Usman Ghayas - Oregon State University, USA released a study way back in 2009 that quantified how much a child born to parents residing in the USA contributed to carbon emissions on planet Earth. It calculated that carbon dioxide emissions generated by an American child are 7 times more than that of what 1 child produces in China and 169 times more than a child in Bangladesh. Recycling, reducing travel by car and making homes more energy efficient only have a fraction of impact on reducing emissions versus reducing birth rate.

Besides this, environmental advocacy groups have been talking for decades about the effect over population has on the environment: It crowds out species other than the human race and hastens climate change. Those species that are being saved from getting extinct eventually will perish when they do not have enough to survive on when the human population keeps increasing.

The United Nations Population Fund (UNFPA) has been highlighting how an increasing population will result in overcrowding habitable areas of the planet, widespread deforestation, increasing economic imbalance, food shortages and the challenges that are a further consequence of these challenges. A number of these have already manifested themselves in developing nations, especially those close to home (like increasing economic imbalance etc.).

And at home, the numbers are quite staggering. The country is home to 207.77 million people according to the 2017 census, which does not include those residing in Gilgit-Baltistan and Azad Kashmir. Out of these, 60% are under 30 years old. While it is the 6th most populous country of the world, its economy stands as only being the 40th biggest; a long way off from what it should be. Also, according to the Pakistan Demographic and Health Survey 2012-13 and Human Development Report of 2014, 50% of the population is underprivileged. Yet the total fertility rate is 3.5, according to the census conducted in 2017.According to the CIA World Fact book, the infant mortality rate, defined as number of deaths of babies until they are one year old per 1,000 live births, is 52.1; while the maternal mortality ratio, which is the number of women who die during childbirth or due to complications resulting from childbirth, is 178.Moreover, couples with an unmet need for family planning are an overwhelming 6.3 million, while the contraceptive prevalence rate (CPR) is 35.4%, out of which 26% comprises of modern CPR.

The CPR has increased due to a number of efforts being carried out by Pakistan's Ministry of Population Welfare (MoPW), including a number of public and private sector organizations being active at the grassroots' level. One such organization involved in planning and consulting to increase access and use of health products, services and information amongst low income Pakistanis is Green star Social Marketing. We all heard of Sabz sitara Clinics that have been active in the country since more than the past two decades. Now, the network includes 7,000 franchised healthcare providers who provide counseling on family planning (FP) methods and supply contraceptives, ensuring competency based classroom and clinical trainings to its own and franchisee staff by medically qualified and trained doctors, monitors quality service and provides on-site mentoring and recommendations using internationally acclaimed monitoring tools. Due to these clinics and other interventions, the social enterprise seems to have been able to avert11,680 maternal and 135,488 child deaths during the 2006 to 2015 decade. Not just this, it provided 22,090,956 couple years of protection (estimated protection provided by contraceptive methods, based upon the volume of all contraceptives sold or distributed free of charge to clients during the ten-year period).

To further the cause as the largest private contributor to the country's family planning services, the enterprise created advocacy goals to prioritize and establish FP and mother & child health (MCH)as a major health requirement; and encourage other development organizations, policy-makers, media and the local community towards the initiative.

To warrant the implementation of these goals, 428 health workers conducted door-to-door visits and held neighborhood meetings and engaged with women and couples in villages, marginalized communities of urban areas, waiting areas of hospitals, clinics and Green star medical camps, held by medical service units (MSU). The MSU's are active in those rural areas of Northern Punjab and KPK where no health facilities exist and provide MCH and FP services free of cost to underserved women. Also, 110 one to two room clinics and 7 signature maternity homes with surgical services were established in these provinces that also act as training and referral sites for Sabz sitara Clinics in the catchment area, and are complete with a patient record management system to strengthen recordkeeping and follow ups.

To increase awareness about modern FP, counsel couples on contraceptive management and its side-effects, dispelling related misconceptions, providing information about such products and referrals to FP clinics, Green star established POOCHO Helpline.

The organization is also working in collaboration with National and Provincial Tuberculosis (TB) Control programs to stop the disease from fast becoming a public epidemic through training private health care providers, strengthening private laboratories, creating awareness and mobilization, and ensuring proper treatment within the communities.

In Pakistan since the past 25 years, the social marketing and franchising organization is a case study that has addressed the married women who have an unmet need for family planning. With work already underway to achieve the commitments made by the Government of Pakistan for FP2020 during Summit 2012, Green star is already developing strategies to further its family planning programme.

What is important though to fulfill our family planning goals and continue to make childbirth a safer experience for Pakistani families, we think about how families think of their children and refocus the debate to achieve optimum results.