Rawat, Pakistan—Sitting in a room full of female health care providers during a refresher training on post-pregnancy family planning, in Islamabad, Pakistan, Tabassam un Nisa, 42 years old, looks back at all the challenges she had to overcome to be the health care provider she is today.
The biggest challenge was not being able to conceive a child. “Sometimes they would call me “baanjh” (infertile) and other times they would make fun of me not being able to conceive despite going to expensive hospitals,” recalls Tabassam, welling up as those memories come back. But she did not let these challenges break her. Instead, she channeled those emotions towards building herself up, so today she can guide other women, making sure they don’t overlook an ovarian cyst, as she did, or other health issues.
Tabassam has made it her life’s mission to support women in their journey, spread awareness about family planning, and educate couples on topics she wished she had known when she was struggling in the early years of her marriage. “In this community of Rawat, the population has an alarming number of uneducated families, especially women,” says Tabassam. “The lack of awareness, opportunities and facilities, coupled with exploding population numbers makes family planning counseling the most important and urgent priority. On average, a family has 11 to 15 children.”
Despite a master’s degree in history, Tabassam felt her calling was to help change the situation for women in the community she served. So she decided to switch her career to health. In 2007, she undertook a rigorous two-year training program on family planning (FP) services, antenatal and postnatal care, adolescent health, general medicine, data management and other subjects at the Regional Training Institute in Islamabad. She then applied for the position of family welfare worker, passed the exam, and was appointed to the role in Rawat. Tabassam became the first woman in her family to hold a job.
Now Tabassam travels more than 30 kilometers a day from her home in Gujar Khan to the health care center in Rawat, approximately an hour’s commute. Despite the long and challenging ride, she reaches the center at 8 a.m. sharp to be present and ready for her patients. To Tabassam, her patients are her top priority. As a health care provider, she offers counseling and FP services, including postpartum FP, and referrals to those who need it.
To support the Federal Government’s efforts to increase the use of FP, Jhpiego, a Johns Hopkins University affiliate, has been developing an integrated model of FP services, counseling and primary health care under a UNFPA-funded program. “Health care providers, such as Tabassam, play a vital role in implementing FP services at the ground level,” says Dr. Aminah Khan, Country Director at Jhpiego Pakistan. “Our trainings cover the areas of family planning and postpartum family planning along with infection prevention, interpersonal communication skills and waste management.”
According to the most recent Pakistan Demographic and Health Survey, modern contraceptive use in Islamabad Capital Territory declined—from 44% in 2012–13 to 35% in 2017–18. And the unmet need for FP increased from 12% in 2012–13 to 17% in 2017–18. In response, the Government of Pakistan is working to improve use of FP in underserved peri-urban areas of Islamabad as part of the Costed Implementation Plan under FP2030 commitments and other recommendations.
In Tabassam’s facility in Rawat, which is led by a doctor, she runs a successful FP unit, offering services with compassion, dedication and empathy. In the past quarter alone—June–August 2024, she received 634 FP clients. Her team also includes two family welfare assistants and a social mobilizer.
Tabassam’s success has involved multiple trainings to learn and sometimes even unlearn traditional and outdated approaches. In this part of her journey, Jhpiego stepped in as a trusted partner, offering various training opportunities.
At the refresher training that Tabassam is participating in now, she learned how to interact with clients. “Having a conversation with women who do not have enough information and are convinced on conventional myths is something I found very challenging,” she says. “Today I learned how to council rather than convince, a complete game changer in terms of approach.”
Pakistan is following an integrated approach in its health care facilities. “Primary health care units mainly handle antenatal and postnatal cases,” says Dr. Zaeem Zia, District Health Officer for Islamabad. “Our approach is to introduce postpartum family planning to families immediately after delivery. This immediate connection allows us to engage with families at the facility where they gave birth, rather than relying on them to return at a later date, which they may not do, especially if another pregnancy occurs.” By integrating FP service into antenatal care, the government aims to address unmet needs all in one place. Since very few women return for follow-up after delivery, this is the optimal time to engage them and improve the contraceptive prevalence rate—the percentage of women using contraceptives.
Jhpiego, under the UNFPA program, has been working with health care centers like Tabassam’s to integrate sexual and reproductive health and FP services with primary health care in Islamabad Capital Territory. This initiative, launched in 2020, is addressing unmet needs in underserved areas and aligns with the Federal Government’s directive to prioritize FP across 18 public health facilities. In 2024, the integration model has trained over 100 health care providers and supported the facility in Rawat and an additional three facilities in sexual and reproductive health and FP services across Islamabad and Gilgit Baltistan.
“Empowering health care providers with the skills and knowledge to deliver quality maternal and newborn care is crucial to saving the lives of mothers and newborns,” says Dr. Luay Shabaneh, Country Representative for UNFPA Pakistan. “At UNFPA, we are committed to equipping these frontline professionals with the training and resources they need to deliver quality care. By investing in our health care workforce, we are not only addressing immediate health needs but also paving the way for a healthier and more equitable future for women and girls in Pakistan.” As Tabassam returns from her training to her center with renewed confidence and expertise, she stands as a symbol of how dedicated individuals and supportive programs can transform challenges into opportunities for growth and impact.
Areej Javed is Communications Specialist in Jhpiego’s Pakistan office, based in Islamabad.
