Every day it seems the headlines bring new worries about the future of Pakistan. But among the many challenges confronting the nation—including a growing Taliban insurgency—one significant problem remains largely undiscussed: its rapidly expanding population.

Consider this: Pakistan’s population nearly quadrupled from 50 million in 1960 to 180 million today. It’s expected to add another 66 million people—nearly the entire population of Iran—in the next 15 years. UN projections predict that by the late 2030s, Pakistan will become the fourth most populous country in the world, behind India, China, and the United States.

And believe it or not, the demographic outlook for Pakistan got bleaker in recent weeks. The new medium-range UN projections for Pakistan’s total population have been raised to 335 million for 2050—45 million higher than the UN projection just two years ago. Why the change? Because birth rates aren’t falling as had been predicted—women in Pakistan have an average of four children—and unmet need for family planning remains high.

The case of education provides a snapshot of how these demographics affect Pakistan, from basic quality-of-life issues to the country’s overall stability. Even though the official literacy rate in Pakistan has increased from about 18 percent to 50 percent since 1970, the number of illiterate people has simultaneously jumped from 28 million to 48 million. The literacy rate for women stands at a shockingly low 35 percent.

As public schools have become increasingly overcrowded, more parents have turned to madrasas in an attempt to educate their children—or at least their sons. It’s no secret that some of Pakistan’s madrasas have ties to radical religious and terrorist-affiliated organizations.

So what does this portend for the future?

Even assuming large infusions of assistance from the United States, Pakistan’s public school system will become even more overwhelmed in the years ahead. Building enough schools and hiring enough teachers would be daunting in any country, let alone one facing as many challenges as Pakistan. It seems likely that enrollments in madrasas will swell, and more children will face a future with no schooling whatsoever. Clearly, this is not a recipe for a more stable and peaceful Pakistan.

Pakistan’s rapid population growth is not inevitable, however. A key driver is lack of access to family planning, which is symptomatic of the overall poor status of women and girls. More than 25 percent of Pakistani women have an unmet need for family planning—meaning the demand is clearly there—and nothing in the Koran prohibits its usage. In other majority-Muslim nations, such as Algeria, Bangladesh, and Iran, family planning has been prioritized and is widely used.

Unfortunately, family planning programs in Pakistan and many developing countries have suffered from both inattention and funding cuts in recent years. Traditionally, the United States has been a major source of funding and technical assistance, but since 1995, U.S. international family planning assistance has fallen 35 percent (adjusted for inflation), even as demand has increased.

Today, more than 200 million women—many of them in the most impoverished parts of the world—have an unmet need for family planning. In countries like Pakistan, the resulting rapid population growth makes it increasingly difficult to provide sufficient education, health care, housing, and employment—and depletes land, water, fisheries, and other vital natural resources.

The Obama administration recently proposed a new U.S. assistance strategy for Pakistan—and a key component is a significant increase in development and economic assistance. Let’s hope it will include an increase for family planning. It would be a wise investment in a brighter, more stable future—for Pakistan and for the world.

Tod Preston is vice president for U.S. government relations at Population Action International.

Photo: Children in Jinnah Colony, Karachi, Pakistan. Courtesy of Flickr user NB77.

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Integrated population-health-environment (PHE) programs “are very cost-effective ways” to develop “community capacity—to strengthen their know-how, and bring…in some additional appropriate technologies” to promote livelihoods, says Leona D’Agnes in this short expert analysis from the Environmental Change and Security Program.

The New York Times’ Nicholas Kristof aptly describes the connections between poverty and lack of access to family planning in a recent op-ed, using a Haitian woman named Nahomie as an example. He rightly argues that we won’t be able to end poverty until women are able to choose how many children to have. He also notes that relative funding levels for family planning have decreased in recent decades, and that development professionals’ attention has shifted to other issues. Yet 201 million women around the world still have an unmet need for family planning.

One of the few off notes in Kristof’s article, I think, is his portrayal of family planning as a difficult, challenging intervention. Of course, it is more complicated than simply giving birth control pills to women and condoms to men. But community health workers with little formal education have been successfully trained to deliver family-planning services to remote communities in developing countries.

While I recognize he has space limitations, Kristof neglected to mention that in Haiti, poverty and lack of access to family planning are linked to severe environmental degradation and natural disasters. A 2006 U.S. Agency for International Development (USAID) report found that “the root causes of environmental disaster in Haiti are acute poverty, rapid population growth, and unplanned urbanization.” To meet their daily needs, the rapidly growing population resorts to unsustainable agricultural and energy practices that deforest and erode the countryside—or move to increasingly crowded cities.

