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INDIA Vs PAKISTAN - Contrasts In Social Development

INDIA Vs PAKISTAN                                                         - Contrasts In Social Development

Sultan Shahin
The Observer of Business and Politics
April 14, 2000
Title: INDIA Vs PAKISTAN - Contrasts In Social Development
Author: Sultan Shahin
Publication: The Observer of Business and Politics
Date: April 14, 2000

MS Kulsoom Nawaz, wife of the deposed Prime Minister of Pakistan, Nawaz Sharif, jolted public opinion in India recently by comparing the political systems of the two countries and observing that India was much more civilised. For the wife of a politician in detention facing charges that could lead to capital punishment, this was indeed an act of great political daring. But this must have come quite easily to her because comparisons with India in every field are a way of life in Pakistan.

Both India and Pakistan have been moving on the path of economic progress with reasonably high success rates for developing countries. But economic progress is not an end in itself and is meaningful only if interpreted in terms of social development. While India too cannot boast of a robust record in the performance of its social sectors like health care, education, population welfare and empowerment of women, Pakistan's record in these sectors is indeed much worse, in several instances poorer than even the most impoverished nations of the world.

Let us begin with population growth, perhaps the basic malaise behind all other ills facing the two countries. While India itself has registered a not-so-low annual growth rate of 2.2 per cent according to the last census, Pakistan's growth rate has been as high as three per cent per annum. This rate has been prevalent since the early '70s and has led to the quadrupling of the country's population from the time of independence. In fact, the last census in Pakistan was held in 1981, and if reports in the Pakistani media are to be believed, the annual growth rate may have neared 3.5 per cent in the last decade.

The reasons for this high growth rate are many. Apart from usual causes like extreme poverty and social insecurity, Pakistani society continues to suffer from medieval practices like early marriage of women and their poor education. Almost 50 per cent of women in Pakistan are married before the age of 20, enormously increasing the chances of conception. In fact, the average fertility of women (number of live birth, per woman) in Pakistan is a high 6.1 compared to India's  3.7. Another factor is poor education of women. There is abundant evidence internationally that well-educated women, being career- oriented, generally bear fewer children. Contraceptive usage is also quite high among them.

According to a 1991 survey, only two- fifths of Pakistani women knew of major contraceptives, and less than a quarter of these actually used them. The reasons cited by them ranged from husband preference to their cost and even a simple lack of conviction regarding their usefulness. Also, about 30 per cent of college graduates reported using contraceptives compared to 8.5 per cent of uneducated women.

However, the programme suffered a setback in 1977 under the banner of the 'Islamisation' programme of General Zia-ul-Haq, and was discontinued. It was only after 1988, when democratic forces began to re-emerge in the country that population control measures were restarted. Expenditure on population control has also remained on the lower side in Pakistan, averaging about 0.06 per cent of GNP.

Literacy is perhaps the most significant index of social development in a country as the performance of all other sectors is dependent on the success achieved in this sector. The average literacy rate in Pakistan is a poor 35.7 per cent compared to India's 49.9 per cent. World Bank figures show that Pakistan's literacy rate is even lower than some of the countries of sub-Saharan Africa like Ghana and Nigeria. School enrolment rates in Pakistan are less than half the averages in India.

It is also quite futile to talk of a single literacy rate for Pakistan as tremendous disparities are prevalent within the country along gender, class and regional lines.

The most distressing aspect that emerges from these observations is the state of education among women. Nationwide, their literacy rate is not even half compared to men. But the gap attains enormous proportions in rural areas where the female literacy, at 5.5 per cent, is just about one-fifth of rural male literacy. The literacy rate of 5.5 per cent is also the lowest in the world for any section of people.

Other averages, like those of enrolment and drop out rates, further impress the dismal state of female education in Pakistan. Primary enrolment rate for girls is 15 per cent below the total enrolment rates, and 8 per cent below secondary enrollment. Girls moving from primary to secondary schools in 1987 were 9 per cent less than boys, implying a higher percentage of drop out for girls. A prime factor behind this is lower school availability and accessibility for girls. Whether or not a school is available in the same or nearby village is claimed to account for one-third of the large gender gap in schools. The distance to a school may not be the most critical factor for boys. But for girls, and especially those in the rural areas, it makes all the difference between a literate and a non-literate status.

In a way these distressing literacy rates are not very surprising. Education has never been a priority issue with Pakistan's planning department, as is evident from the extremely low expenditure budgeted for this sector. It was as low as 1.4 per cent of GNP in the early '70s, and remained around 1.5 per cent between 1975 and 1985. Since then it has increased to 2.3 per cent, but is still nowhere near the requirement.

