Over the last six decades, Pakistan has witnessed four military governments, and the political situation has remained uncertain and in flux. We as a nation have fought four wars with India. There have been an umpteen numbers of political upheavals – from oppositions making attempts to bring down the government to much worse. Democrats have struggled to dismantle military regimes, and military governments in turn have turned to prosecuting dissenting voices. All of this meant that our political history has been rather eventful.
This period has kept us busy over questions such as what kind of political system we should adopt, what should the shape of our constitution be, and whether the Prime Minister should be more powerful or the President. On the geopolitical level, we have confronted the question of how to avoid a two-front situation - where we would face military threats from the eastern as well as western border; whether we should be more friendly towards Washington or Beijing? And whether friendship with Muslim countries should be a central pillar of our foreign policy or should we base our foreign policy around the principles of regional cooperation with our neighboring countries? We were busy, perhaps so busy, that we forgot to pay attention to a crucial problem that would in time, pose an existential threat to the survival of our nation.
In the 64 years between 1958 to 2022, the population of Pakistan has increased from 44.99 million to 235.82 million people. This is a growth of 424.2 percent in 64 years. Growing at 2.1 percent per annum and with a net annual addition of 4.3 million, it is projected to touch 263 million by 2030. It’s not that governments didn’t realize the socioeconomic implications of this massive increase in population. In fact, most of the government with the exception of the obscurantist military regime of General Zia have made policies on the basis of facts and figures that indicated an unsustainable increase in population size in the country. Pakistan was one of the pioneers in the region when it launched a population planning program in the 1960s. Multiple population planning programs have been launched, but all have failed to produce desired results.
After sixty years of efforts under different programs, “only 25 percent of women reported using modern contraception in 2017-18, the lowest amongst Asian and neighboring Muslim countries.” At present, Pakistan is aiming to achieve replacement level fertility—2.2 births per woman by 2030. “Fertility declined steadily from 4.9 births per woman (1990-91 PDHS), to 4.1 births (2006-07 PDHS), and to 3.6 births (2017- 18 PDHS). Surveys reveal that fertility decline generally remained slow after 2006.”
Pakistani policymaking has been persistently shy in making a public case for introducing population planning programs at the grassroots level. This has given an opportunity to religious obscurantists to plead their case more forcefully among common people, and wean them away from any engagement with government sponsored programs.
What are the causes of this marginal success? Expert analysis points out two tendencies in the policymaking processes which led to the failure of successive population planning programs. Firstly, Pakistani policymaking has been persistently shy in making a public case for introducing population planning programs at the grassroots level. This has given an opportunity to religious obscurantists to plead their case more forcefully among common people, and wean them away from any engagement with government sponsored programs. Secondly, Pakistani policy makers generally lack the patience required to put in a sustained effort over a longer period of time for population planning programs to bear fruits in the long run.
We spent this crucial period of our history fighting out unnecessary political rivalries, destructive wars, agitations and political witch hunts. We left this crucial aspect of life in our society unbothered, as it imperceptibly became an existential threat for us. We were not adding figures to our economic growth rate, we were not expanding our financial resources, or our manufacturing capacity, or our exports or our agriculture produce. Pakistan’s economic and financial pie remained stagnant or grew at a snail’s pace during these six decades, but the number of people who were demanding a share in this pie grew exponentially.
One indicator of the lack of interest of our political class in population planning issues is the fact that the Pakistan Federal Cabinet and Parliament didn’t discuss the issues related to population planning for a number of years. The Pakistani parliament passed the 18th Amendment a few years ago, and devolved the subject of population planning to the provinces. Khyber Pakhtunkhwa was the first to make a population policy based on Pakistan’s pledge at the London Conference in 2012 “to make its contraceptive prevalence rate - measuring the use of at least one contraceptive method - 55% by the year 2020.” Later, Sindh and Punjab also introduced their own population planning policies based on similar international commitments.
The military government of General Pervez Musharraf simply ignored population planning as a policy objective when in the year 2000; it diverted the workforce of Lady Health Workers away from engagement in population planning endeavors and toward other health programs.
