Monday, March 29, 2010

Planning a Healthy Tomorrow

Healthy individuals make for a healthy society capable of contributing to progress and stability in the country. Population planning is central to all development plans focusing on health or economic concerns and aiming to improve the quality of life in general,


Over the last two decades, population planning has become an increasingly vital concern for many developing countries of the world. The Mexico City Declaration defines the importance of population planning as a part of human development with the words:

"The principal aim of social, economic and human development, of which population goals and policies are integral parts, is to improve the standards of living and quality of life of the people. This declaration constitutes a solemn undertaking by the nations and international organizations gathered in Mexico City . . . to promote social and economic development, human rights and individual freedom."i

For the Government of Pakistan the development goals targeting health as a primary concern also rest on population planning strategies for their achievement. Unfortunately, the outdated concept of normative ‘values’ prevalent in the society in general has slowed down their accomplishment. For the most part men as decision-makers have resisted acceptance of guidelines regarding population planning and welfare adopted by the government in agreement with UN bodies. They are sceptical about these policies because they view them as an attempt to replace the Eastern concept of family and social harmony with their perception of the western lifestyle as rapidly disintegrating family models. Contrarily, all developed and many developing nations are reaping the benefits of timely and effective implementation of the same policies.

A clear example of rejection for anything connected to the ‘West’ is the recent opposition to the government’s polio eradication drive which met stiff resistance and had to be abandoned temporarily in the tribal areas because it was being perceived as clandestine administration of population control medicines in the guise of vaccination against Poliomyelitis. It also resulted in the murder of a doctor in Bajaur for advocating the cause of polio eradication and administering the drops to small children, while one cleric went as far as to declare that death by an epidemic elevated one’s status to that of a martyr. Small wonder then, that Pakistan remains one of only four countries in the world - India, Afghanistan and Nigeria being the other three - where polio still afflicts a significant number of children and overshadows their prospects of a healthy, productive future.

It is generally accepted by development planners and practitioners that population planning is a human development issue that has a direct bearing on socioeconomic welfare and human rights. Unfortunately, the basic understanding of the general population of Pakistan regarding the same is deficient. Pakistan is the sixth most populous nation on earth, home to an alarming number of 158 million. Roughly, 40% of these live below the UN recognized poverty line and almost half the population is below 18 years of age; 78.2 million have no access to sanitation and 56.9 million have no access to safe drinking water; add to this the high fertility rate of 5.4 births per woman and it presents a bleak picture for the future of the country.

The effectiveness of any future planning regarding employment opportunities, housing, and provision of education, sufficient food and safe drinking water is compromised by disproportionate population growth. According to the 1998 census, the number of housing units in demand is 21.92 million based on recommended occupancy ratio of 6, and a backlog of 2.22 million. At present, 57.9 million live in houses consisting of a single room.

The annual GDP growth rate, cited often by the government sources as a positive indicator of development, touches an impressive 6.6% but this rate is largely restricted to the already economically advantaged section of the country and there is no trickle down effect of the resources enjoyed by the elitist minority.

For them to be truly effective all population-planning policies are required to establish safeguard measures to protect basic human rights, and modified to suit the prevailing cultural and religious concerns; otherwise some sections of societies feel threatened by population control programmes and may reject them altogether. The Pakistan government’s family planning programmes that have been coming under fire of the religious clergy are now being even more vigorously opposed by them since the government has become more active in promoting its policies in the recent years.

It is no secret that in Pakistan women’s status fares poorly on many important indicators of development. Though many development policies of the government have focused on women, due to cultural limitations the results have not been satisfactory. Pakistan has a poor track record of upholding human rights in general and of women’s rights, in particular. While cultural harmony and some of its related aspects are traditionally considered to rest on a woman’s shoulders, most of the time she does not have the right to choose her family size or timing. The effectiveness of any development plan in her favour is diluted by selfishness or ignorance of men in the family, and outside. The everyday media reporting of heinous crimes committed against the female sex are indicative of a deeper conflict rooted in widespread gender bias present in the collective mindset of the society. The overworked and poorly-coordinated judicial and social support system has worsened her plight and exposed her to further humiliation and prejudice.

The health support systems currently in place for the female population are deficient, and maternal mortality is high. This is due to non-availability of essential basic obstetric care to these women. Every year a significant number of women die in Pakistan, as in the rest of under-developed world, from complications of pregnancy and from illegal abortions performed under horrifying conditions of hygiene and professional negligence.

According to estimates by WHO, UNICEF and UNFPA for the years 1990, 1995 and 2000, an alarming half a million women around the world lost their lives to complications arising from pregnancy and childbirth, with 40% occurring in Asia; about 10.5 million women experienced unsafe abortions which may have caused them serious harm or endangered their lives in the process. Also, some 68,000 women die from complications of unsafe abortion each year – almost all in developing countries: 34,000 of these only in Asia. In the year 2000, of the estimated 529,000 women who died of maternal causes worldwide, 95% occurred in the developing countries while less than 1% in the developed countries. WHO sources rightly assert that this huge regional difference clearly establishes that most of these deaths were preventable

The Pakistan government is trying to work with UN Agencies in this regard to safeguard the rights of women and bring maternal mortality down. According to the Ministry of Health, due to the diligent efforts of an efficient network of 96,000 LHWs (Lady Health Workers) working under the governmental National Programme for Family Planning and Primary Healthcare, the infant mortality has been brought down from 105/1000 births in 1994 to 77.1/1000 births in 2006, targeting to reduce it to 55/1000 births by 2008. Similarly, maternal mortality has been reduced to 340/100,000 in 2006 from 500/100,000 deaths in 1994 and now aiming to bring it down to 180/100,000 deaths.

These LHWs, who are now reaching out to 70% of the female population compared to 30% at the inception of the programme in 1999, have often felt threatened and at times been actively stopped from approaching women in the villages, especially in the conservative North West Frontier Province where religious sentiment clashes with population planning concerns. The government is working to provide them job security and creating awareness through mass media to gain acceptability for them in the conservative circles.

In the ultimate analysis, however, while government and the world agencies may promote population control as a solution to many of the problems afflicting the country, population programmes can only work when incorporated with other development strategies, as observed in China, Singapore and Sri Lanka. When applied in isolation, the achievement of population targets is adversely affected in the developing and underdeveloped world by factors including misconceptions about religious beliefs and status of women, threats of high infant mortality and economic pressures. These concerns dissuade people from choosing smaller families and giving preference to wider national interest over their own and ultimately result in the failure of population planning strategies.

i Mexico City Declaration on Population and Development, paragraph 5; International Conference on Population, Mexico City, August 1984

Published: SouthAsia Magazine, Planning for a Healthy Tomorrow June, 07.

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