Demographic change and governance issues.

Nizam-ud-Din, Mohammad

Pakistan is the 6th most populous country in the world while it ranks 4th in Asia. Its population has increased from 34 million in 1951 to an estimated 160 million in the year 2006, growing at the rate of three million persons per year. At this speed of growth, Pakistan's population is projected to reach the 220 million mark by the year 2020; as we arrive at the Population Replacement Level.

While Population Growth Rate (PGR) has declined from over 3 percent in previous decades to its current level of 2.1 percent per annum, which is, nevertheless, the highest population growth rate in South Asia, a dubious achievement when compared to the situation in the neighbouring countries. Therefore, the government policy remains intact, which is to lower population growth rate from its current level to 1.3 percent per annum by the year 2020, to reduce the total fertility rate to 2.1 percent and to reach replacement level of fertility by the year 2020. Unless its growth rate swiftly, by the year 2050, Pakistan is destined to become the 4th most populated country in the world, its population reaching over 305 million mark. In 1950s it was ranked 14.

In the mid-twentieth century when publications such as Population Bomb began to sound alarms on the rapid increase in the population growth rates in developing countries, reiterating on the theories originally presented by Malthus, the leaderships in these countries, including Pakistan, just ignored to pay any attention. Apparently, religious conservatism and, in case of Pakistan, feudal policies, favoured rapid increases in population growth. Not everyone followed the course.

In 1952, a volunteer organisation, the Family Planning Association of Pakistan was formed that began to raise voices in support of women's right to birth control, later renamed family planning. A year later, the Family Planning Association of Pakistan launched few clinics to provide family planning services. (Source: Ministry of Population Welfare website-Frequently asked questions). The advocacy effort of the FPAP and similar activities in the neighbouring India, as well a s the promises of support from the United States, caught the attention of the policy-makers in Pakistan making them to adopt a softer attitude towards family planning. Three years later, the government began to fund the association and noted the need to reduce population growth in its First Five-Year Plan (1955-60). The government soon began to offer contraceptive services through its publicly run hospitals and clinics. Thus population planning (new name for family planning) was a dual effort led by the Family planning Association and the public sector. Later, it served as a model for countries like Indonesia, Korea, and Iran.

In order to deal with this high population growth rate and reduce it to a lower scale, the government decided to launch a national family programme including family planning campaigns and awareness of masses on the benefits of having fewer children. However, the opposition to the terminology, the name of the programme kept changing. In its final form, a less controversial name, Population Welfare was adopted.

During the second plan period (1960-65) in mid- 1960s, the Ministry of Health initiated the Population Welfare Programme in which intrauterine devices (IUDs) were promoted. Payments were offered to hospitals and clinics as incentives, and midwives were trained to treat patients. The government was able to attract funding from many international donors, but the aggressive approach of the programme began to erode public support. The overly ambitious targets assigned to enhance efficiency, backfired when populace felt being pushed and shoved to meet government targets. The proposed solution was to disentangle family planning services from the Ministry of Health structure and assign it to an independent unit. Hence, a semi-autonomous, the Family Planning Council was created in 1965 to run the programme under its own ministry. The annual crude birth rate at that time was around 45 per thousand and death rate was around about 18 per thousand and net growth rate was 2.7 percent per annum.

Pakistan was the 2nd largest country to launch a national family programme in 1960s and its Population Welfare Programme is one of the oldest in the world but has not yielded progress when compared to other countries like Bangladesh and Indonesia. Successive governments in late 1970 through mid 1990s paid insufficient attention to social sector investments: education, employment and health including reproductive health especially in rural areas. Because of local mores concerning modesty, the government avoided explicit reference to contraceptive devices and instead focused its public education efforts on encouraging couples th limit their family size to two children. During the past decade though the programme has enjoyed full political support and commitment, yet it failed to garner support from the masses. The community based approach could not be fully materialised due to religious, social and cultural norms of the society. Low literacy rate particularly among women folk, and male apathy happen to be the other major impediment in the way of programme success. Poor governance, high turnover in the leadership structure and attrition through the inevitable large-scale retirements, played a heavy toll on the programme's performance.

