening to see however, perhaps for the first time in Pakistan, is the growing voice of PWDs themselves, which is both challenging and influencing decision makers at the highest levels, and bringing the discussion on inclusiveness and rights at the centre stage of the debate. This is of course timely, since a number of policies and bills regarding PWDs are in the process of being finalised.
Complete Study is available on this link : https://www.dropbox.com/s/rj8sypnwhmmzvpm/On%20the%20Cross-%20Roads%20of%20Disability%20and%20SRH.pdf?dl=0#
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