A high birth rate is not making life any easier for Pakistan’s 180 million people, already affected by political instability, economic stagnation and natural disasters.
Internal pressures in the country with the world’s sixth largest population are likely to get worse before they get better: At 2.03 percent Pakistan has the highest population growth rate in South Asia, and its total fertility rate, or the number of children born per woman, is also the highest in the region, at 3.5 percent.
By 2030, the government projects that Pakistan’s population will exceed 242 million.
The failure to adequately manage demographic growth puts further pressure on the current population, who already lack widespread basic services and social development.
Pakistan’s health and education infrastructures are poorly funded, and experts have questioned the quality of what is being provided with existing budgets. With a weak economy and low growth, food insecurity and unemployment present further challenges.
“The problem is that if you have a population that is illiterate and does not have proper training, a large segment cannot participate meaningfully in the economy,” said economist Shahid Kardar, a former governor of the State Bank of Pakistan.
“[Based on Pakistan’s population trends], you need a GDP growth rate of 8 percent to employ them.” Pakistan’s GDP growth rate has not exceeded 3.7 percent in the last five years.
If population growth is not managed, experts say, it will exacerbate these negative trends as resources are stretched and improvements in service delivery fail to keep up with demand.
Low use of contraception
A further problem is the low awareness and availability of birth control.
The contraceptive prevalence rate is only 27 percent, and only 19 percent employ modern methods, according to the UN Population Fund (UNFPA).
While demand for contraception has been rising, at least a quarter of that demand remains unmet.
“The main effort is a long-term one, to ensure the availability of contraceptives. There is a rising demand for contraceptives, and there is unmet demand. Many couples want to use contraceptives but don’t know about them or can’t access them,” said Shahnaz Wazir Ali, social sector adviser to the prime minister.
“So the main priority, with an effort by the public and private sectors, has been to ensure that people know about family planning and can access contraceptives.”
Precise data on the participation of the private sector in providing contraceptives and family planning services was not available, but a senior official at Pakistan’s Ministry of Population Welfare put the public-private ratio at 70 percent to 30 percent. “The private sector is a significant player, and its help is necessary in improving population planning,” the official said, requesting anonymity as he is not authorized to speak to the media.
Lack of awareness of family planning techniques
A lack of awareness has cost Mohammed Ghafoor, a 30-year-old taxi driver in Rawalpindi. He is worried about the health of his 10-day-old daughter, and has brought her to the Holy Family Hospital for tests. The newborn daughter is the couple’s fourth child, and their eldest is only six years old.
“I drive my taxi from dawn to midnight, and with rising fuel costs, I usually take home around 200 rupees [just over US$2] every night. Now there is another mouth to feed,” Ghafoor said. “We have moved here from Sialkot and don’t have family here, so my wife can’t go to the hospital herself. I didn’t have the time to take her to the doctor.”
Ghafoor and his wife do not want more children, and their last two pregnancies were unplanned. They have sought family planning guidance, but another addition to the family has compounded their misery.
Every third pregnancy in Pakistan is unplanned, according to a 2011 Wilson Center report on the country’s population issues.
“I’ve had to pull my eldest child out of school because I can’t afford it. He cries every day, says he wants to go to school. I tell him we can either eat or he can go to school, and he says he’d rather starve,” said Ghafoor. “How do I make him understand? How do I make this right?”
Population growth increasing poverty
It is this decision ordinary families must make every day in Pakistan that perpetuates the knock-on effect of population growth in a country where economic opportunities are limited.
“There is a close association between population and poverty. All evidence points to the fact that if you look at households that are big, there is a strong chance that these households will be poor,” said Rabbi Royan, UNFPA's country representative in Pakistan.
“Parents’ resources will have to be spread out for many more children. In a smaller household, they can spend more on fewer children, so there is a better quality of health and education,” he said.
“It provides an opportunity for poverty reduction to take place, and reduce the chance of the intergenerational transmission of poverty.”
Seven million children of primary school age do not go to school, and the UN Educational, Scientific and Cultural Organization (UNESCO) says 30 percent of Pakistanis are in a state of “extreme educational poverty” - receiving less than two years of education.
The country’s health infrastructure is also struggling to cope with demand, with not enough doctors and a lack of critical facilities in many areas.
Only 45 percent of births, for example, were attended by skilled personnel, according to the UNFPA 2012 report on the state of the world’s population.
A demographic dividend?
Pakistan’s failure to adequately manage its population growth and reduce its fertility rate has meant that over the last few decades, the country has become younger.
Today, two-thirds of Pakistanis are under the age of 30, and it is one of the largest youth populations in the world. Several senior government officials have described this as a “demographic dividend”, and expressed the hope that this young population can spark growth and bring prosperity to Pakistan.
"The prerequisite for a demographic dividend is a decline in the fertility rate. With a fertility rate decline, the ratio of the dependent population to the population that is working gets smaller, so more can be invested into generating growth,” UNFPA’s Royan told IRIN.
“If I’m spending less on the education and other needs of my children, I’m saving, which accumulates into the overall saving in the country. That can help spur investment and thus economic growth."
Reaping a demographic dividend, experts say, requires significant investments in education, health and infrastructure. Without these efforts, such a population increase can have the opposite effect, with growing frustration and resentment in the segments of the population deprived of basic services and opportunities.
“There are very serious, adverse consequences of unplanned, rapid population growth. The resources of the state are limited, and already under pressure; with unplanned growth, demands will be enormous,” said prime ministerial adviser Shahnaz Wazir Ali.
“There will be economic consequences, as resources are stretched beyond realistic limits, for housing, food, education, health, jobs and all the infrastructure that goes with it. Despair and frustration among the young can lead to criminal, violent and anti-state activity.”
Risk of extremism?
The Wilson Center’s 2011 study on Pakistan’s population issues echoes this concern, highlighting the country’s failures in education and rising economic disparities as two major factors that contribute to a rise in extremist activity.
Stretched resources, increasing demand, a rising population and the instability that comes with it are forcing Pakistan into a vicious circle.
“I keep hearing this nonsense about a demographic dividend and a young population. But what have we given this young population? Have we given them a stake in the economy and society?” said economist Kardar. “They look at what’s happening around them and they get frustrated and angry.”
“Our demographic dividend is the Taliban.”