While public sector can claim success in keeping the theme of small family size alive through the mass media for a major part of the half century, and by offering, though on a limited scale, access to contraceptive services via IUDs and sterilisations, it is the the private sector that has played a critical role in meeting the demand for temporary and barrier contraceptives. Had the public sector fine tuned its educational efforts by using appropriate communication strategies and improved access to services as purported, it certainly could have made a greater impact on the fertility rates.

Ninth Five Year Plan objectives of the current Population Welfare Programme 1998-2003 were aimed at reducing Growth Rate from 2.4 percent to 1.9 percent, TFR from 5.2 percent to 4.2 percent but still the situation needs to be addressed as the objectives are no where close to be achieved. Currently the TFR estimated for year 2007 is 3.71 children born per woman.

This otherwise dismal scenario has two rays of hope. Pakistan is currently undergoing two very important transitions namely: the demographic transition (declining fertility and mortality) and Economic transition (High rates of economic growth and investments). To grapple with changing demographics we need to formulate and implement an integrated population and development policy focused on economic implications of the changing age structures. Pakistan is faced with its ever largest adolescent population, because of its high levels of fertility over the last few decades and its very recent fertility decline. The adolescent population, in the age group of 15-24, as it enters into its reproductive phase embodies potential population growth for several decades to come.

It constitutes population momentum in the future that will have serious implications for provision of schooling, health services, jobs and other basic amenities of life for the coming decades, if political changes and unstable governments continue to persist, the issues Pakistan faces today, will be compounded manifolds. Undoubtedly, the need to lower the population growth rate and to achieve Population replacement level before 2020 is more now than ever before. This can be attained by meeting the unmet demand of 33 percent of Family Planning services and 100 percent coverage of Reproductive Health and Family Planning services.

The increasing population brought along with it many social, political and economic issues faced by the government which includes situations of civil unrest and crime, possibly the outcome of increased level of illiteracy, poverty and unemployment. These, increasing no. of Population below the poverty line i.e. 24 percent and unemployment rate of 6.5 percent plus substantial underemployment; are the consequences of great expansion in the population. Due to greater number of heirs in a single family the land fragmentation problem has increased which has put serious impact on the agriculture hence economy. One of the consequences is that houses are being built on agricultural and arable land at an alarming rate. The government continues to fail in attaining self sufficiency in food and other goods of basic use and is unable to provide basic amenities to the masses. To fulfill the demands of the population, Pakistan has to import a large variety of items of basic necessities, such as oil and gasoline, which has put pressure on the he balance of the country, hence, creating never-ending trade deficits year alter year. And this great demand of items of daily use has put upward pressure on the prices of these items, thus taking the inflation rate to an officially recognised level of 7.9 percent. The achievement of Millennium Development Goals are difficult, if not impossible, with this state of Population growth. Three basic indicators of Human Development Index of Life expectancy at birth, Literacy rate and standard of living are needed to be improved until 2020. The increased number of children is not getting their due share of food, education and health facilities due to inability of the governments to provide with its scarce resources to the unlimited increasing population.

Typically, governments are destined to fail to cope with the rapid increase in population while they are at early stage of economic development. To meet the needs of the increasing population they must not only catch up with the needs of those are being added into the population as a never-ending stream, but also to catch up with those who were already there from the earlier stock. Invariably, poor and young population is not a significant source of revenue. If there is poor governance, the collection of the revenue becomes an even greater challenge. Governments who must pay for the upkeep of a civil service, defense infra-structure, and often carve out a large part of their income in hard currency, for servicing the international debt, are left with nearly no funds to pay for development activities such as roads, schools, hospitals, creation of jobs and civic amenities. This creates a vast pool of distrust for the government. Increasing population pressure makes government walk on slippery grounds where it advances once step only to slip back two steps. Opposing politicians who like to challenge the government, find its obvious inability to meet common man's needs, an easy target. Voters, choose opponents over existing governments hoping that new rulers will actually deliver. Alas, this is but only a mirage.

