MANSEHRA: A group of female villagers gathered in a village here to seek remedies for their psychosocial and obstetric concerns.

Some of them recalled their past as young brides, sharing experiences of enduring social and cultural taboos.

One of them found herself trapped in the `clutches of ghosts` and still suffers from the trauma, even after marriage.

`Before my wedding, I suffered from fits and was believed to be possessed by spirits. My family as the rest of the villagers thought marriage would be the best solution, so they arranged it,` she said. She added that she had three children, but one of them was seriously ill, and her daughter passed away.

Another woman looking so young of her appearance claimed she was a child bride, and her suffering still haunts her to this day.

`I was married off in my childhood, conceived a baby, but lost her due to a miscarriage caused by complications in my body due to my minor age,` she said.

The counselling session took place in Shahlia village where a psychologist helped heal women`s wounds under the Khyber Pakhtunkhwa government`s Adolescent Sexual and Reproductive Health Initiative.

The programme, which included pre-and post-marriage counselling, psychological support for genderbased violence survivors and family planning services, was rolled out in 10 of the province`s 38 districts in 2021.

`This programme is designed forour youth under the Reproductive Health Act, 2020. It educates them on reproductive health and aims to prevent early or forced marriages in accordance with this legislation, said Dr Lubna Safeer, the district coordinator of ASRH programme.

She added that the programme was providing pre-marriage counseling and training to help eliminate gender-based violence in the communities across the district.

The population welfare department runs family welfare centres, mobile service units, and reproductive health service centres, but much more needs to be done to ensure reproductive healthcare and counselling services for young people and married couples.District population welfare officer Saifur Rehman said that according to the 2023 census, Mansehra has a population of 1,796,000 individuals and consists of 194 village and neighbourhood councils.

`We have currently provided family planning and reproductive health services in only 40 of these village and neighbourhood councils as we cover only 20 % of the population, the remaining still facing unmet needs,` he said.

He emphasized that with increased financial resources, they could extendtheirservices andhelp reduce the current population growth in the district.

Khyber Pakhtunkhwa, with a population of 40.85 million, passedthe Reproductive Healthcare Rights Act 2020 to control its soaring population, particularly in rural areas ofthe province.

This legislation grants married couples the right to freely and responsibly decide the number, birth spacing, and timing of their offspring.

The province has a total fertility rate of four births per woman and a Contraceptive Prevalence Rate of 32.6%.

The Act also gives women the right to decide whether to conceive, abort within a stipulated period, or adopt birth spacing or contraception. Despite this, deep-rooted cultural beliefs, societal barriers, and a lack of awareness about reproduc-tive rights continue to hinder efforts to controlthe birthrate.

Dr Khizar Nayab, the Population Welfare Department`s medical officer at King Abdullah Teaching Hospital said they provided various contraceptive methods, including injectables, pills, intrauterine devices, and implants, but the country`s population continued to grow at an alarming rate. `Social taboos, religious misconceptions, and other barriers hinder our efforts. Many couples do not use contraceptive methods due to these misconceptions,` she said.

The Lady Health Worker (LHW) programme works alongside the Population Welfare Department to address the issue ofoverpopulation and reduce maternal and infant mortality rates.

Dr Nasir Rabbi the District Coordinator of the LHW programme said that lady health workers conduct door-to-door visits, organising sessions to educate women about diseases, pregnancy, andgeneralhealth.

`Despite our efforts, LHWs currently cover only 60% of the district. If we receive more resources, we could extend our reach and further reduce maternal and infant mortality rates,` he said.

Dr Nasir said that LHWs were providing pre-and postnatal care, offeringguidance and ensuringthat women follow safe health practices.

They also encourage deliveries to take place in healthcare facilities rather than with untrained birth attendants.

Religious misconceptions have contributed to the rapid population growth in Pakistan. With a population of approximately 241.49 million, a total fertility rate of 3.6 births per woman, and a low contraceptive prevalence rate of 34 per cent, Pakistan is the fifth most populous country in the world.

`Birth spacing can be permanently adopted by a woman inaccordance with Shariah if the pregnancy poses a serious risk to her health,` Maulana Saeed Abdullah, Principal of Usmania Madressah said.

He said that Islamic Shariah permits temporary family planning when a mother is suffering from health issues, if a couple was traveling abroad for a long period and if a woman was breastfeeding her baby.

The UNFPA`s State of World Population (SWOP) 2023 report sheds light on crucial trends and challenges in population dynamics in the country. It reveals that Pakistan stands among eight countries projected to contribute to half of global population growth by 2050.

Dr Rabail, head of Mansehra`s population welfare centres, said that the situation projected in the report was alarming as it estimated that Pakistan`s population will surpass 400 million by 2050.

`This poses serious threats to sustainable development, social security, and public services. We (Pakistan) must invest more in reproductive health, family planning, and women`s empowerment while making data-driven decisions for sustainable development goals,` she said.

Dr Rabail said that the report presented challenges and opportunities for Pakistan, which currently has a general fertility rate of 3.3 births per woman.

`Illiteracy, particularly among women, child marriages, deeprooted religious misconceptions, outdated cultural norms, patriarchy, gender inequality and a lack of reproductive rights significantly contribute to the country`s high birth rate,` she said.

She said with a rapidly growing population, Pakistan faces significant socio-economic challenges and addressing these issues was crucial to overcoming poverty, inflation and economic disparities preventing the nation from sliding into economic turmoil.