The dilemma of family planning in Pakistan

The last time the Government of Pakistan took family planning seriously was during the period of the Third Plan in the 1960s. The dawn of democracy in the country also heralded in an era where pacifying a range of stakeholders, including those at the far right of the spectrum, became de rigueur. The government began to take a more cautious approach, culminating in the period in the 1980s when family planning was re-named ā€˜population welfareā€™ and disappeared from the priority list of the governmentā€™s service provision. 35 years after that trend began, the population growth rate is optimistically estimated at a little over two percent, but we will only know for sure when the census is tabulated by the end of this year. In any case, it is clear that Pakistanā€™s ever growing population would face ever increasing resource constraints.

Clergiesā€™ views on population planning are not uniform. In addition, limited but significant empirical work on the subject suggests that religious leaders have less influence on this account than is commonly believed. The definitive source of data on demographic indicators in the country is the Pakistan Demographic and Health Survey (PDHS), carried out by the National Institute of Population Studies (NIPS). With a sample size of 14,000 households, and outreach across Pakistan, this is a formidable data collection effort which has taken place only thrice in the last two decades.

The survey is most often referred to when fertility rates or contraceptive prevalence rates are to be quoted. But the more interesting findings relate to attitudes and perceptions. The 2013 PDHS findings show that over half of the currently married women do not want to have more children, while 19 percent would like to delay their next birth. The same pattern holds for men, with 42 percent of married men who were interviewed saying that they do not want more children. Having said this, the same survey shows that only a quarter of currently married women used a modern form of contraception. There is clearly an unmet demand here with the demand that is met, only about 40 percent is met by public health services.

The fact that married couples across different parts and income groups of the country want to restrict family size is unsurprising due to an increase in the costs of living over time. While inflation is on a downward trend for the past couple of years, as per official estimates, it has been in double digits for many years in the last decade. Rapid urbanisation means that families that previously relied on subsistence grain harvests and kitchen gardening to meet their basic food needs are increasingly having to buy food from the markets. The decline in public schooling standards and in health facilities is ensuring that even households in middle to lower income quintiles are looking to access private schooling and clinic options. Even in the remotest parts of the country, there is some sort of access to print, electronic and even social media, which are feeding aspirations like never before.

And here lies the tragedy. If Pakistanā€™s population growth was primarily the result of peopleā€™s desire for large families, it could be explained away in the short-term, as a function of free will. What is very likely happening, though, is that a sizable proportion of people are looking for reproductive health services, and are drawing a blank, at least when it comes to the public sector. If the government feels that it is not up to the task of convincing people to restrict family size, so be it. However, it should at least ensure that those in search of basic public health services are able to access them.