Escolar Documentos
Profissional Documentos
Cultura Documentos
2010
DRAFT
I. Preamble ..........................................................................................................................1
II. Recognizing Demographic Problem and Projections.....................................................1
III. a) Review of Approach - Evidence from the field ........................................................3
III. b) Review of Organizational Pursuits ...........................................................................4
IV. Rejuvenating the Imperative .........................................................................................6
V. Population and Development Goals...............................................................................7
VI. National Population Policy - 2010................................................................................8
GOALS....................................................................................................................8
OBJECTIVES .........................................................................................................8
PREREQUISITES .................................................................................................9
GUIDING PARAMATERS ...................................................................................9
STRATEGIES.........................................................................................................9
Enhancing Access to Service Delivery and Improving Quality..............................9
Advocacy, Communications and Demand Generation..........................................12
Programme Management and Efficiency ....................................................13
Programme Monitoring and Evaluation................................................................14
Research in Population and Development.............................................................15
Population and Development for Policy Support..................................................16
Annex -1 FAMILY PLANNING AND REPRODUCTIVE HEALTH INDICATORS. .18
National Population Policy - 2010
I. Preamble
Right from 1950s high population growth in Pakistan was recognized as a major
impediment to its socioeconomic development process. All population projections and
predictions for Pakistan became true even in the presence of Population Welfare
Programme which was though formally established in early 1960s, could not bring the
desired change in fertility. Pakistan’s population doubled in around 23 years during
1970s and 1990s. Pakistan’s population over the last six decades has increased from 34
million in 1951 to 171 million in mid 2009 – five time increase. The high population
growth rate evolved due to rapid decline in mortality rate and slow change in fertility rate,
which continued over thirty year period. Pakistan witnessed a decline in growth rate only
in mid 1990s with gradual fall in fertility closely associated with a rise in contraceptive
use rate. The onset of much awaited fertility transition – brought total fertility rate down
from around six births in 1980s to around four births in late 1990s. Based on fertility
trends of 1990s, Population Policy 2002 projected to reach replacement level fertility by
2020. The progress witnessed in fertility appears not to achieve this objective. The other
indicators of health such as the infant mortality rate and maternal mortality ratio are also
disappointing according to the Pakistan Demographic and Health Survey 2006-07.
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National Population Policy - 2010
Based on the fertility trends reflected in recent demographic surveys two sets of
population projections up to 2015 and on to 2030 are presented. The assumptions
used here account for recent trends of a moderately faster and slow decline in fertility
accompanied by a standard decline in mortality that reflects improved life expectancy
(at birth for males from 63.7 years in 2005 to 70.0 years in 2030, and for females from
64.1 to 73.4 years for the same period) over the years.
• The Scenario I assumes that unwanted fertility will be eliminated by 2015 and the
total fertility rate will f a l l from its level of 4.1 in 2003-05 to 3.0 children in 2015 and will
continue its decline to reach 2.2 by 2030.
• The Scenario II assumes that fertility will continue to fall at its current pace, with no
special efforts to accelerate the decline. The TFR will be 3.4 in 2015, and 2.6 by 2030.
• The Scenario III encompasses impossibly fast decline in fertility, and as such requires
no description.
These two scenarios differ in their implications for Pakistan’s population size as
well as for the age composition of the population in 2020 and in 2030. According to
Scenario 1, population size by 2020 will be 210 million and 243 million by 2030;
corresponding figures for Scenario 2 are 216 and 255 million. These figures are
considerably higher than the earlier projections of the Planning Commission which
estimate population to be 181 million in 2010, 195 million by 2020. This reinforces
the very sharp difference that fertility trends can make on population size and related
outcomes.
