Author: Maheen A. Rashdi
Publication: Dawn
Date: February 12, 2004
URL: http://www.dawn.com/weekly/review/review2.htm
Pakistan is caught in a population
explosion where the damage is irreparable and the devastation lasts a lifetime.
Maheen A. Rashdi stresses that it is about time the government began to
take this issue seriously.
In a culture where most couples
are quick to secede all responsibility of producing children to nature
there is a large gap to fill before issues of family planning can truly
make headway.
*At one time, family planning was
almost an offensive suggestion if ever made by a doctor or an educated
well-wisher to those happily exceeding the progeny count beyond four.
My earliest memories of the issue
is when I would hear my mother scolding any and every member of our domestic
staff whenever she heard this excuse for their leave of absence: 'Ji meri
wife ki delivery hui hai.' As it always happened to be the fifth, sixth
or even the seventh 'delivery', mother would go on a tirade saying the
usual 'Pehley waley bachon ka to khyal nahi rakh saktey, kya zaroorat hai
aur paida karney ki...' so on and so forth.
As an uninitiated 12-year-old, I
could never understand her reasons for reacting the way she did on the
seemingly happy occasion of the birth of an infant and would put it down
to some great sin the poor chap had committed - as he too would be listening
rather meekly.
It was much later when I realized
that in her small way she was attempting to instill the idea of family
planning in those less fortunate souls to whom such concepts were not only
alien, but almost insulting. And that belief held by the majority has largely
thwarted all efforts launched in Pakistan to control population explosion.
Pakistan's population increased
from 34 million in 1951 to 144 million in 2001. The increase of over 108
million Pakistanis in five decades is daunting - almost scary - as supporting
factors such as a strong economy and sound health and education facilities
have not been reinforced.
It is estimated by the ministry
of population planning that the continuing high population growth will
result in Pakistan's population reaching approximately 220 million by the
year 2020, thus negating most efforts being made towards poverty alleviation.
Since viability of all sustainable programmes outlined to improve the standards
of the populace depends on the growth rate of our population, it is imperative
that population control becomes effective and goes on 'high alert' on the
agenda of the National Reconstruction Bureau.
The fact that a population census
held in March 1998 took place after 17 years makes it evident that no real
push was made in the direction of population control by the changing governments
during the interim period.
The myopic view regarding the very
concept was probably the real reason behind this lethargy, as governments
hesitated to 'take on' the rural and the illiterate populace of the country
the ones primarily constituting the vote bank.
The 1998 census recorded the average
household size as 6.6. This was incidentally recorded after a well organized
and widespread campaign which propagated contraception with the catch line,
"Bachchey, do hi achchey."
Ironically, Pakistan's extremely
high rate of population growth is the direct effect of a falling death
rate combined with a continuing high birth rate. The population planning
ministry says that in 1950 the mortality rate was 27 per 1,000 population;
by 1990 the rate had dropped to 12 (estimated) per 1,000. Should one rejoice
at the drop in mortality rate or bemoan the rise in population?
On average, in 1990, each family
had 6.2 children, and only 11 per cent of couples were regularly using
some form of contraception. Available statistics reveal that the population
growth rate (PGR) has declined from over three per cent in previous decades
to its current level of around two per cent per annum.
But Pakistan is still way beyond
the acceptable rate of growth compared to other similarly developing countries,
some even younger than Pakistan. What is also evident from these figures
is that there has been some progress in the sphere of family planning and
part of the general public has accepted family planning in practice.
The marginal drop in PGR proves
that if efforts put into the implementation of family planning policies
were truly on track, results would have been far more positive. But as
is the case with most government initiatives, half-baked ideas not seen
to completion have resulted in failure in the case of population control
as well.
With over one-third of Pakistanis
living in poverty, the impact of population growth cannot be taken lightly
on any account. It is the very strata living in poverty which also has
to deal with the burden of a large family. Their handful of resources for
an expanding family obviously worsens living conditions further, leaving
these very households to resort to desperate means like suicide, selling
of children into bonded labour, mutilation for begging purposes and so
on.
Placing it as the axis of evil,
over population can rightly be said to contribute to poor housing and sanitation
conditions, malnutrition and a general environmental downtrend. From here
on lack of resources multiply and issues like inaccessibility to safe drinking
water, pressures on agricultural yield and malnutrition in poor families
lead to a nation's collapse.
The failure of governments to sustain
population programming is obvious by the sporadic implementation of such
programmes from Ayub Khan's era. It was in 1952 that the first Family Planning
Association of Pakistan [FPAP], an NGO, initiated efforts to contain population
growth. Three years later, the government jumped in to fund the association,
noting for the first time the need to reduce population growth by adding
the issue in its First Five-Year Plan (1955-60).
Then in the mid-1960s, the Ministry
of Health initiated a programme in which intrauterine devices (IUDs) were
promoted. The programme offered payments to hospitals and clinics as incentives,
and midwives were trained to treat patients.
The government was even able to
attract funding from many international donors, but the programme lost
support because the targets set turned out to be too elaborate and got
run down in the face of the 'ambitious' motives of doctors and clinics
who were over-reporting their services to claim incentive payments.
Then there was the Continuous Motivation
System Programme, in which through an 'inundation strategy', birth control
pills and condoms were supplied throughout the country and simultaneously,
young urban women were sent to visit rural areas to spread awareness. But
that too failed as a sustained monitoring system was not maintained and
as usual the initial verve of the government got mired in crooked dealings
of those involved, and with no vigilance, this initiative also lost its
thread.
Family planning was again highlighted
by the present government and high priority was given to lowering the population
growth rate from 2.1 per cent in 2001 to 1.9 per cent per annum by 2004.
But we have entered 2004 and the 'high priority' agenda has so far failed
to achieve the desired result.
There is no doubt that adding to
the government's failures is the great social barrier that exists in our
society which at times doesn't want to hear what contraception is, let
alone employ methods for it. And even if women - tired of child bearing
and rearing duties - are open to suggestions, because they live in a predominantly
male-oriented society, they are almost helpless.
Educating the rustic male is not
a joke in Pakistan. It becomes a question of who will take the bull by
the horns? Men need to be sensitized to their role as responsible fathers
and husbands; and in recognizing the critical role of women in the family
unit.
To enhance male involvement, the
programmes now employ male workers in rural areas to engage into a regular
dialogue with the male community, and to sensitize the elders and parents
towards male contraception, but progress is slow.
To ensure quality of services and
success of all plans there is much that needs to be done at the state level
to bridge the gap of unmet needs. Accessibility of services, attitude of
service providers, improvement of their technical skills, counselling and
follow ups are the essentials for quality service provision.
NGOs are basically the ones making
some headway in population planning, but their efforts cannot be enough
unless the government supports the programmes with the same commitment.
To ensure quality services and uniform standards, an institutionalized
system must be in place, which the ministry of population welfare has so
far not succeeded in doing.
The list of failed methods and poor
stratagies is a long one. The programmes have a history of either being
hijacked by unscrupulous staff, or being sidelined by governments not fully
cognizant of the place of such programmes in the 'essential' scheme of
things, i.e., economtc progress.
At present it is being said that
the situation is drastic with Pakistan's population growth rate being the
highest in the region. If population control efforts can work in other
third world countries, e.g., Bangladesh, India, Iran and Sri Lanka, there
is no concrete reason for them not to work in Pakistan.
The programme simply needs to be
implemented honestly and diligently, with government and private partnerships
working in tandem for optimum results. But above all a resolute political
will is a must - if the cycle of life is to be preserved.
