[But instead of encouraging fresh ideas over the population crisis, the census has triggered a rash of arguments over whether certain areas have been over- or undercounted, or reclassified as urban instead of rural. These squabbles amount to fights over political and financial spoils, including the number of provincial assembly seats and the amount of funding from the central government.]
By
Pamela Constable
 |
|
Rubina
Rehman, a government family welfare worker, counsels a young mother.
Her
job includes promoting family planning and providing contraceptives to
limit
family size. (Pamela Constable/The Washington Post)
|
Preliminary results from a new national
census — the first conducted since 1998 — show that the population grew by 57
percent since then, reaching 207.7 million and making Pakistan the world’s
fifth most populous country, surpassing Brazil and ranking behind China, India,
the United States and Indonesia. The annual birthrate, while gradually
declining, is still alarmingly high. At 22 births per 1,000 people, it is on a
par with Bolivia and Haiti, and among the highest outside Africa.
“The exploding population bomb has put the
entire country’s future in jeopardy,” columnist Zahid Hussain wrote in the Dawn
newspaper recently. With 60 percent of the population under age 30, nearly a
third of Pakistanis living in poverty and only 58 percent literate, he added,
“this is a disaster in the making.”
The chief causes of the continuing surge,
according to population experts, include religious taboos, political timidity
and public ignorance, especially in rural areas. Only a third of married
Pakistani women use any form of birth control, and the only family-planning
method sanctioned by most Islamic clerics is spacing births by breast feeding
newborns for two years.
Even if the birthrate slows, some experts
estimate that Pakistan’s population could double again by midcentury, putting
catastrophic pressures on water and sanitation systems, swamping health and
education services, and leaving tens of millions of people jobless — prime
recruits for criminal networks and violent Islamist groups.
But instead of encouraging fresh ideas over
the population crisis, the census has triggered a rash of arguments over
whether certain areas have been over- or undercounted, or reclassified as urban
instead of rural. These squabbles amount to fights over political and financial
spoils, including the number of provincial assembly seats and the amount of
funding from the central government.
A few people, however, are paying close
attention to the larger picture. One is Shireen Sukhun, a district officer for
the Population Welfare Department in Punjab province. Her mission is to persuade
Pakistani families to have fewer children and offer them access to
contraceptive methods, but she is keenly aware of the obstacles.
“The fatal combination we face is poverty and
illiteracy,” Sukhun said. “It takes a long time to change people’s mindsets,
and we don’t have the luxury of leaving it to time.”
One outpost in her campaign is a tiny
bench-lined room in Dhoke Hassu, a congested working-class area of Rawalpindi.
Inside, Rubina Rehman, a family welfare worker, listens all day to women’s
problems with feverish babies, painful deliveries and other woes. Once they
feel comfortable with her, she broaches the topic of contraception.
It has not been an easy sell. All the clients
are Muslims, and most have little education. Some have been taught that God
wants them to have many children. Some have husbands who earn too little to
feed a large family but keep wanting another child. Some would like help but
are too shy to discuss a taboo topic.
“When we first opened this post, women were
frightened to come, and some people asked why we were against increasing the
ummah [Muslim masses],” Rehman said. “But we explained how the prophet taught
that you should have a gap of 24 months between each child, and that you should
consider the family’s resources when making decisions. Now we do not face such
opposition.”
On Thursday, a dozen women crowded into
Rehman’s office, some carrying infants or toddlers. Several leaned close and
whispered to her, then slipped packets of birth-control pills into their
purses. One woman named Yasina, 35, explained proudly that she had gotten an
“implant” — a hormone dose injected under the skin that prevents conception for
several years.
“I already have five children, and that is
more than enough,” she said. At first she had agreed to a tubal ligation, which
the government arranges at no cost, but her husband, a laborer, would not allow
it. “So I got the implant instead, and I didn’t tell him,” she said, bursting
into laughter as the other women smiled.
Outside, the markets and alleys of Dhoke
Hassu were teeming with a mix of Afghan refugees, migrants from rural Punjab
and government workers. Some expressed confidence that God would provide for
any children that came, but many said that it was important to balance family size
with income and that their Muslim beliefs did not conflict with such practical
needs.
“If half of our population is young, what
will happen to their lives, their jobs, their needs?” mused Rizvi Salim, 29, a
government railways employee carrying his only child, a 2-year-old girl, in his
arms. Salim said that he was raised with seven siblings but that today “things
have changed. We do believe that God will take care of us all, but we also need
to plan for our futures.”
But upwardly mobile urban communities are
more open to such perspectives than rural areas, where two-thirds of all
Pakistanis live. In village life, the influences of traditional culture and
Islamic teachings are stronger, and the reach of public media campaigns about
baby spacing is much more limited.
Attempts to open rural family welfare offices
are often met with community suspicion and political opposition, but health
officials say more mothers are asking about birth control. The remaining major
taboo, they said, is permanent contraceptive practices such as vasectomies or
tubal ligations.
In Khyber Pakhtunkhwa province, the
population nearly doubled from 17.7 million in 1998 to 30.5 million this year.
The province is home to several million Afghan refugees, numerous Islamist
militant groups and conservative religious leaders suspicious of foreign plots
to sterilize Muslims. But their views, too, are evolving.
“Islam does not contradict the idea of family
planning, but it challenges the Western concept of birth control,” said Mufti Muhammad
Israr, a religious scholar in Peshawar, the provincial capital. He said Islam
allows “natural family planning” via breast feeding but not “stopping the
reproductive system permanently. The prophet Muhammad asked believers to marry
and produce children.”
Hospital officials in Mardan, a large
district in Khyber Pakhtunkhwa, said last week that they frequently deal with
cases of child malnutrition and often see mothers with several very young
children. Although they said more married couples are seeking family-planning
services, women still have difficulty getting their husbands to cooperate.
One pregnant housewife waiting to see a
gynecologist in Mardan had a small child on her lap and a 5-year-old girl by
her side. All looked weak and malnourished.
“My husband doesn’t care about my health or
the health of our children. He can barely support us, but he wants more,” said
Zarina Bibi, 34. She said a doctor had advised her to take a break from
childbirth for several years, but she had no choice. “My husband doesn’t want
birth control.”
Correction: The headline on an earlier
version of this story incorrectly stated the rate at which Pakistan’s
population has grown.
Haq Nawaz Khan in Peshawar contributed to
this story.
Read more