As the new provincial governments devise policies to grapple with various issues, there is one which they can only choose to ignore at their own peril, but which, for one reason or another, does not get the importance it deserves. According to Dr Zeba Sathar, Country Director for Pakistan Population Council, the projected population for Pakistan may reach as high as 395 million by 2050 if no further fertility decline occurs.
Just the thought conjures up pictures of extreme misery, as the already existing chaos seems too much for the resources and the economy. At the rate the population is growing all additional funds allocated in annual budgets for social sectors will not make an iota of difference because inflation and rising numbers will both ensure that everything remains stuck in the bottom pit. The high increase in population growth is also contributing to urbanisation, environmental degradation and the (highest in the region) rate of maternal mortality.
Thus, there is a dire need for lowering the current rate of fertility by implementing effective family planning programmes. About 10 million women with unmet needs live in Pakistan, most of them illiterate and poor. According to Dr Sathar, the projected population for Pakistan in 2050 can be as low as 266 million instead of 395 million if there is rapid fertility decline. The key policy issue for the governments, therefore, is how to reduce growth through voluntary methods. If strong, new investment is made in family planning, the future fertility trajectory could be a half birth lower, leading to a population of 266 million by 2050. The difference between a weak and strong programme scenario is 76 million. That will also avert three million unwanted pregnancies each year and 500 maternal and 100,000 infant deaths annually.
To tackle the issue head on, a comprehensive policy consisting of multiple approaches is required. The approach must address each of the components of growth, including investment in high quality family planning services and reducing the demand for large families through investments in human development. Educating girls can be a powerful driver of fertility decline.
The new governments appear to be alive to the issues and have made commitments in their manifestos to bring about qualitative changes for improvements to lives of all Pakistanis. They have promised a high priority to preventive health. The impetus for such commitment may well stem from the realisation that the challenges in health have impact on many developmental parameters. Indeed, the approach to health must also necessitate a multi-sectoral approach involving multiple departments and stakeholders.
Because of lack of availability of reliable family planning methods women commonly use abortion as a back-up method to terminate unintended pregnancies, which leads to a greater risk of dying from complications from abortion. One nationwide study indicates an estimated one million abortions are performed each year, many of them in under unsafe conditions. The public sector remains the main source of contraceptives. As many as 48 percent of modern method users rely on the government sector.
Weak training about counselling has also resulted in the low use of family planning services. One study reveals that among non-users, about 39 percent reported fears of side-effects as the main reason for not using family planning methods.
The djinn of population has to be controlled, with serious intent and passion, if Pakistan is to go anywhere up in the world. It needs as much focus as do the problems of law and order and energy. The Health Departments of all the provinces must make the delivery of family planning services mandatory in all their outlets.
It is also important that trained family planning counselling is a part of the service provision, while contraceptives are procured directly by the Departments of Health.
If population becomes manageable, there will be lesser need for sound bytes like “use yogurt and lemon if tomatoes are expensive” - as was heard from a minister being questioned about inflationary prices of tomatoes or the visual of Hamza Sharif visiting a Sasta Bazar setup in Shiekhupura on a helicopter! (An ironical paradox that requires a separate column.)
No amounts of subsidies will be able to benefit the population of Pakistan unless their number itself is controlled. The families of the future have to break free from the shackles of wretched, meaningless existences for which work needs to start right away.
Postscript: At times, I feel that we do not want to have any heroes. There is the track record of undermining and under acknowledging Abdul Salaam, Pakistan’s Nobel Laureate, and now there is also silence in appreciating the speech delivered at the biggest world forum, the UN, by Malala Yousufzai, the 16-year-old Pakistani girl, who has become a recognised symbol for education, particularly for girls. The fact that the West savours its saviour complex too much is still separate from the acknowledgement that Malala deserves. Her poise, her delivery, her calm were all amazing for a child of 16. She made Pakistan look good - and that is what matters to me the most.
Some other young ladies who made us feel good in this last week were the first batch of female army paratroopers, who completed their training and successfully accomplished all the required milestones like parachuting down from helicopters. It is these very opportunities that we seek for all the female population of Pakistan, instead of having them married off in their teens without being equipped in any way in how to think or take care of themselves or their families. In a rapidly changing world and century, will our policymakers be up to the task required of them so urgently? I wonder.

The writer is a public relations and event management professional based in Islamabad.