The floods sweeping across Pakistan have caused widespread destruction, ruined livelihoods, displaced millions, and sparked a food crisis. Food prices have skyrocketed across the country as miles of farmland succumb to the deluge, including 1.5 million hectares in Punjab province, Pakistan’s breadbasket and agricultural heartland.

Excerpt from op-ed by Samia Altaf and Anjum Altaf in Dawn:

WE must state at the outset that we have been wary of, if not actually opposed to, the prospect of further economic assistance to Pakistan because of the callous misuse and abuse of aid that has marked the past across all elected and non-elected regimes.

Excerpt from Dawn:

ON Jan 15, 2006, the Karachi Port Trust (KPT) inaugurated its new fountain – the Rs320m lighted harbour structure that spews seawater hundreds of feet into the air.

Also on this day – as on most others in Karachi – several million gallons of the city’s water supply were lost to leakage, some hundred million gallons of raw sewage oozed into the sea, and scores of Karachiites failed to secure clean water.

Over the next few years, the fountain jet would produce a powerful and relentless stream of water high above Karachi. Meanwhile, down below, tens of thousands of the city’s masses would die from unsafe water.

In Islamabad yesterday, Secretary of State Hillary Clinton acknowledged longstanding Pakistani concerns that the U.S.’s ongoing mission in the country is solely military in nature. However, Clinton asserted at the opening of the second U.S.-Pakistan Strategic Dialogue that the “future demands a comprehensive human security, a security based on the day-to-day essentials like jobs, schools, clinics, food, water, fuel, equal access to justice, [and] strong, accountable public institutions.” To that end, she announced a $500 million assistance package earmarked largely for new agricultural and hydroelectric infrastructure development, as well as the construction of new hospitals and other health infrastructure.

Pakistan is at a major demographic crossroads. With a youth-heavy population of some 180 million and an annual population growth rate around 2 percent, the country’s population is projected to swell to roughly 335 million by mid-century. Such explosive growth raises major questions about Pakistan’s future, from looming food and water scarcity, to yawning inequalities in the nation’s educational and economic systems. Some warn that these problems threaten to drive a new generation of disaffected Pakistani youth toward political and religious radicalization.

Recently, I asked a number of leading Pakistani demographers visiting the Wilson Center how their country could best achieve more sustainable population growth rates and effectively harness the economic potential of Pakistani youth.

Educate Girls

Zeba Sathar, Pakistan country director for the Population Council in Islamabad, told me empowering girls through education represents one of the most important means of reducing the total fertility rate, which currently stands at four. “When children are educated—particularly when girls are educated—they take care of their fertility and their family size themselves,” Sathar said.

Yet securing educational opportunity for Pakistani girls has often been an uphill battle, largely due to entrenched social norms. Yasmeen Sabeeh Qazi, Karachi-based senior country adviser for the David and Lucile Packard Foundation’s Population Program in Pakistan, pointed out that a traditional preference for male children in Pakistani society has meant girls do not often receive the same level of family resources as males. This phenomenon has historically fed gender inequality, she said.

“Since boys are preferred, girls are not given the same kind of attention and nutrition, especially in the poorer and less-educated families,” Qazi told me. “But as the education level goes up, you see that this divide starts narrowing.” For Qazi, one of the keys to heightening educational access for girls is to increase both the quantity and quality of schools in rural districts, where two-thirds of Pakistanis live.

Decentralize Family Planning Services

Others I spoke with emphasized improving access to reproductive health and family planning services in rural and urban areas. The federal government’s relatively recent move to delegate operational authority for family planning services to the provincial or district level has encouraged many, such as Dr. Tufail Muhammad with the Pakistan Pediatric Association’s Child Rights & Abuse Committee in Peshawar.

Muhammad said the ongoing decentralization—which he described as “a major paradigm shift”—is meant to increase ownership of population planning policies at the local level, and therefore lead to more effective implementation because “the responsibility will be directly with the provincial government.” Once capacity is established at the local level to design and implement those policies, Muhammad added, “supervisors, administrators, and policymakers will be very close to [family planning] services.”

