According to the latest Pakistan Demographic and Health Survey of 2006-07, Pakistani women continue to have an average of four children. Dr. Zulfiqar A. Bhutta, Chairman of the Department of Pediatrics and Child Health at Aga Khan University Medical center in Karachi, argues that not enough is being done to bring down the birth rate.

"One of the main causes really is ineffective family planning and population control programs over many years - as a result of which our population growth has continued more or less unabated," he says. "I think what we are facing now is a consequence of fertility rates which have remained high, contraceptive needs which have largely remained unmet. And also some of the basic determinants such as female education are the reason why we have not been able to address the scale."

Women have an average of four children each

Lack of information and infrastructure

According to a government report, people in Pakistan regard continuing contraceptive practices as a bigger threat to their health than an occasional induced abortion. Men and women are reluctant to visit government family planning clinics because of a lack of infrastructure and information.

Dr. Zeba A. Sattar, Director of the Population Council in Islamabad, says many important stakeholders are to blame for their failure to address the issue properly. "It has been neglected by two major players: one is the Ministry of Health. They have neglected services. The NGOs have also not been able to do much. And I would say it is also international neglect because there has been a neglect of family planning generally. There is now a renewed commitment on the part of all the major donors, international agencies for family planning but after eight or nine years of silence on this issue."

Sustainable plan needed

National Population Policy for this year is to reduce the fertility rate to three births per woman. The plan is to reduce by two-thirds the number of women who give birth before they reach their eighteenth birthday. But Dr. Bhutta remains sceptical that such schemes can be put into practice. "The policies may exist on paper but the population growth rate continues unabated. We are due to have a census this year, which should tell us in black and white. We haven't even had a census since 1998. So we don't even have objective data as to what has happened to the population growth in the last 12 to 13 years."

Pakistani villagers protest against a shortage of water in Hyderabad, Pakistan

Problems of population growth

Experts worry that the rapidly expanding population could exacerbate a range of problems in Pakistan. Dr. Zeba A. Sattar explains, "We will have to deal with a huge number of additional people in Pakistan, whereas already our water resources, housing and everything is really hard pressed. Above all jobs - the working age population will increase by 70 million in the next 20 years!"

It is hard to imagine how Pakistan can address its daunting development challenges from education to electricity generation, as well as solve its numerous political conflicts and militancy, if it continues to pay scant attention to the crucial issue of population growth.

Author: Jaisu Bhullar

Editor: Grahame Lucas