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Vote banks of the starving

Elections are round the corner and as the candidates head for the hustings it is time they focused on the issues which will make or break the country.

The least talked-about problem and yet the one which poses a grave threat to our existence is population explosion. Pakistan, the sixth most populous country in the world, is on its way to becoming the fifth most populous state.

Demographers say if we continue to neglect the family planning sector we will have 342 million mouths to feed in 2050.

Just the idea itself of what impact this huge population will have on other sectors (especially the economy, education, health, environment — in fact everything) is mindboggling. Yet this basic common sense fact appears to have escaped the notice of all those jostling for seats.

Our performance in the population sector has been a record of failures. Our politicians who don’t care for the welfare of the people appear to be happy with a fast-growing population as that provides them with a vote bank. They hardly care if the voters are hungry and poor.

It is therefore creditable that the Population Council, an Islamabad-based NGO with its headquarters in Washington, is attempting to draw public (especially political parties’) attention to the link between population growth and the well-being of current and future generations. But given our past indifference to this issue, one can only hope for their success.

The fact is that over the years — Pakistan’s official population programme was launched in 1965 while the private sector has been in the field since 1952 — a lot of awareness has been created about family planning. Many myths, however, still abound and are propagated by vested interests. It is believed that people’s religiosity is a major barrier to contraceptive prevalence which even today is a lowly 22 per cent with another eight per cent couples saying they use traditional methods.

The Population Council has prepared an excellent presentation on the subject which highlights all the advantages a lower total fertility rate — at present four births — would bring to the country. You can ask a woman, even an illiterate one such as Yasmeen, who is 27, lives in a katchi abadi and has five children with the youngest — an unwanted child — having been born in 2012.

There are many Yasmeens in our society who have the awareness, who do not want another child but who also do not possess the means to prevent a pregnancy. It is frustrating. They constitute what demographers call the unmet need. It is hardly a coincidence that such women — 40 per cent of married women — come from the underprivileged sections of society. The women with unmet needs are a blot on the conscience of our rulers and policymakers.

One does not find our leaders showing much interest in such issues that are considered to be too mundane for their high-brow plans. Statements issued by them are routine and meaningless. For instance, on Population Day in July 2012, prime minister Raja Pervez Ashraf spoke of his government’s commitment for strengthening programmes aimed at offering services and choices to “all women with unmet needs”. This smacked of a patriarchal mindset. Don’t men have a role to play in family planning?

The strategy adopted is therefore ineffective. It is not even tailored to the needs of the people. Increased funding has not created an impact because the funds have been inappropriately used or embezzled. Dr Adnan Khan, who researches population issues, and his colleagues reporting their findings in the Journal of Pakistan Medical Association state that the government enhanced its funding to $83 million annually between 2003 and 2010.

The goal was to reduce the fertility rates by half by 2010. Only six per cent of this fund was used to purchase supplies, while the rest went into salaries and overheads. The result? A stagnation in the contraceptive prevalence rate. In the last two years, the population growth rate has actually gone up.

A general apathy towards this sector has led to misconceived strategies. Men have not been involved in the mobilisation campaigns and family planning services have not been made easily accessible to users.

Government centres are not sufficient in numbers and are not easy to reach in all regions, especially in the remote rural areas. The simple approach recommended by the United Nations Population Fund and taken by many countries of placing family planning under the health umbrella has not been adopted.

This is the most serious flaw in Pakistan’s population strategy as it has resulted in duplication of the infrastructure and manpower when it could have been avoided. As a result the government’s programme is expensive and inefficient.

As Dr Adnan Khan points out, the public sector provides around a third of family planning services, while NGOs and private providers make available another 15 per cent and more than half of all family planning users buy their contraceptives directly from stores. The government spends more than five to eight times per user than the private sector, while a fifth of pregnancies end in abortion.

A major factor that needs to be highlighted is the low status of women in Pakistan that is a major barrier to family planning. If women will not be accorded the respect that is their due, the girl child will continue to be unwanted and will be discriminated against while boys will be preferred. With such gender biases, can a family planning programme ever succeed?


Zubeida Mustafa, "Vote banks of the starving," Dawn. 2013-04-03.