Manage the “Youth Bulge”

Yet despite the fact that both the public and private sectors are taking steps to address Pakistan’s growth issues, the population crunch will intensify before it potentially eases. Even assuming that greater educational opportunity for girls and increased local control over family planning services help drop Pakistan’s total fertility rate, the sheer size of the current youth bulge—two-thirds of the country’s population is under age 30—means population issues will inform every aspect of Pakistani society for decades to come.

In discussing the current state of Pakistan’s education system, some speakers also asserted that the influence of madrassas, or religious schools, over the student-aged population has often been overstated. Shahid Javed Burki, Pakistan’s former finance member and recent senior scholar at the Wilson Center, said during the panel discussion that inaccurate enrollment estimates created “the impression that the system is now dominated” by those institutions. He noted that more recent figures place madrassa enrollment at just five percent of the total student population.

With a majority of Pakistani students enrolled in regular public schools, he insisted that “public policy in Pakistan has to focus on public education” in order to prevent those students from slipping through the cracks. The problem, he added, was that “the education that they are receiving is pretty bad. It really does not prepare them to be active participants in the workforce and contribute to the economic development of the country.”

Still, most of the experts sounded optimistic about Pakistan’s potential to mitigate some of the adverse effects associated with the near-doubling of the country’s population during the next 40 years. By starting to more openly address an issue that the government and the powerful Pakistani media have long preferred to ignore, they seemed to agree the country is taking a big step in dealing head-on with its looming demographic challenges.

“I don’t look at the Pakistani population as a burden, but rather as an asset,” remarked Burki. “But it has to be managed.”

Photo Credit: “School Girls Talk in Islamabad,” courtesy of flickr user Documentally.

It’s difficult to imagine a scenario for a stable and peaceful world that doesn’t involve a stable and peaceful Pakistan. The country is among the world’s most populous and is also home to the world’s second largest Muslim population, making it the only Muslim majority nuclear state. Its history has been characterized by periods of military rule, political instability, and regional conflicts. This week on dialogue host John Milewski explores the nation’s changing demographics and what they may tell us about near and long term prospects for this vital U.S. ally with guests Michael Kugelman, Zeba Sathar, and Mehtab Karim.

According to the UN’s latest mid-range demographic projections for Pakistan, the country’s population–currently about 185 million–will rise to 335 million by 2050. This explosive increase, however, represents the best-case scenario: Should fertility rates remain constant, the UN estimates this figure could approach 460 million. Such soaring population growth, coupled with youthful demographics, a dismal education system, high unemployment, and a troubled economy, pose great risks for Pakistan. Predictably, many observers depict Pakistan’s population situation as a ticking time bomb.

At the same time, some demographers contend that the country’s population profile can potentially bring great benefits to the country. If young Pakistanis can be properly educated and successfully absorbed into the labor force, such experts explain, then the country could experience a “demographic dividend” that boosts social well-being and sparks economic growth. On June 9, the Wilson Center’s Asia Program, Environmental Change and Security Program, and Comparative Urban Studies Project, along with the Karachi-based Fellowship Fund for Pakistan, hosted a day-long conference to examine both the challenges and opportunities of Pakistan’s demographics, and to discuss how best to tackle the former and maximize the latter.

Pakistan at a Crossroads

In her opening address, Zeba A. Sathar of the Population Council declared that Pakistan is “at a crossroads.” Demography will play a key role in determining the country’s future trajectory, she said, yet there is presently little discussion about demographics in Pakistan. Sathar’s presentation traced Pakistan’s recent demographic trends. Despite its high population growth, Pakistan’s fertility rates have actually been in decline since the early 1990s–a fact that Sathar attributed to progressively higher ages at marriage (for both men and women), but also to the “reality” of abortion. However, Pakistan’s pace of fertility decline has slowed in the last few years–a consequence, Sathar argued, of Islamabad’s failure to promote social development (particularly education) and of the international donor community’s prioritizing of HIV/AIDS funding over that of family planning since 2000. Sathar concluded that achieving Pakistan’s “demographic dreams” will require more educational and employment opportunities (particularly for women) and better access to family planning in rural areas.

