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Family planning may be our last hope

Family planning may be our last hope

It's out, even the Pope has said it that there's no need to "breed like rabbits". He was, of course, addressing the Catholics, but he could well have been talking to Pakistanis.

Pakistan's population explosion may become a threat to the very existence of the nation

The fact that there will be 342 million people in Pakistan by 2050 is giving many people sleepless nights. For years now, demographers have been trying to get the attention of the policy makers, showing them that Pakistan needs to slow population growth.

Today, the signs are all over — perpetual power outages, current petrol imbroglio, 25 million out of school kids, and polio cases through the roof.

Dr Farid Midhet, a demographer heading Jhpiego, who sees a clear link between poverty, inequality and population, is worried that unless the government invests in the young Pakistani population (approximately 56 per cent of the population in 2014) the latter may become a threat to the very existence of the nation.

"If young people are unable to achieve their dreams, their energies may be directed towards undesirable activities," he warned.

Demographic Dividend

Pakistan's population is growing by around two per cent a year but the economy has failed to keep pace with the population growth.

Demographic dividend is defined as a one-time window of opportunity of accelerated economic growth; it begins with changes in the age structure of a country's population as it transitions from high-to-low birth and death rates, which are called the demographic dividend.

Many see this population explosion quite differently

They say Pakistan is well-placed as it has a young and rapidly urbanised population in an ageing world.

"Pakistan is going through a youth bulge in its demographic transition. Data shows that the youth (aged 15-24) is better educated than the older generations and have lower fertility rates and are increasingly urban," said acclaimed economist, Asad Sayeed, director and senior researcher at the Collective of Social Science Research, a Karachi based research and consulting organisation.

However, he said, the setback to harnessing these factors is the "significant inequality, not so much across income levels but across genders and across urban and rural areas."

But accelerated economic gains are not around the corner, at least not yet. And with over half the population living on less than two dollars a day, something is not quite right.

"While investment in human capital is necessary, it is more important that this investment is geared towards women and towards the rural areas," said Sayeed.

Having a large population of young employable people will not automatically translate into economic prosperity.

While the changing population structure is the necessary first step, investment in health, education, sound economic policies, and good governance will result in accelerated economic growth.

Lowering fertility rate

When the number of births decline, the dependent population grows smaller, in relation to the working age population. With more workers and fewer people to support, the country has a window of opportunity for accelerated economic growth.

This is called the demographic dividend. But, a pattern of investments is necessary to harness the demographic dividend.

Take the case of Thailand. In the 1960, 40 per cent of Thailand's population was under the age of 15 and women, on average, had six children. By the 1990s women were having on an average two children.

A desire for smaller families led to investments in family planning, which transformed the age structure. This, in turn, contributed to the unprecedented economic growth.


Comparing Pakistan with Bangladesh

Pakistan scores better in terms of the literacy level of women, poverty and urbanisation - three indicators of development. Yet, when it comes to contraceptive use, whatever the literacy level or economic status, contraceptive use (contraceptive prevalence rate) remains close to 60 per cent across all segments of society. In 1975, 8 per cent of Bangladeshi women used contraception.

By 2010, the number was over 60 per cent. In Pakistan, the CPR is 35.4 per cent.

The “Iranian miracle”

When the fertility rate fell from seven births per woman in 1966 to fewer than two today, Iran recorded the steepest population drop, faster than China’s one-child policy even.

And it came with no coercion. In the late 1980s, Iran’s Ayatollah Ruhollah Khomeini decided that the Iranian economy could not handle the population bulge and used the pulpit.

At the same time, contraception was made available for free at government clinics and the state-run television was used to broadcast information about birth control. Health workers increasingly began to educate patients on family planning to space births.

Pakistan urgently needs to invest in: 

Improving child survival services. Experts say when children live, couples desire smaller families.

Every year, 800,000 children die in Pakistan and 35 per cent of these occur due to malnutrition.

Rigorous immunisation and nutrition programmes, means transition towards healthy adulthood.

Yet, Pakistan is plagued with two of the commonest forms of malnutrition - under five stunting and anemia among women during the child bearing years.

Currently, the abysmally low coverage of routine childhood immunisation against infectious diseases, including polio averages 61.4 and even lower in other parts of Pakistan. Unless routine immunisation can be scaled up to a minimum coverage of 80 per cent, malnutrition will continue to haunt Pakistani children.

