Population Explosion

a. https://www.thenews.com.pk/print/668446-addressing-the-population-explosion-part-ii
b. https://www.thenews.com.pk/print/667912-addressing-the-population-explosion-part-i
c. https://dailytimes.com.pk/646732/pakistans-overgrowing-population-predicament/
d. https://tribune.com.pk/story/2258147/population-growth-challenges-and-opportunities

Foot Notes

Pakistan has a population of 220 million people but nowhere close to the amount of resources
required to house, feed, employ or in any way provide for these people.

London Family Planning Summit 2012

We had committed, during the London Family Planning Summit 2012, that we would increase
national contraceptive rates to 55 percent by 2020. Unfortunately, we have been unable to
follow through on this commitment, not because we tried and failed but because we never
even bothered to try. Like with all issues that require ‘uncomfortable’ conversations, Pakistan
effectively keeps sweeping family planning under the carpet too.

Some steps in Right Direction

As one of the first countries to commit to the FP2020 partnership in 2012, we have taken some
steps in the right direction, which merit mention. Health centres have been established across
Punjab, Sindh and Khyber Pakhtunkhwa. Provincial governments are developing plans to
procure contraceptives. Some policies have been formulated and announced. However, the
government’s messaging has been inconsistent and half-hearted, resulting in inadequate
awareness campaigns and a population caught between fear and religious conservatism.

Budgetary Misallocations

The first issue that must be noted is that of budgetary misallocations. In 2016, Pakistan’s health
expenditure was around a mere 2.75 percent of the GDP. Budgetary misallocations clearly must
be discussed and rectified but it is also important to understand the other important reasons
why Pakistan has failed when it comes to family planning. The adverse impact of this failure will
be especially difficult to deal with as a result of the current pandemic.

Religious and socio-cultural attitudes

There are three major reasons, in addition to the budgetary misallocations discussed above,
why Pakistan has been unable to institute and implement an effective national family planning
programme. First, religious and socio-cultural attitudes have discouraged the use of
contraceptives and deemed the concept of family planning ‘un-Islamic’. This is an area where
we have much to learn from our Muslim neighbour, Iran, which not only revived its family
planning programme in 1989, but experienced the positive impact of its efforts in the form of
rising literacy rates, addressing water shortages, securing access to healthcare and providing
improved quality of health services.

Unlike Pakistan, Iran maintained strong government determination to ensure its family planning
programme succeeded. Religious leaders and mosques were actively engaged; the government
itself set up a condom factory; a huge number of rural health centres were established; and
compulsory premarital contraceptive counseling was instituted. Unfortunately, in our country,
right-wing fanatics dictate policy to the government and not the other way around.

Lack of political will

In place of attempts to alter the misinformed and hostile attitude towards family planning,
there has been a clear lack of political will to engage on this issue. The onus for this falls on
each successive government that has neglected this crucial area, whether it was in November
2015, when former prime minister Nawaz Sharif and the chief ministers of the four provinces
decided not to turn up at the Population Summit in Islamabad, or the lack of implementation of
the National Population Policy in 2010.

In contrast, our neighbours have taken a different path and serve as examples of successful
family planning policies. In 1976, not long after East Pakistan became Bangladesh (and found
itself in conditions far more dismal than ours at the time), the government of Bangladesh
instituted a national policy for population control and family planning. Through this, it focused
inter alia on the improvement of the status of women through education and participation in
social, economic and political life.

Bangladesh provided economic opportunities to women in rural areas and empowered them,
resulting in an increased contraceptive prevalence rate (CPR). Recognizing the limited mobility
of rural women, Bangladesh recruited and trained Family Welfare Assistants (FWAs) and male
outreach workers to carry out home visits, offering multiple methods of contraceptives, sharing
information regarding their use, and maintaining comprehensive records and data. These FWAs
have been described as “agents of change in the remote villages as they were the only contacts
for family planning for many women” (Ghafur, 2017).
The distribution system in Bangladesh was modernized because the government of Bangladesh
recognized the adverse impact of uncontrolled population growth and of gender inequality
shortly after the country came into existence. In Pakistan, political commitment on these two
issues is severely lacking: we have been unable and unwilling to change attitudes towards
family planning or the perception of women in society.

