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Pakistan
Population Planning Policies and Problems
Pakistan's extremely high rate of population growth is caused
by a falling death rate combined with a continuing high birth
rate. In 1950 the mortality rate was twenty-seven per 1,000 population;
by 1990 the rate had dropped to twelve (estimated) per 1,000.
Yet throughout this period, the birth rate was fortyfour per 1,000
population. On average, in 1990 each family had 6.2 children,
and only 11 percent of couples were regularly practicing contraception.
In 1952 the Family Planning Association of Pakistan, an NGO,
initiated efforts to contain population growth. Three years later,
the government began to fund the association and noted the need
to reduce population growth in its First Five-Year Plan (1955-60).
The government soon combined its population planning efforts in
hospitals and clinics into a single program. Thus population planning
was a dual effort led by the Family Planning Association and the
public sector.
In the mid-1960s, the Ministry of Health initiated a program
in which intrauterine devices (IUDs) were promoted. Payments were
offered to hospitals and clinics as incentives, and midwives were
trained to treat patients. The government was able to attract
funding from many international donors, but the program lost support
because the targets were overly ambitious and because doctors
and clinics allegedly overreported their services to claim incentive
payments.
The population planning program was suspended and substantively
reorganized after the fall of Mohammad Ayub Khan's government
in 1969. In late December 1971, the population was estimated at
65.2 million. In an attempt to control the population problem,
the government introduced several new programs. First, the Continuous
Motivation System Programme, which employed young urban women
to visit rural areas, was initiated. In 1975 the Inundation Programme
was added. Based on the premise that greater availability would
increase use, shopkeepers throughout the country stocked birth
control pills and condoms. Both programs failed, however. The
unmarried urban women had little understanding of the lives of
the rural women they were to motivate, and shopkeepers kept the
contraceptives out of sight because it was considered mannerless
to display them in an obvious way.
Following Zia ul-Haq's coup d'état in 1977, government population
planning efforts were almost halted. In 1980 the Population Division,
formerly under the direction of a minister of state, was renamed
the Population Welfare Division and transferred to the Ministry
of Planning and Economic Development. This agency was charged
with the delivery of both family planning services and maternal
and child health care. This reorganized structure corresponded
with the new population planning strategy, which was based on
a multifaceted community-based "cafeteria" approach, in cooperation
with Family Welfare Centres (essentially clinics) and Reproductive
Health Centres (mostly engaged in sterilizations). Community participation
had finally became a cornerstone of the government's policy, and
it was hoped that contraceptive use would rise dramatically. The
population by 1980 had exceeded 84 million.
In preparing the Sixth Five-Year Plan (1983-88), the government
projected a national population of 147 million in the year 2000
if the growth rate were to be a constant at 2.8 percent per year,
and of 134 million if the rate were to decline to the desired
2.1 percent per year by then. By the Seventh Five-Year Plan (1988-93)
period, the multipronged approach initiated in the 1980s had increased
international donor assistance and had begun to enlist local NGOs.
Efforts to improve maternal and child health were coupled with
education campaigns. Because of local mores concerning modesty,
the government avoided explicit reference to contraceptive devices
and instead focused its public education efforts on encouraging
couples to limit their family size to two children.
The key to controlling population growth, according to activists
in the women's movement, lies in raising the socioeconomic status
of women. Until a woman's status is determined by something other
than her reproductive capabilities, and especially by the number
of sons she bears, severe impediments to lowering population growth
rates will persist.
Data as of April 1994
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