Restructuring Pakistan’s Devolved Family Planning Services

This is not an article by Dr Jillani but Im including it here as it would have interested him

In 2014, Pakistan’s population was estimated at being over 188 million making it the world’s sixth most populous country.

Since the census in 1951, the population has quadrupled while the urban population has increased seven times.

Despite lowering fertility rates in the late 20th century, the country’s growth rates are still the highest in the region, and are only exceeded by sub-Saharan Africa across the world. In 2014, the population growth rate of the country stood at 1.49% putting it within the top 35% globally.

Stagnant Family Planning (FP) Policies During the 2000s and Subsequent Devolution 

In the year 2000, the government of General Musharraf initiated an assessment of the Family Planning Program (FPP), which led to the declaration of the first ever National Population Policy in 2002.

This Policy set several long-term goals for the sector including the aim of providing universal access to FP services by 2010 with the aim to reduce the fertility rate to a replacement level of 2.2 by 2020. The 2002 policy however, failed to achieve any of the goals it had set, as population figures for Pakistan continued to increase at levels, straining resources.

One of the major issues remained access, particularly for poor women in rural areas as research points out, “… (that) while access costs are not the primary determinant of contraceptive use… increasing service outlets and outreach programs can lead to an increase (in) contraceptive prevalence”1.

Poor service provision was cited as another factor, as the acclaimed Lady Health Worker (LHW) program suffered due to a lack of equipment provision, inability to retain staff – leading to high-turnovers and an overload of other duties, primarily polio vaccination programs.2

A fear of drug side-effects and other unexplored health concerns was also found to be an important deterrent from the usage of contraceptives.3

Coupled with these problems, low levels of female literacy, weak autonomy for women in society and high mortality rates from neonates all the way to children were all identified as reasons responsible for keeping fertility rates high.4

In essence, what this implied was that the ‘crystallising’ of various socioeconomic factors from the previous decade had not been meaningfully sustained; leading to a stagnation in the implementation as well as outcomes of FP policies. However, surveys showed that these declines have not been due to a lack of desire for FP, pointing to an unmet FP need.

The percentage of women who did not wish to bear any more children rose from 40% (1991) to 52% (2007), with a further 20% expressing the desire to further space birth out. In 2007, it was also shown that 96% of Pakistani women were aware of some sort of contraceptive measure, yet only 30% of women were using contraceptives as recorded in 2007, further underlining the unmet needs gap for family planning options.

Demands of unmet needs for FP were also brought up during an evaluation of abortion practices in Pakistan. Research has repeatedly shown that despite laws restricting the access to legal abortion – the pregnant woman’s physical or mental health has to be at risk in order for abortion to be allowed -the most common types of service users were literate women in their late 20s with several children. This strongly suggests that these women utilize abortion as a FP option, similar to what has already been identified in sub-Saharan religious countries.

This further argues for the unmet need of contraceptive usage and other FP methods. In 2010, the PPP government launched the new National Population Policy, which was created after an extensive round of discussions and planning with various stakeholders. However, this was also when the government had introduced the much-delayed devolution reforms to its functions, with many features of governance redistributing power from the center to the level of the provinces. Consequently, the policy called for breaking up the Ministry of Population Welfare and devolving its functions to various organisations within the provincial governments’ purview. Yet despite the long-held promise of the advantages of devolution, the breakup of the FP services was far from satisfactory. The functions for planning within the health sector, cooperating across provinces and liaising with international donors were all handed over to the Planning and Development Division of the federal government, which was meant to fund the Population Welfare Program.

Further functions related to FP and reproductive health were now being dealt by four separate ministries with four conflicting population planning priorities, based on their provincial assessments. There was a lack of consensus amongst the provinces due to diverging priorities.

Balochistan sought to increase its population, whereas Khyber Pakhtunkhwa was seen to be less public about its efforts in order to avoid a conservative, religious backlash: while Sindh and Punjab both expressed plans to develop programs but have yet to announce any details.

The short-term impact of bureaucracy within the policy meant that many different ministries and organisations were in charge, which slowed down efforts. It was claimed that those responsible for population planning policies were unaware of practical issues and lacked the ambition as well as commitment required for implementation.

Similarly, a lack of assurance towards improving the LHW program was seen to be a significant issue since majority of Pakistan’s population is rural where LHWs are the primary reproductive health service providers5. This is because, although the program had been shown to be effective, it suffered from inefficiency due to lack of sustainability. The decision to devolve functions to various ministries was also criticised for further splintering a governmental function as Pakistan is one of two countries in the world, where the ministries for health and population are separate. Conversely though, it has been argued that “health and population have shared agendas, a paradigm shift from FP being a demographic target to a reproductive health end-point.”6 FP Policies relative success in the 1990s In comparison to the 1990s however, in the 2000s there was only a slight rise in the national average of contraceptive use to 30% by 2007.7

One of the watershed moments in the 1990s was the International Conference on Population and Development (ICPD). This precipitated an overhaul of how to approach family planning policies. A civil society activist described its impact as“… (providing) you ways of reaching men and women in a broader, more development oriented way, and, therefore, (making) family planning more acceptable. From an NGO perspective, women’s rights activists started looking at contraception as a right. ICPD provided ways of looking at the availability of contraception within the larger issues of women’s space and mobility.”9 The ICPD’s approach demonstrated that the newly formed Ministry of Population Welfare (established in 1989) was not the primary institution responsible for family planning.

Two major initiatives were shown to have a significant impact on population rates; the first of these was the establishment of the National Trust for Volunteer Organisations, which was instrumental in coalescing the efforts of NGOs and other civil society forces. The second was the initiation of the LHW program, which saw numerous mid-level cadre health care providers in rural areas travel door-to-door to provide family planning awareness and teach its methods to both men and women. An analysis of the program showed: “…use of reversible modern methods of contraception was significantly higher in localities having good access to literate, female community-based workers than in localities with little or no access. The availability of schools also exerts a powerful influence on contraceptive uptake, but the presence of other modern institutions, or proximity to a town, had no effect.”10 One of the key aspects of the ICPD’s redefinition of FP efforts was a focus on reproductive health that unwittingly led to a withdrawal of donor support for contraception and other family planning resources. However, the government continued to fund the programs and the decade saw the usage of contraceptives increase from 11% in 1991 to 28% by 2000. In rural areas, the increase was from 6% to 22%, while in urban areas the corresponding change was from 26% to 40%.11

The Beginnings of FP Policies in Pakistan

Family planning in Pakistan began with the state’s embrace of an NGO-led program, now called Rahnuma in the 1950s, and the government’s efforts in this field began in the 1960s under General Ayub Khan. His regime’s “vigorous” family planning policies were initially hailed, but suffered from planning and design flaws that eventually led to little discernible impact.12

The next two eras also saw negligible interest by the government in pursuing FP policies. For the Bhutto government, FP was far too closely identified with the previous era, while under General Zia, FP knowledge dissemination was actively opposed. In this regard, the government reduced expenditure on FPPs and banned public service messages on the issue.13

From a policy perspective, a quantifiable change came in the 1990s as this was a decade that also saw considerable changes in the country’s fertility rates. Contraceptive usage doubled from the previous decade, and the country also underwent what is known as a ‘fertility transition’, i.e. when a society moves from high to low fertility rates. During this time, the governments of Benazir Bhutto in particular, as well as the ones headed by Nawaz Sharif actively invested in FP policies

These were far more expansive and effective than previous eras. However, the policies were not solely responsible for changes. According to one researcher: “…the fertility transition is argued to have occurred as a crystallisation of existing desires for smaller families along with a decline in family size desires and a reduction in the social, cultural and psychic costs of contraception.”14

Similarly, others have argued that the achievement of declining fertility rates can be attributed to overall socio-economic development, increases in literacy particularly amongst females, and increasing awareness of the means and benefits of family planning.15 Irrespective of these developments, Pakistan continues to have some of the highest fertility rates in South Asia, and was the last major country in the region to achieve the fertility transition.

Despite similar cultures and economic conditions as other countries in the region, Pakistan has consistently lagged behind in efforts to control its population. Pakistan’s difficulties in this matter have been summed up as “a reluctance or inability to translate reproductive preferences into appropriate behavior.”16

Recommendations

A holistic approach to population planning

“Population growth is a developmental issue, not a clinical problem. No one denies today that top priority must be given to reducing high rates of population growth in the developing world.

The differences are on strategies, not on objectives.