So while Bangladesh in 1990 had 29,0000 female family planning workers actively engaged in
service delivery, Pakistan’s family planning initiatives were already suffering as a result of lack
of communication and coordination between the Ministry of Health and the Ministry of
Population Welfare during this time.

In 1975, Bangladesh had a total fertility rate of 6.3 percent, which was reduced to 3.3 percent
by 2000 and further reduced to 2.3 percent by 2011 (as per the Bangladesh Demographic
Health Survey). Similarly, between 1993 and 1994, the CPR rate in Bangladesh was around 44.6
percent, which was increased to 53.8 percent between 1999 and 2000, and further increased to
58.1 percent by 2005.

Many studies conducted on Bangladesh’s family planning programme demonstrate that even
though there have been fluctuations in CPR, a combination of other measures have led to
decreased fertility rates. This serves as an example of how family planning involves not just
increased provision of contraceptives and information on the same, but also improvements in
access to education, economic opportunities and maternal health services.

The United Nations Population Fund has highlighted that Pakistan has one of the highest
maternal mortality ratios in South Asia. In 2015, Unicef issued a report highlighting Pakistan’s
maternal mortality ratio (per 100,000 live births) as 178 deaths, while the neonatal mortality
rate (per 1,000 live births) was 46 deaths. In 2015, around 5,500,000 babies were born in
Pakistan – an average of around 14,900 babies per day. Major causes of neonatal deaths
include prematurity, birth asphyxia and trauma, and sepsis.

Several reports have highlighted the key reasons for Pakistan’s extremely high rate of maternal
mortality, which include inter alia poor and inadequate access to medical/health care services,
child marriages and lack of family planning. In contrast, between 1975 and 2014, Bangladesh
saw a sevenfold increase in its CPR from 8 percent to 62 percent.

This, of course, underscores the need for coordinated cross-sector efforts in education, general
health services and employment generation,

Poor service delivery

In 2019, Pakistan had a CPR of 34 percent, in contrast with India’s 56 percent and Bangladesh’s
62 percent. Many experts in the field have highlighted poor service delivery as the cause for low
CPR in the country, due to which the poorest of women in Pakistan, mainly residing in rural
areas, are adversely affected. In fact, research also indicates that only one third of married
Pakistani women use some form of birth control.

Contraceptive methods

As per the National Institute of Population Studies, in 2018, the most commonly used
contraceptive methods in Pakistan were condoms and female sterilization. The government of
Pakistan is the largest provider of contraceptives in the country, so it is directly responsible for
its failure to not only improve service delivery, but also its failure in making available more
contraceptive methods.

While the Iranian family planning programme is light-years ahead of what we in Pakistan can
emulate, one of its key reasons for success was because of its targeting of the most remote,
rural locations. Its rural health houses and mobile clinics now cover over 90% of the population.

The lack of leadership commitment at the highest level would ordinarily indicate that perhaps
there is little voter support for family planning. However, at present, we cannot draw any
definitive conclusions on that front. What is required immediately and on a priority basis is a
baseline survey on reproductive age groups, premarital concepts regarding family planning,
post-marital approaches to family planning, etc. A knowledge, attitudes and practices (KAP)
survey needs to be carried out across the country to assess what current behaviours and
attitudes towards family planning are.
There has been input from experts in this area through several research articles and studies,
including a 2015 KAP study of married men and women in rural Pakistan, which provides
important insights into the issue. The 2015 study highlighted how around 28,000 women in
Pakistan die annually as a result of pregnancy-related complications. Moreover, the study
identified that only half of the deliveries in Pakistan occur in the presence of a skilled health
provider, while rural and less educated women are less likely to receive skilled care.

