Asma: I choose choice by ensuring it's here for the long term

MSI is made up of almost 9,000 dedicated professionals fighting for and delivering reproductive choice around the world. As part of our 2023 Annual Review, we featured stories from our healthcare providers, clients, and partners on why and how they choose choice.

Asma is the Country Director of MSS, a locally based NGO in Pakistan supported by the global MSI partnership. She reflects on what she’s seen change over the years, and the innovations in motion that are making reproductive choice more sustainable for the future.

“I can hardly believe that I started at MSI in Pakistan back in 1996! I was a volunteer then. Now, I am at the helm, leading the entire programme. That’s my way of saying that I’ve seen a lot of change in my time.

With the support of donors and the global MSI partnership, we’ve grown, reshaped, and innovated, and now we’re one of the biggest providers of sexual and reproductive healthcare in Pakistan. We’re built from the grassroots up. Our field and support teams are made up of local people who share our clients’ culture and language, which has enabled us to grow our presence and impact while shifting attitudes around contraception.

Because we’re rooted here, it also helps us think long-term. We’ve ramped up efforts to make sure reproductive choice is sustainable, so women and girls will be able to access it for generations to come.

So, how are we doing that? One way is for our clinics to generate their own funding. In 2023, we broke even in our 17 clinics, meaning they are sustaining themselves with no donor income. A huge achievement! We’re working towards the same in our 20 pharmacies that provide quality health products while generating income. All profits are channelled back into our work reaching rural and poor communities. That makes us a social business, combining the best of the commercial and non-profit worlds to create impact.

Another way that we’re looking ahead is by diversifying our services (and therefore our income streams).

Known for providing contraception, we’re evolving our ability to provide different types of healthcare for ‘every stage of woman’—from menstruation to menopause.

Governments also have an important role to play. I know many MSI country programmes are partnering with governments in their own ways to strengthen health systems. I think this is a ground-breaking shift to train and empower people, to cascade knowledge and skills outwards.

Some years ago, we invested in franchising—training healthcare providers across the nation to provide quality reproductive healthcare. In 2023, we transitioned some of them from our direct support to receive government support and quality monitoring, and domestic funding. This is a sustainable approach as we build the capacity of a local healthcare provider, and then ensure they’re in a network of national support and can continue to provide quality services in future.

I remember one of our clients living in an underserved area. She had lost her hand in an accident with a threshing machine so had a disability, was suffering from depression, and had four children to look after. Our field officer and I were visiting her community to train up a local health provider. She told us she was in constant fear of getting pregnant again, so we counselled her on her options and she quickly decided to get an IUD. In a follow-up visit, she shared how her life had transformed now that she has contraception. And I think about the fact that we’d trained her local provider who was walking distance from her home, so she wouldn’t lose access in future. That’s what sustainability is all about.

Choosing choice, for me, is about enabling future potential. I hold this mission very dear to my heart. Making sure women have access to reproductive healthcare is a big contribution to their lives and to this nation. And if we can ensure that choice is here to stay, well, that’s the legacy I want to leave.”