Pakistan is the sixth most populous country in the world, with an estimated population of 183 million. The country is in the midst of an unprecedented demographic transition making the third highest annual net addition to the global population after India and China. The high fertility rate is a major contributor to this situation since the mortality rate has been fairly stable over the years. The burning issue of population can be tackled through appropriate policy measures, enabling rapid economic growth and a demographic dividend. If the issue is not tackled with all seriousness, this tide will cause economic burdens, unemployment, consequent unrest and violence leading to political and civil conflicts.
There are many questions that need to be answered on this critical issue, which has often been politicised over religious and cultural grounds. The unsustainable population growth, reluctance in family planning and birth spacing, and fragile economic and industrial positioning are unable to stem the rising tide of population. Pakistan’s population is projected to reach a staggering 350 million by 2050, almost double its present size, which itself is not a very healthy indicator. As a nation stuck in a plethora of problems on many fronts, we can ill afford to bear such burdens. The major chunk of the population comprises of a large demographic of youth with insufficient prospects of employment — a dangerous portent for policy makers to handle.
The historical analysis of family planning and its developmental impact is not very encouraging. From the establishment of the Family Planning Association of Pakistan (1953) until the recent devolution of powers to the provinces (2010), there have been changes in policies with successive changes in government, which included a freeze on family planning during the Ziaul Haq rule. A national population programme, begun in 1955, and the population welfare programme have been part of the national five-year plans since 1960. Despite these early efforts in family planning in Pakistan, contraceptive prevalence remains low at 35 percent compared to 85 percent in China and 61 percent in Bangladesh. The fertility rate is 4.1 (3.1 urban and 4.0 rural). Following the International Conference on Population and Development (ICPD) held in Cairo in 1994, Pakistan has gradually integrated family planning with reproductive health services and has adopted a voluntary and target-free approach to family planning services.
Let us look at the probable causes for this teeming population. First of all, there is a lack of education, particularly for females regarding reproductive health. This problem is more acute in the rural areas where there is a higher fertility rate. Secondly, early marriage and the craze of having male progeny compel women to undergo successive pregnancies till a male child is born. Third comes polygamy, which is also a factor responsible for strengthening the issue while religious prejudices that birth control is against the order of nature wreak havoc with any population control ventures. Fourth are the lack of medical facilities, particularly in rural areas, and the absence of a vibrant NGO network to propagate family planning. Last but not least, there is lack of spousal communication: women are scared to initiate a discussion on family planning and related reproductive health issues, fearing repercussions from their husbands, which may be in the form of violence, social isolation and even divorce.
Such findings emphasise the need for male involvement and sensitisation towards reproductive health issues and practices. Men, especially the clerics, must be encouraged, educated and trained to talk about such issues with their spouses and then with their family doctors to instil confidence among women that their well-being is of the utmost importance.
In Pakistan, population policies have perennially focused on family planning to the exclusion of other aspects such as education, the economy or about developing a productive work force. This stems in part from the population policy being considered the purview of the population welfare ministry rather than a broader government development document. Thus health, finance, planning, education and other relevant ministries were not involved in the formulation of said policy but only invited to review the final drafts. This lack of engagement of a wider array of complementary ministries and departments such as planning, finance and education in population development suggests that the decision makers are not yet convinced of the benefits of population stabilisation or its role in growth.
Some 95 percent of human population growth is occurring in countries already struggling with poverty, illiteracy and civil unrest. In fact, developing countries are in need of approximately one trillion dollars a year in the new infrastructure so as to deal with the dramatic increases of their populations.
Pakistan’s population programme has been riddled with the problems of implementation. Our media, civil society, judiciary and politicians take scant interest in the subject unlike China and India, which use audiovisual publicity to great advantage and come up with catchy slogans like ‘Hum do hamare do’ (we two and our two) with a red triangle as the logo. In China, the one child norm is strictly enforced, violation of which results in heavy penalties.
In summation, we need to draw up an action plan to ensure the following: stepping up mass communication through messages broadcast over radio and television, with regular slots allotted, particularly late night slots. Healthcare educators should be trained and sent to community groups to explain the various methods of contraception such as condoms, contraceptive pills, intra-uterine devices, vasectomy, medical termination of pregnancy, etc. They should also disabuse the minds of the common people of the wrong belief that family planning is against religion as there is nothing in Islam that forbids it — the prejudices are the creation of clerics. Even the Vatican, after initial objection to family planning, has now accepted this. We must remove superstitions such as men losing their virility if vasectomy is done and the belief that polio vaccination is contraception in disguise.
Contraceptives must be made available at all hospitals and healthcare centres, and with NGOs working in this field; these should be heavily subsidised or even made free. Vending machines for condoms and contraceptive pills should be installed to overcome the inhibition of asking at chemist shops. Sex education should be imparted in a sensitive way to adolescents to prevent teenage pregnancies.
In order to achieve this, the federal and provincial governments need to allot much more of their budgets. The central budget for 2013-14 allocated a meagre Rs 25 billion for health out of Rs 3.5 trillion (0.9 percent), which is totally inadequate. Above all, people in general should shed their prejudices towards family planning and participate actively in the interests of the nation’s demographic health, which is the crying need of the hour.
The writer is a freelance columnist and independently conducting research on the partition of 1947. He can be reached at [email protected] and on twitter @JanjuaHaroon