Table 1.1: Projected Population (Millions) under Three Different Scenarios, 2009-2030
Scenarios 2009 2015 2020 2030
I. Proposed Course: Moderate decline
(TFR 3.0 by 2015, 2.7 by 2020 and2.2 by 2030) 171.2 192.7 210.6 243.6
II. Current Course: Slow decline
TFR 3.4 by 2015, 3.1 by 2020 and 2.6 by 2030) 171.2 195.4 216.1 255.3
“Planned Course”: Impossibly fast decline
(TFR 2.08 by 2020 & 1.92 by 2030) 181.2 194.7 218.0 264.6
Pakistan is a signatory to ICPD Plan of Action 1994 whereby a paradigm shift was
envisioned that provided a much needed expansion in reproductive health areas beyond
simple provision of family planning services. It focused on addressing reproductive
health needs of women of all ages by adopting life-cycle approach. In pursuance to this,
Pakistan adopted National Reproductive Health Service Package in 2001 thus pursuing
family planning within the comprehensive approach of reproductive health. Pakistan is
on track in its pursuit to lower population growth rate and has attained a level of 1.9
percent population growth rate, however the RH Service Package remained partially
implemented. The Population Welfare Programme with the support of other stakeholders
achieved contraceptive prevalence rate of 30 percent in early 2000s rising from only 12
percent in 1990-91. Keeping in view the momentum, the Pakistan Poverty Reduction
Strategy-I envisaged achieving CPR level of 42 percent by 2005-06, and 51 percent in
2009-10. The CPR recorded for 2006-07 shows to have remained at 30 percent – much
lower than the envisaged target.
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National Population Policy - 2010
The trend of contraceptive mix shows female sterilization and use of traditional methods
as major means of practice. This combination has contributed to lower than expected
effect on fertility levels. Over the years four important issues have emerged that need
recognition: decline in the use of three methods (oral pills, IUCDs, and injectables),
persistent unmet need for contraception, widening gap between current and ever use of
contraception indicating drop outs and high incidence of abortion (including induced
abortion) in Pakistan. Family planning service delivery points were increased by all
stakeholders and prices remained undisturbed, but access to services remained
problematic. Fear of side effects especially of oral pills, injectables, and IUDs emerged
as important barrier to its use. The quality of service needed improvements to attract
new clients and enhance continuity of use. Irregular supply and nonavailability of
contraceptives at health facilities have also been recognized as a problem especially for
women residing in rural and farflung remote areas.
Population Welfare Programme had over the years focused on promoting small family
norm and directed all its efforts to limiting family size through awareness and
motivational campaigns. Programme used various media including interpersonal
communications to educate couples regarding benefits of small family. This strategy has
largely been successful in raising levels of awareness about population issues.
However, these efforts in the past mostly mainly focused on urban areas where rural and
peri-urban population has not been adequately addressed and efforts are required to be
focused on rural opinion leaders besides targeting important segments of the society in
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National Population Policy - 2010
the peri-urban and urban areas. Majority of rural poor could not easily internalize the
same due to low literacy rate that hampered it rather in fact mind-blocks remained a
main hurdle in behavioral change process. Access to information regarding
contraceptives remained weak to effectively address persistent misperceptions
regarding family planning and misinformation regarding contraceptives despite repeated
surveys indicating side effects as a major barrier to the adoption and continuation of
hormonal contraceptives. Furthermore, persistent confusions and misconceptions
among less educated and illiterate segment of population regarding religious aspects of
family planning created socio-psychological barriers. These areas though addressed by
communication initiatives of Population Welfare Programme, the message could not
penetrate or influence the target audience.
The Ministry of Population Welfare service delivery network has expanded over the
years to more than 3300 facilities and outlets. Population Welfare Programme service
delivery to-date remained focused on static facilities and limited out-reach services
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National Population Policy - 2010
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National Population Policy - 2010
Learning from own experiences and good examples implemented in several Muslim
countries, Pakistan is now ready to place greater emphasis on pregnancy spacing also
referred as ‘repositioning family planning’. Demographic surveys consistently reveal
significant reduction in neonatal and infant mortality as a benefit of increased birth
spacing of two to four years – a fact if appropriately translated into strategies could bring
about necessary fertility transition. Healthy timing and spacing of pregnancies is a
means and a prime outcome of family planning programmes bearing immediate effect on
fertility management. This approach focuses on birth spacing and timing of pregnancy in
the critical context of reducing pregnancy related risks and promoting benefits of
reduced risks of death to mothers and infants. This is also consistent with Islamic
traditions of infant care and minimizes chances of mothers to experience risks related to
abortion. Religious leaders and Ulema have expressed their open support for this
approach. Major benefit is derived from reduction in high parity births and further
reduction in risks associated with frequent pregnancies which are too close too frequent,
too early and too late.
