Population Matters

Pakistan’s Untold Story

January 14th, 2010

Zubeida Mustafa, a Pakistani journalist who recently retired from Dawn, her nation’s most widely circulated English language daily newspaper, wrote a column last month on Pakistan’s declining population growth rate.  A two-time winner of the Population Institute’s Global Media Award, she reveals that an increase in unsafe abortions, not contraceptives, is behind much of the decline.

The question that has intrigued demographers is how Pakistan’s population growth rate has been falling when contraceptive prevalence has not increased proportionally. The NCMNH and Guttmacher fact sheet answers this question succinctly. ‘The disconnect between low contraceptive use and a relatively small average family size suggests that women are relying on abortion as a method of controlling their fertility.’ Unsurprisingly, the more backward a province the lower its contraceptive use and the higher the abortion rate.

She reports that the problem in Pakistan, as in many developing countries, is not just the unavailability of contraceptives or family planning services, it’s also the low status of women.

As is generally the case in issues related to reproductive health, the problem is rooted in the poor status of women in our society. This time one cannot even blame the law, the prevailing myths notwithstanding. The abortion law as amended in 1990 to better conform to Islamic teachings is quite liberal. In fact, no one has been known to have been prosecuted under this law.

The problem lies in the policy that denies many women easy access to contraceptive cover. Strangely, men have been absolved of all responsibility in family planning matters. As a result the onus of finding a solution rests on women, and their stories are heart rending. At the NCMNH meeting Dr Saadiah Pal presented a number of case studies of women who opted for abortion, some of them dying in the process. But could they be blamed? One who was pregnant for the 12th time was the sole breadwinner of the family and her husband was a drug addict. Another had eight children and was a beggar. And the stories went on.

But as Mustafa points out, the problem is not just cultural, it’s also a failure of political will.  In a country where there are still large pockets of extreme poverty and high rates of maternal death, the government and donor nations are simply not doing enough to enable women to avoid unwanted or unintended pregnancies.

These are the stories the population welfare department should be listening to. The gynecologists and obstetricians are familiar with them as they have to bear the brunt of abortions that go wrong. They know what is needed and this was reiterated at the meeting mentioned above. Their recommendation to show the way forward was, ‘Prevent unintended pregnancy to reduce abortions. Ensure availability of quality family planning services. Increase health and population budget to six per cent of GDP.’

These words sum up in a nutshell what is missing in our population programme that is not making any headway. There is a total absence of political will especially at the highest level and an utter failure to comprehend how basic a slowdown of population growth rate is to the success of our economic development.

Sadly, Pakistan’s untold story is also the untold story of many other developing nations, including neighboring Afghanistan, where women on average still bear six children and maternal and infant mortality rates are among the highest in the world.  Last week, Secretary Clinton gave a major address at the State Department in which she vowed to make the health and wellbeing of women, including access to family planning, a major focus point of U.S. foreign policy and foreign assistance.  Pakistan and Afghanistan would be good places to start.

"A woman listens to a midwife talk about contraceptives while giving her advice on the prevention of unwanted births at a clinic in Pakistan. Since abortion is severely stigmatised in our society women are reluctant to talk about this issue. Most of them do not seek professional help." – Photo by AP.

Posted by Robert J. Walker, Executive Vice President

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