Our family planning failure

Prime Minister Nawaz Sharif and the chief ministers of the four provinces were to attend the Population Summit in Islamabad on November 5-6, but they did not show up – indicating weak political commitment to the serious issue of unrestrained population growth in Pakistan.
The summit was a grim reminder that demographic issues and population planning, issues with far-reaching implications for our survival and prosperity, lack political ownership in this country. Lip service notwithstanding, the country’s rulers have done little on ground to address the issue of population growth.
In the last 68 years of its existence, Pakistan’s population has increased more than five times from 37 million to an estimated 191 million and is likely to exceed 300 million by 2050. It is not hard to imagine the consequences of this huge population with limited resources.
While other nations have successfully restrained their population growth, some of them decades ago, we have miserably failed in doing so. World population is growing by 1.2 percent per year while Pakistan has a growth rate of 1.9 percent. In contrast, in our neighbourhood, Bangladesh has a growth rate of 1.2 percent, India 1.2 percent and Iran 1.3 percent.
A fertility rate of three children per women is considered a desirable goal worldwide, while we have a fertility rate of 3.58. It means that our women, on average, have one more child than they should have for a low population growth. Even Saudi Arabia, an orthodox religious country with huge resources, has a fertility rate lower than that of Pakistan.
We are behind other countries despite the fact that the population planning campaign started in our country as early as in 1953 when a civil society organisation embarked on advocacy and delivery of services for family planning with the assistance of international support. In 1965, the government also set up institutions for population welfare and family planning.
Bangladesh, which embarked on a family planning programme much later than us, is a success story thanks to strong political commitment to this cause. The prime minister of the country chairs the fortnightly meetings to monitor the programme. Our rulers have no such commitment.
Another model in our neighbourhood is Iran where religious clerics, intellectuals and the government are united to keep the population under check; every couple has to receive mandatory counselling on family planning and reproductive health before contracting marriage.
A major factor behind the decline in population growth in Bangladesh and Iran is the higher prevalence of modern contraceptive methods in these countries. Contraceptive prevalence rate (CPR) measures the percentage of women (aged 15-49) who are practising, or whose sexual partners are practising, any form of contraception. In Bangladesh, the CPR is 62 percent and in Iran around 80 percent, while in Pakistan it has been stagnant at 34 percent for decades.
At the London Family Planning 2012 Summit, Pakistan committed to increasing its CPR to 55 percent by 2020, but so far no concrete policy or action has been taken in this direction. No province has yet issued a population policy.
Meagre allocations are made in annual provincial budgets for population welfare, and those too are released towards the end of the year when the departments cannot use funds for want of time. The bulk of the funds allocated for population departments is spent on infrastructure and staff salaries while paltry amounts left for operational expenditures.
Our rulers cannot hide behind the excuse that population planning will lead to a backlash; gone are those days when there was strong resistance to family planning and use of contraceptives. Credible surveys suggest acceptability of family planning and contraceptives has increased over the years. Literacy and urbanisation have contributed to a favourable atmosphere.
According to the Demographic Household Survey, there is a 20-26 percent unmet need of contraceptives in the country or, in other words, seven million women want to use contraceptive methods but they do not have access to them. A study by the Population Council estimated that out of the nine million pregnancies in 2012, 4.2 million were unintended.
There is a glaring lack of affordable family planning facilities. The state has failed in reaching out to the people. If this unmet demand is provided for, Pakistan’s CPR will almost double – leading to a drastic fall in fertility rate and population growth.
In the absence of inadequate facilities, a large number of women are using illegal abortion, mostly unsafe at the hands of untrained nurses, as a method of family planning. According to the Population Council, 2.25 million women resorted to induced abortions in 2012. This number was 0.9 million a decade ago.
An issue is that family planning services are not the part of the public healthcare system. Provinces have separate departments for family planning and healthcare. There is no coordination between the two. Much better results can be achieved by providing family planning services at basic health units, rural health centres and tehsil and district hospitals.
In the mid-1990s, more than 100,000 lady health workers were recruited to provide some basic health services, but family planning was placed at the bottom of their duty list. These workers, if they are properly trained, can play an important role in raising awareness and removing reservations and misunderstandings among women about the side effects of modern contraceptive methods.
There are so many ways, including provision of incentives to couples who limit their family size to a certain number, that can make family planning a success story in Pakistan the way it has been in other regional and Muslim countries. But all these strategies can be implemented only if the rulers, first of all, recognise the significance of this issue.
Email: adnanadilzaidi@gmail.com