Afghanistan — then and now
THAT friendly relations between Pakistan and India help Afghanistan should be obvious to anyone familiar with history. On Sunday, while playing host to visiting Indian Prime Minister Dr Manmohan Singh, Afghan President Hamid Karzai welcomed the on-going peace process, saying that relations between Pakistan and India had a direct bearing on his country. Both Mr Karzai and Dr Singh emphasized that a successful war on terrorism was not possible without Pakistan’s cooperation. This acknowledges Islamabad’s pivotal role in the anti-terror drive, with Mr Karzai praising “our brothers in Pakistan” for cooperating in the anti-terror drive. He said relations with Islamabad were “thriving very, very well”. On his part, Dr Singh also spoke of a “vision” of eliminating poverty, and pledged to work with President Karzai and President Musharraf to “realize this vision”.
Dr Singh’s visit to Kabul should be seen in both long- and short-term perspectives. It is the first visit by an Indian prime minister to Afghanistan after 30 years. The last one was by Mrs Indira Gandhi in 1976. Between then and now, the world has seen cataclysmic events in which Afghanistan found itself in the eye of the storm. It began with the Soviet invasion of that country on Christmas eve of 1979, touching off war, civil war and political instability which have continued to ravage the poverty-stricken, landlocked country to this day. The Soviet withdrawal was followed not by peace but by a debilitating civil war in which the Pakistan-backed Taliban were the victors. The acts of terrorism in New York and Washington in September 2001, the US attack on Afghanistan, and the end of the Taliban rule belong to history. Mr Karzai is now fighting a battle for survival and for preserving Afghanistan’s unity and rebuilding the country. These are challenging tasks in which he needs help. The Taliban have recently shown an ability to strike back, warlords act independent of the Kabul government, and the drug trade has reached alarming proportions. All this has made the job of post-war reconstruction extremely difficult and slow.
During his visit Dr Singh announced a fresh package of $50 million to Afghanistan and offered scholarships for Afghan students. Agency reports speak of Dr Singh using his visit to “blunt the influence of regional rival Pakistan”. This would be the wrong way of looking at it. Islamabad, which has given $100 million in aid to Kabul and has promised another $100 million, should be happy to see other countries extending a helping hand to Afghanistan in the task of reconstruction. A sense of rivalry will help neither the two South Asian neighbours nor Afghanistan. It would be much better if both Islamabad and New Delhi learnt from history and refrained from fishing in Afghanistan’s troubled waters. Pakistan cannot forget the Zahir Shah-Daud era when New Delhi and Moscow encouraged Kabul to launch the Pakhtoonistan stunt and foment trouble in Pakistan’s western regions. At present, too, there are elements in the Karzai government — especially those belonging to the Northern Alliance — who do not entertain friendly feelings for Pakistan. It would be a mistake to try to inject an element of Indo-Pakistan rivalry into Afghanistan’s perilous situation. The Soviet invasion of Afghanistan, the aftermath of 9/11 and the on-going detente between Pakistan and India have created an altogether new situation that is full of possibilities. It would be a pity if someone were to sabotage this process by re-igniting old rivalries, suspicion and controversies that now belong to the past.
Supporting Iran
PRIME MINISTER Shaukat Aziz has announced that Pakistan will not support military action against Iran. This is obviously in response to the American president’s recent threat to Tehran when Mr Bush made it clear a fortnight ago that the use of force against Iran could not be ruled out. It is time it was made clear by all parties in one way or another involved in Iran’s nuclear impasse that force is not to be used. The EU-3 (UK, France and Germany), who had been negotiating with the Iranian government for the past two years, did not act wisely in breaking off its dialogue when Iran announced that it was resuming the conversion of uranium after a two-year break. By calling off talks, the EU-3 has abruptly slammed the door on a peaceful resolution of the crisis. Although the IAEA, which has been investigating the Iranian nuclear programme since February 2003, will be submitting a report to its board of governors next month, it is surprising why the US and the EU have jumped to conclusions and are taking the issue to the UN Security Council. In the council, decisions are taken by a vote and generally the decision is primarily of a political nature — sanctions in this case.
This would amount to declaring Iran guilty even before its guilt has been established beyond doubt. Iran insists that it has not violated the NPT since it has developed its nuclear programme only for peaceful purposes to which it has a right and is not manufacturing nuclear weapons. As for the nuclear weapon states, they are bound to gradually eliminate their nuclear arms, which they have not even begun to do. The West’s attempt to impose sanctions and use force against Iran will be seen as a move to preserve its monopoly on weapons of mass destruction by punishing other states which are merely suspected of moving on the nuclear road. Russia has already warned against a hardline stance and Pakistan’s decision to oppose any resort to the use of force against Iran should strengthen the hands of those who favour a peaceful resolution of the problem.
