By Zubeida Mustafa
THE UNFPA’s State of the World Population 2002 released last week should give much food for thought to policy makers in Pakistan. The first eye-opening information it gives us is that Pakistan’s population stands at 148.7 million.
The national census four years ago had put the head count at 130.5 million. If we accept the 1998 data as authentic — it was the product of a massive and costly exercise — the demographic growth has been phenomenal. That is not all. According to the UNFPA projections, Pakistan will have a population of 344.2 million in the year 2050 and we will be the fourth most populous state in the world after India, China and the US, in that order. What is most worrying in this mass of figures is the very high population growth rate (2.5 per cent) which is higher than many other heavily populated countries such as India, Bangladesh, Indonesia and China.
So the moot point is why Pakistan’s family planning programme has been such a failure? True, it is now explicitly recognized that population growth is very closely linked to the economic and social progress of a nation. But this has to be accompanied with a visible effort in the family planning sector because the two are very closely interrelated. Large families, apart from other factors, hamper economic development.
The UNFPA report specifically identifies investment in health, education and gender equality as being vital to creating an impact on the fertility rate of a country. It has generally been observed that the higher the level of education of the people, especially women, the better their health status and the less the social prejudice against women, the smaller is their family size. The statistics quoted for Pakistan in all these areas are so dismal that it comes as no surprise that the total fertility rate (the average number of children that would be born to a woman in her reproductive years) is dismayingly high at 5.08.
Pakistan’s failure to educate its citizens 70 per cent of women and 41 per cent of men are illiterate and provide them a modicum of health care has resulted in not producing the “population effect” on economic growth. But one single factor which has had the most profound impact on the fertility rate is the low status of women in our society. This has been documented regularly in reports published by many international agencies and the data produced have not registered much of an improvement over the years.
By not empowering women and giving them the dignity that is due to them, the state and society have virtually ensured the failure of the family planning programme. It is difficult to quantify the esteem and value of women in social and economic terms — housework and the unpaid labour of women are not a component of the GNP while in economically productive employment women invariably receive lower wages.
But the UNFPA report, and the earlier one of the UNICEF’s State of the world’s children, 2002, give data which clearly establish the social prejudice against women. This is reflected in the wide gender gap in education, health and other areas of life which logically should not have been there if women had not been discriminated against.
How does the low esteem of women translate itself into high birth rates? It has been found, especially in those classes of society which are educationally deprived, that the family and social pressures on parents to produce sons are immense. Sons are not only a status symbol and are the flagbearers of the family name, they are also regarded as an economic insurance, especially in old age. Given these attitudes, it is not strange that the size of the family is determined by the sex of the children the mother produces and in which sequence. Hence, it is plain that the two-children family norm promoted by the Population Division will never be popular until the girl child gains widespread acceptance — even when she does not have a male sibling.
While this is an important element in the success or failure of the population programme, another aspect to be considered is the contraceptive delivery system. Without adequate contraceptive prevalence (only 20 per cent in Pakistan according to the UNFPA), it is not possible to service the needs of the people.
The fact is that considerable awareness has been created over the last few decades through information, education and communication strategies of the family planning projects. Today it is said that 97 per cent of men and women have considerable awareness about contraceptives and the importance of the small family norms. A very large number of them even want to plan their families but do not have access to any contraceptive services.
This unmet need in Pakistan is a testimony to the failure of the population programme. The problem is that these are issues which are not addressed earnestly and no solution is sought for the challenges they pose. Where solutions are available, they are not explored because vested interests vehemently oppose any change in strategy.
For instance, the UNFPA, under its previous executive director, Dr Nafis Sadiq, had strongly recommended the merger of the health and population set-ups because investments in reproductive health are regarded as crucial accompaniments of investments in disease control. It is believed that it is cost-effective and credible to have health care providers who enjoy public confidence to look after the reproductive health and contraceptive needs of their clients without any extra investment. For many years this idea was resisted tooth and nail by the powers that be in Islamabad.
Although the health policy announced in 2001 by the Musharraf government accepted in principle the rational approach proposed by the UNFPA, the service infrastructure and budget continue to be segregated.
Taking the broader picture one must ponder not just the consequences of this short-sighted approach to the population sector. It is more important to analyze the causes of this mindset. Some of the factors leading to a high population growth rate are pretty palpable notably, poverty, social backwardness, economic underdevelopment and low status of women. Each of these accentuates the others and collectively they make their impact on the population growth rate.
It is, however, interesting to note that the countries which are not doing too well in the population sector also lack political maturity and democratic institutions. This is not by sheer coincidence. The political will and commitment a government displays in promoting the social well-being (which would include family planning) of the people is directly linked to the fact of its political power base. If it is a democratic and representative government rooted in participatory traditions, it would be under popular pressure to adopt policies which promote social welfare and advancement of the citizens. Its dependence on popular votes in a democratic dispensation would make it impossible for it to overlook popular needs.
In undemocratic societies it suits the vested interests to perpetuate high population growth rate and the concomitant poverty. People mired in poverty with large families are so hopelessly trapped in the survival struggle that they have no time and energy to participate in political life. They cannot sustain movements which destabilize unpopular governments. In states with low literacy rates and poor education levels, governments can be exploitative and oppressive because the citizens lack the education and skills to challenge the government with a poor human rights record.
From the UNFPA’s report one can identify the high fertility rate countries as the ones which would never qualify as models of good governance. For instance, Afghanistan, Pakistan, Yemen, Bhutan, Saudi Arabia, Oman, and occupied Palestinian territories in this region have TFRs of more than five. Many countries in sub-Saharan Africa also have high TFRs.
With all the socio-economic factors so closely interlinked in a vicious circle, a calculated effort is needed to break it. Whether the political government will have the time and commitment to attend to issues such as population growth, gender equality, education, health care, we will have to wait and see.
Since demography is so directly concerned with numbers and statistics, it should be pointed out here that practically all the data given by the UN agencies differ from what the government sources give out. Needless to say, the government paints a rosier picture. Some of the figures stated by the UNFPA are also believed to be too optimistic. For instance, the maternal mortality rate of 200 per 100,000 births as stated by the UNFPA is challenged by professionals in the field. Dr Sadiqa Jafari, the chairperson of the committee on maternal health, says that from her experience she finds the rate is actually much higher but is under-reported in the absence of any scientific system of data collection.