As the country’s political narrative continues to play out, lurching from one crisis-ridden episode to the next, the hoi polloi has almost forgotten to hold its breath — so involved is it in the daily grind of living. Perennial and prolonged bijli shortages, water scarcity, fuel shortages, garbage-strewn streets, traffic signals crowded with deserving and undeserving beggars, street children, alarmingly high inflation, traffic congestion, missing law enforcement, cities bursting at the seams…..

Quietly, imperceptibly, adding to all this is the country’s population, growing at 14,000 babies each day, adding to a population that already numbers 187 million. The majority of families are unable to care for their babies responsibly, nor do they have the means to do so.

The population quandary has no ready answer; there are just so many facets to it. To begin with, the economy is unable to provide the wherewithal for living to 187 million. The result is an almost Malthusian nightmare coming true, as the divide between the haves and have-nots grows to well- nigh obscene levels.

Pakistan has already slipped four places in its Human Development Index, and is now ranked at 145 out of 187 countries. A significant reason for this is increasing poverty. A news report (Dawn, Economic and Business Review, June 2012) stated that the government has deliberately pushed back independent poverty assessment reports to avoid embarrassment

With all this is that inexorably growing population, at 1.9 per cent per annum. Simultaneously, millions of expectant mothers fall ill and die — at a speed of 1,400 each day — mainly due to complications arising from repeated pregnancies. According to the World Bank 2010 Report, fertility rates stand at around 3.50 children per woman. And those new born babies are also dying — 664 of them each day. Clearly a pathetic picture, crying out to be remedied.

With this growing population, Pakistan appears to be caught in a time warp; to give an example, we have had, for the past several years, a stagnating contraceptive prevalence rate (CPR). Although awareness of family planning is universal, and lots of couples wish to practice it, the inaccessibility of the supply system is a hindrance. End result: a static CPR accompanied by population growth in fast geometric progression.

There’s a lot more besides; Pakistan probably takes the prize for extreme gender insensitivity and violence against women, which leads to their restricted mobility, malnutrition, and of course, inadequate health care. Pakistan’s women are bearing the brunt of this long-term neglect.

Nevertheless, Dr Sahib Jan Badar, head of the Sindh Maternal, Neonatal and Child Health Programme (MNCH) feels encouraged: “Even if we do not attain MDGs 4 and 5, (i.e. Millennium Development Goals aimed to improve maternal health by 2015) the results indicate positive change: maternal mortality has reduced from 350 to 276 per 100,000 and we’re expecting further good results from the Pakistan Demographic and Health Survey (PDHS), due for completion in 2012. We’re training and deploying more Community Midwives, and they are already making a difference.

“The MNCH has instituted an Integrated Management System, whereby all efforts for population planning, including those by NGOs such as Marie Stopes, HANDS, Aman and Ipas are brought together”.

What about addressing the high incidence of unsafe abortion? (Total abortions in the country are about 100,000 annually).

“We’re working to prevent them, with MVA (Manual Vacuum Aspiration) and the use of Misoprostol, which is now on the Essential Drugs List, and has been endorsed by the Sindh Government”.

The matter is now in the hands of our policy makers: will they look at the positives, and adopt an all-encompassing cross-sectoral approach?

There are encouraging signs: the positive co-relation between secondary education and positive reproductive health outcomes; the widespread desire to educate both sons and daughters, the responsiveness of officials of Health, Population Welfare, Local Government and the huge potential (as yet untapped) of mobile phones, TV, radio and internet for developing innovative strategies for information dissemination. Men themselves are keen on receiving more information; they are unsure of where to go to obtain it. Their greater involvement in family planning is crucially important.

With a wide-ranging, holistic and thoughtful approach to population planning, Pakistan can still succeed in making a difference!