Browsing "population"

Too young to wed

United Nations (UN) agencies are generally criticized for not doing enough but they should be commended for coming up with quality research from time to time, which can and should serve as harsh reminders to governments across the world that they need to get their acts together. The UN Population Fund recently released a report titled “Too Young to Wed” on child marriage, which should alarm all governments in South Asia and sub-Saharan Africa. The two regions have the highest and second-highest percentage of women, respectively, who are married off before they turn 18 years of age.

International conventions declare that child marriage is a violation of human rights because it denies children the right to decide when and who to marry. A country like Pakistan, which is a signatory to the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and has ratified the Convention on the Rights of the Child (CRC), needs to align its local laws regarding child marriage, as both conventions categorically state that appropriate measures will be taken to abolish traditional practices prejudicial to the health of children, such as child marriage.

The evils of child marriage are many. For starters, it cruelly snatches the childhood away and thrusts a child into adulthood well before her time. It directly threatens the health and well being of young girls as complications from pregnancy and childbirth are cited as the main cause of death among adolescent girls aged 15-19. As the numbers of girls who are married as children grows, the numbers of children bearing children will increase and deaths among young girls will rise, further deteriorating the child and maternal mortality rates.

In the case of Pakistan, religion is also cited as a reason for child marriages as it is considered advisable to marry girls off soon after they reach puberty. This, however, is just an excuse. Medical science tells us that puberty only marks the beginning of a gradual transition into adulthood. Religion also asks its followers to educate their children and to follow the path of moderation and if any attention is paid to these other two recommendations, child marriage would become a distant dream.
Girls’ vulnerability to child marriage increases during humanitarian crises when family and social structures are disrupted and many parents marry off their daughters to bring the family some income or to offer the girl some sort of protection. Humanitarian workers noticed a surge in child marriages during the internally displaced persons crisis brought on by the floods of 2010 and 2011.

The child marriage issue is central to many development goals. By dealing with just the child marriage issue, governments can work towards closing the gap in the Millennium Development Goals of eradication of extreme poverty, achievement of universal primary education, promotion of gender equality, reduction in child mortality, improvement in maternal health and better ways to combat HIV/AIDS.

Our own government needs to start a multi-pronged strategy to deal with this issue. First, all provincial governments need to be fully committed to criminalising child marriage and streamlining local laws according to the CEDAW and the CRC. They not only need to invest in female child education but also must invest in campaigns to encourage the maximum number of parents to enroll their children in schools. Contraceptives should be easily and readily available and most importantly, decent employment opportunities should be made available for both parents. A family that can feed and educate its children is less likely to marry them off.

First published in The Express Tribune

May 26, 2012 - population, published work    2 Comments

Where are the health stories in the newspapers?


