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THE Pakistan Economic Survey 2015-16 reminds us of our ticking population bomb. We are told that today the country’s population stands at 195.4 million — 3.7m more than it was the previous year. We have regressed. The population growth rate stands at 1.89pc in 2016. It dropped to 1.49pc in 1960-2003.
Yet few express serious concern about the threat we face from our rapidly growing numbers that are undermining our national economy and destroying our social structures.
Many myths have been propagated to camouflage the official apathy vis-à-vis the population sector. Thus, it is said that there is population resistance to family planning on religious grounds. Another myth goes that people are ignorant of birth control and prefer large families.
These myths have been exploded by the Pakistan Demographic and Health Survey of 2007 and 2014 which established that only a handful of women cited religion as a factor in their failure to limit pregnancies.
Can population NGOs do the government’s job?
As for ignorance, practically all women questioned knew of at least one or more contraceptive methods. It cannot be disputed that irrespective of the views expressed from the pulpit women are now ready to plan their families. According to the two demographic surveys, there is also a substantial unmet need. That means there is a big chunk of the reproductive age female population — 40 pc according to some estimates — who want to limit their family size but cannot.
Then why are we failing in this sector? Of course, there is the usual absence of political will, ineptitude and corruption that marks the government’s working in the social sectors. Policies are there but implementation is not.
The number and performance of population welfare centres that were set up to provide access to contraceptive services leave much to be desired. Media reports indicate that they are either non-existent or non-functional in many remote areas. Poor performance of official service institutions impacts mainly on the underprivileged, the worst sufferers. This is visible in the large family size of the poor.
There is a lot of focus on awareness-raising and research when the key issue to be addressed is that of easy access to contraceptive services for potential acceptors. It is a pity that many who do not want more children cannot avert births because family planning services are beyond their reach.
There is also the need to integrate the population sector with the health system. This was suggested many years ago by Dr Nafis Sadik, the first executive director of the UN Population Fund, to the Pakistan government. But for reasons not known, Islamabad could never understand why a holistic approach was needed for a successful family planning programme.
Another aspect that has been ignored is the need to focus intensely on the status of women. It seems that the progress made by the feminist activists in the 1980s and 1990s in empowering women has been pushed back. With daughters held in low esteem, family planning has suffered a setback. Parental preference for a male child remains pronounced.
It appears that it has been left to a handful of NGOs to sustain Pakistan’s population programme. The biggest of them is Rahnuma-FPAP, the oldest organisation in the field. Having been launched in 1953 when Pakistan did not even have an official population programme, it has an impressive delivery network of 10 family health hospitals, 10 mobile service units and thousands of clinics. It has created referral mechanisms with a number of government and private clinics and practitioners and thus claims to cover an area of 77,910 square kilometres and a population of 12.5m.
Rahnuma’s dynamic and committed president, Mahtab Akbar Rashdi, tells me that her organisation has made all its programmes holistic and integrated. She herself is a staunch advocate of family planning and agrees that low esteem for women is a deterrent to progress in this sector.
HANDS is another large NGO that was launched in 1979 with the mission of improving health and education, with a focus on mother and child and reproductive health. It claims an outreach of 25m people in 42,000 villages. Its Marvi model involving community-based health workers visiting women in their homes was conceptualised in 2007. HANDS claims that it is making an impact.
But can NGOs with their limited resources and capacity achieve what is essentially the government’s responsibility? Mahtab Rashdi complains that “visible political commitment from the provincial governments is yet to be seen”. She specifically identifies Punjab, Pakistan’s most populous province, where the government’s family planning programme “reaches only 17pc of people in the reproductive age”.
This leaves one wondering if family planning also has a political dimension as the census that has been blocked since 2008. After all, doesn’t a big population translate into a big constituency? That is a political bonus in a country where ethnicity determines electoral results.
Published in Dawn, June 10th, 2016