At a Wilson Center presentation in August 2006, USAID’s Rochelle Rainey reported that 40 percent of Haitian women wished to use contraception but did not have access to it. Modern contraceptive methods are used by only 23 percent of the population, contributing to a total fertility rate of 4.9 children per woman. As Ronald Toussaint, a Haitian biodiversity specialist, said: “If we don’t address population issues, it is like the Creole phrase, ‘wash your hands and then rub them in the dirt.’”

Photo: Children in Haiti. Courtesy of Flickr user Billtacular.

“If countries cash in on this window of opportunity” opened by falling birth rates, “it makes a big difference in their chance for development,” says Steven Sinding in this short expert analysis from the Environmental Change and Security Program. “While it is not a sufficient condition for economic growth, decreasing fertility is certainly a necessary condition for doing so.”

“We know how to do family planning, we know what it costs, and we know that it works,” said Joseph Speidel of the University of California, San Francisco, at the launch event for Making the Case for U.S. International Family Planning Assistance sponsored by the Wilson Center’s Environmental Change and Security Program on March 17, 2009. The key missing element, he said, is political will.

Speidel and his co-authors—all former directors of the U.S. Agency for International Development’s (USAID) Office of Population and Reproductive Health—argued that Congress should more than double spending on international family planning in the coming years for health, economic, and environmental reasons.

The Big Ask

Making the Case recommends that the USAID population budget be increased from $457 million in FY2008 to $1.2 billion in FY2010, growing further to $1.5 billion in FY2014. According to the speakers, this increase is necessary to:

• Meet the “enormous pent-up and growing unmet need for family planning”;
• Stabilize population growth rates, especially in Africa; and
• Achieve the Millennium Development Goal of universal access to reproductive health services.

Duff Gillespie of the Johns Hopkins Bloomberg School of Public Health showed that U.S. funding for family planning has been stagnant in real dollars since the late 1960s, despite the fact that there are 200 million women with an unmet need for family planning. Without champions within USAID and the Obama administration, he said, the dollar amounts appropriated for family planning are unlikely to increase.

Speidel explained that growing populations, combined with stable or increasing rates of consumption, contribute to climate change. The current rate of population growth is unsustainable, given Earth’s finite natural resources. Changes in behavior and technology—such as eating less meat or using clean energy—could improve environmental outcomes.

Absolute numbers still matter, however: Although population growth rates have declined, the global population continues to grow. Addressing the nearly one-half of all pregnancies that are unplanned would bring great health and environmental benefits, said Speidel.

According to Steven Sinding of the Guttmacher Institute, although most economists and demographers agree that economic growth leads to lower fertility, whether lower fertility reduces poverty is still a matter of much debate. But the “demographic dividend” generated by slowing population growth is a reality, he argued, and countries can benefit from it if their institutions are prepared to take advantage of it. For example, a USAID study found that one dollar invested in family planning in Zambia saved four dollars in other development areas.

A Broader Base of Support

Ruth Levine of the Center for Global Development urged the authors to avoid “preaching to the choir.” One way to engage other constituencies interested in demographic issues is to broaden the scope of “population” to include not only family planning, but also migration, urbanization, and other key demographic issues.

In addition, convincing World Bank economists, especially the Bank’s next president, of the connections between declining fertility and poverty reduction should be a priority, said Levine, because developing countries put a lot of stock in the Bank’s advice.

By Gib Clarke
Edited by Rachel Weisshaar

Photos: From top to bottom, Joseph Speidel, Duff Gillespie, Steven Sinding, and Ruth Levine. Courtesy of Dave Hawxhurst and the Wilson Center.

“The Terai Arc Landscape has a very high population growth rate; people are very much dependent on the natural resources,” says Sabita Thapa in this podcast from the Environmental Change and Security Program.

“One dollar invested in family planning has a return on the investment of four dollars,” says Duff Gillespie in this expert analysis from the Environmental Change and Security Program.

“If we could do something about unintended pregnancy – which is about 80 million a year – we could dramatically reduce population growth,” and reduce pressure on the environment, says Joseph Speidel in this short expert analysis from the Environmental Change and Security Program.

Speidel, adjunct professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, discusses population, health, and environment issues, and offers solutions for the way forward.

To learn more, please see a full summary and complete video of Joseph Speidel speaking recently at a March 17, 2009, Wilson Center event, “Making the Case for U.S International Family Planning Assistance (Report Launch).”