“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.

“Statistics should be the intellectual sidewalks of a society, and people should be able to build businesses and operate on the side of them,” said Gapminder Foundation Director Hans Rosling at a discussion hosted by the Wilson Center’s Environmental Change and Security Program on May 26, 2009. In his spirited and often humorous remarks, Rosling praised the 25-year-old Demographic and Health Surveys (DHS) program, which is funded by the U.S. Agency for International Development (USAID) and implemented by Macro International, Inc., as “public-private partnership at its best.” The DHS program works with countries’ health ministries to collect data on family planning, child and maternal health, disease prevalence, and other health indicators, and makes the data freely available for public use.

The Beauty Behind the Data

Rosling uses Gapminder’s signature “moving bubble” Trendalyzer software—which Google purchased and made available as “Motion Chart”—to graphically demonstrate global health, economic, and environmental trends. Gapminder uses data from several sources, including DHS surveys, to generate its illuminating displays.

“Sweden, during the last hundred years, didn’t achieve [the] Millennium Development Goal rate” for yearly reductions in child mortality, Rosling explained. “We are putting goals for Tanzania, Bangladesh that [were] never…achieved by any country in West Europe or North America.” The remarkable thing, said Rosling, is that many low-income countries are achieving or even surpassing these demanding targets.

Free Access, Unified Formatting Are Top Priorities

Rosling stressed that access to data must be free, and admonished the World Bank, the Organisation for Economic Co-operation and Development (OECD), and others who charge for their statistics. “They say, ‘No, we can’t give the data to the people because they will make wrong comparisons, and they will make wrong conclusions,’” Rosling continued, “and I say ‘Yes, we call it freedom.’”

Rosling cautioned against “database-hugging disorder,” or statisticians’ tendency to guard their data because of concerns about budgets or misinterpretation. A better approach, he insisted, is to embrace innovations like the Creative Commons license, which encourages sharing information by offering a range of easy-to-understand legal protections and freedoms for creative works, data, and information.

In addition, “we don’t have a unified format for data,” Rosling said, and “that’s why the transaction costs are so enormously high, and that’s why those who put data together in unified format charge for it.” He cited YouTube as an excellent medium for broadening public distribution of data. To the audience’s delight, a live Google search for “sex, money, and health” returned a YouTube clip of one of his own presentations as its top hit.

Improving Lives With Data

“The worst environmental problem today is that two million children die of diarrhea [each year], and that billions of people drink their neighbors’ lukewarm feces,” said Rosling, and yet “water and sanitation data is very, very weak.” Collecting information from remote areas—often the most impoverished—is difficult. Measuring access to potable water is complicated because it requires community-based calculations, which do not fit into DHS’ household-centric methodology.

Rosling called upon young adults to work to “eradicate unnecessary disease and poverty in the world.” He also advocated improved post-graduate training in statistics, particularly in low-income countries.

Better statistical data will foment more effective solutions to development challenges—provided there are ambassadors like Rosling willing and able to unveil the beauty behind the numbers.

Photo: Hans Rosling. Courtesy of Dave Hawxhurst and the Wilson Center.

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Any veteran of the international development field will be familiar with the disclaimer that no single intervention, no matter how effective, is a “silver bullet.” But in The Means of Reproduction: Sex, Power, and the Future of the World, journalist Michelle Goldberg argues forcefully that there is one change that is key to solving environmental degradation, food insecurity, water scarcity, global health challenges, skewed gender ratios, poverty, and both under- and overpopulation: women’s empowerment.

Malthusian Anxieties

As Matthew Connelly documents in his book Fatal Misconception: The Struggle to Control World Population, the family-planning movement sometimes lapsed into questionable moral territory during its early years, when women’s rights were not among its chief motivations. Fortunately, it turns out that family planning is actually more successful when motivated by a larger desire to empower women than when spurred by fears of overpopulation (The Means of Reproduction, pp. 74-76; 84-85). Educated women are more likely to delay marriage, have fewer children, obtain good maternal care, and be less vulnerable to HIV/AIDS, write Caren Grown et al. in a literature review of gender equality and women’s health in The Lancet.

A Birth Dearth—or an Empowerment Dearth?