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National Population Policy - 2010
A robust family planning programme is imperative for Pakistan to regain the momentum
in fertility transition urgently. With a very high unmet need for contraception (25 percent)
several barriers need to be overcome, including misinformation regarding family
planning methods, difficult access to facilities/services, misinterpreted religious precepts
regarding use of contraception, absence of client focused quality services, disrupted flow
of information and availability of contraceptive methods, etc. In this regard, strict
monitoring and evaluation, accountability, assurance of quality services at individual
level, are envisioned to play important role. An effective communication strategy to
address these barriers and build demand for family planning remains a major area
warranting attention. All these issues also need to be incorporated in Health Policy so
that ownership and collective resolve in an important cause is reflected. Quality of
service which includes availability and choice of methods, information to clients,
technical competence of providers, good rapport between users and service providers,
continuity of services and a constellation of services offered, all need to be
comprehensively reviewed and accordingly addressed.
Reduction in poverty remains the mainstay of all economic policies especially after
Pakistan became a signatory to UN’s MDGs in 2000. Over a third of population lives in
poverty while the number of poor has increased dramatically during this decade. This
increase is closely associated with high fertility as well among the down-trodden
segments of population. Changing poverty situation across various regions of Pakistan is
well recorded – as some regions have much higher proportion of poor reflecting isolation
and neglect due to constrained public sector resource availability for uplift activities.
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National Population Policy - 2010
VISION
To create a healthy, prosperous, and stable Pakistan through timely completion
of demographic transition and through mainstreaming population factor in
national development
GOALS
The National Population Policy seeks:-
OBJECTIVES
Short Term:
Long Term:
• Achieve replacement level fertility i.e. 2.1 births per woman by 2025
• Minimize unmet need for family planning services from 25 to 10 percent by 2025
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National Population Policy - 2010
PREREQUISITES
• Full ownership of family planning programme by provincial governments by 2010
• Ministry and Departments of Health take family planning as a priority activity by 2010
• Provision of adequate funds and upfront, and timely releases
• Ministries and Departments formulate Policies and Strategies consistent with the
requirements of actualizing demographic dividend
GUIDING PARAMATERS
Guiding parameters for the improvement of family planning in general and birth spacing
in particular, are the ones stipulated in the Plan of Action of the International Conference
on Population and Development and UN’s Millennium Development Goals 2000, and the
Karachi Declaration 2009 for implementation of Best Practices for Family Planning,
Reproductive Health and MNCH, with particular reference to:
STRATEGIES
The National Population Policy 2010 attaches particular importance to enhance access
to family planning information and services to achieve fertility transition as a combined
outcome of all stakeholders’ efforts and contribution to a vital national cause of achieving
stated goals and objectives. Furthermore, evolving consensus among all stakeholders
on the policy and assuring full support to achieve stated goals and objectives will be
pursued, improved and sustained.
This Policy addresses the critical gap of access to family planning services on urgent
basis, with the first priority essentially aimed at consolidating and upgrading service
outlets of all major stakeholders to actively engage them to taking birth spacing services
close to those who need and in a caring and courteous mode. The prime stakeholders of
family planning service delivery include Ministries and Departments of Population
Welfare, and Health, Social Marketing Organizations, and civil society organizations
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National Population Policy - 2010
supporting population policy goals and objectives. Main initiatives in this perspective
include:
• Evolving an integrated service delivery action plan for all stakeholders with revised
TORs of service delivery points with a view to achieve synergy
• Establishing inter-Ministerial Coordination Committee for regular review of
implementation issues and performance. Establishing a forum to bring the
stakeholders together to review programme and shared goals / objectives. Ministry of
Population Welfare to take lead role and encourage and support activities in areas
where initiatives are needed.
