The ticking population bomb

Pakistan is now the world’s fifth most populous country with a population of 207+ million, depicting a 2.4% annual growth since 1998. Seemingly, the country’s family planning approach has failed to create a serious dent in the population growth. Many blame ‘deep-rooted religious beliefs’ and cultural impediments. But apparently that’s not true.

Let’s look at other countries. India and Bangladesh have a population growth rate of 1.2% and 1.1%, respectively. But what’s happening in other Muslim countries? Iran, Malaysia and Saudi Arabia have growth rates of 1.2%, 1.5% and 2.2%, respectively. We have outpaced them all.

Let’s dig a bit deeper. Future population growth depends on fertility rates, depicting average number of children born alive to a woman during her lifetime. Pakistan’s fertility rate stands at 3.8, according to the Demographic and Health Survey 2012-13. And there is not much difference across provinces, with Punjab at 3.8 and Sindh and Khyber-Pakhtunkhwa at 3.9. Balochistan does have a higher fertility rate of 4.2 but due to small population size, it has little bearing on our national fertility rate. India and Bangladesh, on the other hand, have fertility rates of 2.4 and 2.14, respectively, whereas Iran, Malaysia and Saudi Arabia are at 1.68, 1.93 and 2.71, respectively.

Even more interestingly, if it were not because of our poor healthcare service delivery, our population growth would have been even higher. Average life expectancy in Pakistan is merely 66 years, as compared to 72 for Bangladesh, 74 for Malaysia and Saudi Arabia and 75 for Iran. If we somehow improve our life expectancy to Bangladesh’s or Iran’s level, our population growth rate would be way higher at present fertility rates.

How can fertility rates be lowered? Through increasing contraceptive prevalence rates (CPR), which depict percentage of women who are currently using at least one method of contraception. According to the last reported figures, CPR in Pakistan stands at 35% amongst married women of reproductive age, compared to an average of almost 53% for South Asia and 77% for Iran.

Data shows that 99% of ever-married women and 95% of ever-married men in Pakistan are aware of at least one modern method of family planning. While the uptake of contraceptives is definitely a challenge, the real problem is poor access.

One in every five women wants to space her next birth or stop childbearing entirely but is not using contraception, depicting a very high unmet need. Assuming that married women of reproductive age represent 16% of total population, there are 6.6 million women with unmet need out of a total 33+ million. Adding 3.3 million more using traditional contraceptive methods, we can very well understand that a large part of our failure can be attributed to non-availability of services. Even if we only focus on this segment of 10 million women with clear demand, we can easily exceed India’s CPR and significantly reduce our population growth.

A Population Council report on low modern contraceptive use in Pakistan and neighbouring countries blamed ‘supply-side factors, including poor access to services and lack of counselling and technical knowledge of unmotivated providers’ as primary reason behind low uptake of contraceptives.

Given our poor track record with family planning, there is a need to adopt out-of-the-box approaches. Punjab is the first province to realise the limitations of existing family planning service delivery and has established Punjab Population Innovation Fund to address the unmet need in rural, poor and un-served areas. Other provinces need to follow suit.

Looking at past trend, we’ll touch 450+ million by 2050 but even if we assume that our growth has slowed down to 2%, we’d still be at 400 million. A large population base with a high growth rate is a ticking bomb. It’s high time to acknowledge this.

Published in The Express Tribune, November 19^th, 2017.

Like Opinion & Editorial on Facebook, follow @ETOpEd on Twitter to receive all updates on all our daily pieces.