Family planning must be regarded as an integral part of new models of sustainable human development. Divorced from such development models, and pursued as condom-distribution programs with single-minded zeal to meet ‘unmet demand’ they will fail… We cannot slip a condom on poverty.” – Mehboob-ul-Haq17

It has repeatedly been shown in other countries that successful population planning policies are achieved through a holistic approach to development, where lowering fertility rates end up as the symptom of several directives aimed at social change. There is strong empirical evidence to show that “low fertility is determined mostly by economic, social, cultural, and educational improvements in a population and less so from the availability of family planning programs.”18

Consequently, it has been put forth that an effective and sustainable population policy must be aimed at three major objectives, namely: reducing the rate and incidence of unwanted fertility; decreasing the demand for large-size families or increasing birth-spacing; and greater investment in the health education and employment opportunities, especially for young women.19

Translating these directives into the Pakistani context results in three broad areas for future policies to be pursued in. Firstly, the improvement of the quality of existing services; the inclusion of stakeholders at differing levels with coherent integration of disparate responsibilities; and concerted investment in health education, for the economy by enhancing autonomy for citizens, particularly women.

In terms of improving existing services, the prevalence of unmet FP needs is a major area that needs to be described using evidence-based research especially with regards to the majority of women already utilizing these services by identifying key gate-keepers. The high number of induced abortions and the rising gap between a desire for FP versus an ability to exercise that right, both suggest that there are a variety of reasons that women are not able to access birth-control measures. This ought to be explored, taking male power dynamics into account. Similarly, improving sustained investment by strengthening the LHWs’ program should be a top priority, owing to its proven ability to effect change not only within the context of FP but also with regards to other facets of reproductive and child health.

Issues of overburdened employees, high turnovers and increasing inefficiencies due to a lack of resources need to be addressed in order to make the program robust as well as sustainable in terms of quality of impact. The LHWs’ and numerous other cadres from the most qualified Nurse Midwives (NMWs), all the way down to the Traditional Birth Attendants (TBAs) also known as dais’ should be invested in as well as trained to further their knowledge and further their reach within communities, as most sexual, reproductive needs and child health are sought from women within their own communities due to varied ethnicities, cultures and degrees of beliefs Service delivery at various outlets has to be streamlined for efficiency by spreading health awareness with regards to the advantages of FP via different media and community and religious leaders; as well its benefits to the family as a whole, taking into account their preferences, source of livelihood, beliefs and attitudes.

The advent of devolution has increased the need for articulating policies that bring together the various ministries and governments entrusted with population planning, to ensure a greater ownership of responsibilities by role clarification within systems. Having standardized operating procedures in place which are monitored and evaluated, so that work is based on the objectives achieved rather than an individual are essential to measure achievements.

Advocacy is required within the government, across the federal, provincial and district levels. This would be guided by medical research coupled with social development by liaising with countries’ with comparable work done, to evaluate performances based on achievement of specific population planning indicators.

Further, there is an urgent need to integrate or coordinate functions, with particular attention towards aligning population control policies with the health ministry’s agenda for each specific province, and how these impact the national development goals.

The importance of the private sector can also not be understated as it plays an important role in FP, since it is now the major source for contraception provision in the country and is flourishing very rapidly. The private sector has not been assessed especially in conjunction with the public sector, whereas the state owned programs have shown to be flagging in efficiency.

Finally, the most important aspect of successful population control can be achieved through investments in health education for women as well as female employment opportunities and career development. Much has been made recently of Pakistan’s impending ‘demographic dividend’ whereby the majority of the country’s population would be a young, working-age cohort that can be used to drive rapid development and growth. Without ensuring access to education for females and suitable employment opportunities for women however,

Pakistan not only stands to lose out from this boon (by halving the potential) but also runs the risk of losing its young citizens of both genders to crime and opportunistic terrorism. There is strong empirical evidence linking female literacy and employment with decreases in fertility rates, family sizes as well as vertical propagation of knowledge regarding sexual and reproductive rights.

Similarly, a more economically equitable society would also contribute to a reduction in fertility rates, reducing under-age marriages and change power dynamics with regards to the decision of FP within a joint family structure. These measures are the most effective ones for developing a coherent and successful population policy and y20et their purview lies well beyond the responsibilities of institutions as they currently stand.

Consequently, it is imperative that population policies are made an integral component of social development efforts This can be achieved by synchronizing sexual and reproductive health education through a multi-pronged approach and by coordinating the priorities of differing institutions for a greater national interest.

 

POLICY BRIEF March 19, 2015 B0319-34 ©Copyright Jinnah Institute 2015

References 

1 Fikree, Fariyal, et al. What Influences Contraceptive Use among Young Women in Urban Squatter Settlements of Karachi, Pakistan? International Family Planning Perspectives, 2001, 27(3): pp. 130−136 

2 Yusuf, Huma. “Population Policy: Will It Work?” Review. Dawn [Karachi] 14 Mar. 2010: Print. 

3 Sultan M, Cleland JG, Ali MM. Assessment of a New Approach to Family Planning Services in Rural Pakistan. American Journal of Public Health 2002;92(7):1168-1172. 

4Sathar, Z; Casterline, J. The onset of fertility transition in Pakistan. Population Development Review, Vol 24: (4) 

5 Reference this from the dai bit from phd proposal 

6Nishtar, S. “Population Denominator” The News [Karachi] 11 Jul. 2010: Print 

7 Ibid 

9 Satthar, Z. Zaidi, B. Status of Family Planning in Pakistan UNFPA Report 2010 

10 Sultan M, Cleland JG, Ali MM. Assessment of a New Approach to Family Planning Services in Rural Pakistan. American Journal of Public Health 2002;92(7):1168-1172. 

11 Satthar, Z. Zaidi, B. Status of Family Planning in Pakistan UNFPA Report 2010 

12 Robinson WC, Shah MA, Shah NM. Family planning programme in Pakistan: what went wrong? Int Fam Plann Perspect. 1981;7:85–92. 

13 Khan A. Policy making in Pakistan’s population program. Health Policy Plann. 1996;11:30–51. 

14Sathar, Z; Casterline, J. The onset of fertility transition in Pakistan. Population Development Review, Vol 24: (4) 

15 Wazir, A. Population Dynamics in Pakistan: Past, Present and Future, 2013, SDPI 

16 Sultan M, Cleland JG, Ali MM. Assessment of a New Approach to Family Planning Services in Rural Pakistan. American Journal of Public Health2002;92(7):1168-1172. 

17 Siddiqui, F.

Focus on Population Growth

One is always delighted to see some serious endeavour at rejuvenating population control efforts. After a life­long commitment to population plan­ning and management and yet a sense of defeat in putting a lid on the speed of population growth, one is always apprehensive of the state of popula­tion programmes in the country. We are a nation that is easily placated. We should know that whatever we have gained in terms of lowering fertility rates in the past few years could be washed out in months if the people are not reminded incessantly about the dangers of rapid population growth. 

Steep decline in growth of population during the past decades, around the world, has deflected the attention of demogra­phers and the population community from social engineering, field advo­cacy and delivery systems to theoretical considerations: Practical problems seem to appear in big meets as fillers. 

Problem with the recent population trends in Pakistan lies in the recent achievements being based on topsoil. Even small tremors can shake build­ings erected on unstable ground. The welcome decline in population growth is not linked with the established bedrock of rise in incomes, education, literacy or long term political commit­ment. A good part of the decline in fer­tility could be attributed to enduring social and economic factors. Cohort that is determining the current levels of fertility had grown up in or before the 1970s and early 1980s. During this period there did not take place any outstandig event for progress in the socio-economic situation of families that could affect their reproductive behaviour. The real phenomenon, as such lies somewhere near the surface – Social Marketing? Better delivery system? NGOs? Effective publicity? 

The health and family welfare vil­lage and community visitors pro­grammes introduced during the last decade should yield results both in the Health and the Population sectors, now. And their impact may surprise many. The Pakistani society is passing through a unique stage. The aware­ness about population planning and control is widespread: It is accompa­nied by an awareness of higher living standards and the use of modern conveniences of life. It is difficult to com­mit oneself to the contribution of each factor involved in this change. Yet one can single out the public sector, NGOs and the private sector as the old moti­vators; intensification of their advo­cacy and social change campaigns after the Zialul Haq era are known to have set the stage for a ‘new’ popula­tion control ambience. One remem­bers the rusted sign boards outside population offices, broken furniture, dilapidated buildings, a black out of publicity, a stagnant public sector bud­get, and a totally demoralized – though highly committed and bright – staff of the public sector population ‘welfare’ programme, that confronted the new administration under the new govern­ment. Even highly dynamic persons in the Cabinet had not succeeded in pen­etrating the double-faced policies of the previous era. The advent of pub­licity on the media invigorated the concept of small families as well as the workers. This was a break-through. 

