Once the national census results are released, we’ll know how many people live in the country. By 2050 the population will rise substantially from whatever figure it currently stands at. If “demography is destiny,” what does the future hold for us? Will we become an overpopulated, poverty-stricken, ignorant and bigoted nation, clinging to its medieval traditions, or modern, educated and progressive?
The choice is in our hands —or rather, in the hands of our policymakers. Just before the Panamagate scandal, this nation was, according to financial experts, on the threshold of an economic upswing, draining IMF loans over and the worst finally behind us. Greater provincial autonomy with the 18th amendment introduced new strategies and plans, including for social sector development and population planning.
The positives: Pakistan’s largest-ever cohort of enthusiastic, energetic adolescents could be a major plus.
The downside: an unplanned, rapidly increasing population — with a growth rate that could nullify economic progress, further shrink education opportunities and give rise to increasing hunger and malnutrition. In short, it would force the country into a strait-jacket of poverty and make it untenable for its people. Much of which is already a reality.
According to Dr Jilani, a well-known senior population scholar, after all these years, unbridled population increase is the major impediment to economic and social progress. “It is a painful realisation, that Pakistan is badly left behind in efforts to control population growth, strong resolve, political will and consistency,” he adds.
Demographer Dr Farid Midhet worries about the nexus between poverty, inequality and population growth. “Unless there’s greater investment in adolescents, they could well become a threat to the very existence of the nation… the energies of a youthful population may become directed towards undesirable activities,” says Dr Midhet.
Pakistan’s per woman fertility rates still exceed those of its South Asian neighbours. Each woman has an average of four children — when she would happily prefer three. That extra child per family comes at a huge cost of unsatisfactory access to family planning, contraceptive failures and decision-making not by the woman herself but by others in the family. Millions of women lose their lives during childbirth, while others lose their infants — Pakistan has the region’s highest infant mortality rate.
Contraceptive prevalence continues to remain low due to unavailability or inaccessibility of family planning centres, especially in far-flung rural areas. The Contraceptive Prevalence Rate (CPR) at 35 per cent has been virtually static for many years.
There’s also high son preference, which tempts countless couples to continue birthing children till a boy arrives. Every new baby added to an average-size household increases the population living below poverty line by about 10 per cent. Untrammeled population growth reduces food availability per person and renders the country less food secure.
The Family Planning (FP) conundrum is complex. Woman’s position within the family and her autonomy remain weak, even for decisions concerning their own bodies and personal lives. Their decisions frequently face resistance from family, community or society. Often, women lack knowledge about and access to FP services. At other times, there is fear of side effects, leading to contraceptive failure.
Given that at least 25 per cent women wish to either delay pregnancy or end childbearing altogether but are unable to indicate that, there is need for greater communication, understanding and involvement of decision-maker husbands, and/or mothers-in-law. The spousal age gap is also high. Women are generally seven to 10 years younger than their husbands.
Far too many women are still married before age 20. Child marriage still accounts for about 15 per cent of all marriages, leading to an extended reproductive life span.
There is urgent need for strong implementation of the recently updated and passed Child Marriage Restraint Act, 2016. The Sindh Assembly unanimously passed this bill, the only province to equalise age at marriage for both women and men.
The vacuum left by inadequate contraception is filled with tragedies, mostly avoidable. Eighty women die silent, painful deaths each day because of preventable complications during pregnancy. Countless women survive childbirth with painful rectal or vaginal fistulae, with tragically few treatment facilities. Or they face chronic illness or death due to unsafe abortions. For every mother who dies, numerous children are left orphaned.
Where does the problem lie? In insufficient accessibility and availability of family planning facilities? Women’s and couples’ inability or reluctance to use family planning? Fundamentalist beliefs? Or overwhelming influence of patriarchy and male decision-making?
Probably the answers lie in a mix of all these. A gynaecologist observed: “The medical curriculum itself does not give sufficient importance to family planning; consequently, practising gynaecologists and other doctors rarely stress the significance of contraception to their patients.”
Many consider FP opposed to Islam — an observation confirmed by a recent study titled Fundamentalist Discourses on Family Planning Practices in Pakistan. It quotes anecdotal evidence of local mosque clerics castigating all forms of birth control. Further, some politico-religious parties have stoked the controversies for political ends.
Unfortunately, there is little expression of strong will in political party manifestos. Leading political parties all mention the need to reduce the population growth to 1.5 per cent per annum and promote nutritional, child and maternal health. The PML-N also aims to increase CPR from 35 to 55 per cent by 2020, but few concrete measures have been suggested to reach this target. The JUI makes no mention of the need for population control.
For family planning to succeed from the privacy of the bedroom to the public domain, spousal communication is all-important, as women’s position in our culture, family and homes. All these facets affect the decision to have or not have a baby.
Studies have shown that low spousal communication is an ever-present problem even amongst educated couples. Women have little say about family size. Decisions about the number of children a couple should have, maternal health or child spacing, aren’t often discussed. Unequal gender norms continue to hinder overall progress.
Population planning is decisively linked to the country’s economy and overall development. It’s not only a matter of reducing fertility, equally important is the need to concomitantly address other development issues. Only by incorporating them all can a cohesive, sustainable population planning programme succeed.
The strategies for moving towards the UN’s Sustainable Development Goals (SDGs) could lead to lower fertility, reduced maternal and child mortality — and improved food security, better educational opportunities and healthier families. Gender equality and women’s greater empowerment will further contribute to the achievement of 75 per cent of the post-2015 SDGs’ agenda.
Sindh has recently launched an ambitious programme to increase the current contraceptive prevalence rate from 29.5 per cent to 41 per cent by 2020. “Population is a tremendous dynamic resource, and it becomes valuable when it is healthy, educated, well-informed and productive and contributes to prosperity,” states Dr Tauseef Ahmed, consultant to Sindh’s FP2020 programme.
Published in The Express Tribune, July 11th, 2017.