A country where 58% of the population is food insecure and over 43% children are malnourished, health is an outstanding concern all the time. Add the repeated misery of floods of 2010 and 2011 and displacement of population in hundreds of thousands because of military operations in KPK and FATA and it becomes an ever more pressing concern. When a matter is that critical, you expect to see highlighted everywhere. Unfortunately, the Pakistani media is, by and large, silent on this issue.
Let’s start with the health issues of children. Not only neonatal mortality is responsible for 57% of all deaths in children younger than 5 years in the country, the country also has the dubious distinction of having the highest neonatal mortality rate in the region. Nearly two million children less than five years of age die of pneumonia. Similar number dies of diarrhea every year. According to UN figures, around 432,000 children die before reaching the age of five in Pakistan and the majority of these lives are taken by pneumonia, diarrhea, measles, malaria, tuberculosis and tetanus. But if you go through any newspaper in Pakistan or watch any news bulletin on any of the TV channels, you would think that the only disease killing children in Pakistan is Polio.
Pick any newspaper, almost 90 per cent of the news items about children’s health cover stories about polio vaccination drive of the government, its success, failures and the political mileage politicians get out of it. Half of such stories would be based on statements by political personalities such as Aseefa Bhutto Zardari, Farzana Raja and Shehnaz Wazir Ali during various campaign launches. Ironically we are not even doing that very well and Pakistan is one of the three countries — the other two being Nigeria and Afghanistan — in the world which still has the disease. Pakistan has not done much to meet the millennium development goal of reducing childhood mortality by 2015 and control of infectious disease which should have been the topmost priority remains neglected.
Health experts have noted that the higher occurrence of communicable diseases among children and acute malnutrition in the country is primarily due to poverty, higher illiteracy rate among mothers and the government’s lack of commitment towards ensuring food security to each and every citizen. They also attributed it to the inherent problems in infant feeding practices and access to “right” foods, a problem that can be addressed if media makes it a priority and educated masses about it. Unfortunately media is busy pursuing its own agenda and is content with airing stories of nurses fighting it out with traders in the streets of Lahore during protests for increase in their wages. 
As far as health issues of adults are concerned, one sees stories only about cases of criminal negligence, medical malpractice, lack of infrastructure, absentee doctors and protests and strikes by medical and paramedical staff. There is hardly any coverage given to issues relating to nutrition, health policy, legislation and drug pricing policies, etc.
With the devolution of the ministry of health following the Eighteenth Amendment, Pakistan faces the challenge of developing a reliable provincial infrastructure that would integrate the efforts of various stakeholders in promoting better health outcomes. Unfortunately, we are not even at the stage where a workable policy is developed and budgetary priorities are reassessed, so developing a workable provincial infrastructure remains a distant dream.

Written originally for The Express Tribune, this is the unedited version. 

Hungry and about to explode

How many of us have seen children with thinning, rough hair with orange hue? They are the children who are trying to clean our car’s windshield at every other signal. It is the boy who is working at the tyre shop in our local gas station. It could be our maid’s child playing in our garage and eating dirt while she is attending to us and our children. These pale, skinny, listless children are all around us – everywhere –they are the malnourished children of our world. 
Pakistan is among thefive top ranked countries that have more than half of the world’s malnourished children, says a report publishedby ‘Save the Children’. One in four of the world’s children are stunted. In a country like Pakistan, the figure is much higher. Stunted growth means their body and brain has failed to develop properly because of malnutrition. About 43.6 per cent children in the country are officially reported stunted and if no concerted action is taken, Pakistan will have the highest percentage of stunted children population in the next 15 years. Apart from coming up with national level plans to deal with this acute shortage and price hike of necessary food items, the most obvious way of dealing with this issue is to have less number of children, yet we keep procreating at an alarming rate with absolutely no planning, hoping that God will provide for them – a fatalistic approach that has harmed the country to no end. 
The world malnutrition and hunger has put the philosophical approach that every child brings its own food to rest; however, it is still considered a valid excuse for having large families. What parents do not realize is that their malnourished children are not only disadvantaged as children, they will remain so as adults and will earn at least 20% less on average than those who have had a healthy childhood.
The country’s population is estimated to go up to 300 million by 2030, and our water resources – necessary for food growth, agricultural, dairy and poultry farming, hygiene and sanitation – are dwindling fast. Pakistan has slid from being a water affluent country to a water scarce country; imagine how bad the situation would be with 120 million additional mouths to feed and even less food & water than we have right now.
22 per cent of the people in Pakistan can never afford to buy staple foods such as meat, milk, or vegetables for their families every week, yet they keep on adding to their families. The policy makers and decision makers have to take notice now and take measures to realistically deal with this issue. Poverty reduction measures like Benazir Income Support Programe alone, can never tackle the population time bomb, it has to be paired with stringent population control actions.
In a country where advocating family planning is still a taboo, we need to address this issue as an emergency. There are sections in the society that take pride in the fact that we will become the most populous Muslim nation soon. What is the point in taking pride in producing world’s biggest group of hungry, malnourished children and adults with limited abilities to fend for themselves and lacking prospects for future growth.
We need to create a society where small families are socially desirable and it can be created through deliberate social engineering by the state and clergy. It has already happened in Iran and Bangladesh, and it can happen in Pakistan as well. 
First published in The Express Tribune
PS: Those who accuse me of being anti PTI should know that this piece was neutral, discussed a clear and present danger and never once mentioned ‘he who cannot be named’ yet one of the most dismissive comment I received on the newspaper website was by a PTI troll who prefers to hide behind the alias of Frank Observer. This is what he wrote: 
I’m sick of the liberals, wealthy and the privileged of this country lecturing the underprivileged on how to lead their life. Just because you had the privilege of western education does not mean that you can treat the ordinary working class of this country as ignorant and brainless individuals who need to be told by the upper class like yourself how many children they should have. I believe one should have as many children as one likes, and it should have no bearing on inequality, poverty and injustice in society. I for one don’t need your expert advise in my personal life. So thanks but no thanks. Also, you are distorting attention from the real root causes of inequality and poverty, which are embedded corruption in society, dishonest, selfish, and incompetent politicians and people like yourself who instead of lecturing the politicians are turning this country into a nanny state by dictating our personal lifes to the extent that we should now listen to you for family planning. Guys, bring down the statusquo in the next general election and vote for Imran Khan.

