At 5:24 pm on September 30, 2019, Pakistan’s population was 217,641,492. It would be a few hundred thousand more by the time this article appears in print. Most countries have used population control as leverage to make economic gains. Bangladesh stands out for its stunningly successful birth control policies. Only if Pakistan had adopted similar pragmatic policies it could have 54 million fewer people today. Missed completely, here was a perfect opportunity for Pakistan to make the much-needed economic “great escape”.
All countries that made dramatic economic breakthroughs in the last 30 years managed to drastically reduce the average fertility rate — the number of children born to a woman over her lifetime. Iran drastically reduced its fertility rate from 6.53 to 1.96 in a span of 30 years. Bangladesh brought its fertility rate down from 6.92 to 2.1 since its independence, while Korea (1.21), China (1.65), Hong Kong (1.23) and Taiwan (1.1) made similar impressive reductions. Sadly, Pakistan has been firmly saddled with a very high fertility rate of 3.73 for the past four years. If not immediately addressed, this single factor could negate every effort Pakistan may make to break away from poverty, hunger, disease and illiteracy.
Bangladesh adopted a community-based approach to population planning. It was based on recruiting married, literate village women trained in basic community health and family planning going door-to-door dispensing contraceptive pills and condoms. Belonging to the local village, they had credibility among a suspicious and very religious population. Equally important was the decision to give high priority to girls’ education, which delayed marriages and gave women greater control over their lives.
In the late 1980s, Iran’s supreme leader issued fatwas (religious edicts) making birth control widely available and acceptable to conservative Muslims. He argued that the economy could no longer support a rapidly-growing population. Under the new decrees, contraceptives could be obtained for free at government clinics, including thousands of new rural health centres. Health workers promoted contraception to increase the gap between births and to reduce maternal and child mortality. Family planning counselling was made mandatory for couples intending to get married. Between 1996 and 2016, the average age of marriage for Iranian females increased from 19.8 to 23 and from 23.6 to 27.4 years for males.
Pakistan, on the other hand, could not benefit from religion as an instrument for change and action. It failed to create and implement population control policies that could integrate communities — lady health visitors, religious leaders and BHUs. There was neither easy free access to contraceptives, nor was the media utilised for mass awareness and guidance. There were no innovative incentives created for those who adhered to a two-child policy. Most importantly, it took no steps to raise the marriage age for girls to ensure 16 years of education as per the Constitution.
Every citizen needs food, water, health, education, protection, employment, housing, electricity and a clean environment to live a healthy and productive life. Pakistan’s economic and managerial resources are already bursting at the seams. We squarely failed to meet every Millennium Development Goal. Having 25 million out-of-school children, the most polio cases in the world, highest infant mortality rates, and an inability to provide clean drinking water and treating outgoing raw sewage are just a few of our many predicaments. With this alarming growth in population, it may be impossible to maintain sanity, leave aside progress.
Pakistan’s much-needed break from poverty and disease is critically dependent on its ability to bring down its fertility rate to 2.0 and educating its girls. Let there be an exclusive ministry for population control headed by the most competent ministers in the federal and provincial cabinets. Failure to implement these measures would be a sure recipe for a continued addiction to the IMF besides keeping our children vulnerable to stunted growth, crippling impacts of polio, acquiring HIV by reused syringes and remaining illiterate for never attending school.
Published in The Express Tribune, October 3rd, 2019.
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