While Population Growth Rate (PGR) has declined from over 3 percent in previous decades to its current level of 2.1 percent per annum, Pakistan still has an unacceptably high rate of growth compared to other developing countries. Therefore the Government of Pakistan is attaching the highest priority to the lowering of the population growth rate (PGR) from its current level to 1.9 percent per annum by the year 2004 and to reaching replacement level of fertility by the year 2020.

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. It constitutes population momentum in the future that has serious implications for provision of schooling, health services and other basic amenities of life for the coming decades. The Population Welfare Programme has been able to create universal awareness about family planning with the current contraceptive prevalence rate of 30 percent.  The challenge is to ensure continuous use by current users and increase existing CPR by meeting the percent unmet need for family planning services of currently married women along with sustaining the demand of new entrants in the reproductive age group.

Over one third of Pakistanis are living in poverty. The impact of population growth on poverty is obvious, since poorer families, especially women and marginalized groups bear the burden of a large number of children with much fewer resources further adding to the spiral of poverty and deterioration in the status of women. This large part of the population is constrained to live in poor housing and sanitation conditions and lack of access to safe drinking water. In particular, income poverty leads to pressures on food consumption and adversely affects caloric intakes and increasing malnutrition in poorer families and contributes to high levels of child and maternal morbidity and mortality. Furthermore, rapid population growth contributes to environmental degradation and depletion of natural resources.

The dynamics of Pakistan’s demographic variables compel that a vigilant eye be kept on the phenomena of population growth. The Population Policy of Pakistan 2002 is in congruence with the ICPD paradigm shift to holistic care of the family, client centered quality care in family planning & RH. The government’s Poverty Reduction Strategy and the Population Sector perspective Plan 2012 framework sets out improvements in the quality of life of all persons, including children, adolescents, adults, aged, both male and female.  

Population and development inter-relationships have been elaborated most comprehensively in the ICPD Program of Action in 1994 to which Pakistan is a signatory. The main thrust of ICPD is that each country bring into balance its resources with population through a policy, which is in accordance with its own social, cultural, religious and political realities.

This Population Policy is designed to achieve social and economic revival by curbing rapid population growth and thereby reducing its adverse consequences for development. It is intended to achieve a reduction in dependency ratios, to alleviate pressures on dwindling resources and to help in the reduction of poverty. The Population Policy has several wide-ranging consequences for the economy, polity, human rights and the long-term prosperity of Pakistan.

The Population Policy is the outcome of a participatory process and enjoys the consensus of all stakeholders and partners, within government, NGOS and, civil society.

  VISION

The overall vision of the Population Policy is to achieve population stabilization by 2020 through the expeditious completion of the demographic transition that entails declines both in fertility and mortality rates.

  GOALS

The Population Policy seeks to:-

• Attain a balance between resources and population within the broad parameters of the ICPD paradigm.
• Address various dimensions of the population issue within national laws, development priorities while remaining within our national social and cultural norms
• Increase awareness of the adverse consequences of rapid population growth both at the national, provincial, district and community levels.
• Promote family planning as an entitlement based on informed and voluntary choice
• Attain a reduction in fertility through improvement in access and quality of reproductive health services.
• Reduce population momentum through a delay in the first birth, changing spacing patterns and reduction in family size desires.

  OBJECTIVES

Short Term:

• Reduce population growth to 1.9 percent per annum by 2004.
• Reduce fertility through enhanced voluntary contraception to 4 births per woman by the year 2004.

Long Term:

• Reduce population growth rate from 1.9 per cent per annum in 2004 to 1.3 percent per annum by the year 2020.
• Reduce fertility through enhanced voluntary contraceptive adoption to replacement level 2.1 births per woman by 2020.
• Universal access to safe family planning methods by 2010.

