AS the government wades through its multiple challenges, it has one option to make a huge difference in a reasonably short time. The option of investing in population could be the game changer for most of its priority areas, including improving our abysmal stunting figures, reducing the unpardonable thousands of maternal deaths that take place each year, reducing poverty, and providing a way out of destitution. The prime minister and his newly appointed health adviser must be congratulated for taking a couple of big steps in the right direction.
A major national task force meeting to be chaired by the prime minister and attended by all chief ministers and important federal members is in the offing. The event follows an important meeting of the Council of Common Interests on the topic of population in November 2018. Major decisions are expected soon.
It does not take rocket science to figure out why the population bomb must be tackled to save our country from the exponential spiral of population numbers, and the problems and challenges including of human development, along with gender and poverty, that are strongly linked to it. Why is it then that our alarming population growth trends have generally been neglected in bureaucratic discussions, and do not make it to the IMF framework discussions or parliamentary debates? Why have we been such laggards in action on population compared to other Muslim and regional countries? In short, why have we shrugged off the bet that trumps all development bets, in terms of low-cost interventions with huge impact on the poorest segments and the gender situation?
Population is always considered a red-hot button, to be tackled later.
A key reason is that we continue to harbour — against all the evidence — a huge ambivalence about whether family planning is ‘the right thing’ for Pakistanis. Let us be clear of what this ambivalence implies: a practice that is perfectly fine for the elites, which enables them to leapfrog to better standards of living, is not right for the poor; they cannot practise family planning because they must have children to bring food to the table. So we invest instead in poverty alleviation, safety nets, even pass laws on child labour — but population is always considered a red-hot button, to be tackled later.
If today’s leaders truly commit to prioritising population, they will be joining the ranks of leaders in other countries such as Indonesia, Malaysia, Iran and Bangladesh, who saw clearly that their country’s economic development, social progress and even survival were linked to providing family-planning services to couples in need. No surprise that these major countries in the region have growth rates of 1.5 per cent or less while ours is 2.4pc — twice as fast as theirs.
While almost everyone discusses the economy extensively, hardly anyone (including economists) make the obvious association between poverty levels and population trends, through reduced household sizes, lower consumption, higher savings and reduced economic shocks to the family. While some economists may disagree on the finer points of the causality, it is abundantly apparent that we would have had about 40 million less people in poverty today if our population trends resembled Bangladesh or Indonesia in the last three decades Therefore, one hopes that the high-profile Ehsaas programme does not overlook the potentially pivotal role of population interventions and that it will factor in reproductive health interventions to provide services to the poorest women who have the largest family size, the highest dependency ratio, and who suffer from ill health due to frequent and closely spaced births. Clearly, ensuring that beneficiaries have access to family-planning services is imperative for achieving the objectives of Ehsaas and the Benazir Income Support Programme to alleviate, if not graduate, women out of poverty.
Currently, the almost complete fissure between family planning and health services have crippled women and men from access to seeking information, and adopting contraception. No surprise that contraceptive prevalence is a stagnant 35pc for the last five years, only half the level seen in the rest of the region, where combined services are widely available. Our services are sparse and mainly restricted to population welfare outlets tucked away in special locations.
It is time to launch, once and for all, a new consensus-based narrative about population and family planning to enable us to move out of this crippling impasse and take action in all relevant sectors. Based on extensive deliberations, the federal and provincial governments along with UNFPA, and the Population Council, have crafted a population narrative. Its crux is that parents have complete freedom in deciding how many children to have and when to have them, but while making these decisions, they must also ensure the basic rights of everyone in the family — especially children. And the state is responsible for enabling parents to act responsibly by ensuring access to information and services to enable that choice for parents.
Let us stop talking about the one-child policy of China. It is neither acceptable nor practical for Pakistanis. But building the case for responsible action should not be difficult. Let us call instead on parents to plan families that they can look after well within their means. And the state has to fulfil its mandate of providing necessary information and services to enable parents to be fully responsible for their children’s lives .
The coupling of freedom to choose with responsibility, to strike a balance (or tawazun) between resources and numbers at the level of both individuals and the state, will be acceptable from both a human rights and religious perspective. It will certainly dispel any religious arguments against inaction.
Once again, whether it is in the top three of the Smartest Targets for the post-2015 development agenda, or a common-sense assertion acceptable even in the MMA manifesto, birth spacing between children is the best bet for achieving tawazun between resources and numbers that is being missed at huge costs. Population concerns must trump other concerns of the government, political leadership across parties, media, educationists, and health leaders.
The writer is country director of the Population Council in Pakistan.
Published in Dawn, July 13th, 2019