IRIN Interview with UNFPA representative

Dr Olivier Brasseur, country representative of the United Nations Population Fund (UNFPA) in Pakistan, told IRIN that Pakistan faced immense challenges ahead, but he nevertheless remained optimistic for its future. Faced with a doubling of its population in the next 25 years, increased poverty, urbanisation and declining resources, Brasseur called for a more visionary approach to be taken by government, NGOs and UN agencies alike. Education, which is absolutely vital for Pakistan, would be key to this initiative. QUESTION: Experts estimate that Pakistan’s population will double in the next 25 years to almost 280 million. Why has this phenomenon emerged? ANSWER: This is not an emerging problem, but the result of a very long trend. It’s a multifactored, multifaceted situation. One is cultural. This is a Muslim country. One is a lack of education, particularly among girls. One is the low status of women. Also Pakistan has gone through a difficult history. It’s a mix of many different factors, which is why it is so difficult to curb the population and growth rate. Q: What implications does this have? A: Between the last two censuses, the population growth was 2.6 percent and I rely on that indicator. Two point six in Pakistan means that you have an additional intake of 3.2 million people a year. This means if Pakistan wants to accommodate these people, each year they will have to create a large town like Multan [A western Pakistani city with a population of three million inhabitants]. This should give you just an idea. When you speak about the impact, you must consider that there is already 25 percent unemployment, a shortage of water, and a shortage of agricultural land. This will undoubtedly lead to a problem of wild, unorganised urbanisation. These are the three areas most affected. What can be foreseen is increased poverty, increased marginalisation amongst people and, in the long-term, social disruption. This is the risk and it’s very serious. The population is continuing to grow, but the available resources are not. Q: Is this current growth unavoidable? Are there steps the government and partner organisations could take to reduce the growth rate? A: UNFPA and the government of Pakistan have been dealing with population issues for the last 30 years. The fertility rate and the population growth rate is stalling at this stage. In other words, there is a slight decrease. Why? It’s probably the effect of family planning information. Nonetheless, there is still a long way to go. The current trend shows that there is no belief that you can actually decrease the population. What needs to be done in Pakistan now is increase awareness among community leaders about the issue of population growth and its impact. Specifically, we need to improve education among young girls. In other words, improve the information of youth and adolescents about reproductive, as well as sexual health. This might be difficult to implement at this stage due to the specific circumstances of Pakistan, but we need to start informing youth about their rights - to chose and to space the number of children they want to have, as well as the positive impact of these rights on family health and maternal mortality ratios. Q: Does the current government recognise what will happen if the situation is left unchecked? Does it have a strategy for stabilising the population? A: In 1999, chief executive and current president [Pervez Musharraf], set up the target of 1.9 population growth for the year 2003. This will prove a major undertaking to bring it down from 2.6 to 1.9, but it’s one of the priorities of the government. However, we have to be aware that there is an additional effort to expand the scope of traditional family planning programmes to reproductive health, as coined by the International Conference on Population Development held in 1994. That means we need to have a multi-sectoral approach, involving the Ministry of Health, Ministry of Population, Ministry of Industries and [the Ministry of] Local Government - And of course [the Ministry of] Education. Moreover, with the devolution process under way by 15 August this year, we need to decentralise the activities. In short, there is a lot of work to do. Q: Is there something specific you would recommend the government [to] do? A: Education, information and access to reproductive health services need to be improved. Q: What is UNFPA’s main goal and objective in its role in Pakistan? A: Our major goal is to improve the health status of women, and in doing that, improving the health status of families. When I say improving the health status of women, women in Pakistan have too many pregnancies, too soon and too close together. This produces many complications for further pregnancies: anemia, all kinds of complications you can have during or after pregnancies. This is our priority. The way to reach it is to adopt a multi-sectoral strategy, targeting people that are important in these situations, and that means youth. Youth account for 52 percent of the population of Pakistan, depending on what age rate you use. In short, we have an immense amount of youth, and we need to inform them. Q: In carrying out this role, what has been your agency’s biggest challenge? A: