Nowhere close to Cairo goals

By Zubeida Mustafa
Source: Dawn

How many of us remember the population conference held in Cairo in September 1994? Some of us may recall the rumpus created by the religious lobbies when it was indicated that Benazir Bhutto, who was then the prime minister – for the second time – would be attending the summit. She must be given credit for her courage. Not only did she go to Cairo, she also made a spirited speech in support of family planning.

But there was more to the Cairo conference (termed as the International Conference on Population and Development, ICPD, in UN parlance) than Ms Bhutto’s participation. It produced a 20- year programme of action, which Dr Nafis Sadik, the UNFPA’s executive director at the time and a vocal champion of the reproductive rights of women, had described as “having the potential to change the world”.

Has the ICPD’s programme really changed the scene in Pakistan? Ten years on, it is time for an honest assessment. This document “provides a blueprint for actions in population and reproductive health that countries agree are essential to realizing global development goals”, to quote the UNFPA’s State of the World’s Population, 2004. The report assures us that this programme is essential to end extreme poverty and hunger, empower women, reduce maternal mortality, preserve the environment and stem the AIDS pandemic. This is no exaggeration.

It has now been universally recognized that a burgeoning population is a bane. It obstructs a society’s journey to progress. As the UNFPA’s report points out, the population size, growth and distribution are closely linked to prospects for economic and social development and action in one area reinforces action in the others.

Hence it is not just the availability of reproductive health and contraceptive facilities which impact on the population profile of a country. The standard of education, health awareness and economic development have a direct bearing on its demographic profile.

The three key goals adopted by the ICPD in 1994 were:

* Gender equality in education by eliminating gender gap in primary and secondary education by the year 2005 and arranging for complete access for boys and girls to schools by 2015;

* Reduce infant, child and maternal mortality to no more than 50 and 70 for infants and under-5s respectively per 1,000 live births by the year 2000 and to below 35 and 45 respectively by 2015 Maternal mortality was to be reduced to 60 per 100,000 births by 2015;

* Provide universal reproductive health services to a full range of safe and reliable family planning methods by 2015

While reviewing the first five years of the implementation, the UN adopted some specific targets which suggested a thrust towards an integrated health and population strategy. It was proposed that by the year 2005 the countries should equip the 60 per cent of their primary health care facilities with the capability to provide family planning methods and essential obstetric care.

This didn’t amount to asking for the moon. One can turn to the statistical section of the population report to see how various countries have fared. The attached table gives some statistics for three Third World countries which also happen to be Muslim.

The question we should be asking ourselves and also our policymakers is: why are our demographic and socio-economic indicators so dismal? The popular belief that religion plays a backwardizing role in determining our attitudes towards family planning is evidently a myth. The comparative figures of three Muslim countries from three regions should end this misconception. In fact many surveys conducted in Pakistan have also shown that very few respondents identify religion as a factor in determining their family size.

There are two major causes for Pakistan’s poor showing in this area. First, we as a society have yet to develop a commitment to human rights and gender equality, which should underpin any sound programme for social development. The second is that our ruling elites lack political will to put the people at the centre of their policies.

With this approach, the government has lost whatever little interest it had in the social sectors. As a result, official funding is drying up, supervision and monitoring are virtually absent, accountability is missing and corruption is rampant. It appears that social development is not high on the government’s list of priorities. It has over the years disengaged itself from the health, education, housing and population sectors and has encouraged private entrepreneurs to fill the vacuum so created.

Some of these investors are more efficient and enterprising and manage to produce results by ensuring the accountability of their workers. But this is at a cost which is beyond the reach of everyone making their facilities inaccessible to the poor. Since a successful population policy calls for a holistic approach, it is not surprising that it suffers along with the others.

Social development cannot take place without a change in the mindset and behaviour of the people. With a culture devoid of respect for human rights and gender equality, our country has failed to promote family planning as a norm. It has now been established that a society that does not recognize its women as human beings to be treated equally with men, cannot develop socially or economically.

Many women with large families say that they go on producing children because their husbands/mothers-in-law want them to. They are expected to have a number of male offsprings. Sons being status symbols bring honour and social esteem to the mother in the family and the community which daughters don’t.

The public controversy over the honour killing bill and the Hudood ordinances indicates that the clerics are in cahoots with the feudals to suppress women. And when they are at the helm, can any population programme work? It is now up to the civil society to adopt the population cause. The demand for reproductive health facilities and consciousness raising should be on the agenda of all human rights and women’s rights organizations.

Country Infant mortality ratio
per 1000 live births
Under-5 mortality
per1000 live births male/female
Maternal mortality
per 10,000 births
Primary school
enrolment (%)
Conraceptive
prevalence (%)
Tunisia 23 29/24 120 114/109 51
Iran 33 39/39 76 94/90 56
Malaysia 10 15/11 41 95/95 30
Pakistan 87 121/135 500 84/62 20
Less developed
regions (average) 61 89/89 54
Country TFT* Public health
expenditure % GDP per cap
Education expenditure% GDP % births with skilled
birth attendance
Population growth
rate (%) GDP
Tunisia 2.01 4.9 15.8 90 1.2
Iran 2.3 2.7 11.6 90 1.0
Malaysia 2.9 2.0 17.0 97 1.9
Pakistan 5.08 1.0 20 2.4
Less developed
regions (average) 2.9 1.5
TFT is total fertility rate (the average number of children a woman has in her reproductive life span) Source: The State of the World Population, 2004 (UNFPA)