In the current circumstances of Pakistan, (for that matter, in most developing countries) to hope and expect resolution of the common man and woman's problems through government action, is perhaps, a dangerous perception that perpetuates a myth that should be erased from public mind. Instead, would not it be better that people should be encouraged to address their needs through self-help and community action, with least interference from the government. Government role could be defined to include only those items that it can handle with the resources and expertise at its disposal. Among the legitimate roles for the public sector would be setting minimum compliance standards for public works, education, health, welfare, and finance, etc. Governments could provide services that concerned with foreign countries and governments. Government could also play coordination roles between local and regional units. Is not a systematic process of devolution of state power to lowest levels of administration needed to ultimately improve governance? These questions should be looked into by the experts most knowledgeable in the subject area.

Population factors such as growth, distribution, urbanisation and others have definite and prolonged impacts on the environment and natural resource base of every country such as on forests, soils, freshwater, wildlife, and fish stock, among others; and Pakistan is no exception.

Population increase has not only brought an environmental degradation, it has also ushered in shortage of safe drinking water, diminishing forest resources, climate change due to depletion of ozone layer. Other forms of environmental pollution are marine pollution, noise pollution, depletion of land resources etc. Besides these, environmental pollution has also damaged the beauty and serenity of nature. Almost half of the world population is urbanised because of which traffic problems have multiplied, land erosion, and solid waste disposal are the major civic problems these days. Other major salient features are:

* During the past 25 years, cultivable land has increased by 27 percent compared to 98 percent increase in the population, resulting in smaller individual land holdings alter each generation has passed.

* The urban population will double in the next 20 years at its current 3.5 percent growth rate.

* Each year, deforestation occurs at the rate of 2.5 percent.

* Since only 50 percent of our population has sewerage facility, the other 50 percent chums out wastes damaging the environment and causing a variety of communicable and preventable diseases.

* The increase in the number of motor vehicles, each year, is 4.5 percent. Almost 70 percent of our vehicles have outlived their life span and emit unburnt dangerous gases in atmosphere. In fact, the total number of vehicles in Pakistan emits more noxious fumes in the air as compared to all vehicles in the US. This situation is not only hazardous to environment but also a cause of numerous deaths and disablement due to traffic accidents.

* The industrial and residential areas have merged causing health hazards for the population.

* Excessive use of Polyethylene bags is another serious environmental hazard.

High population growth rate affected sustainable development in Pakistan

* The population profile in Pakistan reveals that in order to achieve sustainable development, empowerment of women, effective use of resources, efficient family planning, and popularisation of small family norm are imperative.

* Each year, 3.02 million persons add to the population of Pakistan.

* With current growth rate of 2.2 percent, Pakistan s population will double in next 32 years.

* High T.F.R ((4.7) and lower literacy rate (35 percent) among females are major obstacles to sustainable development.

* Fifty percent of Pakistan s population is forced to live in one-room houses.

* Over one third of women, with three children in Pakistan, do not look forward to another pregnancy. Nevertheless, they get pregnant because they do not have access to reproductive health facilities.

* Low per capita income (US$ 443).

* Forests, which protect a country's climate and environment, occupy only 4 percent of the total area of Pakistan.

* Pakistan is an agricultural country but per capita arable land is shrinking due to higher pressure on land. In 1951-52, per capita agricultural holding was 1.1 acres due to higher pressure on land which reduced to 0.5 acres in 1977.

* Slowdown in population growth rate, wider coverage of reproductive health services, education of women, and effective steps to eradicate poverty are prerequisites for sustainable development in Pakistan.

