|Birula, living in Bihar, India, was all smiles about her sterilization. |
Photo: David J. Olson
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Several of the same obstacles to family planning came up in both countries — pressure to have a lot of children and to have at least one male child. In some cases, the pressure is there because they cannot be sure if all of their children will survive. The pressure can come from the husband, the mother-in-law or other family members.
In my brief, unscientific visits, I was pleased to encounter several progressive husbands and mothers-in-law, who supported women’s desire to control the size of their families. I hope this evidence is more than anecdotal.
Almost 20 years ago, the study “Factors Affecting Contraceptive Use in Pakistan” revealed that “knowledge of a source and easy access to a service outlet are strongly related to contraceptive use for both urban and rural women, reinforcing the fact that the availability of and access to services are critical factors for raising the level of contraceptive use.”
That is still true to some extent and but programs such as DKT Pakistan and Janani — and others like them — are working hard to change the dynamic and bring contraception as close as possible to those who need it.