Contribution from UNFPA, the United Nations Population Fund, to the International Development Committee inquiry into UK aid to Pakistan

 

Written evidence of 16 April 2021. Submitted by Matt Jackson, Director of the UNFPA London Representation Office.

 

  1. UNFPA is the UN’s sexual and reproductive health agency. UNFPA’s mission is to deliver a world where every pregnancy is wanted, every childbirth safe and every young person’s potential is fulfilled. By 2030 UNFPA aims to achieve:

-          zero unmet need for family planning

-          zero preventable maternal deaths

-          zero gender-based violence and harmful practices such as female genital mutilation (FGM) and child marriage.

 

  1. This written input will look at:

-          the country context in Pakistan regarding women and girls and gender equality

-          the role of UK aid drawing on three UK-funded programmes in Pakistan run by UNFPA i) ‘Delivering accelerated family planning in Pakistan’, ii) ‘Generating data to advance women’s social and economic wellbeing’, and iii) the UN joint programme on ‘Empowering and protecting Pakistan’s women, girls and boys’

-          responding to the COVID-19 pandemic

-          safeguarding measures

 

Country context

 

  1. Pakistan has a population of 216 million (2019 data) and experienced a rapid population growth with over 76 million people added to its population in just the 19 years from 1998 to 2017. Pakistan’s population is expected to rise to 263 million by 2030[1] and it could become the third most populous country in the world after China and India within three decades.

 

  1. Pakistan ranks 154th out of 189 countries on both the UNDP 2019 Human Development Index and the 2019 Gender Inequality Index. According to the Gender Inequality Index, Pakistan has a maternal mortality ratio of 140 deaths per 100,000 live births and an adolescent birth rate of 38.8 (births per 1,000 girls/women aged 15-19). Moreover, Pakistan has high levels of unintended pregnancies: of an estimated nine million pregnancies in 2012, 4.2 million were unintended resulting in 2.2 million abortions, the majority of which were unsafe and contributed to approximately 6% of maternal deaths[2]. High fertility rates contribute to 9,700 maternal deaths each year[3].

 

  1. In public office, education attainment and the labour force, women are worse off than men. Only 20% of parliamentary seats are held by women, and the proportion of women with some secondary education is 27% and their participation in the labour force at 21% which is significantly lower than for men at 45% and 81% respectively[4].

 

  1. The Government of Pakistan’s “Pakistan 2025, One Nation, One Vision” prioritises economic growth and development including the goal of becoming an upper-middle-income country and improving its social indicators, which currently place it among the least developed nations. Pakistan has adopted several key international commitments to gender equality and women’s rights such as the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), International Conference on Population and Development (ICPD), and Universal Periodic Review (UPR). Despite these commitments, Pakistan’s ranking in the World Economic Forum’s Global Gender Gap Report 2021[5] remains the fourth lowest in the world (ranked 153 out of 156).

 

  1. Contributing factors to marginalisation of women include poverty, illiteracy, early marriages, high fertility rates, and cultural beliefs in expanding families. Whilst modest contraceptive uptake has seen Pakistan’s fertility rate decline from 4.2 in 2005-2010 to 3.6 in 2015-20[6], only one quarter of married women of reproductive age are using a modern method of contraception - one of the lowest regionally and globally. Seventeen percent of married women in Pakistan still have an unmet need for family planning[7]. Across South Asia, only Afghanistan has a lower rate of contraceptive prevalence.

 

  1. In broad terms, Pakistan’s family planning programme requires increased support on financing issues including budgetary inefficiencies, contraceptive availability, tackling programme management impediments and programme monitoring. There are also concerns around diluting the focus of community workers on family planning, neglect of demand generation, and increased need for advocacy to create a national sense of urgency to address population dynamics.

 

The role of UK Aid in supporting UNFPA’s result on the ground

 

  1. The Foreign, Commonwealth and Development Office (FCDO) and its predecessor the Department for International Development (DFID) have been long-term strategic and development partners for UNFPA in Pakistan. UNFPA’s mandate is aligned with the UK’s priorities on ending child marriage, advancing women and girls’ sexual and reproductive health and rights, ending gender-based violence and promoting gender equality. Given UNFPA’s complementarities and collaborative advantages also with the government at national and sub-national levels in Pakistan, significant contributions have been made to UNFPA and the FCDO’s common strategic priorities. UNFPA and FCDO’s joint support has been instrumental in generating evidence, enhancing national capacities, strengthening national systems, promoting inclusive policy advocacy and fostering legal reforms on areas of common interest.