Persecuting victims
THE police’s reputation as a corrupt and inefficient institution has become so deeply entrenched in society that no instance of their excesses or irregularities appears to shock any more. Nonetheless, Monday’s news from Karachi about the police registering an FIR against a rape victim and her husband must be condemned in the strongest possible terms. The victim, a maid, is said to have been raped at the behest of her employer and was handed over to the police. They are said to have stripped her before proceeding to file charges against her husband. The victim then approached the Sindh Ombudsman who ordered an inquiry and directed the police to lodge an FIR on her behalf. However, the story takes a new twist because an NGO activist assisting the rape victim, on the orders of the Ombudsman, is now being threatened, ostensibly by the perpetrators. That the activist was abused and threatened by men at the hospital where the victim was having her medical examination done is disturbing and should be properly investigated. The activist is correct in asking for police protection as she fears danger to her life.
This brings us back to our acceptance of harassment and persecution as the norm. A woman falls victim to rape and then the activist aiding her is harassed and persecuted. Society can no longer afford to sit back and watch and must step forward to prevent such degrading acts. NGOs play a valuable role in highlighting wrongs and need support in raising a voice for the oppressed. Not only should both women in this case be given protection, the case must be investigated and the culprits brought to book. In the process, no obstacle should be allowed to come in the way.
Less population, less poverty
THERE may be a great deal of talk about poverty alleviation but we have not been able to do much about it. There are two main reasons. The first is that left to the market, without appropriate government intervention, income disparities tend to increase. There is some sort of a trickle-down effect, but it is so slow as to be imperceptible.
The other is that the population of the poor has tended to increase faster than the population of the better off. This increase has resulted from the efficacy of modern medicine which has brought the death rate down and also decreased child mortality.
Because of these developments between 1951 and 1972 the average annual growth of population rose from 1.8 per cent per annum to 3.6 per cent per annum. It has since declined to around two per cent per year. Between 1951 and 2001 the population grew from about 30 million to 150 million within 50 years. The multiplication of the low-income population has progressively increased the pressure on already inadequate social services such as education, health, sanitation, potable water, etc. and has led to general environmental degradation. The result is a paradox. More of the poor live longer, the more miserable their existence.
For poverty alleviation to be taken seriously, two things are necessary. Development plans for each sector should indicate the number of jobs expected to be created. The other issue which is perhaps more important is the reduction of population growth. Coordination and linkages between population growth and other relevant sectors is essential. Complementary alliances with credible institutions within the public and private sectors are necessary to build adequate momentum for this purpose. Without a strategic multi-sectoral approach a strong multiplier effect cannot be generated.
To improve the quality of life of the poor, one needs to promote amongst them a voluntary desire to have smaller families which can be provided with better nutrition and care. This automatically reduces the pressure on the provision of supporting social services such as education, health, etc. Unfortunately, the old concept of birth control or family planning seems to have run head on into concepts of political correctness. It was therefore transformed into family welfare and population welfare and has finally come to rest after the ICPD conference of 1995 as reproductive health, which is so vague that nobody quite knows what it means. However, as far as we are concerned, the simplest is to take it back to its original meaning, namely birth control and family planning. That is what I have been involved with, off and on, for the last 30 years.
The other problem which happened fairly early with family planning was that it was handed over to the medical profession. Family planning has something to do with medicine but it is essentially a social welfare issue. Doctors are not particularly interested in promoting birth control. As a matter of fact, pregnancy and birth are likely to be more financially rewarding.
Because this problem has been handed over, at least in theory, to the medical profession, it does not get the kind of guidance and leadership required. One of the supposed advances in Pakistan was the handing over of family welfare workers to the ministry of health to be merged with their Lady health Workers (LHWs) programme.
The LHW programme is not doing particularly well, besides family planning is not one of their priorities. Attempts to improve matters have resulted in all kinds of complicated proposals for greater coordination between the ministries of health and population welfare. In practice, these are not likely to work. The focus of the ministry of health is on drug quality and pricing, the medical and allied professions and in the supervision of some large hospitals.
The provincial health departments are focused on medical teaching institutions and nearly all hospitals in the public sector. Rural health tends to be neglected along with family planning which is highlighted by the low contraceptive prevalence rate (CPR) in rural areas.
The obvious thing to do is to amalgamate rural health and population welfare at the grassroots level under a department of rural health and population welfare at the provincial level. The change would be reflected at the federal level also. In effect, this would mean combining the ministry of population welfare with a newly created ministry of rural health, with the necessary consequential adjustments in the field.
The two biggest and most successful proponents of birth control in the UK and the US were Marie Stopes and Margaret Sanger — neither were medical doctors. When practising nursing on the Lower East side of New York City, Margaret Sanger witnessed the close relationship between poverty, uncontrolled fertility and high rates of infant and maternal mortality. In 1914 she published “Birth Control Review” and opened the first birth control clinic in Brooklyn in 1916.
