At 5:24 pm on 30th Sept. 2019, Pakistan’s population was 217,641,492. It would be a few hundred thousand more by the time this article appears in print. Most countries have used population control as a leverage to make economic gains. Bangladesh stands out for its stunningly successful birth control policies. Only if Pakistan had the good sense of adopting the same or similar pragmatic policies as Bangladesh, it could have had 54 million fewer people today. Missed completely, here was a perfect opportunity for Pakistan to make the much needed economic ‘great escape’.
Countries that made dramatic economic breakthroughs in the last thirty years had one thing in common. They all managed to drastically reduce the average number of children that would be born to a woman over her lifetime – also known as the ‘fertility rate’. Iran did a spectacular job of reducing its fertility rate from 6.53 to 1.96 in a span of 30 years. Bangladesh brought its fertility rate down from 6.92 to 2.1 since its independence, while Korea (1.21), China (1.65), Hong Kong (1.23) and Taiwan (1.1) made similar impressive reductions. Sadly, Pakistan since past four years is firmly saddled with a very high fertility rate of 3.73. If not immediately addressed, this single factor could negate every other effort that Pakistan may make to break away from poverty, hunger, disease and illiteracy.
Bangladesh adopted a community-based approach to population planning. It was based on recruiting married, literate village women trained in basic community health and family planning to go door-to-door dispensing contraceptive pills and condoms. Belonging to the local village, they had credibility among a suspicious and very religious population. Equally important was the decision to give high priority to girls’ education, which delayed marriages and gave women a greater control over their lives.
In the late 1980s, Iran’s supreme leader, issued ‘fatwas’, making birth control widely available and acceptable to conservative Muslims. He argued that the economy could no longer support a rapidly growing population. Under the new decrees, contraceptives could be obtained free at government clinics, including thousands of new rural health centers. Health workers promoted contraception to increase the gap between births and to reduce maternal and child mortality. Counseling in family planning was made mandatory for couples intending to get married. Between 1996 and 2016, the average age at marriage for Iranian females increased from 19.8 to 23.0 and for males from 23.6 to 27.4 years.
Like Bangladesh, Iran too made a massive push for educational opportunities for girls. Even the most conservative families began sending girls to schools. Pakistan on the other hand could not benefit from religion as an instrument for change and action. It failed to create and implement population control policies that could integrate the communities, the ‘Lady Health Visitors’, the religious leaders and the basic health units. There was neither an easy and free access to contraceptives nor was the media utilised for mass awareness and guidance. There were no innovative incentives created for those who adhered to a 2 child policy. Most importantly, it took no steps to raise girls’ marriage age or to ensure that every girl receives at least 16 years of education as stated in Article 25A of the Constitution of Pakistan.
Every citizen needs food, water, health, education, protection, employment, housing, transport, electricity and clean environment to live a healthy and productive life. Pakistan’s economic and managerial resources are already bursting at the seams. We squarely failed to meet every Millennium Development Goal. Having 25 million out-of-school children, hosting the world’s highest number of polio cases, stuck with one of the highest infant mortality rates, unable to provide clean drinking water and not treating even one percent of our outgoing raw sewage are just a few of our many predicaments. With this alarming growth in population it may be impossible to maintain sanity, leave aside progress.
Pakistan’s much needed break from poverty and disease is critically dependent on its ability to bring down its fertility rate to 2.0 and to educate all its girls. Let there be an exclusive ministry for population control headed by the most competent ministers in the federal and provincial cabinets. Failure to implement these measures would be a sure recipe for continued addiction to International Monetary Fund besides keeping our children vulnerable to stunted growth, crippling impacts of polio, acquiring HIV by reused syringes and remaining illiterate for never having gone to a school.