In Rawalpindi’s teeming Dhoke Khabba neighbourhood, where Jamila* lives with her husband and three children, it is difficult to walk through any two streets during the summer holiday months without noticing at least two dozen children, their ages anywhere between two and twelve.
The area has two family welfare centres, located within a mile of each other, and it was one of these centres that Jamila and her husband visited once they felt their household finances could not put up with a fourth pregnancy.
“We thought, where would we get the money to support another baby?” Jamila said. “We are already struggling to pay for the education of our children.”
Conversations with population welfare officials, family welfare workers and population management advocates reveal that even if it is after having a few children, many couples in Pakistan’s urban areas, like Jamila and her husband, have increasingly started to opt for family planning.
And yet, at a 1.9% annual growth rate, Pakistan’s population could touch the 300-million mark by 2050, putting a tremendous strain on our cities and resources. “At the macro level, the socioeconomic fabric of society will be affected, and already dwindling resources will be stretched to breaking point,” a February 2013 population policy brief prepared by the Population Council Pakistan, an international NGO, stated. “At the micro level, the well-being of the ordinary Pakistani family is at stake.”
Population welfare officials say the rationale for population management is intuitive: smaller families will use fewer resources, spend less on education and health and be “khush-haal,” as the age-old family planning slogan goes. Pakistan’s per capita Gross Domestic Product (GDP), currently around $1,380, will also increase if population goes down.
But even though economist Dr S Akbar Zaidi believes population management is necessary, he argues that it is a misunderstanding that reducing the population would provide a sudden increase in the GDP growth rate. The current rate is 3.6%, according to the Economic Survey of Pakistan 2012-13.
Lower birth rates and longer life spans are expected to double Pakistan’s total labour force by 2050 - more workers per household could potentially aid economic development and reduce poverty. But without job creation and appropriate policies, this “demographic dividend” could turn into a disaster, Zaidi said in a brief written for Oxford Analytica.
“Quality of population is more important than the numbers,” Zaidi told The Express Tribune. “We should focus on our existing population, provide people health and education services and opportunities to learn technical skills.”
Hussain Bux Mallah, a research associate at the Collective for Social Science Research, agreed with Zaidi but also suggested institutional incentives, such as financial assistance for education of only three children per family, in parallel. “There is a possibility that such conditional social protection reforms could help raise awareness about population control,” Mallah said.
Pakistan’s Lady Health Worker programme has helped increase contraceptive use and at family welfare centres, including those in Dhoke Khabba, effective contraception devices such as the Intrauterine Contraceptive Device (IUCD) – that can prevent pregnancies for up to 10 years - are available for as low as Rs3.
But even then, around 25% of married women who want to use contraception do not have access to it. This inaccessibility leads to three million unwanted pregnancies, 1.5 million unwanted births and almost one million abortions per year in Pakistan, the Population Council policy brief states. Poor women suffer more from high fertility and less access to family planning services.
Better service delivery in rural areas through public-private partnerships, more funding for provincial population welfare departments and prioritizing population management in state policy become necessary steps, then. “If Pakistan is to increase the prevalence of contraception, huge effort and commitment are required both programmatically and financially at the provincial level,” Dr Zeba Sathar, the country director of the Population Council Pakistan, said in an article written for the health journal Lancet.
*name changed on the request to protect identity
Published in The Express Tribune, July 11th, 2013.
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