THE public consensus on the need to curb rampant high fertility has still not happened. Many are still ambivalent as to whether high fertility is our problem or not, just as they were about terrorism until the APS tragedy took place. Probably, because this is not a concern of the elites; it is viewed by them as a problem of the masses.

Families and children of the elite are educated; they have jobs, they will thrive. But what about the less fortunate with shrinking opportunities. And what about the collective destruction of the environment? The water misuse, shrinking of cultivable land to housing schemes, and rampant unsustainable use of nonrenewable resources bound to adversely impact all of us.

Twenty-five years ago, the world community assembled in large numbers in Cairo in 1994, to create a consensus on how the world would tackle the complex issues of population and development. Two outstanding Pakistani leaders deserve tribute for their role in the largest intergovernmental International Conference on Population and Development (ICPD): Dr Nafis Sadiq, the architect of the global agenda and the late Benazir Bhutto, who stole the show among hundreds of political leaders who attended the conference. She was young, powerful and her message strong and vocal: “I dream of a Pakistan where each child is wanted, nurtured and loved.”

It is important to take a message of hope to the population conference being held in Nairobi next month.

Pakistan in the 1990s was a hopeful place for women and girls. The Lady Health Workers programme had been launched, with huge success in creating community outreach to women in far-flung areas, and opening access to conversations about their health and family planning concerns. The National Committee for Maternal Health was set up to tackle the unduly high numbers of maternal deaths during pregnancy. Our population was estimated to be about 120 million — almost 100m less than today. Fertility was just under 6.0 children per woman in 1991 and began to come down fast to 4.8 by 1998. The 1998 census reconfirmed this fertility decline. We were late then, but not lost in our much-awaited fertility transition!

But then by 2000, complacency set in regarding concern about population trends — in marked contrast to other countries in the region. And we did lose our way. For decades we seemed unconcerned about the balance between population numbers and our resources. Today we stand so far behind in the demographic transition that it is plain tragic. Our population growth rate according to the 2017 census is much higher than expected, poverty is harder to fight, our young people are uneducated: 16m are out of school, the majority of them, girls.

It is difficult to justify such stagnation when the rest of the Muslim world has overtaken us — Indonesia in the 1980s, Bangladesh by the 1990s, and Iran by 2000. Had the progress seen in the post-Cairo years continued, we could have had a population growth rate of 1.5 per cent — a level we are aspiring to attain by 2025.

It is important to take a message of hope and change to the ICPD25 conference being held in Nairobi next month. And post-Nairobi, it is vital to raise our game in terms of improving our path to people’s welfare through reducing unwanted fertility. Post-Cairo, after being jolted by the glaring evidence that every 37 minutes a Pakistani woman was dying of pregnancy-related causes, we did achieve success in reducing maternal mortality sharply by 2017. Now, the same resolve is needed to achieve a sustainable population growth rate; this must be our number one agenda for the next five years.

There was a ray of strong hope late last year, when the then chief justice took suo motu notice of the alarming population growth rate. The Council of Common Interests endorsed the recommendations made by the Supreme Court taskforce. A national symposium in December 2018 conveyed public statements from Prime Minister Imran Khan and the chief justice, charting a clear path to making up for lost time. But there has been deafening public silence since then. Above all, a federal taskforce meeting, expected to make major policy announcements, is long-awaited.

Just a few days ago, the health ministry, UNFPA, and Population Council assembled a group of eminent political representatives from across Pakistan in preparation for the ICPD25 Nairobi conference. And despite the different political party affiliations, and diverse regional points of view of Balochistan, KP, Sindh, Punjab, Gilgit-Baltistan and Azad Kashmir, it was heartening to hear a message that was resoundingly clear: everyone was there because they felt that this is the number one challenge facing Pakistan.

It was even more uplifting, to hear their open discussion on what it would take to tackle this issue — whether they proposed more funding, more communication campaigns, or more debate in parliament, there was an unexpected consensus among parliamentarians that more attention was definitely required to tackle high unwanted fertility. The ministers were defensive about progress; the religious leaders offered more of a role for themselves.

What, then, is holding us back? Is it high-level public intent that is missing? We need a public champion that can turn this situation around. Who will rise to champion this cause in Nairobi and after? Once this commitment is established and demonstrated, the rest will fall into place. Yes, the NFC award needs review and we certainly need more family planning services. The ask for the doubling of budgets for family planning services is not a big burden for the larger provinces. But we do need a population fund at the federal level as the CCI clearly recommends. Its announcement would be a clear-cut indication that we put our money where our mouth is, especially for the smaller provinces and regions.

Pakistan is resilient. We can achieve wonders when we want to. Let us do the same for reducing population growth. Let us protect the fundamental rights of our unborn children to a better world. And let us devote all our resources judiciously to reset the life trajectory of the current young generation.

The writer is country director, Population Council, Islamabad.

Published in Dawn, October 26th, 2019