Pakistan has a population of over 233 million, making it the sixth fifth most populous largest country in the world. Although the fertility rate has declined on a national level from 4.9 children per woman in 1990-91 to 3.6 in 2019, it has not changed much for women who are poor and in rural areas, remaining at 4.5 children. In its State of the World’s Mothers 2015 report, Save the Children ranked Pakistan 149th out of 178 countries in its Mothers’ Index which assesses the well-being of mothers.
To address these issues, DKT Pakistan was established in 2012 to serve the poor and underserved populations who have higher unmet need and lower contraceptive prevalence rates. Addressing equity (one of the Sustainable Development Goals) requires tremendous social investment for changing behavior and norms. Meeting equity goals becomes more challenging as we move into remote areas of Pakistan where people have low purchasing power and cultural norms are less conducive to family planning.
DKT Pakistan has extended operations across the country with a special focus on rural and hard to reach areas in collaboration with provincial governments. DKT Pakistan has built partnerships with the Department of Health (DoH) and Department of Population Welfare (DoPW).
DKT’s goal is to revolutionize the reproductive health sector in Pakistan to reach the 27% of Pakistani women with an unmet need for contraception through the following strategies:
- Social marketing of condoms, including the Josh and Prudence brands and other contraceptives such as IUDS, oral contraceptives, injectables and emergency contraception in traditional and non-traditional sales outlets.
- Clinical networks of the Dhanak Health Care Centers network of midwife-owned and managed clinics. Dhanak clinics emphasize long-term methods (such as IUDs), adding diversity to a method mix that is heavily dependent on short-term contraceptives. Most of these clinics are renovations of existing clinics but some are newly constructed. Since 2012, DKT Pakistan has opened over 1,000 Dhanak clinics.
Both the social marketing and clinical network operations are increasingly focused on rural areas, which have reduced access to reproductive health care providers and contraception and contain approximately 65% of the country’s population.
DKT Pakistan reaches new users of family planning products and services by organizing activations in rural villages to educate both men and women on the value of family planning. DKT also conducts community mobilization activities such as door-to-door visits to refer women and couples their nearest Dhanak clinic.
DKT Pakistan tries different strategies to promote family planning and sexual and reproductive health respectfully and clearly within Pakistan’s cultural context. These TV advertisements show how DKT Pakistan creatively promotes family planning in the Pakistani context.
DKT launched contraceptive social marketing sales in neighboring Afghanistan in 2018, where limitations on buying power and conservative values (similar to Pakistan’s) put Afghanistan’s contraceptive prevalence rate at only 22%. Today, DKT sells condoms and IUDs in Afghanistan.