THERE are two aspects to the issue of population. First, there is the provincial divide and second, population growth. The latter became excessive in the 1960s. At the time of the 1971 census, population growth was 3.6 per cent per annum.

By the time of the 1981 census, a provincial problem took over. Due to migration to Karachi, the percentage of the population in Sindh had increased as compared to Punjab and the then NWFP. Reportedly, when this information was put before the cabinet the two governors, Gen Jilani and Gen Fazle Haq, hit the roof.

President Ziaul Haq asked Dr Mahbub ul Haq to 'correct' it, after which the rate of population growth became 3.1 per cent. In all likelihood, Sindh's population had been reduced causing a reduction in the rate of growth. No census was undertaken in 1991 and the next census took place in 1997/98 when Nawaz Sharif and the PML-N were in power. That census commissioner has been quoted as saying: “I have to make sure no individual in Sindh can call himself two.” The objective was fairly clear; numbers were adjusted.

Currently, some people express fears in terms of Karachi's population, which is estimated to be somewhere between 14 and 15 million. According to Wikipedia it is 18 million. Because of provincial problems, this is going to cause a lot of confusion. Population parity between Punjab, Khyber Pakhtunkhwa and Sindh will become an issue. In Karachi, it may lead to trouble between the PPP, the ANP and the MQM.

In terms of Pakistan's total population, there are two views. Official sources put the figure at 171 million, while the UN puts it at 185 million. The rate of growth poses an additional problem. The UN estimates that childbirth in Pakistan will increase by 28 million by 2015.

The rate of birth is extremely important because of its effect on economic growth. The retrogression analysis says that a one per cent increase in childbirth rates leads to slightly more than one per cent decrease in economic growth rate. This is happening in Pakistan. Meanwhile, economic growth also appears to play a role in reducing birth rates. The use of contraceptives rose from 11.8 per cent in 1991 to 27.6 per cent by 2001. From then to 2007, this rate rose to only 30 per cent. Something obviously went seriously wrong.

Something will have to be done to prevent the population from rising to 206 million by 2015. According to the UN, 5.589 million births per year will take place between 2010 and 2015. How many extra 'birth preventions' are possible by then?

If serious success is not achieved, Pakistan will have between 25 and 28 million children under the age of five by 2015. How will they be looked after? Large family sizes are more common amongst the poor, particularly in the rural areas. The challenge is to persuade these people to aim for a better life by reducing their family sizes, and to provide them with contraceptive support.

A related issue is that of mother and child health. Ideally, pregnancies should be spaced about three years apart to protect infant and mother. Infant mortality is the first issue, and then there is the question of how many children can properly be supported on the income available to the family. There is hope that matters can be managed. Some surveys have found a 25 to 40 per cent demand or need for lower birth rates in the poorer sections of the citizenry — a demand that is going unmet. The question is, how competently can we work to help?

Various possibilities do exist. Already, there are some private/public collaborations in terms of numerous basic health units. These need more assistance from the private sector so that family-planning clinics can be set up, especially near important rural areas.

Collaborations with the private sector have also commenced supporting the government's mobile health units in rural areas. These can provide for mother and child health and advocate spacing births. It is not easy to reduce infant mortality and thereby give the poor the confidence to reduce family sizes on the basis of their income. Yet the concept of family size vis-à-vis income must be emphasised.

Thirdly, Pakistan's rich should be persuaded into financing mother and child health centres in the slums of large towns. The private sector must also see what it can do to support the family health and population welfare programmes in the country. A few relatively large non-governmental organisations are already working in this area. Child health is necessary because for the poor, a small family would probably translate to four children, including two boys. Mothers also need to be given importance.

A survey undertaken a few years ago indicated that about a million women opted for abortions, about a quarter of whom did not receive proper medical treatment. Meanwhile, it is estimated that a number of couples remain involuntarily childless. This contrast shows that population growth can be reduced with enough hard work. If Pakistan does not manage this, it will have to deal with the UN's estimate that the population will increase by about 21 million by 2015. An example can be found in South Korea, which has the lowest birth rate. This, in part, has allowed it to develop very fast economically. Pakistan, has taken a different path. A high rate of population in a developing economy leads to an increase in poverty and unemployment. This situation is already in evidence.