Changing Demographics in Developing Countries

The world is undergoing an unprecedented demographic transformation brought about by rapid declines in fertility levels. Between now and 2050, the number of older persons will rise from 600 million to almost two billion. Until now population ageing has mostly been associated with developed countries but now it is no more a developed country phenomenon. Its happening on a very large scale in developing countries (by 2050, 80 percent of the estimated 2 billion older persons will be living in developing countries. Largest and more rapid increase will take place in Asian region particularly in East and South-East Asia.

[FIGURE 1 OMITTED]

Ageing--A Rarely Discussed Population Issue of Pakistan

Like rest of the developing countries, Pakistan is also experiencing an ageing of its population. Population ageing refers to a decline in the proportion of children and young people and an increase in the proportion of people age 60 and over. Increasing life expectancy combined with declining fertility is resulting in substantial increase in the number of older persons. It is a product of dramatic decline in biological components of population fertility and mortality. Pakistan's 60 year or older population has grown from 1.9 million in 1951 to over 11 million by 2006. The UN estimated that the number of people 60 years or older in Pakistan will reach around 42 million by 2050.

The demographic transition is taking place at much faster pace in developing countries than was the case with developed countries. In most of the developed world population ageing was a gradual process following a steady socio economic growth over several decades and generations. In developing countries the process is being composed in two or three decades which is an inevitable consequence of successful Family Planning Programmes leading to demographic transition--that is the shift from high to low birth and death rates.

The challenges of ageing population are daunting and in most cases far exceed existing resources and capacities of most developing countries. Meeting these challenges will require innovative planning and substantive policy reforms in developed countries and in countries in transition.

Population ageing presents a serious challenge for the good governance. While developed countries grew affluent before they become old, developing countries are getting old before a substantial increase in wealth occurs [Kalache and Keller (2000)]. One of the major challenges resulting from demographic trends, the proportion of working age will decrease relative to the increasing elderly population. The old age dependency ratio increases-less working-age people will have to generate the fiscal resources to provide social security for more retired and older persons.

Another challenge faced by developing countries is a shift from traditional to modern institutional structures. In these countries rapid ageing is accompanied by dramatic changes in family structures and roles, as well as in labour patterns and migrations. Urbanisation, the migration of young people to cities in search of jobs, smaller families and more women entering into formal workforce mean that fewer people are available to cater for older people when they need assistance.

Integration of Older Persons in Development Strategies

Despite published demographic data on the trends of population ageing in the developing countries there is remarkably little provision for ageing in public policy. Even where countries do have policies on ageing, they are often separated from mainstream social policy provisions. They are given special allowances or provisions and are treated as a special population. Pakistan needs to meet a dual challenge which is product of demographic transition. It has to meet the needs of increasing number of older persons and to meet the needs of the larger group of young people. Growing transformation in the age structure of Pakistan's population has profound consequences on individuals and families and requires an integration of the changing age structure into the larger development processes.

It is also a tact that great majority of older persons in low and middle-income countries have no or very little formal income maintenance provision for their later life. Eradicating poverty in old age is a great challenge for good governance. It is almost a universal pattern, the poorer an older person is, the less likely is holding entitlements and social health insurance. Policies for poor people must take this into account. This will require more attention at the planning and formulating agendas of the national and local governments as well as international institutions. The failure of government to invest in social protection mechanisms which older persons can cope with and even transcend poverty will have serious repercussions.

Equally important is to recognise the heterogeneity of older persons. It is necessary to distinguish between older people who have potential to contribute to their own well being and others as well as and those who are highly vulnerable with serious mental and physical health problems. This heterogeneity needs to be dealt with unique and separate arrangements. At the same time the needs and priorities of older persons in conflict situations also differ greatly from those of older persons in relatively secure and stable environments.

The new realities of population ageing with an increasing number of older persons and a smaller number of children have to be addressed in positive terms by government in order to avoid conflicting situation resulting from demographic transition. In full partnership with civil society, the community, media, industry and academia, the government has to develop a national strategy to prepare the country for the challenges of population ageing.

