Evaluation of reproductive health programmes across different countries reveals that improvement in reproductive health is directly proportional to women’s economic empowerment and their participation in the labor force. Studies also show that an improvement in reproductive health is most effective when a rights-based model is employed that considers the role of multi-dimensional economic, cultural and social factors that affect the rate of population growth. Pakistan has not learned from these lessons.
The interventions offered to tackle population growth and reproductive empowerment in Pakistan are focused only on increasing access to contraceptives and dismiss other factors such as poverty, a lack of education and a lack of accurate knowledge about reproductive health, amongst others.
Despite a focus on contraception alone, contraceptive prevalence in Pakistan is a meager 26%. Almost 6 million children are being born in the country each year without access to proper education, healthcare or job opportunities. The country is thus producing a rapidly growing unproductive and unempowered workforce.
Last year on World Population Day, President Arif Alvi expressed his concern over the scarce resources and unrestrained population growth in Pakistan. He stressed the urgent need to control this growth.
Yet, despite this “urgent need,” initial results from the 2023 Population Census show that the population in Pakistan has grown to almost 249.5 million people as of May 2023 and this number does not include the population of Gilgit-Baltistan and Azad Jammu & Kashmir.
The population in Pakistan is set to reach a whopping 403 million by 2050. It is clear that statements made by those in decision making positions are hardly ever backed up with action and it is critical for decision makers to empower those that are actually giving birth to children and who will be tasked to provide for them.
According to the United Nations Population Fund’s State of World Population Report 2023, women’s decisions are only taken into account when they align with their husband’s wishes. When there is disagreement, men overwhelmingly have the final say. Lack of women’s empowerment and Pakistan’s societal fabric leads men to making decisions about women’s reproductive well-being.
Most women are provided with no autonomy over reproductive choices. In this regard, a rights-based approach towards reproductive empowerment should be considered that emphasises training on political, social, economic and cultural factors that contribute to an increase or decrease in population growth. This approach seeks to empower women and institutions that directly impact their reproductive health. With such intervention, the government can hope to have more meaningful and long-lasting results to tackle population growth.
The current family planning and reproductive interventions in Pakistan are often foreign funded and focus on the distribution and accessibility to contraceptives. Latest available surveys reveal that there are 4.2 million unintended pregnancies and 2.2 million abortions each year in Pakistan.
Approximately 12 million girls are out of school, 18.9 million girls are married before the age of 18 and 4.6 million girls are married before the age of 15. It is thus no surprise that Pakistan has the third highest maternal, fetal and child mortality rates in the world. The obvious conclusion is that contraceptives are not enough to tackle population growth.
One of the aspects of a rights-based approach that is lacking in Pakistan is access to accurate information about reproductive health including information and understanding of modern forms of contraceptives and different contraceptive options available and their side effects. This approach also includes access to information about post-birth complications if a woman produces too many children, consecutively.
Access to multi-dimensional information empowers women to make informed and responsible decisions. There is therefore a pressing need for capacity building and training of healthcare professionals (such as nurses and midwives) who can accurately guide women, particularly in the rural sector where fertility rates are considerably higher (Pakistan Demographic Health Survey, 2012-13).
Training should be based on awareness and education on reproductive and sexual health rights. The importance of such holistic interventions has been confirmed by the UNFPA, in its State of World Population Report 2023 where it highlights that focusing on family planning alone without instituting structural changes that seek to empower women does not significantly impact the overall social and economic development of a country.
Rights based training is therefore critical in a country like Pakistan where a religious minority peddles the narrative that contraceptives are un-Islamic with the conviction that every child born will be provided for by God.
This is sadly not the case as 40% of people in Pakistan live in abject poverty and are not able to provide their children with even basic survival necessities.
Bearing children without any prospect for education or employment undermines the child and the mother’s right to quality of life guaranteed under Article 9 of the Constitution of Pakistan 1973.
In 2018, the Supreme Court of Pakistan recognised the interconnectedness of a rising population and its impact on fundamental human rights as Pakistan, with meager resources, struggles to provide for its ever growing population. The Court acknowledged the challenges associated with a growing population: poverty, unemployment, an increase in maternal and child mortality rates and their role in depriving the young generation the right to a quality living.
In a country where 6 million children are born each year and economic growth is at a mere 0.29% (increase compared to the previous year), the only way to halt economic and societal collapse is to find a sustainable solution to the bursting population growth.
Whereas a cap on the number of children one can produce is controversial and deprives women of autonomy over their bodies, many women in Pakistan are desperate for some respite from the burdens of continuous reproduction.
At the least, the public and private sector should collaborate to tackle population growth and reproductive rights through a rights based model. Centering all efforts on family planning programmes without improving the abysmal state of education, abject poverty, unemployment and lack of female representation in the workforce is a myopic and reductive way of tackling the rising population growth. It is critical to address the multi-dimensional causes of population growth and that is the way to lead Pakistan towards a more economically empowered society.
Read the other articles from the series below:
On Track For 300 Million, Will Pakistan’s Population Bomb Explode?
Decriminalising Abortion In Pakistan: A Case For Population Justice And Human Rights Of Women
Reframing The Population Growth Debate: Women’s Health And Autonomy