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Let women decide

Without empowering women it is not possible to have an effective population control strategy

Let women decide

It is a matter of some satisfaction that both the honourable chief justice of Pakistan as well as the prime minister of Pakistan decided to form committees to figure out what to do about the high rate of population growth in Pakistan.

No list of members has been announced that I know of but I have a vague suspicion that a large number of men, many of them of a conservative religious bent, will make up a majority of these committees. What is essentially a women’s problem will then be discussed and decided upon mostly by men.

Population control or rather ‘birth control’ after all is primarily a woman’s issue for the simple reason that it is women that give birth. And as such unless women are in a position to control their ability to conceive and to become pregnant, there can be no successful method to control births or the rapid increase in population.

Yes, in an advanced cultural environment men are also held equally responsible for preventing pregnancy but at present other than the use of a condom, there are no reversible birth control methods available to men. The condom is probably one of the best ways to prevent an unwanted pregnancy and it also has a major additional benefit that it prevents the transmission of what are known as sexually transmitted diseases (STDs).

Besides the usual culprits like syphilis and gonorrhea, STDs also include other important conditions like HIV-AIDS, Hepatitis C and a more recently discussed the Human Papilloma Virus (HPV) that is a cause for cancer of cervix (part of the uterus) in women.

The problem with the condom is what might be called a convenience factor. And in most situations where a condom is actually used it is often the women that asks for it or perhaps even insists on it. Sadly that is one thing that I do not see happening any time soon in most male-female interactions in our part of the world.

So then all the wise men, some wise women and a bunch of ‘religious divines’ will try and decide how to make the population growth much less than the growth of our economy so that we can actually crawl out of poverty as a country. Frankly, if we can push our economy out of its doldrums then half the battle will be won.

It is an interesting fact that the countries with the highest rate of increase in population are mostly poor countries. Why do the poor have more children? Considering the high death rate among children, the poor in these countries will have more children so that more of them live on to adulthood. Children for the poor are insurance. Once the children are older they provide economic support and later on become a form of old age insurance.

Not being an economist I will defer to people more knowledgeable than me as far as the question of an acceptable rate of population growth is concerned for a country like ours. That said one thing is clear that the present rate of population growth does need to be brought down.

Different nations have tried different approaches to control population growth. Our neighbour to the east a few decades ago tried to popularise ‘vasectomy’ among men by paying them some money for undergoing the procedure. Vasectomy is a minor operation performed under local anaesthesia that makes men permanently sterile. There was enough of a backlash to make the entire effort extremely unpopular.

The other major approach was the one family one child drive in China. That worked spectacularly and recently it has been liberalised to two children per family. Clearly in a system like ours any such rule cannot be enforced. The downside of any state enforced limit on children is that abortion is used to end ‘unwanted’ pregnancies.

As I have said above, without empowering women it is not possible to have an effective population control strategy. The first step towards population control then has to be education especially for young women. There are many advantages in having educated women but fewer births is one of them.

It is not general education that helps but perhaps one of the initiatives we need is that young women also learn specifics about family planning and different birth control methods. This information can be provided in two ways.

First is the best but highly unlikely possibility that female health including sex-education for girls in high school and in girls colleges should become a mandatory subject. Such education can be provided by approved visiting faculty made up of female physicians that specialise in women’s health.

The second possibility is that ‘lady health visitors’ (LHVs) provide this information to married women in the rural and semirural areas. We already have a system where LHVs are available to perform this function.

These LHVs can be provided with birth control pills and condoms that they can give out to the married families. Here of course two caveats. First is that the poor medical workers going around giving out anti-polio vaccine drops keep getting flak so the same could happen to the poor LHVs giving out condoms and birth control pills.

The second problem of course is that considering the corruption that permeates our public medical sector, many of these condoms and pills will probably get sold off for personal profit. Here I might suggest that if somebody does actually use this stuff that might not be a bad idea at all.

From a personal perspective I believe that Intra Uterine Devices (IUDs) are probably the most reliable as well as convenient form of ‘reversible’ birth control. IUDs are easy to insert and to remove. However like any ‘surgical’ procedure there can be complications especially if the procedure is performed by an inadequately trained medical practitioner.

If we look at what is possible considering the situation in Pakistan, I personally have very little faith that any policy of the national or provincial governments can actually have a meaningful effect on population growth.

The impediments to success of a population growth policy are many. Rampant illiteracy, poverty, established religious obscurantism, and endemic corruption will all prevent any relatively short term initiative from being successful.

In the long term, meaning over a period of many years there is hope. As Pakistan evolves, there is sufficient economic growth to pull most people out of poverty. Of course improved healthcare especially in the area of maternal and child mortality will be helpful.

And yes, education is almost the panacea for all our ills — education not only in matters concerning religion but also about the arts and the sciences. I probably won’t be around to see it happen but if and when we in Pakistan approach almost hundred per cent literacy rate for females, the population growth will probably start approaching zero.

Finally, if our population and our economy keep growing at the present rate and if we throw in water scarcity and weather change, things will start looking pretty bad in a decade or so. And Malthusian predictions will start happening.

Trends look bad but fortunately present trend never continue ‘forever’.

Syed Mansoor Hussain

syed mansoor hussain
The author has served as Professor and Chairman, Department of Cardiac Surgery, King Edward Medical University.

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