 

  1. UK Aid directly supports three current programmes, delivered by UNFPA, in Pakistan: “Delivering Accelerated Family Planning in Pakistan”, “Generating Data to Advance Women’s Social and Economic Wellbeing” and the “UN Joint Programme: Empowering and Protecting Pakistan’s Women, Girls and Boys”. These programmes demonstrate shared UK-UNFPA priorities in partnership with the Government of Pakistan to deliver results aligned with relevant national deliverables and targeted to meet the needs of local communities. The programmes are aligned with the Sustainable Developments Goals (SDG), most closely SDG5 on gender equality and women’s empowerment and in particular SDG target 5.6 to ensure universal access to sexual and reproductive health and reproductive rights. Through collaboration with UNFPA, UK aid is directly contributing to achieving the SDGs, as well as delivering the commitments of the International Conference on Population and Development (ICPD). UK aid also supports UNFPA’s work to focus on the poorest, most vulnerable and marginalised, including minoritised groups such as people with disabilities. Given the scale of the challenge, in Pakistan and globally, it is essential that funding from donors such as the UK continues and, where possible, increases to accelerate efforts to end the unmet need for family planning, end maternal deaths, end gender-based violence and harmful practices, and to achieve the SDGs.

 

  1. Of UNFPA’s donor partners, the UK has one of the most detailed systems of bidding and reporting for aid-funded projects and programmes. Monitoring and evaluation is a key part of agreed projects with the UK, as well as being a core part of UNFPA’s own processes. Lesson-learning and sharing information from similar projects or programmes in other countries provides continuous improvements. UNFPA has over 155 country offices providing opportunities to learn lessons, scale up and share useful data. On occasion, the UK’s devolved decision-making responsibilities i.e. to individual Embassies or High Commissions, can create administrative bottlenecks at the country level that are repeated across a region. This can cause lost staff time and delays to projects on both sides as the same admin issues are worked through to reach a resolution. This is not the experience of UNFPA’s Country Office in Pakistan but has been experienced by neighbouring offices across Eastern Europe and Central Asia.

 

The Delivering Accelerated Family Planning in Pakistan Project

 

  1. The Delivering Accelerated Family Planning in Pakistan (DAFPAK) project is part of the reproductive health (RH) thematic area of the 9th UNFPA Country Programme and is aligned to the Government of Pakistan’s Vision 2025, the United Nations Sustainable Development Framework for Pakistan 2018-2022, the International Conference on Population and Development, Family Planning 2020 and the 2030 Agenda for Sustainable Development. FCDO is the sole project donor covering the timeframe of October 2017 to December 2022 for a total of £90 million. UNFPA is one of seven FCDO partners delivering this programme - the others are DKT, MSI Reproductive Choices, Population Services International (PSI), Palladium, M&C Saatchi and Integrity Research and Consulting Ltd. All implementing partners are part of the Technical Coordination Committee, chaired by the FCDO.

 

  1. UNFPA is responsible for delivering the Enabling Environment: Advocacy and Policy Development component worth £4.7 million over the five-year period. This component supports policy dialogue and development and provides technical assistance to the government and other partners to support a more conducive, coherent and supportive policy framework for family planning. For example, UNFPA supports technical working groups to develop evidence-based policies and advocates for greater domestic resource allocation to family planning.

 

  1. As a consortium programme, the FCDO will rely on official, verified data at the end evaluation to assess impact achievements. However, based on estimations at just over halfway through the project’s life, we expect results so far to be over 2,300 fewer maternal deaths, 3.1 million fewer unintended pregnancies and nearly 1 million fewer unsafe abortions due to increased family planning which has enabled women to choose how often and how many children to have, reducing complications in pregnancy and childbirth caused by poor birth spacing, unwanted pregnancy or poor maternal health. The project also delivers services and information to improve acceptance of family planning and modern contraceptives, improve access and create a more conducive environment for family planning services to continue.

