The political economy of family planning

Pakistan stands as the first country in the world, where the comprehensive family planning program was launched in the 60s. Pakistan has the highest population growth rate in South Asia. Surprisingly, soon after the results of the belated 2017 census, the realisation was that we had surpassed Brazil in standing the fifth most populous country of the world. Yet, there is a plethora of five-year plans and policies; revealing unsatisfactory outcomes. While the crowd is growing day-by-day, it is imperative to look at the political-economic dynamics of the family planning programs, which might be able to show us why we lag in tackling our population growth.

Firstly, over the years, there has been inconsistent political support for family planning. Unfortunately, it has been episodic. For instance, General Ayub’s regime supported the family planning programs, which resulted in the first-ever most comprehensive plan (Five-year Plan of 1960-65) to tackle the high population growth rate. However, the plan was badly politicised by the right-wing religious and left-wing people’s party to overthrow the regime. Subsequently, when Bhutto came into power, there had been insignificant support for family planning because Bhutto didn’t want the same slogan to be raised against his government. Zia’s regime (1977-1988) has been considered “lost years” for family planning programs because of his adherence to Islamisation. He opposed family planning programs at first but started it insignificantly. Benazir Bhutto’s (1993-1996) government revitalised the program and some important progress had been made. The contraceptive prevalence rate raised from 12 per cent to 28 per cent with a 137 per cent increase.

Fortunately, the present government is giving much more importance to family planning programs and overall population issues, resulting from less emphasis on human development. The program Ehaas and the new policy development for the population with the collaboration of Supreme Court are both ambitious in commitments and hopefully, there is a lot to be seen yet. Although the current contraceptive prevalence rate is 25 per cent, the situation is still alarming. Special Assistant of Prime Minister on Health revealed a shocking fact. He said that there were still 3.1 million unintended pregnancies in the last year-and-half since their population didn’t use modern contraceptives.

The UNFPA 2019 report on the political economy of the population in Pakistan revealed that inadequate institutional arrangement to access contraception was among many impediments in the way to control the population growth. The report revealed much more gaps in this regard.

The critical role of LHWs (Lady Health Workers) faced multiple issues such as low salaries, no clear distinction of their responsibilities and training. However, studies have shown that LHWs cover 50 to 70 per cent of areas in provinces to access FP services. The areas where LHWs do their work have higher contraceptive prevalence, contrary to those areas where the LHWs don’t serve.

Apart from that, the private sector, which comprised of NGO facilities, pharmacies, hospital clinics and dispensaries have not been utilised. In urban areas, mostly the private pharmacies and shops are major sources of contraceptives, while in rural areas, mostly, the main sources are the LHWs, public hospitals and local shops. More importantly, the less technical bureaucrats, having no knowledge and expertise with unstoppable shifts in the political arena, are the main weaknesses of the FP.

Thirdly, less attention to socio-cultural barriers, inequitable gender norms are real hindrances for effective family planning programs. Women empowerment is closely linked to human development indicators (health, wellbeing, gender equity, women education and employment). In this context of human development, the index of Pakistan stands 150th among 189 countries, where we lag behind some south Asian countries as well. Low financial support from the federal and provincial governments is one of its major causes. Pakistan is spending hardly 0.9 per cent of the GDP in this regard.

Women’s education and their empowerment are due to the situation in pre-post-neonatal timings and spacing. Other than that, there are huge misconceptions and fears among people about the contraceptive methods and its dangers such as their wives would face sterilisation. That’s why they mostly prefer the most traditional methods such as withdrawal and condoms. These are the main methods among the three most important methods of contraception. The need for more resources, low educational goals are also the reasons behind the failed state of affairs of the FP programs.

If women are less empowered and little educated, they will probably take little part in the decision-making about having children. Less empowerment leads directly to less control on fertility, which is a quagmire to other issues. For instance, delay in lowering the fertility rate results in the requirement of more infrastructure and services to serve a large population. Secondly, the growth of population in schools makes it difficult to achieve educational goals. Lastly, the less favourable age structure of economic development leads the situation to less potential of demographic dividend.

Last, but not the least, is the question of religion. Pakistani society is inherently religious, where every problem has been dealt with ideological explanations. People are bewildered whether population control could be good or bad from a religious point of view. Most people consider it anti-religion, that is why there is a negligible impact of family planning programs and its outcomes. Religious question and the stacks of youth are very important in the area of FP. Youth (which is 64 per cent below the age of 30) has a positive attitude towards the FP program and its implementations. Therefore, Imran Khan became the Prime Minister, mostly due to the support of youngsters, as they could see him potent enough to bring every contradictory issue on the front line and solve it without taking any conservative belief into account.

It is an important area to be taken into consideration if one is willing and serious to tackle the curb of population explosion. It is high time we first look into the things, which could be helpful if get bettered. The first is power. We see the power in Pakistan in the form of politics. The political will of the incumbent will be crucial to enhance the effectiveness of family planning. Other than that, awareness programs are indispensable to be launched with one national narrative for tackling population explosion. These awareness programs were launched in the 1960s but were of no use. It means that there should be a national narrative. Religious leaders can play their role by seeing the matter rationally and instructing the masses concerning the better well being of the people.