July 18, 2004

‘The prevailing demographic transition because of which the population growth rate has declined in Pakistan may not continue in the next decade,’ says Dr Zeba A. Sathar

DR ZEBA A. SATHAR is Country Director of the Population Council. The Population Council is a US-based international NGO that deals with the issue of population. It seeks to improve the well-being and reproductive health of current and future generations around the world. The council has been active in Pakistan since 1957, establishing its permanent office in 1991.

Dr Sathar is rated among the world’s top demographers. She is responsible for the overall planning and implementation of the council’s different projects in Pakistan. Being the country director, she also manages and supervises financial and administrative affairs.

In an exclusive interview with Dawn Magazine, Dr Sathar talks about the ongoing demographic transitions, including family planning issues, in the country.

Q: Will the ongoing decline in the population growth rate (PGR) of the country continue? If not, what should be the future strategy of both public and private sectors working in the population field?

A: The current demographic transition because of which the population growth rate has declined to 1.96 per cent in the country is quite encouraging, but there is no guarantee that the trend would continue in the next decade. Therefore, whenever I meet the people from the federal population ministry and the United Nations Population Fund (UNFPA), I always stress that some innovative measures should be taken so that the ongoing trend would continue. Otherwise things will be similar to Bangladesh, India and Egypt where after a steep decline in their total fertility rate (TFR) from eight, they are now stuck at four.

In our society, to bring the TFR to four is a possible task, but to further decrease it to two will be the real aim in time to come. I think with a proactive public-private sector partnership, we can achieve that goal.

Q: Are the annual budgetary allocations made by the government for the population sector being effectively used?

A: Earlier, to run family planning programmes was considered a donor-driven agenda; but over the last few years handsome allocations in the annual budget for the population ministry has fetched some positive results. As far as the ineffective utilization of budget is concerned, it is not only restricted to the population ministry but exists in all sectors of the country. However, with the passage of time, the population ministry has become a bit more confident that they could deliver the goods. Similarly, a change in behaviour in society depends on the persons or families related to the issue.

At present, the public development sector in the country is getting enough funding. To make use of the budget effectively, the public sector has to adopt a more flexible approach. And if a certain NGO, CBO or doctor is operating well in given circumstances, it should be fully supported.

Q: In most countries, the population issue is taken care of by the health ministry; but in Pakistan it is working as a separate ministry. Does it make any difference?

A: You are right, but in Pakistan, 80 per cent of healthcare facilities are provided by the health ministry. Some people complain that the health ministry does not attach necessary importance to family planning programmes. This means that the role of the population ministry should be of a coordinator.

Q: Has the National Trust for Population Welfare (NATPOW) achieved its objectives?

A: I don’t think that the trust has been effectively used. It has failed to achieve the desired results. Personally, I think that the basic idea behind forming the NATPOW was a good one. Its intention was to bring the private sector working for population welfare programmes on board. What we need at present is to make the NATPOW an independent body. I have had discussions with some international donor agencies which are ready to pump in the money for the purpose; but at the same time, they express reservations regarding the management structure of the NATPOW. I believe that the government should give it a free hand. And the ministry can have limited representation in the NATPOW. People only need the guarantee that their money is being properly used.

Q: What is the level of political and financial commitments in the country as far as the population sector is concerned?

A: In the past, political commitments used to be a problem, not anymore. We live in the age of innovative ideas and must forget the things that we did in the past. Civil society participation is increasing with every passing moment and organizations like the NATPOW can really turn things around.

Q: Are the Lady Health Visitors (LHVs) overburdened, as the ministry of health has also engaged them in a number of additional duties?

A: Yes, they have been overburdened. As far as family planning programmes are concerned, they are doing a great job. Since they have been asked to take part in campaigns like anti-polio drives, their emphasis has shifted a bit. Of course, either their number should be increased or their duties should be minimized. It is unfair to expect a lot of the LHVs when we pay them Rs1,500 each for such an arduous job.

Q: Don’t you think there is a lack of understanding regarding the Reproductive Health (RH) issues in our society?

A: It seems that the RH is thought of as only a family planning matter, whereas it is not just about that. It also covers the sexual health of young and old people and issues like infertility. Unfortunately, owing to a lack of information, in most parts of the country, when a man or woman faces such a problem he or she approaches local Hakims and ends up having a permanent sexual disorder.

Q: How would you rate the level of professionalism in the population sector?

A: As far as the ministry goes, people at the technical level are good. However, those who hold administrative posts keep on changing with regular intervals which has an adverse affect on different campaigns. Also, professionalism in the medical field is not worth writing home about. Doctors and paramedics in public and private sectors are mainly interested in minting money which is a serious matter of concern.

Q: Is the media campaign of the population ministry doing well?

A: There is a dire need for changing the campaign. Fresh and innovative ideas must be incorporated into the ongoing drive. This is where media can chip in with various suggestions. We have to go for slogans that can make people feel a sense of ownership in following family planning programmes.

Q: How do economic conditions of a household affect the family planning issue?

A: The economic factor is of great importance as families are always driven by their economic conditions. The government and NGOs can help in providing the required services but at the end of the day it is a very personal decision. Some people can afford more than two kids. Ultimately, it is the parents who have to decide what sort of life they want their children to lead. One must keep in mind that there is a difference between urban and rural lifestyles. At the village level, a couple needs more than two children to work in the fields, whereas, in the urban areas, you will hardly find parents that prefer more than two to three kids.

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