In the following panel, Wilson Center Senior Scholar Shahid Javed Burki noted the long-standing failure of demographers and economists in Pakistan to work together on the country’s population issues. This failure, Burki asserted, has resulted in poor choices and bad policy. He also criticized officials and scholars for being reactive in their population proposals, rather than proactive. Burki emphasized that good policy choices can produce favorable results. If, for instance, the population policies launched in Pakistan’s early decades had been sustained to the present, the country today would have 30 million fewer people. Similarly, had Pakistan followed the Bangladeshi approach and concentrated on the economic empowerment of women, today there would be more than 40 million fewer Pakistanis. Good policies matter, Burki repeatedly asserted, and Pakistan’s large and growing population, if dealt with wisely, can be an asset rather than a burden.

Development Through the Bangladeshi Model and Education

Like Burki, Yasmeen Sabeeh Qazi of the Packard Foundation pointed to Bangladesh as a relative success story. She highlighted Bangladesh’s reproductive health services system, which has served to increase the health of Bangladeshis and reduce their poverty. Indonesia and Iran, whose fertility rates are one-half Pakistan’s, provide other examples in the Muslim world where official policy has made a significant difference. Qazi’s presentation emphasized the linkages between family planning, reproductive health, and development. Noting that one-third of pregnancies in Pakistan are unplanned, she underscored the correlation between smaller family size and higher gross national income. She urged the government to fashion a population policy that expands access to reproductive health services, strengthens the health system generally, promotes education (especially for girls), and creates more jobs.

Moeed Yusuf of the U.S. Institute of Peace examined the prospects for radicalization of Pakistan’s youth. Pakistan’s stratified education system, Yusuf cautioned, is not training productive, employable members of society. Only graduates of elite private schools or of foreign schools are prepared for the economy of the 21st century. Meanwhile, the economy is not producing the quality jobs the young expect, leading to an “expectation-reality disconnect” that fosters not only un- or underemployment, but also anger and alienation. Moreover, the state, by deliberately cultivating the ultra-right elements in Pakistani society who most want to radicalize the country’s youth, is part of the problem. Still, Yusuf added, echoing the hopefulness of other speakers, it is not too late. These disturbing trends can be reversed, with help from outside friends like the United States, which, Yusuf counseled, should focus on assisting Pakistan’s education system, support rural private schools, and allow more Pakistani students to study in the United States.

Plugging Public Sector Holes with Private Initiatives

Saba Gul Khattak focused her luncheon address on the work of the Pakistan government’s Planning Commission, of which she is a member. In recent years, Pakistan’s population programs have been devolved from the federal to the provincial and sub-provincial levels. This decentralization, she averred, has opened the way for a genuine reform agenda. But it has also contributed to a situation where no one at the federal level feels any “ownership” over the country’s population programs. Implementation has always been the most vulnerable point in the policy process–and the lack of “ownership” only accentuates this problem today. Khattak emphasized the linkages between population, health, education, and development. Today, she asserted, children are seen by their parents as a source of old age security. Only when the government fills this void through the establishment of an effective social security structure will Pakistan be able to reduce its fertility rates. Development must accompany a truly effective population program.

In the afternoon panel, Sohail Agha of Population Services International discussed the role of the private sector in family planning in Pakistan. He argued that this sector has made a “substantial contribution” to Pakistan’s increased use of condoms: In 2006-07, a period when condom use spiked by nearly 8 percent, about 80 percent of this increase was covered by contraceptives provided by the private sector. Additionally, he noted that a 2009 survey found that urban Pakistanis exposed to social marketing campaigns about condom utilization increased their use of the contraceptive by 10 percent. Furthermore, he described private-sector-led health financing plans for women’s fertilization–a method of contraception that, like condoms, has increased over the last 30 years in Pakistan.