The health sector in Pakistan defies all logic. Access to health facilities (hospitals, nursing homes and health centres) is just 55 per cent compared to 65 per cent for India. Average calorie intake in Pakistan measures 2,316 per person per day, while in India it is 2,395 per person per day. Infant mortality rate in Pakistan is 8.8 per cent to India's 8.0 per cent. Access to water resources is only 68 per cent in Pakistan, compared to India's 78 per cent.

An interesting fact emerged from statistics released by the Government of Pakistan a few years back, listing the main causes of deaths in the country. Almost 64 per cent of the deaths in Pakistan are caused by infectious parasitic diseases. Diseases like malaria and tuberculosis account for another 10.5 per cent and 5.5 per cent, taking the toll of all infectious diseases to 75 per cent, ie, three- fourths of all deaths in Pakistan. In rural areas, the situation is worse and infectious diseases account for almost 80 per cent of the deaths.

What is the reason for this high incidence of deaths due to infectious diseases? Access to water resources and sanitation is low in urban areas, and almost non-existent in rural areas. Resources that are available are unhygienic and contaminated due to lack of upkeep.

Only around 52 per cent of the country's population has access to drinking water. While in urban areas drinking water is available to 80 per cent of the people, it is as low as 45 per cent in rural areas. Proper sanitation facilities are available to just 22 per cent. In urban areas the figure is 53 per cent, but in rural areas only 10 per cent. In fact, as late as 1985, sanitation facilities were absolutely nil in rural Pakistan. It,  thus, does not come as a surprise that diseases like typhoid, cholera, intestinal infections, malaria, tuberculosis etc have such a high incidence in the country.

These figures also reveal a deep-rooted urban bias in the health sector of Pakistan. Even though 60 per cent of Pakistan lives in rural areas, an overwhelming section of medical personnel and health facilities are located only in cities. For example, 85 per cent of all practising doctors work in the cities, which comes to a doctor-population ratio of 1:1801. The rural doctor-population ratio happens to be a pathetic 1:25829. Similarly, only 23 per cent of the hospitals in the country are located in rural areas and only 8,574 hospital beds (18 per cent of total) are available to a population of 80 million.

The health budget in Pakistan is less than 1 per cent of the GNP. Out of this, more than four-fifths gets allocated to urban-based curative health facilities at the expense of rural health programmes. An important reason for a lack of trained medical manpower in rural areas is lack of facilities. Even if some well- intentioned doctors want to serve in rural areas, the abysmal conditions force them to change their mind. The government's approach to the whole issue can be gauged from the fact that though it 'urges' doctors to go to rural areas, it actually pays them less than their colleagues at equivalent positions in urban health centres.

Even in urban areas, these health facilities are largely restricted to use by the upper sections of society and are beyond the reach of those living in slums and katchi abadis. Pakistan has undergone a very fast rate of urbanisation at around 4.8 per cent per annum, largely due to migration from rural areas. Thus, slums and katchi abadis constitute a large section - around 40 per cent nationwide - of the urban populace. Health centres and other medical facilities are virtually non-existent in these settlements. Sanitary provisions and water accessibility are also practically nil and, in several cases, even proper sewage facilities are not provided. Under such extreme conditions, it is no wonder that three-fourths of the deaths are caused by infectious diseases.

The degraded status of women in Pakistani society is already evident from our discussion on population welfare and the education sector. Some observations made by Pakistani economist S Akbar Zaidi in Issues in Pakistan's Economy provide further clues:
* Pakistan has the lowest sex ratio in the world: In 1985 there were 91 women for every 100 men, down from 93 in 1965.
* According to studies conducted in 1989, Pakistan was one of only four countries in the world where men lived longer than women.
* Primary school enrolment rates for girls are among the ten lowest in the world.
* While the incidence of ill-health and premature death among the poor of both sexes is very high in Pakistan, women and girls are the worst affected.

* Pakistan's maternal mortality rate is the highest in South Asia and greater than all other Muslim countries, essentially due to birth-related problems. This is compounded by the very high prevalence of babies with low birth-weight - only three countries in the world have a higher percentage of such babies.

* Only 13 per cent of the labour force is constituted of women, substantially below the 36 per cent average for all low-income countries.

The discrimination meted out to women in the Pakistani society has wide- ranging implications for the country as a whole. As economist Giovanni Cornia has observed in his paper in Tariq Banuri's Just Adjustment: Protecting the Vulnerable and Promoting Growth, the unsatisfactory social and economic development record in Pakistan depends to a very large extent on the low status of women in society, on their low level of literacy, on their restricted access to basic services, and on a pervasive gender bias in the access to economic resources which is the source of a severe intra-sex and intra-household income inequality. Women are married at an early age, have shorter lives, work longer hours, remain mostly illiterate, and have minimal opportunities for schooling, training and gainful employment. Their low and secondary status precludes any significant decision-making role even in fertility control.

(The author is freelance commentator)

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