Monday, September 25, 2017


There was an old woman who lived in a shoe
She had so many children, she didn’t know what to do
She gave them some broth without any bread
She whipped them all soundly, and put them to bed

In his article in the New York Times, entitled ‘Pakistan, Let’s Talk About Sex,’ Mohammad Hanif of Exploding Mangoes fame explodes a few myths, including one that imagines that Bangladesh, because it was once more populous and down in the mouth compared to its Western wing, must be so still.
The separation of Bangladesh from Pakistan occurred in a horribly tragic way, but in the long term it was the best thing that Bangladesh did for itself because since then that country’s economy improved. When it was part of Pakistan it had a greater population than West Pakistan, it now has a population of 163 million. That is 44 million less mouths to feed than Pakistan at present.
You wonder how Bangladesh achieved that.
Soon after its separation from Pakistan, Bangladesh adopted a community approach to family planning. Married, literate women of a given community were trained in basic medicine and family planning, and employed to visit homes where they dispensed contraception and referred women to clinics. According to Professor John Cleland of the London School of Hygiene and Tropical Medicine, these women ‘acted as a bridge between the modern medical world and the village. They were literate so they were part of the elite, and as villagers they had credibility among a suspicious and very religious population.’
Bangladesh went further. It prioritised education for women, which delays marriage, and childbirth, and gives women greater control over their lives. By means of these policies, Bangladesh has succeeded in halving its population from six to less than three children per woman, from the 1970s to the present.
Why has Pakistan been unable to achieve the same results? The answer, as for many other things, boils down to government apathy and what is known as ‘religion’ (but is not) standing in the way.
Pakistan once possessed a federal Ministry of Population Welfare. In 2010 the federal Ministry of Population Welfare ceased to exist and the job devolved to the provinces in this, the sixth most populous country of the world with a population of 197,015, 955 as of July this year.
Pakistan employs a network of lady health workers too, but it has failed to go beyond that. There is no stress on education for women. A large segment of the population believes that artificial contraception and family planning are against nature and religion, and almost as many people believe family planning is a Western conspiracy to render the population sterile.
The lack of a considered policy extends to a lack of facilities related to conception and childbirth. The numbers for maternal deaths remain extremely high.
There is another country that had interesting experiences with family planning, and that country is Iran.
Once upon a time, couples in Iran were required to attend classes that educated them about contraception. They had to do this before they were married. And contraceptives were free. The government promoted childbirth not before 18 years of age, and after 35.
But the government in Iran did not make education a ‘key facet of the program’ which meant that adults could not make informed choices in the matter. It also failed to ‘address religious opposition to family planning.’ That meant that even though contraception was easily available, and it was free, only 37 percent of women accessed it. The birth rate did not go below seven children per woman.
Of course when the monarchy fell, the so -called Islamic Revolution brought with it the usual interpretation of religion. The legal age for marriage was dropped to thirteen, and the government campaigned to increase the population. Within ten years, by 1986, the population grew from 34 million to 50 million. After the long Iran Iraq war, the government realised it wasn’t easy to rebuild an economy and manage a large population. Suddenly what was un-Islamic before ceased to be so, and a ‘One Is Good, Two Is Enough’ campaign was launched. In fact, when the Minister of Health requested it a fatwa was issued which said that contraception was fine by religion, so long as it was not harming anyone’s health, and so long as it was used with the husband’s consent. In ten years’ time the number of woman accessing birth control went up to 74 percent. The program also impacted on women’s lives. Women became more educated.
This worked. The population fell even below the target six children per woman. It fell to four.
Sadly things were reversed yet again. ‘More Children, A Happier Life’, states a bill board in Tehran, showing a father with his five children, cycling happily on a cycle meant for six. There is no mother in the picture. These facts, incidentally, are taken from a feminist magazine, called
Pakistan can learn several things from its own experiences in the field, and from both Bangladesh and Iran. It can learn to start with that coyness in such matters gets no results. Sex is something that must be discussed, tradition notwithstanding.
Pakistan must realise that planning, long and short term is crucial, geared to the particular conditions in the field. That funding a project is not enough. It is also not enough to make contraception free, or inexpensive. The public must be educated so it can judge the benefits on family planning for itself. And in the long term it is important that women’s education is stressed as well as men’s.
Teams of health workers should belong to the very community they visit to obtain the trust of the people. They must be qualified so that the public knows it is worth taking their recommendations on board. They must also not be seen as a threat to the religious brigade, the existence of which is a common factor in all these three countries.
In conservative societies religion and men have a greater voice than women. Religion or what passes as such has the power to make or break societies, men the power to make and break families. Until women are able to stand up for themselves the religious brigade and men must be on board for any or all of this to succeed. Then alone can family planning succeed in any meaningful sense.

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