What's Behind Pakistan's Family Planning Stigma?
Pakistan is struggling to control its rapidly growing population.
Pakistan is struggling to control its rapidly growing population. Health professionals and activists say the influence of religious clerics, a patriarchal society, and lack of access to contraception are behind the rise.Sardar Jan Muhammad Khilji, a 50-year-old resident of Quetta, capital of Pakistan's western province Balochistan, is proud to have many children. He is said to have welcomed his 60th child in January. Khilji said he has fathered 60 children with three wives, but refused to discuss further details with DW.
Mastan Khan Wazir, a resident of North Waziristan, Pakistan's tribal area bordering Afghanistan, told DW that he has had 22 kids, some of whom passed away. The 70-year-old, who has three wives, says he still feels young and wants a fourth wife.
All of my wives are from the same tribe, he said, adding that one of his wives is the widow of his younger brother who died in India-administered Kashmir while fighting Indian troops.
"I want to have more kids because they can fight the infidels and enemies. I am proud to have over a dozen kids."
Wazir says he "keeps his three wives separately." "One of my wives is in North Waziristan, another in Dera Ismael Khan and the third in Rawalpindi. If I keep them together, they will quarrel."
Wazir says family planning teams never visited his area. "Even if they had come, nobody would have listened to them. They cannot prevent us from having more kids, it is given by God."
Pakistan's growing population
Pakistan is the fifth most populous country in the world, with around 231.4 million people in 2021, according to the World Bank.
In 2022, the United Nations Population Fund (UNFPA) calculated Pakistan's fertility rate per woman to be about 3.3.
The conservative Islamic nation has one of the highest birth rates in the world, with 22 births per 1,000 people.
World Population Review estimates that the country will reach its peak population in 2092 with 404.68 million people.
What's driving families to have more children?
Former Balochistan assembly lawmaker Yasmin Lehri believes that a desire to have more male children is one of the factors motivating Pakistanis to have many kids. In tribal society, having boys is a symbol of status and power, she told DW, adding that families with more children wield more power and influence.
"Men will continue producing kids until they have baby boys. Some marry twice or thrice if they don't have sons from first and second wives," Lehri said.
Lawmaker Kishwar Zehra, meanwhile, says some families believe having more children could boost their income. "That is why they have more and more kids, forcing boys to work in factories or workshops and girls at people's houses."
Rukhsana Anwar, central president of the National Programme Health Employees Association in Punjab, believes religious clerics are the biggest hurdle to family planning. Most female health workers encounter arguments because clerics propagate against family planning, declaring it anti-Islamic, she told DW, adding that family planning carries a social stigma.
However, political party Jamiat Ulema Islam refutes that clerics are responsible for preventing efforts aimed at controlling population growth. Muhammad Jalal ud din, a leader of the party, told DW his party did not believe in forcing people to have family planning. "Clerics don't oppose family planning. Anyone who wants to do it can do so, but people should not be told or forced to carry out family planning if they don't wish."
Women face burden in population rise
Due to an economic crisis, government departments, including pakistan's population department, are facing scarcity of funds, and state employees have reported delays in salaries.
Anwar from the National Programme Health Employees Association told DW the government has not been providing contraceptives to female health workers. "The relevant government departments have no pills, injections and not enough condoms, they say they don't have funds."
The health worker says Islamabad is more focused on preventing maternity-related deaths.
"We don't say preventing such deaths is not necessary, but controlling population growth is also important," Anwar said.
Tipu Sultan, a Karachi-based health expert and former president of the Pakistan Medical Association, believes that authorities are not taking family planning seriously.
"There are now vested interests who want this population growth issue to stay here because it could help them get perks and privileges and money from international donors."
Women in Pakistan face the brunt of birthing and raising large families.
Citing the Pakistan Nutrition Survey of 2018, UNICEF says in its report titled Pakistan Maternal Nutrition Strategy 2022-27 that 14.4% of women of reproductive age are underweight, 24% are overweight, 13.8% are obese, 41.7% are anaemic and 22.4% face vitamin A deficiency.
"I have seen extremely frail women with frequent pregnancies. Weak women give birth to weak children, adding to the army of malnourished children, which results in stunted growth as well," Sultan said.
Edited by: Sou-Jie van Brunnersum
(The above story first appeared on LatestLY on Apr 03, 2023 09:00 PM IST. For more news and updates on politics, world, sports, entertainment and lifestyle, log on to our website latestly.com).