EXECUTIVE SUMMARY

COUNTRY REPORT OF PAKISTAN

FIFTH ASIAN AND PACIFIC POPULATION CONFERENCE

AT THE UNITED NATIONS CONFERENCE CENTRE, BANGKOK, 11-17 DECEMBER 2002

The sustained high fertility and rapid growth of population has made Pakistan the sixth most populous country in the world with a population of 145.5 million and will become the third most populous country by the year 2050. The declining mortality and sustained high fertility resulted in accelerated growth rates of population since the fifties. It is pertinent to recall that, Pakistan was a pioneer among developing countries in supporting family planning activities even as early as in the 1960s. All its Five Year Plans beginning with the First Five Year Plan 1955-60 to the current Ninth Five Year Plan 1998-2003 have each articulated and suggested specific strategies and measures to reduce the high population growth rate. However, the contraceptive prevalence rate remains low at less than 30 percent and total fertility rate still persists around 4.5. The growth rate of population is estimated around 2.1 percent per annum. The initial decline in fertility reduction may be attributed to increase in age at marriage and gradual social and economic change, coupled with urbanization and modernization. Exposure to the mass media has further helped in changing the perceptions, attitudes and behavior of the population, particularly those who are decision makers.

In July 2002, Pakistan’s first ever National Population Policy has approved by the cabinet. It is consistent with ICPD objectives, focused on national needs, seeks to incorporate population concerns into relevant development strategies and plans and has integrated factors amongst others, relating to family planning care, empowerment of women and improvement in service delivery. The population Policy addresses population issue centering on meeting the needs of families in the unique social and cultural setting of Pakistan. It builds around the two essentials factors, sustained political commitment and the necessity for mobilizing broad support of various stakeholders, to achieve sustained economic growth within the context of sustained development. They directly contribute to improving the welfare of individuals and the nation as a whole through reduced poverty, better health, education and enhanced living standards. On the whole, the Population Policy sets out a broad framework and provides futuristic vision to achieve the ultimate aim of reducing poverty and raising the quality of life of the common man and woman.

Pakistan ranks low in terms of gender related human development indicators when compared with countries of similar level of development. The achievement of gender equity is recognized as a cross cutting theme for all development programs in Pakistan. Although some progress has been achieved in developing women’s capacities in all sectors of development. It is generally observed that gender discrimination starts earlier in a woman’s life cycle. Females both as children and growing adults have greater incidence of malnutrition, child mortality, and lesser opportunities in access to education and employment than males. There appears to be a continuation of past trends as females get less education than men, and are discriminated by law as well as socio-cultural traditions and practices in the society such as, their marriage, political rights, or reproductive rights. Although there are positive signs of improving in mortality, school participation and work participation, resulting in narrowing of gender disparities in recent years, yet the gender dimensions of demographic and social change need to be stressed further in all policies and development plans.

In Pakistan, the level of urbanization has gradually increased. The share of large cities in total urban population has also increased. About one-third of the people in Pakistan live in urban areas, of which 50 percent are concentrated in the seven major cities, having a population of more than one million. The unplanned and rapid urban growth is usually associated with a wide range of social, economic and environmental problems, and is seen by planners and city dwellers alike as providing the context for a poor quality of life. The positive role of urbanization has often been over-shadowed by the deterioration in the physical environment and quality pf life in the urban areas caused by the widening gap between demand and supply of essential services and infrastructure. Increase in urban poverty in the 1990s can be a consequence of rising unemployment rates. With more and more people shifting out of agriculture, and the shrinking of agriculture lands due to expanding cities, a food deficiency is feared in urban areas.

The fact that more than 20,000 women in Pakistan are estimated to dies every year from pregnancy and child-related causes reinforces the importance of ensuring that all pregnant women receive adequate antenatal care during pregnancy and that deliveries take place under the supervision of trained medical personnel in a hygienic environment. In Pakistan infant mortality is still 85 per 1,000 live births and that is one of the highest in Asia. Pakistan ranks third among the world’s countries in number of infants who die of neonatal tetanus, which can be prevented by immunizing mother as part of prenatal care.

The poorer the women, the higher the fertility rate, the less frequent the use of contraceptives, and the less knowledge about contraceptive methods. Women’s use of contraception is almost three times lower in the poorest 20 percent of households than in the wealthiest 20 percent. Only 28 percent of women were using contraceptives in 2001. This represents a notable increase from 12 percent in 1990-91 but still very low compared to other neighbouring countries. The unmet need for contraceptives is one of the largest in the world. More than one-third of Pakistani women wish to space the next birth or limit the family to its current size but are not using contraceptives. The most common cited reasons, as obstacles to use contraceptives are their perceptions about husband’s disapproval, fear of side effects, and the socio-cultural religious taboos against birth control. The Population Policy proposes to address this issue and target male to convince them about the benefits of small family, their role and responsibility in birth spacing and well being of the family set up.

Although abortion is illegal in Pakistan, about 23 percent women had experience at least one or more spontaneous and 3 percent induced abortion in their life. About 42 percent women had heard about AIDS, mainly from television and radio. Less than one percent of women go for breast examination for cancer.

The concept of adolescence as a distinct period of development is still fairly new in Pakistan. Most beliefs and practices in this multi-cultural society are still premised upon the assumption that the transition from childhood to adulthood is brief and marked by the onset of marriage, particularly for girls. But the reality of in life is rapidly changes. Today's adolescents, the largest generation of 10–19-year-olds in history, are coming of age in a world that is very different from the one in which their parents grew up. They are the next generation of parents, workers and leaders. To fill these roles to the best of their ability, they need the guidance and support of their family and their community, and the attention of a government committed to their development.

Programs and policies need to protect adolescents and to promote their health, safety, and secure development, rather than continuing to leave ill equipped to manage in an adult world. As economic modernization, urbanization and mass communications change the expectations and behaviour of adolescents, adaptation to new ways will likely be inconvenient and sometimes painful. But adaptation is inevitable and inescapable.

In Pakistan, the proportion of the population aged 60 and over is estimated to increase from just under 5 percent in 2000 to 15.7 percent in 2050. At the same time the proportion aged 0-14 years is expected to decrease from 41.8 percent to 21.9 in 2015. The median age is estimated to increase from 19 years in 2003 to just around 35 years in 2050. Similarly, the dependency ratio between working age population and the population aged 64 and over will increase from 5.8 in 2000 to 14.1 percent. Though people of more than 60 years of age account for just above 5 percent and although the present priority remains population stabilization, ageing requires some attention since the above development will take place at a faster than it did in Europe.

Pakistan’s Population Welfare Program has undergone a major structural and programmatic change from a highly centralized federally funded and managed program, it stands devolved to provinces for greater ownership. From a purely service-delivery oriented its new focus is to address broad issues of population welfare. Male involvement, hither to a neglected focus is now a major initiative. Population is now considered as a cross cutting issue critical for countries development. We are now on right direction and hope to achieve our demographic goals.

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