PAKISTAN enjoys the dubious distinction of being the fifth most populous state in the world. But unlike the four countries that precede it in population size, Pakistan has been unable to manage its demographic growth and economy to its advantage. The shocking revelation made by the census last year was that Pakistan’s population had grown faster in the last five years. The annual growth rate was 2.55 per cent. It had been 2.4 pc in the 2017 census.
Other indicators are no better. The Pakistan Demographic and Health Survey 2017-2018 puts the total fertility rate at 3.6pc and the contraceptive prevalence rate at an appallingly low 34pc (which includes more than 10pc users of highly unreliable customary methods). The unmet need is 17pc. This data discredits the government’s performance, and testifies to the disinterest of our rulers in improving the quality of life of the people.
There are many factors that account for the rapid rise in numbers. The most important is officialdom’s reluctance to bring the population issue into the public discourse. There is no open debate on it. Along with this silence is the unwillingness of opinion-makers to take action against patriarchal structures and practices in our society. As a result, the status of women remains low.
People like Mashkoora are a ray of hope for family planning.
The UN has been convening international conferences periodically on population development. The Cairo conference of 1994 was a landmark one as it adopted the Programme of Action and for the first time there was a paradigm shift from controlling population as an economic compulsion to the human rights dimension of individual men and women. A Shirkatgah report describes the emphasis on education, especially for girls; gender equity; infant, child and maternal mortality reduction; the provision of universal access to reproductive health services, and the inclusion of family planning and sexual health in the programme to empower women and girls. This is one of the most reliable pathways to the improved well-being of all.
All this has been beyond Pakistan. In the pre-Zia 1970s, the population programme had made a reasonably good start. Population centres were scattered all over the country, and motivators and counsellors played an effective role in getting people to become acceptors. The population growth rate fell to 1.9pc. Then came a dark age for women and the progress achieved was reversed. Now I see light at the end of the population tunnel.
I often hear from people working in this sector that they meet women who confide in them that they do not want many children but their partners do not agree. So some seek to space their children on the quiet. But they are unsure if that is a wise thing to do given their men’s demand for large families. Since women have traditionally been the focus of birth control strategies and male motivators have never been the forte of any population programme in Pakistan, this is creating an unrecognised dilemma.
Now we have an answer offered by a remarkable Lady Health Worker in Khero Dero. She is Mashkoora, a widow aged 43 and the mother of seven. Mashkoora has endeared herself to her clients. Called ‘Maasi’ by the women she has emerged as their saviour. Mashkoora was hired by the Ali Hasan Mangi Memorial Trust (AHMMT) as a motivator and counsellor to persuade women to space their children and have themselves sterilised if they already had a large family. Her achievement? In a span of two years, she has personally arranged for the tubal ligation of 144 women, made numerous couples acceptors and created a demand for family planning advice.
Mashkoora’s real feat is her ability to talk to men and persuade them to become acceptors. I asked her how she manages this in our patriarchal society. She tells me she has no qualms about talking to men on the issue. She is persuasive and explains to the men the ill effects of frequent pregnancies on a woman’s health, and worse still, the neglect children suffer from when there are too many of them. She says she reminds them of how it affects them adversely.
Mashkoora may be illiterate but she is worldly-wise. She has educated her children and knows what would appeal to a man. For instance, she tells me that she introduces herself as Mashkoora from AHMMT. That is half the work done as all the people from the 44 villages she visits are beneficiaries of one or the other of the Trust’s projects — house-building, toilets, solar panels, school, healthcare, micro-loans, etc. A bond of mutual trust already exists that Mashkoora uses to her advantage.
Without her even knowing it, Mashkoora is what the paradigm shift, that was witnessed at the UN International Conference on Population and Development, suggests: treat family planning as a matter of human rights rather than economic compulsion.
Published in Dawn, March 22nd, 2024
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