THE mere mention of Pakistan’s population triggers off reactions such as ‘our major problem’, ‘looming disaster’ and ‘our most serious challenge’. A more rational response is that with a population of at least 190 million (pending the postponed census) and limited resources, rapid population growth is a matter of running on a treadmill towards disaster.
While even a poor person on the street would tell you that life has changed due to a rapid increase in abadi, there is no commensurate visible priority given to the population sector or to demographic issues by powerful lobbies in government or the private sector. Programmes and policies to tackle not a macro-level problem, but one posing a huge burden of distress to families, in particular the poor, are virtually absent. The neglect is costing us dearly, in terms of lives lost, development gains, and the sheer growth of the numbers of uneducated, unskilled, under-resourced poor Pakistanis being added in millions each year.
Among the longish list of the woes facing Pakistan, this is one that we have brought upon ourselves! There seems to be no recognition of the problem, therefore no show of commitment of political will to take a strong position on a huge development issue that most other nations decided on decades ago. Unlike Bangladesh, a model success story, population has never been declared a national priority by Pakistan after separation.
Why is Pakistan decades behind its South Asian neighbours and the community of Muslim nations, with which it proudly identifies, in its fertility transition? Paradoxically, the key reason why Pakistan is lagging behind most regional and Muslim countries in its reproductive health indicators has been wavering political commitment and lack of sustained support by successive governments.
The political will to implement must precede policies. The latest demonstration is Iran which has managed to orchestrate the fastest decline in the modern century. With the religious leadership, intellectuals and policymakers totally on the same page on this issue they have realised the collective good of their decisions. Even Saudi Arabia, a country less concerned with resources, has a fertility rate of one child less than does Pakistan.
In Pakistan, population issues have been pushed into the background. Apart from customary statements on World Population Day, there has not been any unequivocal position or commitment or concrete plan of action. Year after year, not unlike the awful curse of growing terrorism, one political leadership after another slips from our hands, and we continue to add to the population momentum which will continue for many years to come. This is despite our work with political parties prior to the 2013 elections when they all showed their support in a widely aired Geo TV debate.
While a minority of policymakers privately agree that this should be a priority, they say that hesitation stems from a variety of reasons. Political governments are fearful of a backlash from the religious right. Were other Muslim countries not afraid of such a backlash? If the underlying fear is of a religious backlash from clerics, the government would be pleasantly surprised to learn that religious leaders may be ahead of them in recognising this as a priority area which has their blessings and full endorsement. Perhaps the most significant achievement of UNFPA support has been the endorsement by the religious leadership of the permissibility of birth spacing in Islam as a means of ensuring mother, child and family health and wellbeing.
Contrary to popular perception, religious leaders are not averse to birth spacing.
The majority of leaders of the leading religious schools of thought have offered their services in this regard. What they do support is the promotion of appropriate birth spacing for mothers’ and children’s health, and reversible contraceptive methods.
There is also a widespread belief that the main electorate is not interested in practising family planning and hence bringing up the issue will erode the political base. This is the basic fault line and disconnect with reality. It is based largely on the outlook of the ’70s and ’80s when the majority wanted more children. No longer is this true. Fertility preferences have changed and the majority of men and women are keen to invest in better education and the health of their children. The poor have as many as two unwanted and mistimed pregnancies, quite at odds with the common belief that they ‘prefer to have more children’.
They also realise that severe economic hardships prevent them from investing in a large family. In fact, the lack of family planning services, which should be an essential part of primary healthcare, is a fundamental denial of the rights of several million women who resort to induced abortions in unsafe conditions.
On World Population Day 2015 that is being observed today, there should be no hesitation in taking a firm stand on this important human rights issue. We should honour our national and international commitments and issue a strong policy statement about population. This should be coupled with the implementation of accelerated family planning programmes in the provinces. At the London FP 2012 Summit, Pakistan pledged to raise its contraceptive prevalence rate to 55pc and to ensure universal coverage of family planning services by 2020. The provinces are ready to take up their responsibilities and have set FP2020 goals based on their own ground realities.
About seven million women with unmet need will get their right to opt for family health and Pakistan’s poor will definitely have relief from the endless burden of crushing expenses and illnesses associated with frequent and closely spaced pregnancies. The numerous benefits include saving the lives of thousands of mothers and hundreds of thousands of infants and children, not to mention multiple other economic and social development benefits.
Reproductive health services in the public and private health sector lie untapped, underutilised and unaccounted for, because of weak indication, or the virtual absence of any sign, from those in charge that these services are a priority. A major show of cross party, cross religious lines, cross provincial support will change the destiny of this country.
The writer is a demographer who is country director of the Population Council in Pakistan.
The Population Disconnect | Zeba Sathar
Published in Dawn, July 11th, 2015