However, electronic media made the two most significant contributions to behavioural change and the huge community of Pakistani expatriates living abroad who regularly carried the concept of modern living to their communities during visits home. An­other valuable change that has been taken place quietly is softness in attitude of the religious community, especially the younger clerics. This might have encouraged couples to practice spacing of children. In all probability, it is not a change in doctrine that has prompted this change of heart. It must be the practicality of a small family that is prompting young clergy to look the other way if a follower uses popu­lation control methods to space their brood. The popularity of modem elec­tronic communication gadgets must have helped. Most of these devices have reached even the remotest parts of the country, through the courtesy of migrants to cities who regularly ex­change gifts with their ancestral vil­lages. One should not be surprised if within the next few years, the family size in even remote rural areas with large number of dwellers working in cities or abroad, record sharp decline in fertility and mortality. 

These developments have given rise to new social attitudes – in many instances, conflicting with the stereotyped traditional beliefs. Yet they have been made to exist side-by ­side without evoking any serious dis­sensions in the community. However, this phenomenon remains on periph­ery of the basic package required for a permanent adoption of the small fam­ily norm. Pakistan’s family planning programme has been lagging behind other countries of the region so badly that the recent advances apart, it stands at a humiliating last place in the list of many indicators. And this has happened inspite of the fact that a number of family planning pro­grammes in the area owe their success to replication of the Pakistan model. The main reason for tardiness in Pak­istan was the failure of the social sec­tor and key economic areas to beat the rate of population growth. The back­log was so tremendous – and it went on inflating – that the solo-economic infrastructure did not ever catch up with increase in population and the backlog of unmet social and economic needs of society. Other developing countries succeeded in offsetting the lag by making gains in incomes and their distribution, education, health care, women development, etc. leav­ing Pakistan far behind. 

Situation still is not all hunky dory . With a huge chunk of population still living below the poverty line, a tremendous number of children still out of school, female literacy and edu­cation remaining at levels far below the figures for males, status of women continuing to be miserable, inade­quate health facilities and meagre health education, and the clouds of ob­scurantism looming large over the head, do not auger well for a change involving family norms, traditions, and community pressures. Unless rapid changes take place in these sectors, a metamorphosis in society will remain distant. Upsurge and commitment in some of these areas in the recent past should not go unnoticed by the popu­lation community. The cause of women has recorded significant boost. There has been a rapid rise in noises from the education sector – though some not clearly comprehensible. Health sector has introduced many innovative schemes, community health visitors being the plum project. However, the most important development is con­stant across the board, emphasis on poverty alleviation. If these initiatives are implemented faithfully, the population picture in Pakistan may change radically within a few years. It should, however, be remembered that the pop­ulation management will have to ex­tend the scope of its activities. How can migration, mortality, aging, ur­banization, population research, etc. be kept outside a setup dealing with population of the country? By the wary, why not call the ministry and the provincial departments the ministries etc of Population Management, Popu­lation Control or simply the Ministry of Population? ‘Welfare’ clearly smacks of a cover up. Population con­trol is not a crime!

March 11, 2004

Growth, Employment and Poverty

It was a little more than 50 years that as a Master’s student of Economics, I started a folder on poverty. The first entry in the khaki covets was a report from some United Nations organ. This folder has travelled with me all my life. Many a paper was added and as many were lent to others which never came back. The file was consulted whenever one got entan­gled in the subject of poverty. By the time one finished one’s education, one had con­cluded that the biggest hurdle in the way of economic development and ‘eradica­tion’ of poverty was rapid population growth. 

However, the slowly growing folder kept its place in the front row. One did not write specifically on poverty or its contributory factors until 1973 when, as a staff member of the Economic Commis­sion for Asia and the Far East (ECAFE), one joined the in-house rabble-rousers struggling to add social dimension to ECAFE. The lobby succeeded, and the name of the Commission was changed to ESCAP. As a reward, one was asked to conduct a study of poverty in Asia and the Pacific region, based on available data. But there was dismay in store: The 60­ plus page study had to be reduced to less than 15 pages as a number of coun­tries refused to admit that they were poor – purely for domestic political reasons. One, as a result, did not find himself pre­pared to waste time on something that governments of the region were not pre­pared to even acknowledge. Later efforts in the line of duty confirmed that status quo was dearer to governments of most of the developing countries of Asia. They paid only lip service to poverty eradica­tion (later on alleviation) on the ground they did not have the courage to bring about change in the social and economic structure of their nation. 

Poverty however, is not an issue that can be sidelined. The stench of poverty and its presence around the developing countries are so over-bearing that they jolt planners and policy makers of all dis­ciplines – and some politicians, every time they think of development. The writer is no exception. 

Islamabad, this week is witnessing two events that directly address the phe­nomenon of poverty. Mahbubul Haq Human Development Centre has brought out their seventh South Asian Human De­velopment report with focus on employ­merit – the only sure way to alleviate eco­nomic poverty. The Pakistan Society of Development Economists is holding its annual conference on Institutional Change, Growth and Poverty Levels in Pakistan. One from his reclusion, has been following developments in efforts to alleviate poverty, debates on the extent of poverty, and measures to lighten the bur­den of various non-economic aspects of poverty. 

The poor and their poverty have been present in this world since the beginning of time. The institutions of beggary, char­ity, alms and their place in all religions of the world grant them such a visible and strong role in human society that beyond certain limits, they cannot even be questioned or condemned. Their concept of poverty may not be related to the phe­nomenon of poverty that the modern scholars consider as a product of erratic social and economic policies. But there is no denying the fact that the charity driven institutions have a place in the psyche of every believer of a religious faith. This factor alone, takes away a good deal of the gravity of the problem: Faith ordains that providence has marked some indi­viduals and groups to be poor! This ren­ders the task of alleviating poverty more difficult. Reduction in poverty, apart from scientific measures, is a function of social, cultural and political will of the people – and their rulers. And unfortunately for the poor, the rulers nowhere are prepared to part with their possessions and let their good fortune be shared by less fortunate members of even their own clans. 

Poverty, therefore, is not entirely an economic circumstance as it was once conceived. Poverty now has been classified into a wide array of depri­vations and incidents of poverty. This categorization is now widely accepted and much of it used in policy making. But coming down to serious business, the at­tention is instantly diverted to economic poverty and the economic measures re­quired to reduce its gravity and incidence. 

One would like to extend the sway of poverty to all the various forms of impov­erishment. But before pressing the argu­ment further, one should try to visualize a scenario in which the richest segments of society dominate the legislatures, the chosen one’s out of them neutralize the bureaucrats or encourage them to adopt the life-style of the power elite, wealth is concentrated in a few hands, and corrupt practices to get rich have become a norm. What sort of law will be allowed to be en­acted and implemented in such a situa­tion? In such an ambience, even the friends and sympathizers of the poor are liable to become a party to get-rich! Im­ported regimens for the civil society, aca­demic and research endeavours have only exacerbated the condition. 

Poverty in a way, is a subjective term. It includes people who are poorer and de­prived in comparison with the rest of so­ciety. But poverty, in current parlance is the denial of the basic needs of an individual or community. The basic needs in material terms would include food, shelter, clothes, clean drinking water, sanitation, health, education, etc. and most of them can be provided by financial spending. But there are ‘needs’ which cannot be purchased: So­cial status; recognition, justice; the freedom of thought, speech and opinion; the. right to hold and practice one’s faith; the right to hold one’s cultural and social val­ues, for example – which give a purpose to life. 

One, by experience has concluded that the crux of poverty is the deprivation and the denial of opportunity to acquire and maintain all that is needed by human be­ings to lead a respectable and happy life. This brings in employment – to sustain the body and opening avenues for mental and spiritual growth. 

Rates of employment in South Asia have a greater significance than elsewhere, as they reflect the situa­tion of one-fifth of humanity living in free economies – at least technically. Economic poverty defined by basic needs, depends heavily on the availability of productive employment for its amelioration. Income, and many intangible benefits accrued by employment can lay the basis of further steps towards decline in poverty and con­tainment of its expanse. The South Asia Report states that economic growth has not been able to generate matching em­ployment opportunities. 