The Sindh assembly, for instance, increased the minimum age of marriage from 16 to 18 years in order to empower women and to push the fertility rate down. Moreover, last year, the Sindh Assembly unanimously passed a very sound piece of legislation: The Sindh Reproductive Health Care Rights Bill, which recognized the right to plan one’s family as an inherent right of the individual. Pakistani media, however, is full of news stories about the inefficiency of Sindh’s bureaucracy and administrative structure. One analysis of Sindh government policy implementation process in the Daily Times notes, “Sindh’s provincial departments are marred with inefficiencies, red tape, and needless procedures. Poor monitoring and accountability traditions make it difficult to trace progress of any policy or sanction an act of non-compliance.”
Experts point out that the 1990s saw some stability in policymaking on population planning in Pakistan. This was the time when Lady Health Workers were introduced in Pakistan’s society with the prime responsibility to educate rural areas womenfolk in population planning techniques. Researcher Abdul Rehman Nawaz at the University of Punjab notes in his paper, titled, Is the population explosion a threat to Pakistan’s Economic Development? that “in this regard, from 1993 to 1998, Pakistan's government initiated successful family planning programs to reduce fertility. To provide the family planning services at a community level, Lady Health Workers were recruited. Later, due to a lack of implementation, inter-sectoral coordination, and inappropriate oversight, the program could not reap the benefits of the momentum provided by the government in the early 1990s.”
The military government of General Pervez Musharraf simply ignored population planning as a policy objective when in the year 2000; it diverted the workforce of Lady Health Workers away from engagement in population planning endeavors and toward other health programs. “Counseling women played a critical role in all three Muslims countries (Turkey, Iran & Bangladesh) to educate and encourage clients and address fears and myths of family planning and contraceptive technology. Unfortunately, it never received adequate attention by all stakeholders in Pakistan, especially after dilution of the tasks of Lady Health Workers in 2000 and beyond, in support of other health programs” reads a report of National Institute of Population Studies.”
The overall political trend in Pakistani society to lean towards religious conservatism really explains the lack of interest on the part of successive governments to be shy and impatient in their attitude towards this important policy issue. A policy brief from the National Institute of Population Studies point out that the government of General Musharraf stopped giving importance to the Lady Health Workers’ role in helping educate women in society which is considered “a critical pillar to social change and major factor in fertility decline” after the year 2000. General Musharraf’s government’s interests and investment in giving Lady Health Workers this role gradually declined following 9/11, and the commencement of the American led War on Terror, when the local population in Khyber Pakhtunkhwa and Punjab started to perceive family planning as a “foreign funded conspiracy” to halt growth of population of Muslim families in Pakistan.
Religion is certainly not a factor in making Pakistan politicians and policymakers shy—it’s their opportunistic, bad faith approach towards dealing with public affairs that makes them coy about mentioning words like fertility and contraceptives in public.
The Musharraf government was already under pressure from religious parties who were opposing the American occupation of Afghanistan. Perhaps, the Musharraf regime thought it appropriate to cut down the role of Lady Health Workers in rural areas in order to divert pressure away from the government. Lady Health Workers, according to most research reports, are generally counted as success stories as far as population programs are concerned. Not surprisingly, Lady Health Workers often are at the receiving end of terror attacks in rural areas of Khyber Pakhtunkhwa.
Two other factors are generally considered to have contributed greatly to the failure of population planning programs in Pakistani society. Firstly, at the administrative and bureaucratic level, the review of the ongoing program and regulatory part that has to be played by the government bodies is virtually non-existent. “The role of the state towards ‘policy review’ and ‘regulatory tasks’ remained nonexistent at federal and provincial levels. Good understanding and developing improved assessment of progress and coordination with partners are critical for timely achieving goals,” reads a government report.
Secondly, the devolution of population planning to the provinces has not contributed positively to the success of population planning programs. “The devolution of functions in 2010 diluted the national cause and has not improved but contributed to further neglect of the importance in real terms. The spirit of devolution in terms of building capacity and authorizing districts for planning, action and accountability lacked seriousness.”
Pakistan’s political class will have to abandon its shyness towards discussing family planning issues if it is serious in preventing a disaster that is likely to follow a population explosion in our society. Religion is certainly not a factor in making Pakistan politicians and policymakers shy—it’s their opportunistic, bad faith approach towards dealing with public affairs that makes them coy about mentioning words like fertility and contraceptives in public. After all, the clergy that is ruling Iran is more conservative and more pious than our policy makers, and yet in Iran, women health workers played a leading role in making population planning programs a success.