“The downward trend, in terms of donor funding for international family planning, since the middle of the 1990s to around 2006 has been reversed,” José Rimon II, senior program officer for global health policy and advocacy at the Bill and Melinda Gates Foundation, told ECSP Director Geoff Dabelko following a discussion on the future of family planning at the Woodrow Wilson Center.

“Poor countries can’t begin to deal with food issues, with economic pressures, with conflict and shortages of water and grassland that may lead to social conflict, unless they begin to deal with population problems,” journalist Nicholas Kristof tells ECSP Director Geoff Dabelko in a video interview.

“Water shortages,” warns South Asia scholar Anatol Lieven, “present the greatest future threat to the viability of Pakistan as a state and a society.

This warning may be overstated, but Pakistan’s water situation is deeply troubling, as described in a new report from the Woodrow Wilson Center’s Asia Program, Running on Empty: Pakistan’s Water Crisis.

Water availability has plummeted from about 5,000 m3 per capita in the early 1950s to less than 1,500 m3 per capita today. As Simi Kamal reports in the first chapter of Running on Empty, Pakistan is expected to become “water-scarce” (below 1,000 m3 per capita) by 2035—though some experts project this could happen in 2020, if not earlier.

In an unstable nation like Pakistan, water shortages can easily become security threats. In April 2009, alarm bells sounded when the Taliban pushed southeast of Swat into the Buner district of the Northwest Frontier Province. Not only is Buner close to Islamabad, it lies just 60 kilometers from the prized Tarbela Dam, which provides Pakistan with billions of cubic meters of precious water for irrigation each year.

Soaked, Salty, Dirty, and Dry

According to Kamal, Pakistan faces significant and widespread water challenges:

• Inefficient irrigation.
• Abysmal urban sanitation.
• Catastrophic environmental degradation.
• Lack of water laws to define water rights.
• Lack of a sound policy on large dams.

An arid country dependent on agriculture, Pakistan allocates more than 90 percent of its water resources to irrigation and other agricultural needs. Unfortunately, intensive irrigation and poor drainage practices have waterlogged and salinized the soil.

Women and Water in Rural Pakistan

Rural women and small farmers are particularly affected by Pakistan’s water crisis. Women bear the primary responsibility for obtaining water, but have been traditionally been shut out of government water-planning and decision-making processes. However, government and media initiatives, described by Sarah Halvorson in Running on Empty’s chapter on water and gender, are increasingly highlighting the importance of women’s participation.

Meanwhile, Adrien Couton reports that Islamabad’s water projects mainly benefit large and wealthy farmers—even though Pakistan has approximately four million farms smaller than two hectares.

Pakistan’s Thirsty Cities

With most of Pakistan’s water dedicated to agriculture, less than 10 percent is left for drinking water and sanitation. A quarter of Pakistanis lack access to safe drinking water—and many of them reside in the country’s teeming cities.

Worse, the drinking water that does exist is quickly disappearing. Lahore, which relies on groundwater, faces water table declines of up to 65 feet, as described by Anita Chaudhry and Rabia M. Chaudhry in their chapter on the city.

The scarcity of clean water in the cities—exacerbated by a lack of wastewater treatment—is a leading cause of deadly epidemics. At least 30,000 Karachiites (of whom 20,000 are children) perish each year from unsafe water.

Pakistan Must Act Now To Solve the Water Crisis

Pakistan arguably has the technological and financial resources to provide clean water. So what’s the hold-up? In her chapter on public health, Samia Altaf argues that the problem is the absence of a strong political lobby to advocate for water—and that no one holds Islamabad accountable for fixing the problem.

The report offers more recommendations for addressing Pakistan’s water:

• Invest in existing infrastructure and in modest, indigenous technology.
• Strike appropriate balances between centralized and decentralized management.
• Devote more attention to water allocation and distribution on local/individual levels.
• Understand the links between agricultural and urban water pressures.
• Embrace the role of the private sector.
• Conserve by favoring water-saving technology; less water-intensive crops; and water-conserving urban building design.
• Address structural obstacles like systemic inequality and gender discrimination.
• Take immediate action. Tremendous population growth and rapidly melting glaciers in the Himalayas ensure that the crisis will deepen before it eases.

The need for immediate action cannot be overstated. While Pakistan’s water crisis may not threaten its viability, it is undeniable that so long as the crisis rages on, essential components of the nation—such as the vital agricultural economy, the health of the population, and political and economic stability—lie very much in the balance.

Michael Kugelman is the Wilson Center’s South Asia specialist. He is co-editor, with Robert M. Hathaway, of the recently published Wilson Center book Running on Empty: Pakistan’s Water Crisis, on which this post is based. Much of his work has focused on resource shortages in Pakistan and India.

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Celebrity philanthropists such as Bono, Angelina Jolie, and George Clooney have shined their star power on global issues like AIDS, genocide, and refugees. In last month’s Vogue, supermodel Christy Turlington turned the light on one of the most overlooked problems: maternal mortality.