• Shift thrust of expansion of service delivery outlets from urban to rural and to
outreach / community based service delivery. Urban slums will also receive greater
attention to meet their service needs. In this regard, strong NGO support is essential
to this policy to provide FP/ RH services using level community resources, and
disseminating accurate information on family planning to clients. Furthermore, an
active community based distribution programme which provides services as integral
component – and probably more importantly - help legitimatize and broadly
disseminate information on family planning.
• Encouraging innovative initiatives to enhance easy access to family planning
services.
• Ensuring availability of quality family planning services and products including
emergency contraception in all public and private sector facilities.
• Expanding contraceptive choice to include fertility awareness methods including
lactational amenorrhea method (LAM) and standard days method (SDM), to improve
adoption and continuation
• Rationalizing contraceptive methods availability at all facility consistent with clients’
requirements of pregnancy spacing i.e. promoting pregnancy spacing methods
• Ministry of Health to explore all avenues to operationalize family planning activities
for birth spacing especially at service delivery points as part of the efforts to reduce
maternal and informant mortality and that such efforts to include tetanus vaccination,
antenatal and postnatal care, child immunization, etc.
o Contraceptives are included in the health essential drug list.
o Contraceptive services are provided as part of primary health care.
• NATPOW to frame its rules of business to govern its own operations as an
autonomous body and serve as a key coordinating linkage with NGOs, to help in
charting a course of action through their respective expertise, and devise a system
for regular feedback for exchange of information. With a new Board of Directors and
full-time Chief Executive Officer in place, opening up of a grants making channel
should revitalize the role of the NGOs in service delivery.
• Enhancing Public-Private Partnerships to devote more effectively to extend its out-
reach to rural areas, while deepening the efforts in the urban areas, with focus on
involving more private providers, health establishments of public and private
organizations and industrial concerns, in order to realize its full potential.
• Ministry of Population Welfare to strengthen networking with other potential
parastatal organizations, especially those with whom MOUs are already in place.
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National Population Policy - 2010
• Ensure service standards protocols are adhered to and client satisfaction monitored
• Take measures to decrease various barriers to access to family planning
• Strengthen Training Institutes to address management improvement training needs
and adopt / encourage interactive training methodologies. Quality of Service and
Client Centered trainings to become core activities.
• Assist Ministry and Departments of Health in the inclusion of care for miscarriages /
post abortion in policies, guidelines, protocols and standards for health facilities.
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National Population Policy - 2010
Human resource development to fully operationalize and maintain the system also
requires necessary attention.
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National Population Policy - 2010
into the public domain for discourse, as it relates to family planning and
healthy timing and spacing of pregnancies (HTSP). Promoting dialogue
on important population issues in all media channels
o Engaging Religious leaders as social mobilizers will be piloted and
replicated on successful outcomes. Promote use of supportive religious
material on HTSP in Friday sermons, public gatherings and counseling
o Promote male involvement in RH/FP through innovative activities
especially in rural areas
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National Population Policy - 2010
PSDP. Therefore, the oversight and coordination of these three Directorates should rest
with one independent wing chief.
Human Resource Management: Following areas will be pursued for improving human
resource management: Career planning, succession planning and posting right person
to the right job. Promotion mechanism will be improved by enhancing program
supervisors involvement in Departmental Promotion Committees. A Human Resource
Development Plan was designed in the previous Policy document but remained
unattended. HR Plan is considered a major step to increase staff efficiency and will be
developed, while provincial Departments will be guided to evolve the same. Attention will
be given to:
• Monitor the availability of management training for population personnel (government
and non-government) in the system, and the level of training of professionals serving
in the field.
• Reorganize Human Development and Skill Enhancement institutions (RTIs and
PWTIs) to use modern training methodologies and techniques
• Ensure resources to support necessary training and education.
Development Planning: To-date Programme planning remains devoid of evidence based
scientific findings. Ministry of Population Welfare will actively promote use of research
findings to evolve plans at all levels. Needed studies will be authorized to justify, expand
or close/reduce inefficient components to minimize external influences.
• Institutionalize Operational planning at all levels to instill accountability and
monitoring for timely implementation of planned activities.