However, one cannot help viewing poverty as a disease caused by avarice of a few, and nurtured by despotic rulers, ab­solute monarchies and self-serving economic and financial supremo’s of present day. Unless deep structural changes are brought about, and institutions are to re-establish a just society, economic growth motivated by profit making will not lead to a sustainable just society. After decades of direct and indirect poverty alleviation and public works programmes and billions of rupees of foreign grant and loans, what we have got is a warning that the poverty may be moving to engulf a sizeable chunk of people immediately above the poverty line. This, in a few years may mean the relegation of almost half the population of the country to the state of living under the poverty line compared with 40 percent at present. 

What is needed to supplement the short and medium term economic programmes for poverty alleviation is the beginning of sweeping changes in political, social and economic policies aimed at bringing about a change in thinking and attitudes. Almost the entire Third World has its roots in despotic rule followed by brief colonial, but an equally oppressive rule. Unless basic changes occur, there is always room for the revival of the so-called failed systems in a modified form or the evolution of new ones!

January 15, 2004

Census: Counting Human Population Growth

Launching of the report of the Census Data Analysis Project the other day, reminded one of many a task, which despite its importance for the nation, is not recognized as such by vast majority of the people. Census of population is one such undertaking. Once it has been conducted in the field, everybody except some technocrats and users of its data, for­get about it, not realizing that the statistics generated by this operation will affect their lives for the next ten years through policies and plans using the census figures. A country with a population of 150 million produces such a tremendous amount of data during the census, that it can keep a battalion of research workers busy in processing, analysing and re­porting for the decade to come. 

We, in Pakistan, could not utilize all the data produced by all the five on a continuous basis. Temporary staff was re­cruited to count population during a fixed period. Equally, non-permanent personnel were engaged to carry out data entry. Even the staff that analysed the data and wrote reports did not know about their future. Once the operation was over and broad results became available, the bulk of the staff was disposed off, leaving behind only a skeleton strength of permanent employees. The practice, apparently, is universal: ac­tually, it varies. 

The permanent census staffs in other coun­tries are much larger which does not allow any slackness in research and analysis after the departure of temporary staff. Pakistan experiences a slack period until preparations for the next census begin, reducing research and analysis to a trickle. This tendency is illustrated by the fact that even a most desirable post-census evaluation survey to assess cov­erage of the census and detect any errors could not be car­ried out after the 1998 census. It was only one out of many pitfalls of a census. They can happen anywhere, if census is not given the place that it commands. The census of popula­tion in British India aimed at compiling a complete economic, geographical, political, production, and land-use profile of British territories. 

Although much of this system was inher­ited from the Suri, Mughal and earlier kingdoms, yet the British perfected it. Census of population was an important component of the British information scheme. Yet, problems did occur at times, e.g. in 1931 and 1941 due to bitter rivalry between the Hindu and Muslim populations. But quick cor­rections were prompted by frequent use of census figures by the government. 

Pakistan inherited from the British, the tradition of hold­ing a census every ten years. The census of 1951, as such, was held on time despite highly unsettled conditions com­pounded by arrival of around seven million refugees within a few months.

But the 1961 Census saw tempering like the 1941 Census. This time, the tussle was between East and West Pakistan lobbies, instead of  Hindus and Muslims. As a result, there was estimated five to seven percent under enu­meration in West Pakistan. This tendency took root and the census, once considered almost sacred, fell prey to ethnic, parochial and dirty local politics. The East versus West Pakistan competition, however, disappeared with the emergence of Bangladesh. But it was succeeded by provincial, linguistic and political prejudices.

The 1971 census could only be held in 1972 due to the separation struggle in erstwhile East Pak­istan. But it was held to be comparatively fair because it was conducted in a society stunned by the shock of East Pakistan debacle. 

The 1981 census had to face the brunt of well organized lobbies in favour and against other regions, commu­nities and political parties. Technically, this census is recog­nized as superior to earlier exercises. However, the-results had some big surprises in certain areas of Sindh and Balochistan: Their population came out to be much higher than could be justified. This started right from the housing census. There was clearly a political hand in these distortions. This census, however, was instrumental in bringing into open the miserable condition of education, especially that of women. There were other candid statistics. However, the mischief committeed at enumeration in the field intensified the struggle for numerical superiority. 

Census, which was due in 1991, was postponed again and again. The 1990s saw four governments of two main parties. Each of them claimed to have greater following in some constituency. They were afraid that the census held by a gov­ernment of the rival party would manoeuvre to depress popu­lation figures in their areas of influence. The census thus was held in 1998. But what happened during the seven years of postponement was so irresponsible and bizarre that one would prefer not to discuss it. Only one episode will suffice: On this particular occasion, the big count was due next morning when suddenly the government decided to stop it. Next day, instead of the big count, there was an announcement that the census operations had been postponed due to ‘inclement weather’: While according to many a source there was not even a speck of cloud anywhere in Pakistan! This incident speaks volumes about how the nation of ours has ruined its institutions and thrown the sanctity of tasks of national importance to dogs. 

The census was, finally, held in 1998, after a delay of seven years and a gap of 17 years. However, the important step of post-census survey was missed mak­ing it difficult to assess the accuracy of results. This short­coming was belatedly met through launching of a census data analysis project, by combining resources of two United Na­tions bodies (UNFPA and UNSD), and two Pakistani agencies (PIDE and PCO). Coordination was assigned to a former joint director and economic demographer, Dr Mohammad Irfan, under the overall supervision Dr A R Kamal, Director PIDE. The work was distributed among a team of 18 senior so­cial scientists-cum-demographers. A technical committee over saw progress of the project. These arrangements have been described in detail to give an idea of the work involved in cov­ering only one step of census operations. One can well imag­ine the requirements of a high calibre permanent organization! One could not go through the entire report due to time constraint, yet some conclusions can be drawn. 

Feeny and Alma, two eminent demographer team members, in their paper, are of the opinion that the 1998 population was under­-enumerated; though supervision and controls were good, due to the presence of military personnel during fieldwork. Inac­curacies, thus, could have been introduced at the data-entry and data processing stages. Illegibility of numerous enumera­tion forms received over long distances and stored in bulk was one of the major problems. Unfortunately, the forms were dis­posed off rather early so no checking could be done for er­rors. 

There are reports that at least 92 percent of filled ques­tionnaires had at least one blank entry. Had the original forms been retained, these errors could have been detected before the final tabulations. Although equipped only with a browsing of the summaries, yet one would not hesitate to venture to list measures, which could assure regular and re­liable decennial censuses in future.

First: The census objec­tives should again be re-oriented to the real goals of a cen­sus. It should unfold a complete picture of population and its environs for purposes of policy making. The census should be unburdened of its role, determining the share of provinces in the NFC awards, as far as possible.

Second: There should be permanent autonomous census organization to conduct the decennial census. It should also undertake research stud­ies on a continuous basis. It should be component of an information gathering network, engaged in population research, in the light of developments in related fields, in collection with other research organizations.

Third: Census Organization should have highly qualified staff at all levels. It should be headed by a professional population scholar and re­searcher committed to the job on permanent basis. Quality of even the enumerators should be assured.

Fourth: Processing of data should be made efficient and foolproof by stringent training, approoriate salaries and proper work plans. Raw data should be retained for a reasonable period of time for re-checking and

Fifth: Data evaluation funtion should be built in the budget so that it is not missed.

December 25, 2003

Urbanization: Kindling Social Activism

The story of social and eco­nomic development of Pak­istan, in more than one ways, is closely linked to the history of urbanisation of the nation. According to the 1951 Census of population, only 17.4 percent of the population lived in the urban areas. By 1998, this proportion had risen to 32.5 percent. By including communities with urban characteristics and areas adjacent to the large cities, this percentage could be above 39 percent. By 2004 it must have been raised further as the current urban growth rate – in spite of declara­tion – could be as high as about 3 percent per annum; it was 3.47 percent for the period 1981-98. 

The total urban population in 1998 according to official figures was 43.0 million (about 51 million if urban char­acteristics and contiguity to large cities are accepted as criteria of urbanisa­tion); it was about 5.9 million in 1951. This population is distributed over 468 centres declared as urban in 1998 as compared to 208 in 1951. These are important figures. But the really signif­icant development from the point of view of social and economic well being of the population is the degree of .con­gestion in towns and cities. In 1951, Pakistan had only one city with more than one million population containing 18 percent of the urban population. By 1998, this figure rose to 7 cities har­bouring 50.1 per cent of the total urban population. This happened at the expense of cities with less than one mil­lion population that lost their percent share of the total except the 50,000 to 99,999 categories that recorded a slight increase. Most of them could be Tehsil or district headquarters or small trading centres. Other lower categories gained in number of centres; however, their share in the urban population de­clined. 

