Dr Mohsina Bilgrami, a professional public health specialist, is currently serving as country director of Marie Stopes Society (MSS) Pakistan — a client-focused social enterprise committed to delivering high quality, affordable reproductive health services.

What are some of the major impediments in lowering the present growth rate?

With an official annual growth rate of 2.1 per cent, which is quite high even by the South Asian standards, Pakistan is well on its way to become the fourth most populous nation by 2050. I believe that the major hurdle in lowering the growth rate is the lack of political commitment by the successive governments who failed to comprehend its importance and adopted ad hoc policies which, too, were not fully implemented  — the outcome of which can easily be assessed by these alarming statistics.

Out of the aggregate 89 million female population, nearly 28 million are of the reproductive age. Of these, only 19 per cent are using modern contraceptives while seven million couples have unfulfilled needs regarding birth control. It aptly explains the failure of our national policies to address the issue.

Lack of education and awareness remains a critical issue, and society at large is unaware of the benefits of having smaller families and birth spacing on the family’s health in general and women’s health in particular. There are religious prejudices which stigmatise contraceptive use, and people are very often reluctant to utilise available facilities.

Accessibility to birth spacing information, methods and services in the rural areas is challenging. As a consequence child and maternal health suffer adversely from it. The idea remains hostile to many men and large families in urban areas which is detrimental to our cause. There are many misconceptions about the use of contraceptives, and couples tend to believe that it is hazardous to their sexual and reproductive health. Last, but not least, the government spending in this area is meagre, women’s health ranks low on their list of priorities.

How is the population issue directly related to the status of women in our society?

There can’t be two opinions about it. Inequitable gender relations also play a pivotal role in undermining inclusion of women in taking decisions regarding their reproductive health, which causes health problems, malnutrition, and, of course, repeated pregnancies with little spacing that make them weak and vulnerable to all sorts of diseases.

This inequality affects a woman’s overall wellbeing, educational opportunities, acquisition of meaningful skills and self-actualisation. In short, they are trapped in the vicious circle of poverty and deprivation in which all the above mentioned factors complement each other.

Even when they are working, in most instances, their work is not included in the government’s statistics and at the micro level their income is considered as part of household earning over which they have no control.