• Overhaul program monitoring and supervisory system and regular performance
reviews and putting in place a result oriented mechanism at the lower tiers.
All Population Programme components will articulate their own desired results—
outcomes and outputs that best capture the intended and actual results of efforts. These
measures are then used as the basis for assessing performance. An important
consequence of RBM is to reinforce the value of partnerships. RBM shifts the focus of
the organization from outputs (number of contraceptives distributed, number of clients
contacted and recruited), to outcomes (proportion of clients contacted, contraceptive
prevalence rate, etc.) - which necessarily require a coordinated work of all components
managers. Rather putting emphasis on outcomes, it becomes imperative for the Ministry
to invest in engaging all stakeholders and building partnerships to achieve its objectives.
Furthermore, the approach adds to public sector investment efficiency and effectiveness
at all levels.
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National Population Policy - 2010
Ministry will monitor the nature and quality of ongoing population sector activities of all
stakeholders. Of particular importance is external monitoring of service delivery systems
of all provider levels to ensure service quality, and compliance with quality standards.
Programme evaluation under this policy will be a critical tool to assess the efficiency and
effectiveness of family planning and reproductive health interventions and should be
included in the design of programmes from the beginning, along with suggestions for
improved measurable indicators.
Family Planning and reproductive health services must be measured more effectively. A
list of process and outcome indicators is placed (at Annex-1) that would be used to
assess achievement of family planning and reproductive health programme at various
levels. Monitoring of these selected priority indicators on regular intervals will be
produced on provincial and district levels. These Programme level indicators will be used
for tracking progress and comparison across provinces and regions. All Programme
components will evolve their own process, output and outcome indicators to monitor
regularly. Capacity building on these aspects is important to successfully implement this
initiative.
Ministry of Population will work with Provincial Population Departments to build capacity
of field monitoring at district levels. Pilot to be initiated across all provinces focusing on
district profiling, use of this data for local decision making and performance improvement
as a guide to be replicated across all districts. Necessary resources for all field
monitoring and supervision activities must be protected and ensured. Population Welfare
Programme strategies to collect data would now include community needs assessments,
sample studies and more of client satisfaction surveys that provide independent
information, in addition to data from programme management information system. To
improve services and care two-way flow of information based on these measures is
considered essential.
The National Population Policy 2010 rests all future direction on evidence based
research and rigorous monitoring of Programme. The generation of knowledge is taken
essential element in strategies to improve service quality, enhancing programme
efficiency and encourage self criticism. Population Policy has benefited from various
researches undertaken on Pakistan in various aspects of fertility transition, reproductive
health and family planning activities. This Policy encourages examining FP/RH research
system to improve upon and strengthen capacity to establish a sound knowledge basis
for policy and practice. Limited research capacity in Pakistan calls for collaborative
research projects and strong institutional links important to build capacity and provide full
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National Population Policy - 2010
support to policy formulation. Future research areas are to focus on how fertility
transition can be achieved in shortest period with operations research needed to
enhance access and removal of misconceptions. Research on social mobilization, male
responsibility, and innovative communications, and advocacy are needed urgently to
direct programme initiatives. Translating research findings into policy options have been
a major barrier, which should be addressed on priority allowing wider audience to benefit
from opportunities. Promotion of research culture will be highly encouraged and
supported.
NIPS is entrusted with policy research covering all aspects of RH/FP and fertility
transition, population and development. NIPS will continue to spearhead data gathering,
analysis and research efforts to ensure that planners, decision makers & programmers
get up-to-date reliable estimates and more specifically analysis on the key
interrelationships between determinants of fertility transition and other critical indicators.
Evaluation of the population welfare programme components using credible independent
third party agencies is envisioned. Partnership with local and international academic
agencies will be encouraged to support demographic research in Pakistan. Research on
age dynamics and urbanization is needed to support realization of demographic dividend
in shortest time period. Operations research on barriers to contraceptive acceptance and
fertility transition is urgently needed to guide programme managers make necessary
modifications. Client satisfaction and feedback is the main stay of urgent feedback
needed by all Programme components. These are to be regularly formalized to include
all aspects of access to services and facilities.