“I have had a woman say to me, ‘This PHE [population-health-environment approach] makes sense to me because I do not live my life in silos. I live my life in a way that all these things are integrated, and what you are saying to me makes sense, because my life is one of integration,’” said the Sierra Club’s Roger-Mark De Souza, in his lilting Trinidadian baritone.

“Knowing is not enough; you must act and let your government know that family planning is a right and saves lives,” said Maurice Middleberg of the Global Health Council at a recent event in Chapel Hill.

The other panelists at “How Can Family Planning Efforts Help Us Achieve the Millennium Development Goals?” (Dr. Martha Carlough of UNC, Dr. Ward Cates of Family Health International, and Pape Gaye of IntraHealth International) all provided compelling statistics demonstrating the effectiveness of family planning as an intervention that addresses the Millennium Development Goals (MDGs).

MDGs 4, 5, and 6 – reducing child mortality; improving maternal health; and combating HIV/AIDS, malaria, and other diseases, respectively – all have obvious connections to health and woman’s reproductive health. An unmet need for family planning, which is measured as the percentage of women of reproductive age who desire to space or limit their births but are not using contraception, can undermine the achievement of these goals.

For example, very early motherhood not only increases the risk of dying in childbirth, it also jeopardizes the well-being of surviving mothers—and their children, too. A child born to an adolescent mother has a greater risk of dying in infancy or childhood.

“Contraception is the best-kept secret in HIV prevention,” said Dr. Cates, who cited research that found that “current contraceptive use in sub-Saharan Africa prevents an estimated 577,200 unplanned births to HIV-infected mothers” and thus prevents the birth of an estimated 173,000 HIV-infected infants each year.

Family planning can help meet the other MDGs, including ending poverty and hunger (Goal 1); providing universal primary education (Goal 2); and promoting gender equity (Goal 3). Young mothers frequently miss out on education and socio-economic opportunities. Being able to make their own decisions about family planning and reproductive health can empower women and improve gender equity. When women are given equal opportunities for education, health, and employment, they are more likely to invest in the education and care of their children. This helps them break the cycle of poverty, hunger, and disease.

Although the MDGS don’t include any formal targets for sexual and reproductive health, the UN Millennium Project has stated that the MDGs cannot be achieved in low-income countries without access to sexual and reproductive health services, including family planning. The panelists agreed that family planning is a cost-effective intervention that provides broader positive benefits for development.

But the real strength of their presentations lay in the personal stories behind the statistics. Middleberg closed the discussion with a story about a woman in Latin America who told him that she loves her husband but was afraid of him every time he touched her. Now, after having undergone sterilization, she no longer worries and can love her husband with no fear of becoming pregnant.

A mother of six interviewed in a 2009 news article about the Philippines’ new family planning bill said, “How can one keep on having children? We don’t earn enough to feed them, much less send them to school.” New York Times columnist Nicholas Kristof interviews a Haitian woman with 10 children in a dramatic video interview, “Saving Lives with Family Planning.”

Underlying all of these facts and stories is the belief that one’s health and well-being, including access to family planning, is a right. But as Middleberg said, believing is not enough.

EngenderHealth, an international reproductive health organization working to improve the quality of health care in the world’s poorest communities, is asking Americans to create a video explaining why we should care about international family planning. Contribute your thoughts on YouTube’s Video Volunteers project.

Lisa Basalla, MPH, is a research associate with the Carolina Population Center. She graduated from Case Western Reserve University with a MPH focusing on reproductive and adolescent health. She has worked with Johns Hopkins University’s Center for Communications Programs on its reproductive health knowledge management project as well as a HIV-prevention behavior change communication project in Malawi.

Photo: A billboard promoting family planning in Phnom Pehn, Cambodia. Courtesy flickr user olerousing.

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The Population Reference Bureau’s 2009 World Population Data Sheet shows that global population numbers will reach 7 billion in 2011. Among its key findings, PRB notes that “population growth is one root cause of increases in global greenhouse gas emissions. But the complexity of the mechanisms through which demographic factors affect emissions is not fully taken into consideration in many analyses that influence governments’ climate change mitigation efforts.”

The U.S. Global Change Research Program, which integrates federal government research on climate change, released Global Climate Change Impacts in the United States this week. The report examines climate’s likely impacts on various regions of the country.

The Guardian examines ongoing conflicts over natural resources between indigenous people and governments.

In her final dispatch from the Bonn climate negotiations, Population Action International climate director Kathleen Mogelgaard notes the conspicuous absence of demography in international climate discussions.

A webcast is now available of the Johns Hopkins University-Population Reference Bureau symposium “Climate Change and Urban Adaptation: Managing Unavoidable Health Risks in Developing Countries.”

A new policy paper from the World Bank seeks to answer the question, “Do the households in game management areas enjoy higher levels of welfare relative to the conditions they would have been in had the area not been designated as a game management area?”

A Commission on Climate and Tropical Forests, led by John Podesta, president and CEO of the Center for American Progress, and Lincoln Chafee, former Republican senator from Rhode Island, has been formed to advise President Obama on how to reduce tropical deforestation through U.S. climate change policies, reports Mongabay.com.