One did not intend to indulge in analysing the vast yet fascinating area of urbanisation. The purpose, essentially, was to point out the tendency of popu­lation to concentrate in the largest cities unmindful of the social, economic and environmental impact of such aggrega­tions. Yet they have been artificially sus­tained despite absence of the basic requirements of life. Other facilities also could not be provided at the scale that people of a modern city were justified to demand. Ironically, even then the largest cities continue to add to their popula­tions even though 35 percent of their citizens have to live in slum areas and majority of them do not have steady employment, and their families do not have access to clean drinking water, sewerage, health and ed­ucation! 

There is hardly any use lamenting the living conditions in large cities, un­less there are plans to change the ap­proach to life. The tendency to migrate to towns in search of better opportuni­ties in life and spurning pressures in the rural areas is universal and understandable, and may not be that problematic to manage. Difficulties arise from the desire of every migrant to share the bounty of the large city – which cannot provide them with amenities that they had been dreaming of. Crowding is li­able to depress the living conditions of even the existing urban residents as their extended family size is distended by arrival of relatives from the ‘village’: For these eager young men and their families there is no mid-way stop be­tween village and the large city. Factors like the presence of earlier migrants, availability of an odd job, disappear­ance of the restrictions imposed by tra­ditional village society, sudden exposure to glitter of the city and the opportunity to indulge in the fulfilment of sup­pressed desires and fantasies make the large city choice-destination for the uninitiated youth. 

One called urbanisation a fascinating area of study due to the highly intricate forces operating in migration of hu­mans, especially from village to the city. The phenomenon is not confined to the traditional ‘pull’ and ‘push’ factors. Deep inside, there exist a wide array of social, economic and cultural pressures which motivate people to move from their original homes. Selection of desti­nation has its own mechanism that is based on aspirations of the migrant and the immediate availability of shelter, se­curity and cultural acceptance.

The refugees from India in 1947 tended to migrate to urban areas, especially the big cities – they were 29 percent urban in India; by 1951, 45 percent of them settled in urban areas, especially those where Hindus and Sikhs had mi­grated to India in large numbers. 

Most refugees tried to settle in cities near their point of entry into Pakistan. Most of them tended to settle where they had a shel­ter and the means to sustain them – land, business, trade, and job. The less educated decided to settle where their relatives and friends from an earlier wave had set up their homestead. Only the more educated ventured to go to far off places like Quetta, Peshawar, etc as compared to the less educated who pre­ferred to travel less due to fear of un­known localities, speaking strange lan­guages. It caused serious over-crowding in places like Karachi, Lahore, Hyder­abad, Multan, etc, near the points of entry. The underlying motive to settle was soon established as the opportunity to make economic and social gains – a departure from the original aim of sav­ing families’ lives from the marauding hordes of hooligans. 

Coming to the present day situation, the nation is confronted with a state of cities that cannot be the envy of any­body. Although migration from rural to urban centres has slowed down, yet it will continue forever. The expatriate population abroad will continue to introduce their relatives to new and modern ways of living, raising aspi­rations of the entire population of their village. The social sector devel­opment will not match the demand of the people for many more years to come. The scene until that time will re­main of semi-educated crowds trying to burst into a modern ambience without knowing the limits of their rights, and their obligations towards society. Fric­tion caused by fast social mobility, in­cessant movement of populations be­tween rural and urban areas, almost 4 to 6 million Pakistanis abroad and a flux of money to relatives who did not earn a it, have all contributed to social, cul­tural and political turmoil that the Pakistani society is experiencing. With the international situation getting more uncertain and restive, our attention may remain riveted more to concerns related to international developments leaving the local scene to carve its own course within loose parameters. 

There are no quick fixes to the situa tion. The country, steadily, will move towards urbanisation but accompanied by a trace of complementary characteristics. Left unattended, this condition can lead to complete chaos ushering in law of the jungle at not a distant day. To correct the situation, we must realise that the turbulence is related to break down of the process of reconciling thet past and present social values; deep confusion caused by lack of resolution of our allegiance to religion and pragmatism; the tussle between lust for money and greediness on the one hand, and traditional exhortations to adop simplicity and austerity on the other; lack of demarcation between honesty and legitimacy, and the obligation to be honest and upright. These are major decisions that have to be made in spite of widespread indifference and compulsions imposed by avarice and inflated egos. 

Our system of government – with all the alterations and adjustments – cannot bring itself to help people make personal decisions. Nor can the clergy and the foreign inspired NGOs can cut any ice; they have their own limited agendas. An opportunity should be provided to the biggest stakeholders of a smooth change, rule of law, peaceful co-existence and an efficient and devoted work force: These stakes belong to industrialists, traders, merchants, labourers, teachers, lawyers, doctors, and the like. What they look forward to is profit or a place in society or both. Their business, offices and home and their persona have to give an impression of prosperity, distinction, recognition and ‘class’. Small community bodies can bring about changes that will provide neighbourhoods with the motivation, the will and the means to meet demands of the people. A word of caution: If past is any guide, links between neighbourhood bodies and the government, political parties or foreign NGOs will be the end of their usefulness, even if they com­prised angels and saints!

 August 12, 2004

Beyond Human Fertility

It is an irony that while industrial countries of the world are clamouring about zero or even negative increase in their birth rates, the developing world continues to be crushed under the weight of its burgeoning population. Despite a reluctant decline in growth rate in some parts of the Third World, rise in popu­lation remains high, in comparison with the pace of eco­nomic growth in the majority of the poorer countries.

Short­age of labour caused by low population growth in the advanced nations is being helped by migration from the high growth countries of the poor belts. But the arrangement has created a horde of racial, cultural and social problems both in the recipient, as well as the donor countries. Combined with problems of pure demographic genre, changes in the composition and distribution of population should be caus­ing headaches of gargantuan proportions for every country of the world. 

Pakistan has been conscious of impending problems cre­ated by rapid population growth, right from the beginning of economic planning in the country. This realisation was both the result of the wisdom and foresight of our venerable early planners, as well as the frightening over-crowding resulting from waves of refugees moving between India is and Pakistan after Independence. While the refugees were settling down in their new homes and the gaps created by the departure of Hin­dus and Sikhs were being filled, the fast decline in death rates and the prevailing high birth rate could easily be predicted as the source of a major problem to confront the country in the coming years. This was a timely and accurate assessment of the situation.

Starting with the fast semblances of population control activity in 1954, family planning movement emerged as a focus of attention of the liberal groups in the society. But si­multaneously, it became a favourite target of the traditional and obscurantist elements. Over half a century of efforts by the NGOs and the strong – sometimes half-hearted when not negative – backing by the government, the family planning programme ended up as the ‘Population Welfare Programme’, thanks to the fear of religious elements dear to the govern­ment in the 1980s.

The emphasis however, remained on de­clining the birth rate. It was almost 40 years after the ad­vent of family planning as an entity that signs of a downward trend in fertility became discernible. Although late, yet the ef­forts of all the people involved in endeavours to lower down fertility rates in Pakistan were vindicated. However, the nation still continues to add not less three million souls to its popu­lation every year. That cannot be dismissed as a routine natu­ral phenomenon; the battle will have to continue to bring this number down.           

The family planning – or if you are in the government, population welfare – programme in Pakistan was so distinct due to a strong support of some regimes, hot debates over its legitimacy, and a handsome inflow of foreign assistance that everybody wanted to swallow, though nobody was pre­pared to defend it. Although, almost every person with edu­cation in modern disciplines considered population growth as the biggest hurdle in the way of economic and social progress, hardly anybody was ready to stick their neck out to advocate the programme – that was left to the personnel working in the population departments or devotees in civil society and the NGOs. There is absolutely no doubt that the efforts at lowering human fertility have to continue vigorously as the factors required to make fertility decline, or attain self­ sustainability in sectors, like education, health, income generation, women’s development etc. are still weak. Trends of decline in fertility is no ground for complacence, unless it holds itself for a period of time and the factors helpful to lower fer­tility have come into being. 

