It is a desire that Pakistan can ill afford. The sixth most populous country in a world that recently surpassed 7 billion inhabitants, Pakistan has South Asia’s highest fertility rate, at about four children per woman. Amid massive electricity shortfalls, failing schools, high unemployment and rising Islamist militancy, many here say the booming population is a ticking time bomb.
“Do we want to become the fifth-largest nation with large segments of the population falling below the poverty line who are uneducated and unhealthy?” Prime Minister Yousuf Raza Gilani said on World Population Day in July.
But Pakistan’s family-planning efforts have lagged far behind those of other large Muslim-
majority nations, including Iran and Bangladesh. In those countries, governments have stuck to population-control policies and backed them with money and political will, according to researchers. In Pakistan, where the powerful military consumes a large chunk of the budget and development spending has stagnated, family-planning efforts have consistently fallen victim to tumultuous and weak governance.
Today, just one in five Pakistani women ages 15 to 49 uses modern birth control. Contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength.
Yet religion is hardly the main obstacle, public health workers say. Although some clerics scorn birth control, health workers have persuaded other imams. The bigger cultural hurdles, the workers say, are husbands and mothers-in-law, as well as the inability of many women to make decisions for themselves.
Young brides commonly live with their husbands’ families after marriage. In most such units, the mother-in-law runs the house. If a health educator stops by, the mother-in-law must first be approached, as Shahid experienced in Mirwah.
“So what? I will take care of the children,” the mother-in-law, her arms covered in bangles, said when Shahid expressed concern that the daughter-in-law, still a teenager, was not using birth control.
Leaving the house, Shahid — who works for Greenstar Social Marketing, a nongovernmental organization that trains health providers and markets subsidized contraceptives — vowed to woo the mother-in-law in successive visits.