The FALAH project increased use of family planning and birth spacing services by removing barriers and expanding knowledge to protect the health of women and children.
Brief intervals between births and next pregnancies are associated with higher childhood mortality, premature births, low birth weight, stillbirths, miscarriages, and increased maternal morbidity and mortality. Yet many women in Pakistan lack access to family planning education and services that would allow them to space their pregnancies and safeguard their health and the health of their babies.
Through the Family Advancement for Life and Health (FALAH) initiative, the Population Council worked with health and population welfare departments of the Pakistani government, religious leaders, and rural communities in more than 20 rural, socially conservative districts to promote birth spacing as an acceptable health intervention to protect the lives of women and infants.
From June 2007 to March 2012, FALAH worked to increase adoption of World Health Organization–recommended birth spacing practices according to the Healthy Timing and Spacing of Pregnancies guidelines (a minimum interval of 24 months from birth to next pregnancy). Because the views and opinions of religious leaders and scholars are critical in shaping public opinion, FALAH sought to educate and inform them on the need for more effective family planning interventions to help mitigate perceived religious opposition.
Efforts to increase religious and community leader support for birth spacing included consensus-building meetings with religious scholars to solicit their views and involvement in promoting birth spacing; coordinating television interviews with prominent stakeholders; and arranging visits to Islamic countries to observe advocacy programs with religious leaders and discuss how they can be applied in Pakistan.
FALAH improved knowledge about the benefits of birth spacing; raised awareness of risks associated with closely-spaced pregnancies and pregnancies too early or late in a woman’s life; expanded knowledge of contraceptive options; and improved access to quality care in the public and private sectors. FALAH achieved these goals by building capacity among healthcare providers, encouraging the adoption of new methods (e.g., Emergency Contraceptive Pills, the Standard Days Method), and supporting the commercial sector in marketing and distribution of contraceptives.
FALAH increased contraceptive use by 8% in just four years. Unmet need for birth spacing fell from 14.2% to 10.8% over the same period. Through group meetings with trained educators and free consultations at mobile clinics, more than half a million people received family planning services. Messages raised awareness of birth spacing benefits and brought about attitudinal and behavior change. FALAH sensitized over 1,500 district-level religious leaders, who became proactive advocates of birth spacing.
FALAH mobilized a movement away from the traditional family planning concept of promoting small families, to a new concept that encourages birth spacing as a way to improve maternal and newborn health. This helped remove religious and cultural barriers to family planning and garnered acceptance from the Pakistani government, policymakers, and general population. As a result, the Prime Minister of Pakistan recommended that birth spacing services should be mandatory at health facilities nationwide.
As a result of continued advocacy, the Department of Health recognized the connection between reduced fertility and positive health outcomes. Around 35,000 public healthcare professionals and service providers from the public and private sectors were trained in offering client-centered family planning services. With increased availability of contraceptives and more trained staff, district-level health systems began to offer birth spacing services. Continued priorities include supporting the delivery of family planning services through the healthcare sector, strengthening advocacy programs, and exploring strategies to link services with community mobilization activities.
- 50 million people heard FALAH's mass media messages on the benefits of birth spacing
- Religious scholars from all major religious schools endorsed the concept of birth spacing as a means of improving family well-being
- Contraceptive acceptance is higher among husbands who attended FALAH’s interactive theaters or heard birth spacing massages via FALAH’s radio programs.
- An 8.5% increase in contraceptive use in the FALAH districts, signifying more than a 2% increase in users a year
- Contraceptive acceptance has been highest among poor, rural, and younger couples.
Client-Centered Services for Better Health
- More than 35,000 health care personnel from both the public and private sectors have been trained to provide client-centered reproductive health services
- Lady Health Workers’ visitation rate and family planning clientele increased considerably
- Staff of 70% of Rural Health Centers/Basic Health Units of the Health Department are now providing birth spacing services
- Client-centered services by trained providers have led to fewer side effects being reported by clients and greater contraceptive continuation rates.