However, during the years that the population-conscious people were busy in lowering the birth rate, the picture of human pop­ulation underwent a revolution. Important ­developments have taken place in the form of the emergence of a huge adolescent population, a fast increase in the number of the aged population, alarming migration from rural to urban areas, large-scale international migration, unprecedented urbanisa­tion and a backlog of shortages of essential goods of human use, ranging from potable water to employment opportunities, etc. Most of the developing countries suffer from the tendency to pursue doggedly only one goal, remaining almost com­pletely ignorant of the emergence of other monsters around them, indicating a dearth of holistic comprehension. Pakistan is no exception. While most of the population people were busy in beating high fertility, other population-related phe­nomena developed into small tempests. Besides the new phenomena witnessed in other developing countries, we got the unsolicited gift of 3.5 million Afghan refugees – almost half the strength of refugees received in 1947-48. 

We had better appreciate the importance of these de­velopments in the context of economic and social health of the nation and the enormous efforts that the present and future generations will have to make just to main­tain the status quo, not to talk of providing new facilities. With 43 percent of the population under 15 years of age, and about 5.5 percent population aged 60 years and above, a net addition to population numbers at, the rate of 1.9 percent, at least 3.5 percent growth of city inhabitants, and unending stream of migrants from rural to urban areas and abroad, 8.27 percent rate of unemployment, a nation cannot take life leisurely. Strain on resources and pressures on government and the civic bodies are already showing. Question regarding shortage of essential goods and services, inadequacy of education, health and transport facilities are being raised by all quarters. Law and order situation and tension among various organs of society and sections of the government are a direct manifestation of the stresses and strains that the society is undergoing – as well as producing. 

Although a distinct department or organisation serves every sphere of society, and there exist institutions to coordinate their activities and keeping harmony among them, yet population, education, health and other social sectors are relegated to stay with other low priority areas – contrary to rhetoric – population change is not even fully understood. It is high time that we strengthen the population management process in the country and extend its coverage to all aspects of population dynamics. There are isolated studies of various phenomena and some seminar proceedings and speeches and articles on different problem areas but there remains a dearth of in-depth studies or multi-disciplinary action to cover every development in the area of population. Aged population is looked after by one department, infants and mothers are the domain of health programmes, children are left to the education departments, women development is still struggling to gain the attention of the ruling elite that it deserves. Internal migration is a recognised orphan – international migration is studied for its importance as the source of billions of dollar of home remittances! 

I have a good idea of the problem of coordination among the areas related to population: At least the factors directly related to population like migration, mortality, population statistics and research in population etc which are wandering in disinterested offices should be placed together. An O&M exercise in this respect will be in order. In the meantime, the coordinating organs already provided for should be resuscitated and made into working entities rather than remaining once-a-year or once-in-five year ceremonial bashes. 

Let us take the matter seriously. During the ten minute that you might have taken reading this article at least 80 children must have been added to the population – at least one-third to live in poverty!

July 8, 2004

Pakistan Has Allowed Streams to Develop into Floods

Humans tend to have the weakness that with the slightest relief in a crisis, they like to become complacent and slow their efforts. Pakistanis of our times go a step further: They, at the first indication of a break, make themselves believe that the danger has passed and now they can live happily ever after. As a result we have allowed small streams to develop into floods and small bruises grow into cancers. Perhaps, the gravest consequence of this tendency is the still galloping rate of population growth. We have been trying to slow it down by fits and starts but have not been able to establish a firm trend of fertility decline based on durable economic and social policies. On the contrary, the manifestoes of our political parties released for the recent national elections show some serious digressions which make the future course of the nation unpredictable, especially with respect to socio-economic issues which are detrimental to management and welfare of population.

There have been indications that Pakistan has entered the era of demographic transition which will ultimately make us achieve a stable population. Some people have been so encouraged by this prospect that they are bent upon disposing of population management as a distinct function and fuse it into other outfits. In the frenzy of possible merger, it has been forgotten that the ministry and departments of population had a significant role in moderating, and now reducing, fertility: Their down-grading could extinguish the flame that had sustained population workers through almost five decades of uncertainty of service, indignity at the hands of the obscurantist lobby, and fluctuations in the all important political will of myriad governments.

A far more threatening factor is the school of thought which genuinely feels that with the break-through in fertility, there is no longer a need for population management and monitoring of population trends. This is a very narrow view. Pakistan, every year, adds about 3.0 million persons to its population which is roughly about the combined population of Multan, Sukkur, Peshawar and Quetta, as estimated by the National Institute of Population Sudies. The population of Pakistan, as a result has already risen to 145.5 million – it will double to 291.0 million by the year 2035 after crossing the mark of 167.7 million in 2010 and 195.5 million in 2020. This needs to be checked, as the country already lags behind the demand in so many crucial areas, like education, health, housing, productivity of food crops, water availability, energy, etc. The situation calls for triple effort – meeting existing shortages, providing for new additions and producing extra to raise living standards. Our resources cannot back an endeavour of such gargantuan dimensions. So we are left with three options: Either we allow the nation to slip into greater misery emanating from worsening supply and demand gap and stoke inflation to lower savings and investment: Or accept foreign debts and dependence on foreign investment for a long time to come: Or slow down population growth to a level that it becomes core of the process of sustainability. There is hardly any comparison between the three: Reduction in population growth has no alternative as it determines the volume of consumption besides affecting the quality of population which is easier to improve in small populations.

The need for managing population trends, by now, is being felt by vast majority of the people. But there do exist some areas of resistance. There is a sizable community of conservative elements which does not approve of any modern idea or practice. A number of cultural values of local origin have been dubbed as religious commands. These elements have been opposed to interference in the composition of population and the measures that can bring about a change in components of human population. The common man, today, pays much lesser attention to arguments against essentially private decision of husband and wife and immediate family members, as compared to early days of population regulation programme in the 1960’s, mainly due to widespread adoption of the small family norm. This has taken place due to mounting economic pressure and heightened aspiration levels besides contribution of the Population Community. The disturbing reality is that this change is not based on conviction created and strengthened by an understanding of the problem and social change created by education. Dismal education levels and miserable literacy rates among the females render the change favouring small families rather superficial and feeble which may not always transfer into permanent change in attitude.

Second: Whatever the causes, the outfits working for small population size have never earned the confidence and respect of the community except a few NGO’s which have initiated programmes to win and empower women to strengthen family as a unit and improve the lot of women. Nobody can ignore the contribution made both by Public and Private sector in applying brakes to the runaway population growth in the country. But respect by the society was eluded as the major thrust of population programmes had been on lowering fertility ignoring other components of population dynamics. If the entire literature about population of Pakistan is reviewed, one would be shocked to discover, that academic and research work in the field of Mortality and its causes, internal and external migration and the economic parameters of population problems constitute a fraction of the work carried out on fertility and the programmes fielded to lower it. This is true for most parts of the world, but it had definitely caused adverse effect in Pakistan; it made population-related programmes controversial on many scores, revolving around the moot question of limiting family size while other serious problems remained un-attended.

The concentration on births and rapid increase in human numbers would have been eased only if the entire population issue had been analysed by components of population and problems facing groups of population in various age brackets instead of taking total population as an entity which most of us had been doing over the years. As a result of this approach, we transformed the study of population phenomenon into a cold statistic existing among a caboodle of social, economic and political variables. This took the discipline of population out of immediate and discernible concerns of life on the ground: Its main focus got confined to women of reproductive age who were a small proportion of total numbers. Population programmes, as such became a source of dirty jokes and a popular topic for satire and ridicule. Had it addressed all the problems confronted by society, the situation would have been different.

To illustrate the divergence of needs, the last Census of Population conducted in 1998 counted the population of Pakistan at 127.43 million – excluding FATA. Out of them, 38.55 million or 30.2 per cent were below the age of 9 years. 24.68 million were in the adolescent group of 15 to 24 years of age. 41.73 million. 41.73 million, in the age group 25 to 59 were in the working age group – but about 19.41 Million of them were women who did not work for ‘economic gain’, but most of them were home-makers and in the reproductive age group. 2.62 million persons in the age group 60-64 could be considered in a transitory stage – some working and some not. A hefty 4.36 million above 65 years of age were those who could be considered retired or the senior citizens.

Even a casual look at these figures will reveal that each grouping of population has distinct needs besides requirements common to all, like shelter, food, etc. Infants and children need their milk and cereals, besides small garments, paediatric medicines, vaccines and tranquil homes. The children of school going age need schools and teacher, school equipment, books, transport to school and uniforms. Adolescents’ requirements are physical as well as psychological. They need education, training, security and avenues to channelize their energy. Working population – needs employment opportunities, economic security, peaceful surroundings for the family. The oldest population, presently a small percentage is going to increase, as the fall in mortality and fertility rates and a rise in expectancy of life continue. This population needs a host of special services, medical assistance and care. These requirements will intensify as the population continues to shift to urban areas and the joint families break down. There is the need to formulate plans for this population so that they remain useful to society while leading healthy and happy lives.