As Goldberg points out, empowering women is also the solution to slowing the rapid population decline being experienced in many European countries and some wealthy Asian ones. “In contemporary developed societies, birthrates are highest where support for working mothers is greatest, a fact conservatives simply ignore in their doomsday surveys of future European decrepitude,” says Goldberg (p. 204).

Thus, comparatively religious, socially conservative European countries like Italy and Poland have some of the lowest fertility rates on the continent (both 1.3 children per woman), while more secular countries like France and Sweden, with their generous paid parental leave policies, public day care, and after-school programs, have some of the highest (2.0 and 1.9, respectively).

Strong Women, Healthy Families

Women’s empowerment is key to human health. The more education a woman has, the healthier her children are likely to be, explains Goldberg (p. 75). In addition, as Grown et al. point out, “in societies such as Bangladesh, where husbands control most household resources, when women did own assets, household expenditure on children’s clothing and education was higher and the rate of illness among girls was reduced.”

But the connection between empowerment and health also works in the other direction: In sub-Saharan Africa, women constitute 57 percent of people living with HIV/AIDS—a direct result of women’s sexual, social, political, and economic subordination (pp. 224-225). Women often do not have the standing to refuse sex, or to demand that a man wear a condom. They also frequently lack the financial and educational resources needed to leave violent or unfaithful husbands (p. 225).

Bare Branches: Sex Ratios and Security

A preference for sons persists in many parts of the world—especially Asia—and the spread of ultrasound, which can detect the sex of a four-month-old fetus, has made sex-selective abortion hugely popular for couples seeking to have a son. But the growing imbalance between men and women has potentially grave security implications for countries such as China and India, warns Goldberg. As Valerie Hudson and Andrea den Boer point out, Indian states “with high sex ratios, such as Uttar Pradesh, have much higher violent crime rates than states with more normal sex ratios, such as Kerala.”

As Goldberg puts it, “as long as women lack an identity without a husband or a son, sex-selective abortion will continue to deform India’s—and Asia’s—demographics” (p.194). She isn’t hopeful about quick progress: “Like any democracy, India will probably find it easier to slouch toward disaster than to infuriate the defenders of patriarchy. Ultimately, though, unless the country finds a way to break through the encrustations of centuries of misogyny, its democracy itself could be in danger from an unmanageable excess of men” (p. 198).

Toward Nine Billion Hot, Hungry, Thirsty People

Goldberg’s take on the links among population, the environment, and security is admirably nuanced—although I would have appreciated a more extensive discussion of demographic security and population-environment links. She acknowledges that the food riots of 2008, combined with growing concern about water scarcity and climate change, may have generated more attention for family planning and reproductive health.

But she reminds us that the main population-related response to these problems—a commitment to decrease fertility in the developing world—misinterprets the causes. The food shortages were largely the result of growing consumption by middle-income people, combined with continued high consumption in the rich world. Climate change will undoubtedly become much worse if all people in the developing world start to live the high-carbon lifestyles we do in the West, but to date, climate change has been caused almost entirely by industrialized countries.

The Micro and the Macro

Goldberg’s storytelling skills are superb, making The Means of Reproduction both an exciting and enlightening read. She illustrates her broader arguments about women’s rights with compelling stories about individual women and men. She demands that we respect these people’s experiences while arguing powerfully against succumbing to the temptations of political correctness and relativism:

“In thinking about the situation of women in vastly different contexts, there are a number of dangers. One is assuming that Western ways are self-evidently superior and that all women would choose them, if only they could. But another is assuming that women in other cultures are so different from us that situations we would find intolerable—bearing child after child into grinding poverty; being utterly at the mercy of fathers, husbands, and brothers; having one’s clitoris sliced off with a razor—do not also cause them great pain” (p. 9).

Goldberg has pulled off an impressive feat: The Means of Reproduction is accessible enough to serve as an introduction to the debates around population and family planning, but complex enough to inform readers about the latest controversies and battlegrounds in the field. Goldberg does have an opinion, but it’s based on reams of research. Here’s hoping The Means of Reproduction finds a place in the canon.

Photo: Women and children at the health post at Sam Ouandja refugee camp in the Central African Republic. Courtesy of Pierre Holtz/UNICEF and Flickr user hdptcar.

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