Pakistan's Increasing Population.

A report has confirmed that Pakistan's population is rapidly growing. Based on current trends Pakistan's population will double in size every 20 years, An alarming prospect for a country struggling with a stagnating economy and the effects of climate change. 

The reason behind this increase in population is Pakistan's fertility rate which at 3.5 is far ahead of other countries in the region.

Fertility rate refers to roughly the average number of children born per woman. Yet talking about fertility rates and family planning in the context of overpopulation isn't necessarily helpful the movement for family planning has essentially been linked to this idea around population control.

Now the government of Pakistan has been always opposed to this ideation and similarly those of us who are working in the field of public health also take this view where family planning is an empowerment process.

It's a process which individuals have to understand and adopt and choose for improving their lot in life, And it's not something that can be or should be imposed by the state. It is often assumed that Pakistan's high fertility rate stems from people simply choosing to have more children for a variety of religious and cultural reasons but that's not quite the case.

The idea that people want large families that's a myth and misconception.

The DHS (Demographic and health survey for Pakistan) from 2018 very clearly shows that couples who have one child immediately post birth of their first child they at least over 40  to 45 percent don't want to have a child within the next two years.

As the number of children increases this proportion keeps dropping. That doesn't mean that taboos around reproductive health don't exist in Pakistan but younger people have a low understanding of what family planning means. 

It's not a part of their larger cultural discourse, In fact it is considered taboo and frowned upon to talk about at the household level or at the family level, And because of these impediments a lot of these young people don't even get a facility when they get there. 

Women service providers and doctors are often very biased because they are representatives of this culture. They will often deny the service that "You are too young to delay births right now."  That also happens in part research has shown.

However the biggest challenge to better family planning in Pakistan is simply a lack of resources.

Pakistan currently spends less than one percent of its GDP on healthcare lower than most countries in South Asia, resulting in less accessible and poorer quality healthcare for its people as a result Pakistan has nearly doubled the rates of infant mortality and under five mortality than it's surrounding countries.

Both key aspects of family planning services despite these obstacles pakistan has still made some progress, The government of Sindh couple of years ago declared family planning and reproductive health as essential services. Other provinces too have increased their investment in improving quality of care.

Mobilizing lady health workers and training community-based midwives.

Because of this the use of contraceptives in Pakistan has slowly inched upwards, Driven mainly by increased use of long-term contraceptive methods.  Despite that Pakistan lags far behinde other comparable countries in this metric, While socio-economic divides and the use of contraception remains stark throughout the region.

If pakistan is to make a step up in this regard, It not only needs to invest more resources but also fundamentally change its discourse surrounding the concept of family planning. 

There continues to be a gap in terms of how people see family planning. They think of it as stopping children which is absolutely not what family planning is about.

Family planning is about planning when to have a child and what responsibilities do we need to fulfill towards the child.

So People who are families who come from privileged backgrounds who haveb ability to pay for services and where women have access to education, As up to 10 years of education family planning becomes near universal in these households.

Which indicates that when women have access to finances and education family planning gets taken out.

This discourse needs to change that family planning is a health issue it's a social development issue.