This list will look rudimentary. The planners have been planning for these groups as a part of macro plans. But they are mentioned only in macro plans: But their role as a part of the population management strategy never came strong and clear except for women in the fertile age group. The Interim Population Sector Perspective Plan formulated by the government only this year has been perhaps the first government initiative which pledges to work closely with the Health sector, and underscores the need to cover the welfare of population with special needs like women, youth, the aged and extend the area of service to the entire population rather then concentrating on birth rate. If the environment become conducive, all components will fall into place by this strategy.

To conclude, population growth and size are a crucial factor in the life of a nation. It should be brought to the centre of development – and not taken lightly. Its study and programes should cover all aspects of development and administration, and with that objective in view, it should involve all sectors of the economy and all governmental and non-governmental entities. But it should not be allowed to lose its identity. The country will still need it for some time to come.

Population Research for Policy Development in Pakistan

 

 

 

Let it be a confession that it was many decades back that as a post-graduate student, one was convinced that population numbers and the pace of their growth were the base element of economic development. Almost at the same time, it came to one’s mind that population control was the answer to rapid population growth – the biggest challenge to economic progress. A little later, it became clear that such a whole lot of questions remained unanswerable due to extreme paucity of research in population dynamics as well as other components of development. A further dimensions was added that literacy, education, health, shelter, i.e. the social sectors were essential for the control of population. Later on, the inadequacy of GNP as a measure of prosperity and development got translated into Human Development – a step forward from social development.

 

These are natural stages in the development of ideas. But an effort at understanding the march of human progress would lead to human inquisitiveness, exploration, and the relationship of matter and ideas –  and what we call research. And let us admit that we in Pakistan have not made much progress in trailblazing or making any startling discoveries since our appearance on the map of this world. Partly, it was due to lack of demand for research, since we have been quite happy with what we inherited from the past or what we borrowed from the industrialized world. But mostly, a tradition of research could not shape up as existing body of research was hardly, if ever, used by official or private hierarchy. What was produced was either the addition of latest discoveries and inventions that reached us as largesse of the West, or it was the result of individual inspiration and perseverance.

 

Theme of the Faisalabad Conference points to the use of population research in policy development. What one can deduce from it, could be the role of population research in evolving population policies. But it could be extended to the part played by population research in national policies of various descriptions. Both inferences are valid. In fact, the relationship can be examined for research and policymaking in all aspects of life. We have created research bodies, practically, in all departments. But we have never encouraged these organizations to introduce innovations or devise new solutions to problems in their fields or to contribute to global fund of scholarship.

 

Population provides a good example of how research in that field worked. Starting from a scratch, research was introduced in biological, socio-economic, and field impact of family planning. A good deal of research was carried out using the latest methodology. But step after step programmes for awareness and contraceptive use could not achieve their target. Population growth rate during the height of family planning touched new heights instead of declining. Problem with population policies was the adoption of imported ideas which were not workable in the Pakistani society. A major mis-step was taken at the very beginning of the population control effort: The Programme was geared to concentrate on women in a society where, overwhelmingly, women could not take any decision without male consent. It was much later that men were brought into the program as equal partners. Likewise, experiences of various countries were widely exchanged and put in practice, only to fail. This is a known fact that all the methods to control population that had failed in Pakistan, succeeded in other countries. Perhaps, the greatest let-down in Pakistan was the delay in accepting that population issue was a multi-disciplinary area, and without the advancement of education, health, housing and human development in general, it could not be tackled. Conduct of population programmes independently, did not yield any considerable results which made family planning only a matter to joke about.

 

The culture of research in Pakistan has many impediments. On the top is the paucity of funds. Since research, generally, is not considered a priority, adequate development funds are not provided, and there is no monitoring of research activities. Since research findings are not put to proper use, research does not have a direction or continuity. Research flourishes only in departments which utilize their  research. In most cases, equipment, raw materials – in some cases even the special stationery – are not available easily. There are no adequate facilities for repairs. Libraries are inadequate and poor. Software and books are not easily available. There are not many functioning guilds or associations which could provide genuine forums for examination of research output or professional discussion. It takes away the big incentive of recognition for the researcher. Their talent and achievement also go unmentioned. They, as a result, either move to developed countries or start producing mediocre work, re-inventing the wheel. The recognition, the time, the funds are major conditions for research. Since they are not available, the standard of research is hampered: In turn that shuts future prospects for producing high class products.

 

Since accomplished persons are not located in the immediate vicinity, constant guidance or assessment of quality are missing, which discourages output of a high caliber. The biggest obstacle in the way of research are, perhaps, the outside administrators who try to impose discipline over what they hardly understand. Many a researcher is known to have gone into a slumber due to such interference and quite a few research projects are abandoned halfway due to exasperation of head and the staff. Cumbersome procedures to obtain funds, hire staff, purchase equipment, and the tempering of reports to favour some agency or individual ruin the very ambience of conducting objective research.

 

There cannot be a dispute over application of research in policy making. Every policy maker will make a solemn commitment to stand by research findings – if they are from ‘reliable’ studies! But, in most cases, they are nothing more than a declaration of intent. When leading discussions, listening to consultants, or writing a summary for the Cabinet, there are plenty of directives, pressures and constraints which change the direction and substance of the submission. What is wanting is a mechanism by which research findings are made to figure in policies and decisions. Let there be a research coordination committee in each ministry – where they do not exist already – which must meet regularly, examine reports and submit important findings with a coordinated resume to Minister and Secretary on a quarterly basis. It should also recommend areas for further research for consideration of the Departmental or Central Development Working Parties. This might work wonders for both research and policies if implemented seriously.

(News December 11/ 2003)

Seeking a Reversal to Population Growth

(News August 30/ 2001)

 

 

With every passing day, population of the World increases by 232,877 million persons i.e. 9703 per hour, 162 per minute, and 270 per second. This is the result of a low death rate and high birth rates. This, by any standards is unacceptable. 34 per cent of the World population lives below the poverty line; 27 per cent do not have access to safe drinking water; millions do not have shelter on their head; Many millions live on daily per capita supply of calories below the minimum level. Take other basics like education, health, environment and transport: they all are below the standard in case of vast populations. Problems are increasing all over: global warming, floods, droughts, epidemics, new diseases – to count a few. Then who is pleased at increase in population? We are adding a burden on earth that we are ill prepared to bear.

 

Population of the World in 1927 was 2 billion. In 72 years, it had increased to 6.1 billion or 6000 million – a three time increase. Gone are the times when people in most parts of the world used to celebrate a birth in the family with fanfare. Now, those who celebrate the birth of every birth in the family may be taken as irresponsible, if not imbecile; though there still do exist cultures in which the quest for a male child leads to bloating of the family. Also, almost 25 per cent of the world population is still illiterate while in most of the developing countries, almost one third live at less than one dollar a day: One does not expect small families in such a milieu. There is no doubt that fertility has declined in many parts of the World during the last 50 to 100 years, but most of this decrease has been confined to countries which have emerged as industrial nations; the under-developed countries are still experiencing quite high birth rates. Family Planning movement, after World War II, emerged as a controversial yet significant development. The development process during the past decades has shown that fertility decline has been most noticeable in countries where incomes, literacy, female education – accompanied by political will – recorded a rise. Although it is still disputed, yet most evidence indicates that as social indicators like literacy accompanied by a rise in standards of living took root, basic changes in thinking started occurring, which included fertility and mortality decline.

 

One should be clear that while the motivation for small families was provided by extraneous influences through education and communication, the methods for curbing the birth rates were supplied by the family planning programs. In fact, the changes wrought in society would not have affected fertility were the services been missing from the scene. As such, population control methods, research, technology and organization remain crucial for lowering birth rates. One of the major mistakes that Pakistan, and some other countries, committed in the beginning of their development plans was to keep their population decline programs in a separate closet, away from mainstream planning. This was a set-back that many countries could not overcome for a long time, after they had realized the close relationship between socio-economic development and population growth. Pakistan is still struck in the quagmire produced by low socio-economic development and unjustifiable levels of fertility.

