According to Pakistan Public Opinion survey 2009, the most important issues facing Pakistan included inflation, unemployment, terrorism, electricity and water shortage, poverty and corruption. Interestingly, the replies did not even include explosive population growth, which ultimately has led to all of the above mentioned problems. None of the major political parties in Pakistan have focused their policies on how to control the population problem. Some facts should be considered to understand the gravity of this humongous problem facing our country. With close to 200 million people, Pakistan has nearly six times the population of Afghanistan (or Iraq), twice the population of Iran, and almost two-thirds the population of the entire Arab world put together. On the other hand, Pakistan ranks 46th with regards to its GDP and 136th with respect to its Per Capita Income.
There are a number of factors responsible for the population explosion in Pakistan. There are the socio-economic factors, education level of parents, cultural hesitance in using contraceptive methods, a general lack of awareness about the impact of increased population and resistance offered by religious elements in some parts of the country. Any solution to such a multi-faceted problem has to be versatile, ingenuous and with participation of all the stake holders. We need to learn from the gains achieved in this regard by high-population Muslim countries including Indonesia, Egypt and Iran (Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases). A cursory glance at the strategies used by these countries in population control can provide lessons to be followed in our country apart from indigenous tweaks and solutions.
The first and foremost task is to involve community leaders including the members of clergy and school teachers in the policy making process. The biggest hurdle in tackling the menace of population explosion is the antagonism offered by religious organisations. Back in the 1980s, the family planning ministry had to be renamed “Population Welfare” ministry, a euphemism to soothe the fears of the clergy. Making the clergy part of the process would give it a much needed legitimacy in rural areas, where the population load is increasing day by day. For the urban population, school teachers have taken the mantle of community leaders and their help would be crucial in ensuring that people consider this problem as their own. Awareness about population control has reached majority of people, courtesy of electronic media in the last 20 years. What still needs to be done is to emphasise that active participation by the populace is required for controlling the over-all population of a country. At the moment, only 30 per cent of married couples are practicing family planning, which is undesirable.
Media also needs to play a part in breaking the taboo associated with using contraceptive methods and family planning.
Secondly, a very important step that is crucial for attaining population control is secondary education for mothers/potential mothers. Pakistan already has a low literacy rate, and female literacy is even lower than the national average. Girls are supposed to study up to 5th grade or 10th grade and then quit education to work at home. This phenomenon is more pronounced in under-developed areas including Southern Punjab, Northern Sindh, Balochistan and Khyber Pakhtunkhwa. Due to tremendous efforts regarding awareness of this situation in the last 20 years, a gradual change has been seen in the attitudes of parents but much more work still needs to be done. Incentives have to be provided for parents who send their daughters for Secondary education apart from free books and good schooling facilities. Based on my clinical experience in Gynecology and Obstetrics department, I strongly recommend awareness campaigns including workshops and interactive sessions at secondary schools for girls throughout the country to address issue of family planning and basic awareness about pregnancy. This would help in decreasing the infant mortality rate and deaths associated with pregnancy.
Thirdly, a major problem regarding family planning services in Pakistan is the inadequate provision of contraceptive devices for both genders. According to a paper(Alternate Scenarios for Population Control in Pakistan, by Tauseef Ahmed and Syed Mubashir Ali) published in Pakistan Development Review 1992,
“Pakistan’s population programme has always followed a supply-oriented approach assuming that demand exists, but unfortunately, the major constraint which inhibited the programme was the poor supply of contraceptives and lack of consistency in the contraceptive mix”. Non Governmental Organizations (NGOs) have played a huge role in population control over the years but the state should also work extensively in this regard, because it is in our mutual benefit. A related issue in this context is the decentralisation of the population control services right at the local council level. It would decrease the level of bureaucracy involved and result in easier supply of services.