This blog is certainly not about exploding mangoes but about the exploding Pakistani populace. The recent reactions of surprise on results of the census seems bewildering. Pakistan’s population is now over 207 million with a growth rate of 2.4 percent per year since the last census in 1998. The results were predictable and expected, as Pakistan has not implemented any large-scale population related interventions for over a decade. We should not be expecting results because inaction does not usually deliver them.
Pakistan’s efforts to reduce fertility and population growth were transformed during the 1990s. The period between 1990-2006 saw effective policy making under the Social Action Program with multiple interventions e.g. expansion of public sector provision, large scale private sector participation including social marketing innovations, improving access to women through community based providers. All the right things that delivered huge results. Fertility declined from around seven to four children per woman, and contraceptives use increased from 10% to over 30% - a 300% increase. Appropriate actions delivered results and some still can be photocopied and expanded on scale for making progress.
The actions started to wane after 2006 and was followed by a decade of inaction. Public and private sector interventions stagnated, community based service delivery given a deadly blow, and with no new ideas, resources started to dry up. Results duly stagnated and the population continued to explode. Pakistan is on a dangerous trajectory with a stagnant fertility decline and contraceptive use. What is worrying, and to some degree scary that the country has the largest ever cohort of adolescent youth going into active reproductive age. Without decisive action, the population explosion is likely to continue and could easily double by 2047, when Pakistan will be 100 years old, putting enormous strain on the country’s ability to deliver basic services to its population despite economic growth.
Pakistan GDP is growing and is expected to grow further in future. The real GDP per capita (constant US$ in 2007) is projected to grow from $1,000 in 2015 to $2,283 in 2050. At the present trend of fertility decline, it’s estimated that its population will be about 345 million in 2050 (at 2.8 children per woman).
However, Pakistan could grow much faster to a per capita GDP of $3,414 in 2050 if it achieves the South Asian average fertility reduction rate, with a population of 276 million in 2050 (based on 1.84 children per woman), if appropriate actions are effectively implemented. The cost of inaction will be a forgone GDP estimated to be $2.3 trillion between 2020 and 2050, which means a loss of $76 billion per year. This will have serious economic and social implications for the people and the country.
There is greater realization that Pakistan cannot afford procrastination. There have been positive actions recently, especially at the provincial level both in Punjab, Sindh and KP focusing on girl education, maternal and child health, nutrition, procurement and supply of contraceptives, introduction of new contraceptives, targeting the poor, etc. However, these actions need to be significantly and exponentially enhanced in all provinces. The large youth bulge can be turned into a great opportunity (demographic dividend) but the dividend unfortunately, is not automatic. Policy action is needed now for rapid acceleration of fertility reduction.
Pakistan needs to position its policy and strategic narrative around “family planning plus” as a priority development agenda with an enhanced scope of interventions and innovative “out of the box” thinking. It also needs to have commensurate financing to transform and boost the reproductive market for family planning products and services. This requires sustained political leadership; scale-up evidence-based interventions using multi-sectoral approach and increased investments predominantly targeting the private sector.
Essential interventions will need to include:
- Resolving the fragmentation of reproductive health service delivery and using branding/social marketing for public sector services;
- Continue to prioritize girl’s education increasing female enrolment, retention and quality in secondary schools with economic empowerment women/youth by scaling-up skills development, entrepreneurship and financial inclusion initiatives;
- Scaling-up public financing for private sector market shaping programs including subsidizing local manufacturing of family planning products to lower prices benefiting all providers and consumers;
- Financing an intensive behavior change communications campaign besides introducing life skills education in all higher secondary schools; and
- Leveraging social protection system to target the poor.