Engaging Youth and Political and Religious Leaders

Shazia Khawar of the British Council discussed the “Next Generation” report, a 2009 Council study about Pakistan’s youth. The report, based on a survey of 1,500 young people across both rural and urban Pakistan, concludes that young Pakistanis are deeply disillusioned about their country and its institutions, with three-quarters of those surveyed saying they regard themselves as “primarily” Muslims, not Pakistanis. The report’s “critical point,” said Khawar, is that Pakistani youth participation in policy development is nonexistent. To this end, the British Council has spearheaded several initiatives to engage the country’s youth in Pakistani politics and to spark dialogue between young Pakistanis and policymakers. Khawar concluded, however, that success is possible only if Pakistan’s top political leaders “pledge themselves to this agenda.”

Mehtab S. Karim of the Pew Research Center offered a comparative perspective, discussing demographics in the broader Muslim world, with particular emphasis on Bangladesh and Iran. Why, he asked, has Pakistan experienced less fertility decline than most of its fellow Muslim-majority nations? He suggested that the answer lies in the failure of Pakistan’s political and religious leaders to make early and sustained commitments to family planning. In Bangladesh, he explained, the country’s very first government made lower population growth rates a “prime goal.” And in Iran, spiritual leader Ayatollah Khomeini issued a fatwa in support of contraceptive use soon after the Islamic Revolution. Yet in Pakistan, according to Karim, religious figures have consistently opposed Islamabad’s family planning efforts, and the government has proven unwilling or unable to combat this resistance.

Scott Radloff of USAID discussed his agency’s family planning and reproductive health (FP/RH) projects in Pakistan. FP/RH aid to Pakistan was largely cut off during much of the 1990s due to the Pressler Amendment–a 1985 modification to the U.S. Foreign Assistance Act that banned most U.S. military and economic assistance to Pakistan unless the U.S. president certified that Pakistan had no nuclear weapons. President George W. Bush waived this prohibition in 2001, and since then USAID FP/RH assistance has risen to nearly $45 million. Current interventions focus on strengthening services within Pakistan’s Ministry of Health and Ministry of Population Welfare; improving contraceptive supplies and logistics; expanding community-based services; and increasing awareness and commitment, including among religious leaders.

Participants concurred that Pakistan’s demographic situation is fraught with risk. Yet they also highlighted a series of hopeful signs. Yusuf noted the absence of an “imminent” danger of youth radicalization; Khawar pointed to the testimonies of “many young leaders determined to do their part” that flow from the “Next Generation” report; and both Karim and Qazi cited Bangladesh and Iran as proof that successful family planning programs are possible even in countries marked by deep poverty or conservative Islam. The presenters were also in accord about the necessary policies moving forward: more extensive family planning and reproductive health services, better education, and more job opportunities (particularly for women). At the same time, speakers repeatedly underscored the profound challenges facing the implementation of such policies. Still, for all the talk about major obstacles and challenges, there was recognition that more modest and simple steps can be taken as well–such as promoting more discussion about demographics within Pakistan, and especially among experts from different disciplines.

Michael Kugelman is program associate and Robert M. Hathaway is director of the Wilson Center’s Asia Program.

Photo credit: Traffic in downtown Karachi, courtesy Flickr user Ali Adnan Qazalbash.

The landmark Women Deliver conference, which concluded last week, reinvigorated the global health community’s commitment to improve reproductive health at both the grassroots and global levels. Providing a major boost was the Gates Foundation’s announcement that it will commit an additional $1.5 billion over the next five years to support maternal and child health, family planning, and nutrition programs in developing countries.

“We haven’t tried hard enough,” said Gates Foundation co-founder Melinda Gates. “Most maternal and newborn deaths can be prevented with existing, low-cost solutions.” Examples of these efficient and effective solutions were presented at the three-day conference’s dozens of panels on a wide range of issues, including climate change, contraceptive commodities, fistula, gender inequities, adolescent family planning, communications and technology, and much more.