In fact, the average distance to a reproductive health facility in Pakistan’s rural areas is
greater than that to urban areas, which effectively renders these health facilities useless for
rural women who do not have transportation or finances. Another important fact the 2015
study highlighted was that over 70 percent of our population tries to access private sector
healthcare, thus reflecting an appalling lack of both availability of and confidence in public
health facilities.

Pakistan’s family planning strategy needs a jumpstart and revamp. At this stage, we cannot
afford the Government’s messaging being poorly framed and targeted, as per routine. The
government must involve communication experts in its messaging on family planning. Clearly,
the “kam bachay, khushaal gharaana (fewer children, prosperous home)” is not helping with
our family planning programme.

Our unabated population growth is a time bomb waiting to explode and will affect us in ways
we have not even begun to imagine due to the shortsightedness of our leadership

Reasons:

 This almost unchecked population growth is a governance issue because of the strain it
lays on resources leaving the government with limited choices to produce quality
human beings — a critical area for the development of a country’s economic base.

Covid-19 and Population

 When the government announced a lockdown in April, FP (Family planning) services

were the first casualty and women were unable to get either supplies, or antenatal or
delivery care. This was particularly true for rural women relying on government
 facilities. With a disruption in FP services, it is not hard to imagine a spike in unexpected
pregnancies, unsafe abortions, pregnancy-related complications and maternal deaths.

 The country’s population, already increasing at an annual rate of 2.3pc

 Digital Technology: If this pandemic has taught us one thing it is to think out of the box.
There is huge potential in digital technology. This may be an opportune time to train
healthcare providers in telemedicine. Already quite a few women doctors have returned
to work using the telehealth platform and this may open up a new world for scores of
others like them.

Crucial Points:

 According to the recently released ‘The 2020 World Population Data Sheet’ Pakistan’s
annual population growth rate is 3.6 percent which is highest in the region and if it
remains growing at the same pace, it will have double the population in the coming 19.4
years.

Consequent Problems:

 The problem of rapid growth in population is like keeping a ticking bomb in hands which
can explode at any time because at the same time when the population is growing
speedily, the resources in the country are also decreasing.
 Consequently, inflation, hunger, dearth of urban facilities, violence, extremism, suicides
and criminal activities increase.
 Growth of population also affects the environment as the more population uses more
resources which include land, water, wood, gas, air and other natural resources.
 It nevertheless has created conditions, such as climate crisis, which has strained the
earth’s capacity to generate resources at the optimal level.
 Though we take pride in the so-called youth bulge that overpopulation has bestowed
upon us, the reality is that this demographic change has led to a rise in urban migration.
 There is a direct correlation between demography and security. Historically, population
growth has been one of the destabilising factors in the least developed countries. Young
people are usually more susceptible to extreme behaviours. A study conducted by
Population Action International shows that about 80% of the world’s civil conflicts since
the 1970s have occurred in countries with young, fast-growing populations.
 Solutions:
 Family planning is also a basic right of humans but due to the problems like gender
inequality, keeping women away from education, employment and decision making, the
women are restricted from this right. The only solution to control the overgrowing
population of the world is adoption of family planning practice but due to lack of
education and mental awareness our society has not been accepting this blessing and
for many people it is still a taboo.
 Exploding of day by day growing population bombs can only be rendered by mass
mobilization and dissemination of awareness of social, political and religious entities
regarding adopting family planning techniques among populace.
 Second is by introducing human development interventions such as: providing every
child equal opportunity of getting an education until high school; creating universal
health coverage system with a focus on prevention to mitigate environmental hazards;
generating employment opportunities through business development; and bringing
more women into the workforce.

Introduction:

 Way back in 1798, Thomas Malthus was astonished to see the growing mass of
humanity and warned about its consequence. He said, “The power of population is so
superior to the power of the earth to produce subsistence for man, that premature
death must in some shape or other visit the human race.”