I rest my case 

Jun 23, 2010 - population, published work    20 Comments

Living and dying in Pakistan

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Something really sad happened last week: Akbar Ali poisoned himself, his wife and three of his six children because of poverty. The man and his daughters are dead, while the wife is still alive.  Only God knows what he must be thinking before he decided to take the toxic pills and leave his younger children to suffer alone. But this is something we will never know. Akbar was a worker at a garment hosiery factory and lost his job because the factory closed due to the current energy crisis. His problems compounded because he had a large family to support.

This is not the first poverty related suicide in the country and it won’t be the last. Berating the government for rising poverty will not make much difference unless it is backed by some serious thinking and action to tackle the issue. Akbar and his family would have been alive if he had a smaller family.

The biggest threat to Pakistan is neither its hostile neighbour, nor an international Zionist conspiracy. Rather, it is the country’s rising population. Pakistan’s population grew exponentially — from 33 million in 1947 to over 180 million in 2009. With over three million Pakistanis born every year, Pakistan is the second largest contributor to the world population after India. The total fertility at 4.0 is highest in the region as women in Pakistan have more children than its neighbours.

Although Pakistan initiated its first population control programme in the 1950s, it has not achieved much since then. There is minimal impact on use of contraceptives (only 23.9 per cent) and fertility has not reduced dramatically like it has in Bangladesh and Iran, although they started their family planning programmes in the 1970s and 1980s, respectively.

One of the reasons for the failure of family planning programmes in Pakistan is the administrative structure. Family planning is curiously separate from the health ministry and while it comes under the federal government, health is a provincial subject which completely de-links the two. Amalgamation of family planning in health is integral to achieve any success. Provision of all health services should be linked with family planning. The government needs to be pro-active in teaching young people about family planning and sternly deal with populist politicians who try to derail any such educational efforts.

A coherent approach is needed to combat the social and cultural stigma attached to it and it should be combined with effective service delivery in all parts of the country. Running adverts on TV is useless if the information provided on ground is ineffective and outreach activities are non-existent. To date, the biggest reason for the failure of the programme has been the lackadaisical attitude of successive government’s and lack of political commitment. Unless that is altered, change will remain elusive.

Forty per cent of Pakistan’s population lives below the poverty line and it can no longer ignore the fact that small families can help in coping with poverty more effectively. The government needs to realise and impart this message to others that low birth rates are needed to create national and personal wealth. Problems of high unemployment, increasing poverty, floundering education system, crises of food, water and energy will be exacerbated if we continue to add more and more people. If the population growth is not checked on priority basis, the country will be undone by the sheer number of its own people.

Originally written for Express Tribune 
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