 

The volume of population and its rate of growth have to be seen in the light of the capacity of an economy to supply basic needs of the population, and leave room for development, savings and investment. Pakistan started recording a decline in fertility in early 1990’s. But its economic development indicators have not developed a consistent trend towards improvement. Whatever it means for the economy, it does not augur well for stabilization of population. Slow and erratic economic and social progress does not provide firm foundations for a family planning program. The most crucial social sectors like education, health, women development etc. have not reached the levels from where they could bring around the population to evolve a small family norm, which should be the ultimate aim of a sound population control program. As a basic principle, economic planning should be made to sustain savings, investment and production levels. Every increase in income and every decrease in population will result in better living conditions and a steady decline in population growth leading to a stable population. This simple fact has yet to sink in the minds of our general public. We have attained almost universal awareness of family planning as an instrument of checking population growth. But the ratio of population that is convinced of having a small family or those practicing family planning remain very low. The crusade for small families, therefore, must continue.

 

Inhabitants of a civilized country have the basic right to free elementary education and free primary health facilities besides the fulfillment of basic needs. We, like other developing countries, recognize these rights: this is another matter how we treat them on the ground. One feels that the choice for size of the family and the freely available facilities to exercise that choice is also a fundamental right of the couple. But assertion and practice of that right is not easy in a society bound by traditions and dominated by uneducated self-styled leaders of public opinion. The countries which have succeeded in realizing the importance of slowing down population growth, also accepted the importance of literacy, education and liberalism. We have not been so lucky. Fifty four years after independence, we are still only 49 per cent literate and only 12 per cent of our youth graduate from the high schools. How could any new ideas take root in such a milieu? In fact, whatever has been obtained in modern living is not less than a miracle. There still remains the need for stressing the imperatives of low population growth and a dependable service delivery system.

 

What we really need is to plan our economy for the poor – to meet their basic needs, and to pull them out of poverty. The government has started a large poverty alleviation program, and every social uplift programd has been hitched to it. This is very good. But one cannot help stressing that population need to be brought to the centre stage of development. We just cannot be complacent with some decline in fertility. Our growth rate is still one of the highest in the region. We have to cope with a growing number of young people. Our aged population has started increasing to worrying levels. Our men still do not care about the number of children or the health of their mothers. Our women still spend most of their lives under the scepter of the mother or sister in law without the freedom to visit a doctor, attend a school or go for shopping without a chaperone! The totally ignored factor which can reverse the fertility decline – and which we await eagerly all the time – is foreign remittances by our workers abroad. In all probability, they can make the families of workers careless and expansive making them mindless of the size of the family.

 

This is not a very happy scenario. Population growth in Pakistan is still a matter of worry. We better continue to remind people about the perils of a large and fast growing population: And that no amount of agricultural, industrial, economic or social development will be able to sustain the sort of population growth that we indulge in. A concerted and pointed emphasis, as a part of the overall process will continue to be required in the years to come. It will have to be simple, convincing, practical and need-oriented.

Monitoring the Menace of Population Growth

 (News May 11/ 2001)

 

Almost half a century back one got convinced that rapid population growth, “is a rock on which all hopes of improved conditions of living may flounder. It admits no approach except that the rate of growth must be low”, as late Mr Zahid Hussain, the first Chairman of the erstwhile Planning Board of Pakistan put it. After all these years, one still feels that the unbridled population increase continues to be the major impediment to economic and social progress of the developing countries. One also has the painful realization that Pakistan is badly left behind in the efforts to control population growth due to, only partial success in fertility decline. It will be repetitive to go into the causes and effects of various population programs – they are now rudimentaries of the process and are well known. Our successes and failures have taught us a thing or two. One of them is the requisite of strong resolve and political will and the consistency – commodities that we have been lacking in our national life since almost our existence.

 

Sometime last year, the population program personnel were perturbed – perhaps for the umpteenth time over the news of Program’s dislocation. The wind of down and right sizing which were sweeping the portals of the government offices had also created panic in the offices of population. After long months of uncertainty, one is relieved to learn that things are setting down. The Chief Executive’s review Committee has agreed that the Population Welfare Division would continue to exist even if some functions of the ministry of population welfare are devolved to provinces and districts. The Committee and all the other friends of population programs deserve to be commended for their appreciation of the continued need for spreading the message of sanity regarding family size.

 

Almost everybody finds an alibi to complain about the slow progress of the Population Program, inefficiency of personnel, and diverse activities of the private sector which relegate fertility control to a secondary position. However, very few people recognize the difficulties encountered by programs of social change in an illiterate and conservative society. It took almost forty years to transmit the message of family planning to all corners of the country. Expression of delivery facilities was still a more difficult task. Isn’t it a shame that after almost fifty years of information and education, and continuous augmentation of service delivery system, there still exist people who have to be convinced about the desirability of having small families – as if it were a favor to the government or other organizations propagating population control and it were of no use to the family concerned. In a milieu like that, even the breakthrough that has been made so far, is not short of a miracle. The awareness of family planning methods, contraceptive prevalence and the decline in fertility, in the neighboring countries indicate as to what we still need to do.

 

We have attained almost universal awareness of family planning. But those practicing family planning methods are only thirty per cent of the total married couples. The yawning gap between awareness and practice levels reflects hurdles on the way, first: the lack of motivation which would prompt them to act. Second: the failure to start practicing family planning as a part of daily life. As said before, one does not want to repeat the reasons which gave the Program the stigma of being a wastage of time and money; they are already known widely. It will suffice to say that awareness of family planning methods, in case of two-third of the total married couples is somewhat superficial so it has not been converted into practice. Likewise, the default over the use of family planning methods may be due to lack of information about an outlet for contraceptive supply, absence of the opportunity to use contraception within the household, fear of family members, friends and influentials who are opposed to family planning. There are a horde of other reasons for not practicing family planning even if one feels the need to adopt it.

 

However, the most damaging obstruction to the adoption of small family norm is the non-acceptance of family planning as a economic and social necessity for raising a healthy family, improving living standards, assisting the nation in achieving better distribution of resources, and making the community collectively prosperous. One will be justified to suspect that a fair part of the people who do not practice family planning in spite of having the knowledge of contraceptive methods, may never take up family planning methods during their fertile years; they might even become averse to family planning once they have completed their families. One has come across many such persons pleading large families in order to justify the many children that they have produced in their life-time. They may be ignored, but the effect they could have on the advocacy of small family, cannot be dismissed lightly.

 

The point one is trying to make is that the implications of rapid population growth will have to be communicated to the masses perpetually as a reminder to our present predicament and the bleak future scenario. It is especially necessary as the creation of an environment conducive to the birth of fewer children, affording a chance of better living conditions, call for repeated  reminders. Social change is directly opposite the traditions entrenched since centuries. It involves change in the entire society. Society is like a living body. One limb cannot be tempered with without disturbing the others. China has provided us with the information that even a government with tremendous popularity and the might of the state could come across problems in promulgating one-child norm. The traditional value of a large family, particularly a number of male off-spring did not let the families easily reconcile with the idea of a single child. Our condition is not very different. Our rural areas cherish many males in the family, when they look for security now and in old age. The children, once grown up – will contribute to family income, deter enemies and physically assist in running the household. These values and convictions are not easy to change. It will be a gradual process of socio-economic evolution which will transform society. It will be prompted by inner demand for better life including that of the present generation within their life-span, which – it is recognized – is not possible without fostering the small family model.

 

One holds the conviction, based on observations extending over various cycles of the population program, that a major reason for its unspectacular achievements has been its isolation. No doubt, it had been an appendage of the Health ministry for some years. Also it had been a part of the ministry of planning and development. Further, it had been proclaimed repeatedly that it was a multi-disciplinary subject. Still further, population had been examined as a variable in all development proposals and projects. But the fact of the matter is that the dynamics of population were never integrated with the overall economic and social development, in spite of its tremendous impact as a resource and as the ultimate beneficiary of development. The propaganda height of the Program was achieved during the Ayub Khan era, in its formative years. But solid changes were made during the Ziau Haq regime when the Program was attached to the Planning Commission. If there is the resolve to strengthen the Program – which I believe is there – the Population Welfare Program should work closely with the Planning and Development Division. And it should assume the role of a major player in the development process.

 

We should not forget that rapid and high population growth can wreak havoc with the economy, social set-up, and the environment. We have seen only a few shortages so far. But more, and far grievous ones will befall if the national resources are devoted only to cater to the consumption needs of a burgeoning population which will hamper savings and investment, defying any efforts to plan for the future.