 

  1. The project’s geographical coverage is broad with particular focus on the provinces of Punjab, Sindh, Khyber Pakhtunkhwa and specific districts of Baluchistan. The Programme is comprised of four components:

•         Behaviour change communication to identify and address social and cultural barriers to using modern contraceptives, and to deliver evidence-based, tailored messages through a wide range of appropriate channels

•         Service delivery working with private sector partners to improve the coverage and quality of contraceptive goods and services offered

•         Third-party validation, monitoring, research and peer review for the coordination of data reporting, validation of reported results and quality control of research activities by partners

•         Advocacy and policy development to create an enabling environment that supports policy dialogue and development, and provides technical assistance to the government and other partners to support a more conducive, coherent and supportive policy framework for family planning.

 

  1. UNFPA’s engagement and interventions in the DAFPAK project focus on creating the overarching context of policies, procedures, strategies, budgets and legal frameworks in which national and sub-national institutions and individual functions create an inclusive family planning policy, as well as providing leadership for innovation through technical assistance and facilitation of multi-sectoral collaboration. So far, this resulted in:

•         Population issues highlighting family planning and reproductive health featured for the first time in the manifestos of all the leading political parties—the Pakistan People’s Party (PPP), Pakistan Muslim League–Nawaz (PML[N]), Pakistan Tehreek-e-Insaf (PTI), and Muttahida Majlis-e-Amal (MMA) during the 2018 election campaign

•         The Supreme Court of Pakistan took note of the alarming population rate reported in the 2017 Census and made Family Planning a human rights issue. It took Suo Moto Notice on 4th July 2018 and constituted a Task Force to frame clear, specific and actionable recommendations to address matters relating to rapid population growth

•         The Council of Common Interest (CCI), the highest-level decision-making body in Pakistan, approved 8 sets of recommendations on Population and Family Planning which became a national roadmap

•         A historic National Symposium on Population and Family Planning was held on 5 December 2018 and was attended by the Chief Justice and Prime Minster of Pakistan

•         Federal and Provincial Task Forces were established to monitor the implementation of the CCI recommendations. The Federal Task Force is chaired by H.E. the President of Pakistan while provincial Task Forces are chaired by respective Chief Minsters

•         National and provincial costed action plans for the CCI recommendations were developed

•         Population and family planning were included in the national development agenda in the Prime Minister’s ‘Ehsaas’ Policy Statement on Poverty Reduction Strategy in 2019 (‘ehsaas’ being a local word for ‘compassion’ to highlight the current Government of Pakistan’s social safety and poverty alleviation programme).

•         High-level participation in the 2019 ICPD25 Nairobi Summit and a renewed and bold national commitment to ICPD agenda

•         The Senate of Pakistan passed a unanimous resolution in support of Population and Family Planning and establishment of the first ever Pakistan Parliamentary Forum on Population in 2020

•         UNFPA also provided guidance in the drafting of strategic family planning documents which guided national and provincial advocacy and programming as well as tools to track policy and programme implementation.

 

UK Funded Gender Programmes in Pakistan

 

  1. Gender-based violence against women and girls (VAWG) and child marriage is a significant public health concern in Pakistan. In addition to the impacts on the health and social and economic wellbeing of girls and women, gender-based violence (GBV) and harmful practices also carry high economic costs for societies and are an impediment to achieving the sustainable development goals, specifically SDG5.

 

  1. UNFPA took the lead in conducting the Pakistan Demographic and Health Survey (PDHS) 2017-18 in collaboration with the UK (involving UK Aid), the Punjab Commission on the Status of Women (PCSW) and the Pakistan Bureau of Statistics, with the aim of providing accurate and reliable data to inform policies, produce research, generate policy dialogue, improve public service delivery and develop interventions targeted at improving the social and economic status of women in Punjab. The results showed that 28% of women age 15-49 have experienced physical violence since age 15 and that 15% of women experienced physical violence in the 12 months preceding the survey. The percentage of women who experienced physical violence is highest in FATA (the Federally Administered Tribal Areas) at 56%, followed by Balochistan (48%) and Khyber Pakhtunkhwa (43%). The percentage of women who have experienced spousal physical, sexual or emotional violence is highest in FATA (66%), followed by Khyber Pakhtunkhwa (52%) and Balochistan (49%). 

