Need for structural changes to lower population growth

An important sector for action is girls’ education, which exerts a potent influence on demand for family planning

Pakistan’s high population growth rate is a major impediment in the way of achieving our development goals. Although we initiated family planning (FP) programming 50 years ago, our efforts to lower our population size have yielded suboptimal results.

In many parts of the world, fertility began to decline well before the advent of FP programmes and contraceptive advancements. It resulted from a confluence of interlinked factors, including public health reforms; improving working and living conditions; improved sanitation and personal hygiene leading to lower incidence of communicable diseases and mortality; the emergence of new opportunities for upward social mobility through industrialisation; and universal education. Clearly, such structural changes must accompany FP programmes to influence fertility behaviours in favour of smaller families.

Amartya Sen points out that economic and social development is associated with smaller families (Sen 1994), and indeed, global evidence shows that if both parents are earning stable livelihoods with prospects of upward social mobility, they tend to have fewer children to enhance household savings and living standards. The government must therefore invest in a nationwide skill development programme targeting a variety of vocations to enhance employability and also encourage women through soft loans to earn livelihoods both within and outside their homes. In addition, rural uplift schemes may be considered to reduce rural poverty through such approaches as the One Village, One Product scheme adopted in Japan and Thailand that helped rural communities to manufacture unique products with a strong market appeal.

Fertility rates tend to be high in agrarian societies such as ours, where entire families earn their livelihood by contributing labour. Some Latin American countries have been able to reverse this tendency by introducing agricultural reforms, such as communal farming that allowed only one family member to work on a collective piece of land with a fixed wage. But for a lasting boost to our economy and alleviation of poverty, we must plan for diversifying our economic base to introduce value addition to our agricultural produce through industrialisation and a shift towards manufacturing.

Apart from economic measures, an important sector for action is education, especially girls’ education, which exerts a potent influence on demand for family planning. The provincial governments must ensure that Article 25A of the Constitution, which stipulates free and compulsory education, is fully enforced by providing the infrastructure for affordable education for both boys and girls. It is also important to fully implement the anti-child labour laws, because as long as it is possible for children to be employed they will remain economically lucrative to poorer families.

With a growing elderly population, old-age social security benefits must be introduced so that reliance on offspring as a retirement strategy is reduced. A national scheme similar to the Benazir Income Support Programme could be introduced to help the poorer segments of the country’s elderly population in meeting their needs.

Another important determinant of fertility decline is migration, both internal and external. Urban fertility is lower than rural fertility as urban residents have more opportunities for social inclusion and better healthcare choices. But this is true only if urbanisation is planned; unplanned rural-to-urban migration puts pressure on urban infrastructure and creates slums where high fertility persists. Proactive policies, involving both the federation and provinces, are needed to reap the benefits of sustainable urbanisation and also to actively tap international job opportunities for our surplus manpower.

Health interventions are also crucial. If out of every 1,000 births, 62 infants continue to die parents will factor in losses while planning their families. At a time when we are facing a serious economic crunch, all domestic resources, including private sector philanthropy and corporate social responsibility, must be tapped to enhance the federal Public Sector Development Programme budget to support maternal and child health initiatives. For instance, the mandate and coverage of the National Health Insurance scheme be broadened to include access to preventive care such as family planning services.

Post-devolution all the provinces have developed their respective population policies. The federation can play a facilitating role in supporting the implementation of these policies through resource allocation, legislation and regulations while remaining within the ambit of the 18^th constitutional amendment.

The objectives and processes of sustainable development and fertility decline are inextricably linked, and strategies for one cannot afford to ignore the other.

Published in The Express Tribune, October 18^th, 2018.

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