Overcrowded and underprepared: Pakistan’s crisis

Population growth can be a double-edged sword: it can either provide a growing labor force that drives economic growth or become a ticking bomb waiting to implode.

As the population rises, so does the demand for goods and services—especially for necessities like food, water, energy, and public services such as health and education, creating a need for increased business activity to meet increasing demand.

Business activities, in turn, generate labor demand, which is fulfilled by an expanding workforce from within the same population that initiated the cycle. This creates a mutually beneficial cycle that circulates wealth in the economy: money flows from population to industry when goods are consumed and returns to population in the form of wages for the labor supplied.

As the economy grows, the role of government regulation and public policy becomes increasingly crucial for this process to work smoothly.

Population growth must remain within levels sustainable by economic development.

In the absence of comprehensive long-term planning, as is the case in Pakistan, population growth creates a strain on resources that a low-performing economy cannot support, ultimately leading to socio-economic deterioration. If Pakistan continues to grow at its current rate, its ability to sustain its people will diminish, plunging the nation further into poverty, inequality, and social chaos (Figure 1).

Figure 1.Pakistan’s population is projected to double by 2050 if the current growth trend prevails.

The latest population census of Pakistan reports an average annual growth rate of 2.55% from 2017 to 2023, three times the global rate of 0.88%. In contrast, other South Asian countries have reduced their growth rates to align with the middle-income average of 0.8%. Pakistan nearly achieved this milestone as well, lowering its growth rate from 3.1% in 2000 to 1.2% in 2016.

However, since then, the trend has reversed, moving closer to the average of low-income countries (Figure 2). The population growth rate has consistently climbed in the years following 2016, raising the question: What happened post-2016 that unraveled decades of progress?

Figure 2. From 3.1% in 2000, Pakistan’s population growth was reigned in to 1.2% in 2016 but has been on the rise ever since.

Frequent political, economic, and social turmoil has shifted national focus away from human development to survival.

In the hallways of policymaking, population is then a forgotten agenda. To date, there has been no national population policy that streamlines and guides efforts towards realization of Pakistan’s international commitments, including universal access to family planning services, addressing information needs, ensuring contraceptive commodity security, and mobilizing funds for family planning and reproductive health activities.

Statements expressing concern are made every now and then by government officials, but these remain futile without policy prioritisation of population planning.

To put the gross neglect in perspective, the government spent $38.6 million on contraceptive procurement1 from 2014 to 2019 – an average of $7.72 million per year. In comparison, USAID invested about $18 million annually from 2010 to 2016 in contraceptive provision under the USAID|DELIVER Project.

After the USAID project ended, subsequent governments failed to maintain stock availability uniformly, diverting two-thirds of the funds planned for contraceptive procurement elsewhere (Figure 3).

This highlights the underlying problem in population planning: most progress made is contingent upon donor efforts, as the government appears to waive the cause in favor of other purposes.

Funds in this country tend to flow towards projects with the highest political returns, and population planning simply does not make the cut.

The provinces of KPK and Balochistan that exhibit higher population growth2 rates than the rest of the country spent the least in this regard, despite having greater reliance3 on public sector provision of reproductive health services.

Both supply and demand side problems are at play here: low prioritization of family planning by the government leaves the provinces with higher unmet need for contraceptives (21% in KPK and 22% in Balochistan, compared to 16% in Punjab and 18% in Sindh as of 2018), while cultural norms and remoteness of areas limit access to facilities.

Desired fertility (the number of children an individual or couple wants) remains high; UNFPA4 finds that most couples initiate family planning after the third or fourth child.

Demand creation for reproductive health services remains a significant challenge as social norms and geographical isolation create hurdles for service delivery teams, particularly those engaged in door-to-door outreach. This calls for robust public awareness and accessibility programmes that encourage and facilitate the use of family planning services.

Figure 3. Funds spent on contraceptive procurement are significantly lower than the allocated budget, especially in Balochistan and KPK.

Low prioritisation of population planning is one issue, but another significant challenge is the inefficiency stemming from its poor integration into the broader economic development strategy.

Population growth is tied to human development, particularly to gender equity and rights. Women who are educated, independent, and have the freedom to make decisions regarding reproduction have lower fertility rates and improved health.

Investment in empowerment and autonomy of women through creation of education, employment, and participation opportunities is imperative for the success of population programmes5.

Public investment in human development avenues remains dismal in Pakistan, and socio-economic factors further limit women’s ability to benefit6 from even these limited opportunities. Education and health expenditure are significantly below regional averages7.

Female literacy stands at 49%, only 27% of women aged 15-49 years are using any family planning method, and only 25% of women participate in the labor force.

Due to lack of employment opportunities, mobility restrictions, workplace insecurity, and a conventional view of gender roles, educated women display lower economic participation – only 25% of women with degrees are working8.

The impact of low public spending is exacerbated by the glaring gender disparity among beneficiaries, resulting in subpar performance on development fronts.

A quick look at human development indicators shows that Pakistan is lagging in education, gender rights, and family planning compared to its regional neighbors.

Countries like India and Bangladesh have much higher use of modern contraceptive methods, greater autonomy for women to exercise their reproductive and health rights, and better enrollment rates at all educational levels (Figure 4). It is no surprise, then, that Pakistan’s fertility rate is significantly higher than both India’s and Bangladesh’s (Figure 5).

Figure 4. Pakistan consistently lags India and Bangladesh in key drivers of population growth.

Figure 5. Despite an overall decline, Pakistan’s fertility rate remains ~1.5 times that of comparator countries.

Bangladesh is hailed as an exemplary model of population control, owing to its gender and social transformation. It augmented its family planning program with gender-focused initiatives9 that improved literacy among girls, enhanced access to contraceptives, and dispelled traditionally held reservations regarding family planning.

India, too, brought its fertility rate below the middle-income average through a framework focused on healthcare services and meeting needs, such as the unmet need for contraceptives.

It is important to note that Bangladesh and India did not achieve these results solely on the back of higher spending. In fact, their expenditure proportions are quite similar to Pakistan’s10.

The key difference lies in the integration of human development efforts—particularly gender equity—with population planning, coupled with a visible commitment to both causes. These two are not the only lesson in successful population planning despite having limited resources; Thailand, Rwanda, and Costa Rica also share tales of success11 with three things in common: investment in education and health, increased access to contraceptives, and women’s empowerment.

The question remains: What triggered the change post-2016, and why have policymakers and subject experts not addressed this alarming trend in Pakistan’s population growth trajectory? If a shift of this proportion is overlooked, all plans of economic development today will become unviable within a few years.

1. Landscape Analysis Of Contraceptive Commodity Security In Pakistan, UNFPA (2020)

2. Population Census 2023, Pakistan Bureau of Statistics

3. Pakistan Population Situation Analysis 2020 (UNFPA)

4. Pakistan Population Situation Analysis 2020(UNFPA)

5. Issue 7: Women Empowerment (UNFPA)

6. National Report On The Status Of Women In Pakistan, 2023 (NCSW & UN Women)

7. Economic Survey of Pakistan 2023-24

8. Policy Brief on Female Labor Force Participation in Pakistan (Asian Development Bank, 2016)

9. Gender and Social Transformation in Bangladesh, World Bank (2008)

10. Social spending in South Asia—an overview of government expenditure on health, education and social assistance (UNICEF, 2020)

11. Population policies that work (Population Matters, 2023)

Copyright Business Recorder, 2024