 

Generating Data to Advance Women’s Social and Economic Wellbeing

 

  1. This project focused on increasing the economic empowerment of women and decreasing women and girls’ vulnerability to various forms of discrimination and exclusion. Outcomes included enhanced awareness among key stakeholders and increased evidence-based interventions that promoted women’s economic and social wellbeing and empowerment in Punjab and at national level. The project ran from August 2015 to December 2018 covering the provinces of Punjab and Khyber Pakhtunkhwa, with UK support over this period totalling £3.8 million (GBP). Results included:

•         the development of standardised indicators on the economic and social wellbeing of women with provincially representative baseline data on these indicators available for Punjab

•         the development of evidence-based model interventions through piloting and testing for scaling up and replication by Punjab and other provincial governments

•         young women and communities were made aware of their economic and social rights and supported by their male peers

•         strengthened institutional capacity of the Khyber Pakhtunkhwa Commission on the Status of Women to advance women and girls' rights through multi-sectoral coordination mechanisms

•         strengthened GBV prevention and response within Public Health and Social Services, enhancing the skills of health professionals and service providers and rolling out the pilot implementation of National GBV & Health Protocols aligned with WHO clinical guidelines and the Essential Services Package (ESP).

 

  1. In particular, the survey generated reliable statistics on the prevalence and incidence of VAWG in the Punjab province of Pakistan accounting for over 50% of the country’s population. This data is now being used to inform policies and programmes on VAWG and women’s empowerment in Punjab, as well as to tackle gender disparities and support strengthening of response systems across both target provinces. In addition to its primary objectives, this FCDO-supported initiative allowed UNFPA to train and strengthen the capacity of Pakistan’s institutions to collect data against VAWG indicators and resulted in an increased understanding, appetite and receptivity for data on VAWG amongst parliamentarians, policy makers and government departments. The Survey included a module on Violence against Women, which supported the generation of data at district level for the first time. The Khyber Pakhtunkhwa Commission on the Status of Women’s five-year strategic plan was created with support from the project, and district committees were trained on issues such as GBV and sexual and reproductive health. GBV protocols and a clinical handbook for the health sector’s response to GBV were also endorsed as part of training for health care providers.

 

UN Joint Programme: “Empowering and Protecting Pakistan’s Women, Girls and Boys”

 

  1. The ‘Empowering and Protecting Pakistan’s Women, Girls’ and Boys’ project works with Pakistani society and government institutions to support raising the voices of, and choices for, women, girls, boys, youth, religious minorities and other marginalised groups to protect them from exploitation and prevent discrimination and intolerance at all levels. The project runs from January 2018 to March 2024 and aims to strengthen government institutions with effective policies and action plans for the protection of women and girls’ rights; prevent and respond to gender-based violence and end child marriage. UNFPA leads on the coordination and governance module and implements the programme on Essential Service Package for women and girls alongside UNICEF, WHO, UN Women and UNODC. The programme is solely funded by UK Aid with a budget of £17.2 million, of which £6.48million is allocated to UNFPA’s areas of responsibility. The project covers the provinces of Punjab, Khyber Pakhtunkhwa and is also at the Federal level.

 

  1. Results delivered so far include new legislation, policies and action plans at federal and provincial levels to support the protection of women and girls' rights, to prevent and respond to incidences of gender-based violence and to end child marriage. In particular:

•         a roadmap for the implementation of the Protection Against Harassment of Women at the Workplace Act 2010 was developed and is now being implemented in collaboration with the Ombudspersons office and other government departments. Members of the government department inquiry committees have also been trained on the implementation phase

•         a roadmap for the implementation of the Criminal Law Amendment related to sexual violence including rape was developed in collaboration with Pakistan’s Ministry of Law and Justice

•         support was provided for the strengthening of the Commission on the Status of Women at federal and provincial level, enabling the Commission to effectively fulfil their mandate to advance gender equality and women and girls’ rights

•         support was provided to the Government (the National Assembly, the Ministry of Human Rights, and the Women Parliamentary Caucus) and civil society partners in developing legislation to address GBV and reproductive rights for persons with disabilities

•         a Memorandum of Understanding was developed between UNFPA and Pakistan’s Ministry of Law and Justice to combat sexual violence and establish justice and legal redress mechanisms

•         UNFPA conducted a political and economic analysis of child marriage in Khyber Pakhtunkhwa and Punjab which was well-received by key stakeholders and parliamentarians. In addition to providing information, UNFPA’s interventions on ending child marriage are being used to support policy work at the provincial and national levels in collaboration with government departments and parliamentarians.