The biggest challenge, I would say, is to bring the bureacracy of Pakistan to a vision... We need to elaborate together a strategy based on the next 10 years at least. We all know where we have to go. From that, we can unfold the threats to the goal we really want to have. Of course, there is a mechanical process. The people that were born yesterday are there, and will of course produce children. It’s like a boat stopping its engines, and the boat continues on for another three miles or so. The population phenomenon is like a tanker in the channel. So that, too, is a constraint. Q: What is the most important thing in Pakistan in facing such challenges? A: Education, education, education - particularly education among women. Q: In your view, what is your agency’s most significant achievement? A: That’s a good question... One big achievement of UNFPA in Pakistan was being able to have a long-term relationship with the government and civil society - to start the ball rolling and keeping the population agenda afloat for the last 20 years, despite all political episodes that may have occurred in the country. The next challenge for us is to build a vision for the next 10 years. As I said, things have changed. The population dynamics are changing. As I alluded to earlier, we will have this urbanisation phenomenon and will have to change our strategies to assure a more effective population control. This is what we have to do for Pakistan... I really believe that we, UNFPA, the government, NGOs and the private sector can achieve something. It is absolutely vital for Pakistan. Q: Despite being limited to urban centres, social marketing initiatives have proven to be highly effective in raising awareness of contraception and reproductive health in Pakistan. Will the work of these activities slow down the birth rate in the next two decades? Should these initiatives be extended to rural areas? A: Social marketing is already there. It may not be Pakistan-wide, as the country is quite big, but it’s already there in rural areas. I am a fan of social marketing. It’s very useful, and I think should be a mandatory complement to activities made by NGOs and government. There are things that you can do in social marketing that you cannot do when you are sitting in government; for instance, information for advertisements of products for the prevention of HIV AIDS. If you are a government agency, you cannot do that, as it doesn’t have the same dynamics. This is why in a recent meeting I had with government officials that we decided we would support social marketing as part of a national plan on reproductive health. Q: Is there some way it could be extended in the rural areas? A: It has to be expanded, because the social marketing schemes are predominately in the urban areas. I hope we can expand it - expand, as Pakistan is a big country. You have to build a network for your sales, advertisements. It’s not an easy operation. Social marketing is not completely self-funded, but I do hope we can expand this. Q: Most of the country is aware of contraception, but there is still a great un-met need of people who cannot access contraception for reasons of cost, tradition, family pressure, or lack of the spouse’s cooperation. What is UNFPA doing to address this problem? A: This is exactly what I was trying to convey earlier. First of all, we have to assure the availability of contraception and, with the government, we are trying to provide contraceptives from our own funds. What we are also trying to do with the government is to promote local production of contraceptives. One of the social marketing schemes has already organised the production of all contraception pills, and we need to expand the range of products, but also the capacity of production. That said, we have to make sure it is competitive on the international market. It doesn’t make sense to spend US $1 even in Pakistan if we could spend 30 US cents on the worldwide market making contraceptives available and accessible. Accessible means we need services and services are entrusted with people. There is a lot of training and capacity building to do in the government level, from district to federal level. Then, of course, you have the cultural, social and other factors. This is where we need a strong advocacy programme. We have to mobilise the decision makers, inform the users, and make sure we can overcome any psychological resistance to contraceptives. This is very important. Q: In light of World Population Day, what is your prognosis for Pakistan in terms of the future? A: The good thing is that indicators show population growth is stalling right now, probably in the range of 2.2 to 2.3 percent per year. That is good news... In five years there isn’t going to be much change, as you have this mechanical process of cohorts producing other cohorts. In terms of population growth itself, I don’t think there will be a significant change from what we know right now. Nonetheless, I am optimistic, because I can see that there is a real concern from the government. The president has been very clear about population growth. In a meeting I had with him, I found him extremely well-briefed. This, of course, is a very good sign, but we must put words into action. That is probably the greatest challenge.