Population and SDGs: The Inextricable Linkage

As the 5th most populous country of the world, with an estimated population of 234 million, a large proportion of the country’s resources are consumed instead of being accumulated as capital for development purposes. The rate of development, therefore, lags behind that of population growth, which triggers stagnation in social service delivery.

According to a study by the Guttmacher Institute and Population Council, in Pakistan the annual outlay of US$1.894 billion to provide newborn and maternal healthcare to all pregnant women would be lowered most effectively by reducing the number of unintended pregnancies, estimated at US$298 million of the total. Every additional dollar spent on modern contraceptive services lowers the cost of maternal and newborn care by US$2.66. This would provide life support to the current economic crises that the country is going through. The impact of family size on household savings and poverty emphasizes that a large population size and weak job creation prospects further aggravate Pakistan’s current economic predicaments as well as stifle poverty reduction efforts. Improved and timely family planning efforts can enhance gainful employment for women and increase standards of living for smaller families.

At present, Pakistan has a relatively young population and high dependency rate, however, if suitable policy actions are implemented culminating in a lower fertility rate, the dependency rate can be reduced resulting in a “demographic bonus” that can propel the economy to a higher growth trajectory.

By investing in a fertility decline through a robust family planning program, Pakistan can significantly reduce the numbers of people in poverty; it can divert resources to improving maternal and infant survival, nutrition, and educational attainment. Climate change and population growth have strained Pakistan’s natural resources; therefore the country needs to take urgent action to mitigate the negative impacts of climate change by adopting an integrated approach that jointly considers climate change, environment, and population growth.

The challenges confronted to achieve most SDGs are affected by population dynamics, in terms of age structures, population growth and migration and are exacerbated by huge and ever-increasing population numbers. Hence most goals are linked to family planning. The fact that sexual and reproductive health and rights (SRHR) and family planning have been referred to more than once in the SDGs demonstrates their importance. Family planning can contribute to several other health and wider SDGs, and at the same time reduce the burden on the health system. Currently, large gaps of unmet needs of education and family planning point towards major under-investment particularly for adolescent girls and women resulting in dropouts and low transition from primary to secondary education as well as early marriages, unwanted pregnancies, child labour, and extreme violence against women and children.

Pakistan is falling behind most of its neighbours and many other Muslim countries in terms of its overall health indicators, particularly maternal and child health indicators. The main social determinants include poverty, high rates of illiteracy, lack of empowerment among women and girls, and also high fertility rates. In many cases, the deaths and morbidity stem from pregnancies that were never intended or are inadequately spaced or poorly timed. The achievement of gender equality and sustainable fertility rates are interlinked to wider societal structures of power. Therefore, lack of female empowerment in terms of decision-making leads to difficulty for women to exercise their reproductive rights resulting in a higher birth rate overall.

Family planning improves maternal, perinatal, and infant health outcomes by enabling healthy timing and spacing of pregnancies. By following the 60 percent Contraceptive Prevalence Rate (CPR) target decided by the Council of Common Interests (CCI) taskforce, Maternal Mortality Rate (MMR) can be brought down to 77, and the under-five mortality rate can be reduced to 61 per 1,000 live births (as per the Population Council estimates).

Addressing unmet need for family planning by facilitating access to contraceptives, increasing the number of health outlets in the public and private sector, with trained healthcare providers and most importantly, empowering women by providing equal access to education and employment opportunities would be a step in the right direction.

The government should promote family planning as a socially and religiously acceptable practice through the media and introduce the new narrative of tawazzun/balance, that gives parents the freedom to plan the number and spacing of their children according to their resources to fulfill the basic rights of each family member.

It is also imperative to provide reliable and frequently updated data on demographic parameters such as fertility, infant and child mortality, contraceptive prevalence, unmet need and demand, through representative surveys as well as analysis of routine monitoring data collected through information systems.

Family planning and its impact on SDGs needs to be more deeply entrenched in our national political discourse for more effective policy formulation. Understanding how family planning outcomes directly and indirectly feed into improvements in other SDG indicators may persuade structural reforms which are needed to bring about the changes that would enable the entire health infrastructure to actively engage in providing family planning.

Zalla Khattak Works on Population and Development at the Population Council, Pakistan.