  STRATEGIES

• Develop and launch advocacy campaigns to address special groups, such as, policy makers, opinion leaders, youth and adolescents.
• Increase ownership of population issues by the stakeholders and strengthen their participation in the processes of service delivery and program design.
• Reduce unmet need for family planning services by making available quality family planning  & RH services to all married couples who want to limit or space their children.
• Adopt a shift from target oriented to people-centered needs and services.
• Ensure the provision of quality services especially to the poor, under-served and un-served populations in rural areas and urban slums.
• Coordinate and monitor a comprehensive network of family planning & RH services in Pakistan.
• Build strong partnerships with concerned Line Ministries, Provincial line Departments particularly Health, Non-Governmental Organizations and the private Sector including the industrial sector to maintain standards in family planning by providing assistance/guidance through advocacy, training, monitoring and other means of participation and quality assurance.
• Strengthen contribution to population activities by civil society players, particularly NGOs and media.
• Expand the role of the private sector by making contraceptives accessible and affordable of contraceptives through social marketing of contraceptives and through local manufacture of contraceptives.
• Decentralize program management and service delivery to provincial and district levels.
• Ensure availability of the four prioritized areas of the Reproductive Health Package, i.e. family planning, safe motherhood, infant health and RTI / STDs through nationwide service delivery outlets in the public & private sector.
• Harness support, cooperation and involvement of men in strengthening the family as the basic unit of society and in small family size decision making.
• Ensure Population and Family Life Education for school and college students.

  AREAS OF POLICY FOCUS

Population mainstreaming entails incorporation of the population factor in development plans to promote social justice and address poverty through socio-economic development in the context of migration, urbanization, environment and sustainable growth. This Policy is developed and co-ordinated through a multi-sectoral strategy towards population issues in which there is a synergy between population dynamics, economic revival and poverty alleviation programmes. The connectivity of population with poverty, status of women and sustainable development will be established because they are intrinsically interrelated and progress in any component can catalyze improvement in others.

The strategy of this Policy is essentially aimed at tackling the more immediate objectives of reducing the high unmet need for family planning services through bringing FP services into the fold of health outlets, developing greater partnerships between various arms of the public sector and public private sector partnerships. The reduction of the gap between what married women want in the way of fewer children and longer spacing and utilization of family planning services will be the first thrust of this policy.

Ensuring quality in a wide range of family planning services will be the major short-term goal of this policy. In the longer run whilst the public sector will not relinquish its responsibility as service provider, recognizing the magnitude of the task it will fully engage the non-governmental and private sectors. To achieve this requires the building of capacity of non-governmental and private sector partners to cope with future needs of service delivery.

Service provision in family planning & RH will concentrate on improving access & expanding coverage with special emphasis on rural & under served areas and slums. This will be achieved through Population Welfare Program’s infrastructure & through the health service delivery infrastructure, partnerships with private sector and networking with civil society. The provision of family planning service will include RH, counselling services for attitudinal change for enhanced family planning practice and ensuring adequate supplies. Contraceptive choice is to be widened by providing training to service provider in latest techniques. Quality service provision will be ensured through regular monitoring.

Service delivery will specifically include:

1. Strengthening Community-Based Services: Population in rural and remote areas where there is established unmet need do not have adequate access to affordable family planning & RH services. These communities need special attention, which is being addressed through community-based workers and out reach services. Female community workers will provide family planning services and serve as a referral for clinical methods. Male community workers will at the grassroots provide information and counselling, health education & awareness through IPC.
2. Linkages with Institutional Service Delivery System: The high unmet need for family planning requires a  concerted effort, by all stakeholders. The large Health Department infrastructure, relevant Provincial Line Departments, Public & Private Sector Institutions and others will provide comprehensive family planning services and attend to referrals.
3. Strengthening and upgrading the existing Family Welfare Centers: The gap in universal awareness of family planning & the contraceptive use rate will be addressed through quality client centered family planning services which are accessible and affordable. Family Welfare Centres will be strengthened and upgraded to function within the ICPD framework of integrated service centres, which address the holistic needs of a family. In addition to family planning & RH services, basic social services will be offered in an integrated manner and will be run by a local management committee in which elected women councilors will be actively involved. Serving the community in a coordinated manner.
4. Public-Private Partnerships: Social marketing will be encouraged and facilitated to intensify efforts in urban / semi urban areas and move out to rural areas by associating registered medical practitioners, hakims, homeopaths, paramedics, chemists/druggists and networking with CBOs. These activities would be built around advertisement, outdoor publicity, point of sale promotion, Inter Personal Communications, training and dispensation of products including interventions such as Norplant Implant and facilities for voluntary surgical contraception. Initiatives for local production of contraceptives would be supported and facilitated to reduce dependency on imported products.
5. Male Involvement: Men have a dominant role in decision making in the family setting, their active involvement is, therefore, essential in planning family size, supporting contraceptive use, assuring adequate nutritional status of pregnant women, arranging skilled care during delivery and avoiding delay in seeking emergency obstetric care. Men need to be sensitized to their role as responsible fathers and in recognizing the critical role of women in the health of the family. For enhancing male involvement, male workers have been recruited in the rural areas to engage into a regular dialogue with male community and sensitize the elders and parents. Provision for male contraceptive surgical procedures will be strengthened, and the method promoted.
6. Improve and Ensure Quality of Services: Provision of quality services need to be ensured to address the large unmet need for family planning and for improving contraceptive use rate. Accessibility of services, attitude of service providers, their technical skills, counseling and follow up are the main pillar for quality service provision. Basic standards for quality service provision are required to be formulated through a consultative process of all stakeholders. For ensuring high quality services of uniform standards at all service outlets a system of technical supervision and monitoring needs to be institutionalized. MoPW will be responsible for laying down standards for family planning service provision and will be involved along with other stakeholders in preparation of protocols for monitoring family planning standards and will also be responsible to make required improvements. Training, orientation & refresher courses will be conducted periodically at training institutions of MoPW.

The Policy addresses those who being illiterate lack knowledge or have inhibitions to practice family planning. There is need also to address prevalent fears and misconceptions. A change in beliefs and the value system is required to reduce fertility to replacement levels. This will be done through a carefully designed program of advocacy and promotional campaign, which addresses all segmented target groups. 

The Policy also addresses the issue of population momentum, which due to its current ever-largest cohort of adolescents entering reproductive lives will be the main engine of population growth in coming decades. The two-pronged strategy addresses adolescents through population and family life education in the formal & non-formal education sector and reaches out to young couples with appropriate media, interpersonal messages and services.

An Advocacy Campaign will be devised to build and sustain adoption of the small family norm.  It will raise awareness about population and development issues by engaging change agents to communicate on the impact of runaway population growth on the lives of the individual, family and communities.

• Advocacy programmes will utilize all channels of communication particularly the media, interpersonal communication and mass education to convey the macro and micro effects of runaway population growth. It will address the public and various influential groups as follows:
• Public Representatives: will be given orientations on the population problem and its critical link to social and economic progress. They will be invited in turn to be advocates of the programme.
• Policy/Decision Makers: will be targeted to enhance their understanding of the inter-linkages between population and sustainable development, to integrate population variable into their sectoral planning, commit increased level of resources and extend overall support to the population sector.
• Opinion Leaders: will be sensitized about the continued benefit of birth spacing, safe motherhood and responsible parenthood for enriching and improving the quality of life.
• Men: Males will be sensitized that family planning is a need for their own health and family well being.
• Youth & Adolescents: Youth are the future generation and need to be sensitized about the wide-ranging consequences of rapid population growth for the individual, family and nation and, therefore the need to build a mindset for responsible parenthood.
• Medical Profession: medics and paramedics will be motivated to accept family planning as integral to the work of their profession, particularly in the context of primary health care.
• Organized Sector: Organized sector is to be associated as a partner to educate, inform and provide services to their employees through their infrastructure in family planning & RH.
• Intelligentsia/Influential Groups: will be provided information about inter-relationships between population and sustainable development to sustain awareness, understanding and enhance social acceptability of the programme in society.