•         UNFPA supported the Government of Punjab to effectively manage their Gender Management Information System (GMIS) which is an administrative data set widely used by the departments responsible for gender policy and programming. 

 

Responding to the challenge of COVID-19 in Pakistan

 

  1. UNFPA is playing a leading role in the global response to the COVID-19 pandemic. For further details, see UNFPA’s written input to the International Development’s Committee inquiry into “Humanitarian crises monitoring: coronavirus in developing countries” of 17 April 2020, 8 May 2020, and 30 October 2020. UNFPA’s contribution to Pakistan’s response to the COVID-19 pandemic has primarily been through repurposing DAFPAK project resources (as agreed with the FCDO) and repurposing UNFPA core resources. UNFPA worked with Pakistan’s Ministry of Health and National Disaster Management Authority to ensure the continuity of family planning and reproductive health services. UNFPA also contributed to:

•         the development of standard public awareness messages disseminated through social media, FM radios and TV in regional languages

•         training of health workers including doctors, nurses and midwives across Pakistan in infection prevention and control, and personal protection

•         the provision of personal protection equipment (PPE) and hygiene kits to health workers across Pakistan

•         the development of standard operating procedures (SoPs) and business continuity plans to be used during COVID-19 response and similar emergencies

•         the establishment of a national helpline on maternal health and family planning in collaboration with the Pakistan Society of Obstetricians and gynaecologists

•         a GBV strategy to build on stakeholders’ complementarities and collaborative advantages as a guiding framework to ensure the effectiveness of interventions

•         tele-psychosocial support (a ‘by distance’ service) and GBV referral services in collaboration with State-led helplines and civil society partners resulting in over 55,000 individuals reached via social and electronic media with information, and over 19,000 people receiving referral support via local partners Rozan and Punjab Helpline, with a focus on reaching women and girls with disabilities

•         the formation of GBV multisectoral prevention and response mechanisms in Khyber Pakhtunkhwa province

•         strengthening the health sector’s response to GBV through readiness assessments of health facilities in Khyber Pakhtunkhwa and Punjab and training courses for care providers on GBV protocols using a specially developed clinical handbook

•         the expansion of a safety app for women in partnership with the Punjab Safe City Authority to include a panic button and chat option without triggering risk from the perpetrator even when confined in the same home.

 

Safeguarding measures

 

  1. UNFPA ensures that any potential partner is aware that sexual exploitation and abuse are strictly prohibited. Agreements with partners include a policy of “zero tolerance” and that the implementing partner, its employees, agents or other persons engaged to perform services under a UNFPA Funding Agreement shall not engage in any form of sexual exploitation and abuse, including strongly discouraging sexual relationships between employees, agents or other persons engaged by the implementing partner and beneficiaries of assistance, since they are based on inherently unequal power dynamics, and undermine the credibility and integrity of the work of UNFPA. Agreements also outline the terms and measures of prevention, reporting of allegations to UNFPA and investigation procedures. These measures are backed up by due diligence, training on preventing sexual exploitation and abuse (PSEA). 

 

  1. In addition to these systems, in July 2020 UNFPA introduced the United Nations Protocol on Allegations of Sexual Exploitation and Abuse Involving Implementing Partners Assessment Process and Technical Guidance. According to the protocol, partners are assessed and scored based on a set of eight core standards integrated into the selection process and reference check stage.

 

[1] Human Development Index, 2020, Table 7 Population Trends http://hdr.undp.org/en/content/human-development-index-hdi

[2]              Pakistan Demographic and Health Survey 2006-07, National Institute of Population Studies

[3] Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2015

[4] Gender Inequality Index 2020 http://hdr.undp.org/en/content/gender-inequality-index-gii

[5] World Economic Forum’s Global Gender Gap Report 2021 https://www.weforum.org/reports/global-gender-gap-report-2021

[6] Human Development Index, 2020, Table 7 Population Trends http://hdr.undp.org/en/content/human-development-index-hdi

[7] Pakistan Demographic and Health Survey 2017-18 https://dhsprogram.com/pubs/pdf/FR354/FR354.pdf