For doing so, Margaret Sanger was chastized by the authorities for maintaining a public nuisance. In the same vein, 20 years later, in 1936, a federal court classified contraceptive literature and devices as obscene material and only allowed physicians to prescribe contraceptives to patients who, in their opinion, needed them. The efforts of these two pioneers are represented in Pakistan by Marie Stopes International and the Family Planning Association of Pakistan which is affiliated with the International Planned Parenthood Federation founded by Margaret Sanger.
Pakistan’s programme is behind India, Bangladesh and Sri Lanka’s but it is not an absolute failure. From a contraceptive prevalence rate (CPR) of about 12 per cent in 1990-91, we had achieved a contraceptive prevalence rate of about 30 per cent for modern methods by 2004: but this is not good enough if our ambition is to stabilize population growth by the year 2015: which means that a fertility rate of a little less than four has to be brought down to about two within the next 10 years — the average number of surviving children to all women throughout their reproductive age.
At present, according to government statistics which are biased in favour of government efforts, two-thirds of the national programme for promoting modern contraceptive use is done by the government and one-third by the private sector. The real proportion may nearly be half and half. As a result, there is a great deal of talk about public-private partnership, but the specific proposals for doing so are moving far too slowly. It is the first time that the government has woken up to this possibility, but it is still too novel a concept and a great deal of humming and hawing is going on in the relevant ministries.
NGOs are divided into two groups — FPAP and Marie Stopes who operate through their own clinics and the two social marketing organizations which operate largely through the private sector. There is a difference in social marketing also. One model promotes existing manufactures of contraceptive material. The second sells its own branded products at subsidized prices.
International experience seems to indicate that the manufacturer’s model is more suited to middle income countries. Subsidised sale is more successful in low-income groups. In the NGO sector, the social marketing organizations provide 75 per cent of private sector contribution to contraceptive use. The evaluation is done through couple years’ protection (CYPs). Each contraceptive method has a certain weight estimated on its effectiveness over a year of use.
According to present surveys, there is an unmet need in 30 per cent of married women of reproductive age who want to practise family planning. The problem is not so much a lack of demand as it is a lack of supply. The problem is more acute in the rural areas which have a much lower CPR. In urban areas it is around 40 per cent and in the rural areas about 20 per cent as estimated in 2001.
The largest demand appears to be for voluntary surgical contraception which means that women think they have achieved the desired family size and want to avoid further pregnancies. Unfortunately, this is the most difficult to organize. The lady doctor has to be trained in the surgical technique, but the more difficult part is setting up the physical facility, i.e. an operating theatre which ensures a sterile environment. In rural areas, the logistics of travel between home and the clinic present a serious hurdle. Mobile surgical units are an answer, but they are expensive and difficult to manage efficiently.
The problem, mentioned earlier, which Margaret Sanger had with the authorities, was the result of attitudes embedded in American society. We have a similar attitudinal problem in Pakistan. There is little religious hostility and family planning is widely accepted but people, nevertheless, feel shy about openly supporting it. For instance, the organization I am associated with rented a place for a family planning clinic.
However, as soon as the landlord discovered its purpose, he revoked the agreement, as the neighbourhood was averse to such a development. The same happens with philanthropy in the private sector. They are prepared to contribute time and money towards education and health and other good causes, but they feel shy about family planning: although large families amongst the poor is the main cause of problems in the social sectors.
The same attitude is reflected in the government. The present government has thrown money at it. However, the government has not given it administrative priority. For example, since the beginning of the year 2000 we have the seventh secretary of the ministry of population welfare, and it is not unlikely that we may soon have the eighth.
Stem cell end run?
THE announcement by a group of researchers at Harvard University that they have managed to turn adult skin cells into cells that behave like embryonic stem cells offers the potential for an end run around the political feud over stem cell research.
Embryonic stem cell research is controversial because generating stem cells requires the destruction of a days-old human embryo. Yet the Harvard team has produced apparent stem cells by a different means: Using existing embryonic stem cells, they coaxed adult skin cells to “reprogramme” into stem cells themselves.
If the technique becomes viable, it could yield genetically individualized stem cells for patients with a range of diseases for which stem cell therapies might prove compelling. And critically, it could be done without either destroying anything plausibly considered a human life or by creating a cloned embryo. It would be a wonderful development if science simply outstripped the current debate over the morality and ethics of this potentially life-saving research.
As promising as this work might be, however, it is still nascent. Opponents of relaxing President Bush’s restrictions on federal funding for stem cell research cite alternative procedures for creating stem cells as one reason Congress should proceed slowly. But as the new study’s authors insist, their technique is not yet ready for prime time.
Researchers have not figured out how to remove excess DNA from the cells they create — which contain genetic material from both the skin cell and the embryonic “starter” cell. In other words, lawmakers cannot yet bank on this procedure — or any other alternative procedure — to relieve themselves of the duty of deciding whether current stem cell research warrants federal support. It does.
The Senate will soon take up a bill, already passed by the House, to free up federal money for this potentially life-saving research. Senate passage is still necessary.
— The Washington Post