TFT SPECIAL: On Track For 300 Million, Will Pakistan’s Population Bomb Explode?

TFT SPECIAL: On Track For 300 Million, Will Pakistan’s Population Bomb Explode?
The global theme on this World Population day is ‘Unleashing power of Gender equality: uplifting voices of women and girls to the world of infinite possibilities’. The theme is both a recognition of women’s contribution and concern for their lagging behind to invisibility, in some cases.

According to the 2023 Global Gender Gap Index, no country has yet achieved full gender parity. Iceland (91.2%) takes the top position, 14th time in a row. It also continues to be the only country to have closed more than 90% of its gender gap.

At the current rate of progress over the 2006- 2023 span, it will take 162 years to close the Political Empowerment gender gap, 169 years for the Economic Participation and Opportunity gender gap, and 16 years for the Educational Attainment gender gap.

The time to close the Health and Survival gender gap remains undefined. Southern Asia has achieved 63.4% gender parity, the second-lowest score of the eight regions. Bangladesh, Bhutan and Sri Lanka are the best-performing countries in the region, while Pakistan, Iran and Afghanistan are at the bottom of both the regional and global ranking tables.

At the current rate of progress full parity in the region will be achieved in 149 years.

Women solely bear the burden of continued population boom. Pakistan has achieved the rank of the fifth most populous country of the world and is amongst the ten most water stressed country in the world and eighth most vulnerable nation to the climate crisis.

Pakistan has the highest population growth rate in comparison to countries in region and muslim countries i.e. 1.93. An average Pakistani women have the most children in the region i.e. 3.6. only 34/1000 couples use contraceptive which is lowest in the region. Pakistan’s Maternal Mortality Ratio (MMR) stands at 186 per 100,000

As per the Pakistan Demography and Health Survey 2017-18 only 92% women aged 15-49 do discuss Family Planning (FP) at a health facility or with a Visiting Lady Health Worker (LHW). The facts of the survey are depressing and shocking:

  • 8% of adolescent girls are married as a child i.e. under the age of 18years.

  • 90% of married girls aged 15-19 years have no access to any material or conversations on  Reproductive Health (RH) or FP needs at either a health facility or with a LHW.

  • 51% of women aged 15-49 do not participate in decision making regarding their health; and only 18% had least birth spacing (7-17 months) between the two pregnancies.

  • The percentage of least birth spacing has increased to 33% for married adolescent girls aged 15-19 years.

  • Among married women aged 15-49 years, if married before the age of 18 years the mean number of children born are 6.1; and it reduces to 4.5 if married after the age of 18.

The Pakistan Maternal Mortality Survey (PMMS) 2019 informed that n Pakistan, only 34% of women aged 15-49 were informed about such complications by a healthcare provider; 52% sought treatment for one or more pregnancy-related complications and 58% did not want to go alone. for 42% distance to health facility was an issue; 30% didn’t have money for treatment; and 21% did not get permission for accessing health care.

  • The Maternal Mortality Rate (MMR) for Pakistan stands at 186/100,000. The cause of death for 18% of girls aged 15-19 is pregnancy related.

  • 67% married women ages 15-49 reported at least one complication during pregnancies; which increased to 83% for married aged 15-19 years.

An adolescent, unhealthy and nutritionally deprived mother who does not have good physical and mental health is an intergenerational health threat both for the mother and the child.

Children born to adolescent mothers have higher mortality rates besides other health complications. Pakistan National Nutrition Survey 2018 informed that among children under the age of five 40% were stunted, 18% wasted and 29% underweight.

Pakistan has the highest maternal and infant mortality rates in the region i.e. 62/1000 die before being One and 11000 women annually die in child birth. This can be reduced if contraceptive use rises from 34% to 52% saving 3800 mothers.

The Pakistan Population Situation Analysis 2020, details how fitsula is the leading complication of teen pregnancies - turns into a lifelong health disability, besides being a stigma leading to social ostracization.

An estimated 5,000 to 6,000 women annually develop obstetric fitsula. Obstetric haemorrhage (41%) is the leading complication and cause of death for mothers, besides hypertensive disorder (29%).

There is strong association between age at marriage and education. Total Fertility Rate for Pakistan is 3.6 (15-49 years) which falls with increasing mother’s education i.e. from 4.2 births for women with no education to 2.6 births having a higher education. It is most evident is in FATA/NMD where 41% of women with no education were married before 18. It came down to 20% with primary education and only 5% for women with secondary education.

FP/ contraceptive use among married women of ages 15 to 29 rises with age and is higher with higher educational attainment and wealth. Women with no education has highest unmet FP needs. Rapid population growth rate in Pakistan is outpacing employment opportunities. Women labour force participation stands only at 22% as their access to education is compromised  due to non availability of schools and early marriages.

Our population is growing so fast that Pakistan simply cannot achieve universal primary education until 2075.

The SDGs’ full achievement depends on women and girls having information, services and means to decide SRH rights and being free from discrimination, coercion, and violence. Pakistan needs a cross sectoral and integrated population policy focusing on lowering the fertility rate to which can result in 10million less population by the year 2030 as against business as usual which is based on high fertility rates.

The Constitution of Pakistan guarantees to protect the fundamental rights of all its citizens. Article 9 of the Constitution guarantees the right to life, which includes the right to health and article 14 interpreted to have right to reproductive health as well.

But a child is not considered aright holder and an adolescent girl in child marriage faces grave threat to her life and that of her child. Health inequities, besides being intergenerational, affect both the demographic transition and socio-economic convergence.

Marriages and especially early marriages terminates education and contributes to higher adolescent fertility. At the ICPD25 summit, Pakistan also recognised the prevalence of child marriage and its effects on the health of adolescent girls.

Pakistan needs long term political will, increased public financing and efficient spending for family planning.   An increase of 2% of GDP and efficient spending to ensure availability of contraceptives, coupled with advocacy, can make the change happen.

It needs institutional reform to integrate Population Welfare departments with Health departments – at provincial level-  to improve access of FP services for women as part of ensuring universal health coverage. It needs engendered multisectoral interventions to harness the tail end of the demographic dividend by increasing investment in youth’s education and skill development.

It should be mandatory element of all sectoral policies to demonstrate the impact of population growth by developing a strategy for coping with a burgeoning population.

Girls/women education, health and protection are core elements of women empowerment, gender equality and equity. A progressive societal narrative need to project women as productive members of the family that can be the bread winner and not depicted as a burden that parents have to marry off.

The unacknowledged, unpaid work in the care economy and informal labour of women needs to be documented and integrated into the public discourse to establish that it takes “two” to make the family and economically support the family. We need to develop a public discourse that does not associate the words rights, consent/choice as taboo topics but in fact develop and amplify voices for women and girls by focusing on their equity and seek accountability for their suffering.

(Data sources: The Population Council of Pakistan).

Read the other articles from the series below:
Decriminalising Abortion In Pakistan: A Case For Population Justice And Human Rights Of Women

Reframing The Population Growth Debate: Women’s Health And Autonomy

Reproductive Health And Its Relation To Women’s Economic Empowerment