61 per cent children in Pakistan suffered from iron deficiency anemia, 54 per cent from Vitamin A deficiency, 40 per cent from Vitamin D deficiency and 39 per cent from zinc deficiency (Save the Children).


Spacing births by investing in family planning


With an accelerated family planning programme though, Pakistan can bring the 342 million figure down to 266 million.

This will prevent unintended pregnancies. Pakistani women and men want, on an average four children.

“Seven million women have declared that they do not want more children or want to space births, but are unable to do so," said Dr Zeba Sathar, the country director of the Population Council of Pakistan.

This is so due to issues of access to family planning services, concerns about side effects and the poor quality of services, leading to non-use or high levels of contraceptive discontinuation.”

And when a woman does think of family planning, it is only after she has had five or more children, according to studies carried out by the Population Reference Bureau (PRB), a Washington D.C.-based research organisation that monitors population trends around the world.

“Bad governance and Illiteracy, specially female illiteracy” are the two reasons why FP programmes have never made much headway in Pakistan, according to Midhet. "Contraceptive use works as part of an enlightened and educated culture where women have some decision-making power,” he concluded.




Investments in education are critical to seizing the opportunity of a healthy workforce. Additional quality training and skills in young people will equip them to compete in the global economy.

According to the EFA Global Monitoring report of 2012, Pakistan ranks second in having the most out-of-school children in the world.

Whilst India’s education budget is 4 per cent of the GDP, in Pakistan, it has been held down to under 2 per cent, with recent announcement by Prime Minister Nawaz Sharif to enhance it to 4 per cent by 2018.

Alif Ailaan's report states that out of the 25 million out-of-school children, 13.7 million (55 per cent) were girls. Improving secondary school enrollment — especially for girls — will accelerate progress towards the dividend.

While school enrollment for children aged 6-16 years stood at 79 per cent (36 per cent girls and 64 per cent boys), by age 16, 55 per cent of those children drop out of school.

When girls stay in school longer, particularly in secondary school, there is more likelihood of delay in their marriage and therefore, childbearing.


Economic policies 


The Food and Agriculture Organisation said that to feed a population of nine billion in 2050, the world must increase its food production by an average of 60 per cent or else risk serious food shortages that could bring social unrest and civil wars.

Along with investments in health and education, sound economic policies are imperative in creating create jobs for the youth and to harness the power of the age structure transformation.

Youth population, according to population projections of the planning commission, is approximately 56 per cent of the total population in the year 2014.

Given that women are having fewer children and are now reaching higher levels of education, more women can transition to paid and higher-skill jobs. Right now, it does not look that way.

According to the Labour Force Survey 2012-13, a population of 188.2 million is causing enormous stress on resources.

The unemployment rate has increased from 6.0 per cent in 2010-11 to 6.2 per cent in 2012-13 with rural unemployment increasing from 4.7 per cent in 2010-11 to 5.5 per cent in 2012-13 and urban unemployment is stable at 8.8 per cent in 2012-13.

Currently, 36 per cent of Pakistan’s labour force is aged between 15-24. This number will rise to 50 per cent by 2020.

There are approximately four million jobless youth, between the ages of 15-24, in Pakistan; if we don't do anything the number is likely to rise to 8.6 million by 2020.

Pakistan needs to find employment for 1.7 million people each year, if it is to avoid the long-term rise of youth unemployment. Current projections expect the youth labour force to double over the next 6 years, and to make up half of Pakistan’s total labour force by 2020.

This reasons for growing unemployment are a rise in population and a drop in job opportunities for a large part due to power shortages, resulting in lower production.

Women’s participation rate is around 21 per cent and it has remained static for some years now. In East Asian countries, around 70 per cent of women participate as effective members of the workforce, while this rate is close to 50 per cent 


Good governance 


A good way of understanding governance is to look at the government’s efficiency.

The World Bank's example of the “manner in which the state functions, specifically to its ability to mobilise revenue and its ability to use that money in a way that minimises waste and corruption — and maximises results” is a good enough explanation.

All political parties mentioned governance as a priority area in the manifestoes that they issued before the elections of May 2013, yet it remains elusive. Consider this: Pakistan has one of the world’s lowest tax-to-GDP ratio.

We have institutions whose job it is to hold the government accountable - like the National Accountability Bureau, the Public Accounts Committee, the Judicial Commission, the Election Commission of Pakistan, Ombudsman institution, the Federal Investigation Agency and various provincial agencies but all are hounded by the government's interferences and a lack financial autonomy.

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