Sunday May 26, 2024

The other time bomb

By Sherry Rehman
October 01, 2023

Pakistan is a nation focused on the crisis du jour. Crises like ‘climate change, environment and population’ are only mentioned occasionally in the newspapers or soft news morning shows, because structural issues are not hot, live topics anywhere in today’s clickbait media. Although as disasters advance with relentless intensity and scale, climate news has made a ratings-breakthrough in international headlines this is not the case in Pakistan.

Yet as time bombs go, climate and population are live ammunition in countries with low economic growth rates, agricultural economies and spiraling head counts. Pakistan’s population growth rate is now 2.55 per cent, overtaking all in South Asia. The numbers as computed in the 2023 digital census are highly contested, but even the base numbers show 241.49 million, a surge of 35 million in six years. In contrast, India, China and Bangladesh have lowered population graphs because there is a consensus that high population growth rates dramatically enhance vulnerability, especially in land use, agriculture and water resourcing.

Pakistan’s reluctance to prioritize population dynamics with climate advocacy has obscured a vital connection that erodes the capacity of both urban and agricultural communities to cope with growing stress, with not enough coordinated planning or public education built into the debate. Despite the risks environmental and climate stress can place on vulnerable communities, dependent on shrinking water sources and agriculture as their principal source of livelihoods, in Pakistan the scientific connections made between climate change and population are thin. The data is spectacularly weak, especially given the sensitivities to family planning and contraception, yet a growing body of evidence suggests that the connection is profound as well as simple.

The IPCC’s Sixth Assessment Report (2022), has unequivocally identified rapid population growth as "a key impediment” to achieving climate goals. Countries like Pakistan have a low carbon footprint globally, so high populations have not resulted in high emissions per capita. The problem is not demographics itself or a supply-side argument in which high population is linked to high emissions. Quite the opposite. In general and of course on historic time-maps, wealthy populations have very high GHG emissions. So the issue for developing countries is that unchecked population growth exposes higher numbers of people to vulnerability if the state does not have the resources to adapt costs, or to mobilize assistance or factor in high-expense resilience infrastructure. Lack of access to technology, soft skills, and high heat and weather volatility in agri-based economies exposes livelihoods to overall fragility.

In developing countries, when populations explode, inequality and its deprivations sharpen their demographics at the bottom of the social pyramid. In fact, climate change, conflict, and pandemics are all crises that impact the poor first, with 828 million going hungry all over the world in zones of vulnerability. Pakistan’s food insecurity is only growing as its water and food resources don’t meet the nutritional requirements of its underprivileged, who have become trapped in cycles of high food inflation and low resilience to extreme weather impacts. The erosion of soil, wetlands, forests, and rangelands clearly impacts rural livelihoods in life-changing disruptions. Yet agriculture is not the only intersection with climate and population where impacts are multiplied.

The pace of unchecked urbanization, where migrations to cities enhances the pressures on under-performing, under-resourced and contested municipal services also impacts dangerously with population density factors. Cities are now home to over 38 per cent of Pakistan’s population, with 40 per cent of the urban population now living in informal, often unhygienic squatter settlements known as katchi abaadis. Most of these settlements become the epicentre for disease in high heat or flooding, because there is little drainage or solid waste management functional institutionally across these areas, leaving hundreds of thousands impacted by urban heat island effects or urban flooding.

Water-borne diseases flourish in both rural swamplands and urban stagnant pools of foetid water, as local governments struggle to manage clean water-supply and drainage of settlements in the absence of working toilets and basic sanitary services. It is here that the term ‘urban underclass’ applies the most poignantly. Families living in cramped quarters with little cooling or safe cooking or washing options become frontline examples of climate-impacted urban fragility and health risk.

Without the big push to stabilize growth rates, based on the fact that vulnerability changes its impacts very quickly for the poorest and most under-serviced communities, high population growth rates are all set to further compound the impacts of climate breakdowns, water scarcity, urban sprawl and agricultural stress. High population growth rates also add to the national burn rate of expensive, imported energy sources with demand driving a 3.0 per cent increase in import of fossil fuels such as oil, liquified petroleum gas, natural gas and coal.

The capacity and institutional weakness of the public health sector adds to the problem, particularly with population planning pushed to the margins of national priorities. For a country which ranks as the fifth largest in the world in terms of population, low economic growth rates add to a Malthusian scenario where one growth rate overtakes the latter.

The way forward is obviously a renewed surge in family planning, yet the focus and drive of governments in the 1990s is missing today. Fertility transitions are rarely a part of public discourse, but they need to be front and centre of development discussions and government plans. While women’s bodies, maternal morbidity, health choices and empowerment are all part of the debate, women’s rights to exercise choices and to have autonomy over their bodies, need to be core to the intervention designs.

This is rarely the case in Pakistan, where in a high number of cases, women are not given the choice to marry or pace pregnancies with the basic information they need to make best choices. At the heart of the problem is of course power, nestled in the dark heart of patriarchy, which at its worst iteration sees women as fungible breeders, stripped of choice or agency. Despite parliamentary pressure, and legislation by one province, Sindh, where adulthood, and therefore a minimum age for marriage, is now defined at age 18, there is a crisis of forced marriages and unprepared young mothers being pushed into health and psychological trauma not of their own choice or making.

The links between malnourishment of children under-five are not difficult to make. Households where mothers are given no access to reproductive health options or family planning choices and knowledge are the ones where children are under-nourished and often stunted in their growth. The Global Hunger Index says that almost 50 per cent of Pakistan’s women and children face high nutrition deficits, which triggers deficiencies and long-term serious health impacts.

Many population taskforce conclaves later, including one created by the Supreme Court in 2018, the same recommendations resonate in policy papers, yet are not reflected as a surge in either federal or provincial government priorities. No rocket science is needed. Currently, our Contraceptive Prevalence Rate stagnates at 30-35 per cent. An enhancement of the CPR can be brought to 50 per cent, which will lower the fertility rate to 2.8 children per woman by 2025, and a push to 60 per cent by 2030 will bring that to 2.2 children per mother. This would lower our population growth rate to 1.5 per cent by 2024 and to 1.1 per cent by 2030.

The good news is that typically, families have demonstrated a need for both contraceptive knowledge and materials, in almost all surveys. That demand was most effectively met by the federal government’s huge public push for instituting the Lady Health Workers programme in 1994 by prime minister Benazir Bhutto, who ensured a winning combination of political consensus, high-level messaging and programmatic resourcing. Family planning was not just demystified but also projected as a women’s health issue, with LHWs fanning into unreachable homes and communities to impart both knowledge and free contraception.

Given that today many of these same 125,000 LHWs also double as polio vaccinators, the programme needs a public push and resourced scaling up. In bigger numbers, enhanced by social media outlets for FP materials, they will meet the needs of the targeted population if they are actually recognized as the real backbone of Pakistan’s primary healthcare system. This would be a big leap forward, again.

The writer is the former federal minister for climate change and environmental coordination.