Family Planning in Asia and the Pacific - International Council on ...

coord<strong>in</strong>ation between <strong>the</strong> two ma<strong>in</strong>l<strong>in</strong>e m<strong>in</strong>istries of health<strong>and</strong> population welfare, with <strong>the</strong>ir respective prov<strong>in</strong>cialdepartments that are m<strong>and</strong>ated to deliver services, orwith <strong>the</strong> overall health system <strong>and</strong> LHWs. There has alsobeen <strong>in</strong>sufficient heed <strong>and</strong> concern about <strong>the</strong> supply ofcontraceptive commodities <strong>and</strong> on <strong>the</strong> role of <strong>the</strong> privatesector through social market<strong>in</strong>g, which was expected toexp<strong>and</strong> to rural areas but rema<strong>in</strong>ed restricted to urbanareas, through organizations such as Key <strong>and</strong> GreenstarSocial Market<strong>in</strong>g.S<strong>in</strong>ce <strong>the</strong>n, <strong>the</strong>re have been spurts of activity, such as<strong>the</strong> Population Summit 2005 <strong>and</strong> <strong>the</strong> formulation of<strong>the</strong> National Population Commission <strong>in</strong> one stroke,which meant that <strong>the</strong> k<strong>in</strong>d of debate that preceded <strong>the</strong>formulation of such commissions <strong>in</strong> Indonesia <strong>and</strong> Brazildid not happen.Lack of underst<strong>and</strong><strong>in</strong>g of populationissuesWhile demographic issues are brought out periodically asa topic of deliberation when doomsday scenario forecastsare recognized, <strong>the</strong>se issues are sidel<strong>in</strong>ed when times areeconomically good or when o<strong>the</strong>r more press<strong>in</strong>g issues areat h<strong>and</strong>. Population issues are not generally understood<strong>in</strong> bureaucratic or political circles, much less amongwider sections of society. This is because at no po<strong>in</strong>t hasserious attention been devoted to study<strong>in</strong>g Pakistan’slarge population numbers, <strong>the</strong>ir distribution <strong>and</strong> <strong>the</strong>implications <strong>the</strong>y hold for <strong>the</strong> country’s development,politics <strong>and</strong> ultimate stability. In fact, <strong>the</strong> demographyof Pakistan <strong>and</strong> population policy have largely been <strong>the</strong>responsibility of only a particular m<strong>in</strong>istry <strong>and</strong> a h<strong>and</strong>fulof professionals <strong>and</strong> organizations, with virtual statedenial, apart from occasional statements from state leaderson World Population Day or o<strong>the</strong>r similar occasions. Noserious debate has taken place ei<strong>the</strong>r <strong>in</strong> <strong>the</strong> parliament, <strong>the</strong>senate or, for that matter, <strong>in</strong> any of <strong>the</strong> th<strong>in</strong>k tanks <strong>and</strong>universities, or by <strong>the</strong> media, which is quite vibrant <strong>and</strong>free <strong>and</strong> usually responsive to issues close to <strong>the</strong> public’shearts <strong>and</strong> m<strong>in</strong>ds.While politicians may f<strong>in</strong>d population issues contentious<strong>and</strong> sensitive for religious reasons or for reasons hav<strong>in</strong>gto do with national award for resources, it is curiousthat economists <strong>and</strong> planners are guilty of neglect of thisimportant parameter that is here to haunt <strong>the</strong>m now, <strong>and</strong>certa<strong>in</strong>ly will haunt <strong>the</strong>m even more a few decades down <strong>the</strong>l<strong>in</strong>e. Undoubtedly, from <strong>the</strong> Third Five-year Plan onwards<strong>the</strong>re was a mention of population growth imp<strong>in</strong>g<strong>in</strong>g onresources, but <strong>the</strong> <strong>in</strong>ter-l<strong>in</strong>kages <strong>and</strong> <strong>the</strong> reasons whyPakistan’s population cont<strong>in</strong>ued to multiply were not seenas central to development plann<strong>in</strong>g (Sathar, 2011).Even now, FP is not seen as a nationalpriority. With <strong>the</strong> 18th amendmentMoPW will be one of <strong>the</strong> first federalprogrammes to be slashed, even thoughall high population countries have anational/federal level m<strong>in</strong>istry.Director-General Technical, M<strong>in</strong>istryof Population WelfareRole of <strong>in</strong>ternational politics<strong>International</strong> population movements <strong>and</strong> politics havedef<strong>in</strong>itely affected <strong>the</strong> twists <strong>and</strong> turns of Pakistan’s policies.The World Population Conference held <strong>in</strong> Belgrade <strong>in</strong>1965 was a confirmation of <strong>the</strong> role of family plann<strong>in</strong>g,but its outcome was to be upturned by <strong>the</strong> th<strong>in</strong>k<strong>in</strong>g at <strong>the</strong>World Population Conference held <strong>in</strong> Bucharest <strong>in</strong> 1974regard<strong>in</strong>g development as <strong>the</strong> best contraceptive. Thatth<strong>in</strong>k<strong>in</strong>g stalled <strong>the</strong> focus on family plann<strong>in</strong>g programmes,only to be reversed at <strong>the</strong> <strong>International</strong> Conference onPopulation, which was held <strong>in</strong> Mexico City <strong>in</strong> 1984. Thereal l<strong>and</strong>mark was ICPD held <strong>in</strong> Cairo <strong>in</strong> 1994, when<strong>the</strong> best possible balance was sought between population<strong>and</strong> development, lay<strong>in</strong>g out all its possible dimensions.Ironically, this took <strong>the</strong> biggest toll on family plann<strong>in</strong>gprogrammes, <strong>in</strong>stead of FP penetrat<strong>in</strong>g <strong>and</strong> permeat<strong>in</strong>gto all aspects of development, rang<strong>in</strong>g from education<strong>and</strong> women’s development to environment <strong>and</strong> health tomention a few.The ma<strong>in</strong> message of <strong>the</strong> 1994 ICPD Programme ofAction was <strong>the</strong> evolution of <strong>the</strong> term reproductive health,which was a holistic concept encompass<strong>in</strong>g many aspectsof family plann<strong>in</strong>g, safe mo<strong>the</strong>rhood <strong>and</strong> gender-basedviolence etc. The diffuse <strong>and</strong> large set of programmes tobe implemented, comb<strong>in</strong>ed with <strong>the</strong> dip <strong>in</strong> United Statessupport for family plann<strong>in</strong>g, led to a dramatic reduction <strong>in</strong><strong>in</strong>ternational resources for both reproductive health <strong>and</strong>– especially – family plann<strong>in</strong>g. Fur<strong>the</strong>rmore, <strong>the</strong> AIDSepidemic caught <strong>the</strong> world’s attention, <strong>and</strong> <strong>in</strong>ternationalfund<strong>in</strong>g for HIV/AIDS <strong>in</strong>creased several-fold as a result,whereas funds for RH, especially family plann<strong>in</strong>g, dippedradically, fall<strong>in</strong>g to <strong>the</strong>ir lowest levels <strong>in</strong> <strong>the</strong> early years ofthis decade.Due to ICPD, <strong>the</strong> development agendawas broadened. Even though o<strong>the</strong>rrelevant elements, such as rights, male212