This Policy seeks special efforts to translate research findings for policy and
programmatic support. NIPS and Planning Directorate will establish regular annual
forum to review up-to-date research done on Pakistan and translate it to support policy
change and programme improvement. The forum will bring researchers and planners at
all levels, especially the provincial and lower levels to build their interest and capacities.
Capacity building of users including emerging policy makers needs special attention
through training programmes. Higher education and studies will be encouraged to
promote frequent interaction among policy makers, academicians, researchers, and
programme managers. Promotion of demography and academic pursuits will be actively
encouraged among young professionals.
Support by three sectors is critical for realizing population sector goals. Female
education is without doubt the most important and significant contributor to achieve
fertility transition in any developing society. Neglect of female education in Pakistan over
the past did contribute to slow adoption of contraceptive methods and resultant slow
fertility transition during 1970s and 1980s. To-date the full benefits of female education
have yet to be embodied in the population sector dynamics. These include building
strong linkages between sector targets, tailoring curriculum to rising population
concerns, and use of teaching staff in promoting birth spacing agenda in the youth.
Preparing youth for marketable skills also remains to be attended to enable youth to
become productive individuals. Female employment also exhibit positive association
with fertility transition but has remained low key measure in Pakistan and not given
adequate attention as female empowerment link to support population sector goals.
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National Population Policy - 2010
Urbanization in the recent past has witnessed tremendous boost and has given shocks
to development planners in terms of meeting unprecedented pressure on services and
amenities. The projected urbanization growth over the next two decades which
encompasses massive internal migration pattern seeks innovative population
redistribution policies through building new towns and industrial parks for opportunities of
livelihood and wellbeing. Urban development policies especially the urban slums are
imperative to maintain fair distribution of youthful population and economic development
process across all urban areas besides being a way forward to protect environment and
promote sustainable development. Ministry of Population Welfare will take lead to
organize Population and Development meetings to bring population growth and
distribution centre stage of development process and help evolve effective links and
sectoral policies in education, skill enhancement, urban growth, labour and manpower,
social welfare align with changing demographic realities.
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National Population Policy - 2010
Ministry of Population/Health
FAMILY PLANNING INDICATORS Level Frequency Source
National Annual National
1- Contraceptive Prevalence Rate
Provincial Surveys or
2- Contraceptive method mix and “
Regional
3- Current and ever use of contraceptives
“ or
4- Source of availability / access
“ special
5- Distance to source
studies
6- Reasons for non-use “
7- Costs and satisfaction with methods
Provincial Annual HH
8- Unmet need for contraception
/ Survey
9- Quality of family planning services Regional /
- supply aspects: staffing, lack of supplies and choice district Bi-annual MIS
of methods, staff attitude towards clients; staff levels
explained side effects/misperceptions Special
Surveys
- demand aspects: availability, client satisfaction
Special
10- Drop out and reasons for drop out Same Yearly
HH
Surveys
Same
11- Proportion women reporting contraceptives Same Same
access at doorstep
12- Stock out of any contraceptive method at all Same Quarterly Pop. MIS
govt. facilities and NGO outlets & HMIS
13- No. of clients served with FP: No. of current
users (old and new users)
FERTILITY INDICATORS
1. Total Fertility Rate and related indicators National/ After 2 Large
Provincial years surveys
Large
2. Couples reporting no pregnancy during last 3 years National/ After 2
Provincial years surveys
3. Women reporting high risk pregnancies: National/ After 2 Large
*Pregnancy age (< 18) in last 3 years Provincial years surveys
*Pregnancy age (>=35) in last 3 years Regional
*No. of births >=3 small survey
if regional
*Space between last 2 births less than 3 years
4. Proportion reporting unwanted pregnancies (last 3 National/ After 2 Large
years) Provincial years surveys
5. Desired family size Same Same Same
6. Couples desiring no more births or desiring a birth National/ After 2 Large
after 3 years Provincial years surveys
7. Percent of households having received services National Annual or Large
from LHW in the last two months Provincial in 2 years surveys
Regional
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National Population Policy - 2010
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