A multipronged policy is needed to face challenge posed by the younger cohort and ageing population. Different strategies should be adopted to cater for needs of younger persons and ageing population. Equally important is to invest on younger' human capital development as they would be supposedly taking the role of yesterday ageing population.

Income generating and micro-credit schemes can have a support function for older persons who lack family and community support. However, these schemes have a limited outreach and are not necessarily appropriate for the more vulnerable and frail order people. Fiscal policies and economic and social security issues to assess the poverty and vulnerability of older persons, including access to pensions, insurance and health care and other types of social protection need to be adopted. Small amounts of financial help to older persons, if properly targeted, can have a significant impact on their wellbeing. Again, the context is important, for example, difference between supporting schemes in urban and in rural settings and for male and female older persons.

Equally important is to stop treating elderly people as a homogeneous group and over looking the differentiation in the experience of ageing for men and women. There are significant difference in the way ageing affects men and women. The needs and demands of the elderly women should be given priority in welfare policies.

Headings from the Presentation

Pakistan's Population Growth and Public Policy Response

* Pakistan's Population Growth.

* Pakistan's Public Policy Response to High Population Growth.

* Current Government's Population Policy and Goals.

* The Onset of Demographic Transition in Pakistan.

* Pakistan's Growing Elderly.

Changing Demographics in Developing Countries: Challenges for Governance

* Changing Demographics in Developing Countries.

* Changing Demographics: Challenges for Governance.

* Changing Demographics : Policy Challenges for good governance.

* Short Term Implications by 2010.

Population Living below Poverty line 35
Population with no Access to Sate Drinking water 56
Population with One Room House 57
Population with no Sanitation 77

Source: National Institute of Population Studies, Islamabad, 2004.

* Additional Requirements in Health by 2010.

Requirements Number

Doctors 175,000
Nurses 40,000
Hospital Beds 35,000
Annual Health Expenditures Rs 14 billion

Source: National Institute of Population Studies,
Islamabad, 2004.

* Additional Requirements in Education by 2010.

* Sharp increases that will put severe strain on the governance structure of Pakistan.

* Civil Unrest and Crime.

* Poverty.

* Unemployment.

* Over Crowding.

* Land Fragmentation.

* Import of Food and Fuel.

* Environmental Degradation.

Integration of Older Persons in Development Strategies

* Absence of Older Persons in Public Policy and Governance.

* Dual Demographic Challenge to Good Governance.

* Changing Age Structure and Development Strategies.

* Integration of Older Persons In Development Strategies.

* Older Persons and Partnership with Civil Society.

* Recommendation for a Comprehensive Policy for Older Persons.

* Population ageing has to be brought on to the overall development policy and research agenda, This include:

* To explore the links between social-economic and legal conditions of the older persons and the protection of their social, economic, political and civil rights.

* Fiscal policies and economic and social security issues to assess the poverty and vulnerability of older persons, including access to pensions, insurance and health care and other types of social protection.

* Work and educational opportunities and life long learning. Equal opportunities for the older persons.

* The impact of changing patterns of family structures on inter-generational relationships and old age security, resulting from urbanisation, migration, socio-cultural changes.

* To explore a balance between the potentially conflicting needs of young and old:

* Strengthen the institution of family to support older persons, establish community homes and centers for education health and care on the one side and the independence and privacy of young people and women's work outside the households on the other.

* Establish especial housing structures and living arrangements particularly for the poor and physically challenged older persons.

* Life course approaches to promote awareness amongst the younger population towards factors and behaviours that will affect their mental and physical well being in old age.

CONCLUDING REMARKS

Given the size and significance of the growing older population of Pakistan, estimated to reach the 42 million mark in the next forty years, PIDE should organise a high-level conference of government, civil society organisations, community leaders, and older persons to focus on the interconnection of good governance, ageing, and poverty.

Mohammad Nizam-Ud-Din is Vice-Chancellor, Gujrat University, Gujrat.