The following training programme and human resource development would be key features of the strategy:

• Family Planning Training: Population Welfare Programme has a nationwide institutional set-up of Training Institutes. They are equipped not only to provide pre-service and in-service training to all population welfare training personnel but also on an organized basis respond to the training needs of nation building departments, public sector organization and NGOs.
• Human Resource Development (HRD): A Human Resource Development Plan will be prepared for programme personnel. This has assumed added importance because of the need for re-training in new skills and management approaches. In addition, there has been neglect in maintaining the level of programme staff which is currently denuded due to superannuation and limited recruitment. It is proposed to address these needs in the HRD Plan. As a starting point under the devolution plan, District Government personnel will be re-trained in new methodologies of planning, coordination functions, problem-solving skills and improving their capacity to manage activities relating to the population sector.

The Program which to date has been federal will be defederalized with administrative, financial & programme transfers to the provinces: The defederalization will further decentralize the program to the District level in line with Governments devolution plan. This will be done through subsidiarity of the Population Welfare Program at the district level. In addition, Health Departments are mandated to provide family planning services in the primary health care infrastructure.

The Policy recognizes that population is a crosscutting issue, which cannot be addressed in isolation and warrants an institutionalized coordinating mechanism. Coordination is required at all levels within the government and outside and with all stakeholders. This function rests with the Population Welfare Division.

The following interventions would be critical for an effective monitoring and evaluation mechanism:

Management Information System

The Ministry of Population Welfare will ensure a review of its MIS system so that it is based on a District monitoring of socio-economic demographic indicators and incorporates quantitative and qualitative data on programme result based performance.

Logistic Management Information System

It is imperative to institutionalize an uninterrupted supply of a range of contraceptives. Since the policy envisages active involvement of all public and private sector agencies in the dispensation of Family Planning/ Reproductive Health services, therefore an omni watch on the stock position of contraceptives in the services outlets of all sectors would be crucial. This requires a strong and established Logistic Management Information System (LMIS). Efforts would, therefore, be made to introduce a computerized inventory control system at central warehouse for proper records of receipts, issue and for smooth distribution of contraceptive supplies to all outlets.

GIS /Mapping

A proper mapping in each District of health, population welfare, NGO & private sector family planning facilities is visualized, this would reduce duplication of resources, increase coverage especially of un-served and under–served regions by relocating facilities, establish a blue print for effective referral system at the district level, streamline services and finally serve as a tool for planning and monitoring purposes.

NIPS will continue to provide national data analysis and research findings to ensure that planners, decision makers & programmers receive operationally relevant information and analysis on the key interrelationship between population and development variables. Under NIPS mandate it is entrusted with research covering all aspects of population and development such as education, health, women, environment, labor force, aging, adolescents and urbanization. This is in addition to NIPS traditionally strong research areas, which include family planning, fertility, mortality, evaluation for the population programme components etc. The mandate also makes the Institute responsible for imparting training in the field of population and development. NIPS would also broaden its focus to cover a wide range of population and development issues and to collaborate with the community of researchers within and outside the population field in implementing the agreed agenda.

  Funding

The Planning Commission had allocated an amount of Rs.9.5 billion for the Three-Year Development Plan (2002-2005) an average of over 3 billion per annum. Keeping this as a bench- mark, implementation of the Population Policy would require a financial input of Rs.24 billion for the remaining 8 years of Perspective Plan 2012 and subsequently another Rs.16 billion at a declining rate of Rs.2 billion per annum till the year 2020. Hence a total of Rs.49.5 billion requirements are estimated for the next 19 years for achieving the fertility replacement perceived under the Population Policy by the year 2020. Major part of the financial inputs will cover the provision of subsidized contraceptives to the clients, service delivery, training, advocacy, and research and to cover human resource and infrastructure gaps essential for achieving the population policy objectives.