“Accessibility has become a real challenge for us given the way our population is increasing,” said Climate Change Minister Sherry Rehman, while briefing the media last week on how daunting a task it was proving for the government to relocate thousands of people from Pakistan’s southern coastal districts that were facing the threat of being struck by Cyclone Biparjoy.

The provincial government of Sindh, backed by Pakistan’s armed forces and disaster management authorities, had to evacuate more than 80,000 people along with their livestock. Most of them were living in mud and wooden houses built along the shores of Thatta, Badin, Sujawal and Umerkot districts.

Now, with the climate-induced natural disaster having passed without causing any human or infrastructure damage, it is time to pause and reflect on what must be done to prevent major losses from such occurrences in the future too.

Are we prepared?

Cyclone Biparjoy may have dissipated without causing any devastation, but Pakistan cannot survive on sheer luck alone. This won’t be the last time that the nation of over 230 million is threatened by a natural disaster. Of late, meteorologists have been sounding the alarm on frequent climate-induced disasters in the coming years, as Pakistan remains one of the most impacted countries due to climate change, despite contributing very little to global greenhouse emissions.

In fact, the country is still reeling from the devastating effects of last year’s floods that had killed more than 1,700 people and damaged crops and infrastructure worth more than $30 billion across the country. The cash-strapped government had to seek international support after a third of the country was inundated by the floodwaters.

Will the authorities, both at the federal and provincial levels, be able to manage such crises with the limited financial resources they have in hand? Is it even possible for a resource-constrained nation such as Pakistan to save such a huge population from calamities?

No strength in numbers

The latest census exercise has estimated the country’s population to be just shy of 250 million, which makes Pakistan the world’s fifth populous nation on earth after China, India, the United States of America, and Indonesia.

Pakistan’s total fertility rate (TFR) — births per woman — stands at 3.3 per cent, exceeding the global average by 157 per cent, according to the State of World Population report 2023 developed under the auspices of the United Nations Population Fund (UNFPA) Division for Communications and Strategic Partnerships.

The report projects Pakistan’s population to cross 400 million by 2050 and puts the country as one of eight that will account for half the projected growth in global population by that time. The other seven countries in the list include the Democratic Republic of Congo, Egypt, Ethiopia, India, Nigeria, the Philippines and the United Republic of Tanzania.

Last month, the UNFPA and Pakistan’s planning ministry organised a workshop in Karachi where experts concluded that high fertility leads to infant mortality and malnutrition. Pakistan, which is already facing unprecedented economic conditions, would clinch the fourth position in the next 27 years if the country does not arrest the current 1.9pc annual population growth rate, according to the UNFPA forecast.

Reproductive health measures

The country’s high TFR can be attributed in part to factors ranging from deep-rooted cultural misperceptions to hard economic realities such as inflation.

Pakistan still has a rigid family system, where women are not allowed to exercise their right to reproductive health. Families pressure women, no matter how feeble they are physically, to give birth to a baby boy and force them towards repeat pregnancies until the desired result is achieved.

This denial of a basic right to women not only disrupts the government’s family planning programmes, but also increases the mother and infant mortality rates in the country.

In Sindh alone, over 2,800 women die every year at the time of delivery. Every 60 out of 1,000 infants die before the age of one, while half of the province’s children under the age of five are suffering from stunted growth, according to UNFPA data.

The United Nations agency states that every year, as many as 2.2 million pregnancies are aborted in Pakistan due to lack of family planning.

High inflation, which rose to a record 38pc last month, is now weighing on people’s financial capacity to access reproductive health facilities. The inflated prices of food and energy are adversely impacting the purchasing power of consumers, especially the salaried class.

While gynaecologists are charging more than double for consultancy, the prices of contraceptives have increased by as much as 150pc due to the government’s restrictions on the import of raw materials in recent months, shortening supplies.

Where do we go from here?

According to the UNFPA, 34pc of Pakistanis have access to the use of modern contraceptives, resulting in a high unmet need, unwanted pregnancies and unsafe abortions.

The country can save the lives of more than 200,000 mothers and infants, besides averting almost $1.1 billion in direct health care costs, every year simply by increasing this number to 50pc.The move will also help Pakistan avoid more than 11 million unintended pregnancies and seven million unsafe abortions by 2025, according to the United Nations agency.

The Government of Pakistan will have to make family planning a national priority and use national television channels and social media platforms such as YouTube, TikTok to create awareness among people. It should also increase its family planning spending and introduce schemes, ranging from granting subsidies on contraceptives to starting door-to-door awareness campaigns specially in the country’s remote areas.

It can bank on the help of international partners such as the UNFPA, which is already working with the Government of Pakistan and other stakeholders in line with the International Conference on Population and Development (ICPD) Programme and the Family Planning 2030 national commitments.

Islamabad must realise that family planning is a national security issue. Climate experts have warned the country of very tough weather conditions going forward. Saving the world’s fifth largest population from hostile weather conditions and climate-induced disasters will be the biggest challenge for the resource-constrained nation.

Failure to do so will inevitably result in disaster, jeopardising thousands, if not millions, of people and putting further strain on the cash-strapped economy.

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