CONTRACEPTION
Clearly, Bangladesh learnt much while we unlearnt.
ISHAQ Dar’s visit to Dhaka promises a reset in our relationship with Bangladesh. This is a welcome development. We would do well to enter this new phase of the relationship with some humility. We may have improved our international profile in defence capability, but economically there is still much to be done — and indeed learnt from Bangladesh. A critical area for emulation is population management. A recent meeting of experts chaired by Prime Minister Shehbaz Sharif clearly brought home the threat posed by rapid population growth. It was agreed that it is akin to running fast to stay in the same place, and that we need to get off this awful treadmill as soon as possible.
Several years ago, Dr Zafarullah Chowdhry, who was to Bangladesh health what Prof Muhammad Yunus is to microfinance, was invited to Lahore by then chief minister Shehbaz Sharif. In his speech, Dr Chowdhry said that Bangladesh had benefited from Ayub Khan’s family planning programme. With half our population growth now, clearly Bangladesh learnt much while we unlearnt.
Population growth is determined by the fertility rate (the number of children born to a woman of child-bearing age) which, in turn, is driven by the contraceptive prevalence rate. Thus, the desire to have fewer children manifests itself in the desire to use contraceptives. With twice Bangladesh’s population growth, our contraceptive prevalence rate is half. Programmes to manage population growth thus have to focus on increasing the contraceptive prevalence rate.
Fertility rate is the highest (contraceptive prevalence rate the lowest) among relatively low-income women, as children are future breadwinners. Thus, if infant mortality is high, more children will help ensure that some survive. If stunting is high because of malnutrition, poor cognitive skills and a low future income stream, households will want more children. Both these factors will matter more if women do not work. On all these counts, we measure poorly against Bangladesh.
Reducing the demand for children requires the provinces to get their act together since nearly all of the policy levers affecting infant mortality and stunting are in their remit. And yet, we have designed the National Finance Commission award such that the population size determines the provincial share in the divisible pool. This incentivises provinces to have more children. The provinces say all the right things about population growth but have no real commitment to actually do something about it.
Reduced demand for children shows up in fewer births if there is an adequate supply and take-up of contraceptives. Provincial population programmes have focused on supplying contraceptives but there is a widespread view that government clinics are failing in this. They are hard to reach, and given the social norms governing sexual practices, women of child-bearing age do not wish to be seen looking for them. This results in the poor take-up of contraceptives, ie, there is an unmet demand.
Punjab tried a different approach to address the unmet demand for contraceptives. Then chief minister Shehbaz Sharif set up, under Section 42 of the Companies Ordinance, the Punjab Population Innovation Fund (PPIF). It was placed under the direction of an independent board that worked with private clinics (in close proximity to households) to provide family planning services. A pilot in district Rahim Yar Khan was designed to motivate low-income women of child-bearing age, identified using the BISP database. A voucher was given to defray the cost of travel to private family clinics. The pilot was evaluated to show an impressive increase in the use of contraceptives. Further evaluation by the World Bank has now resulted in the programme being replicated all over Punjab. It should be scaled up countrywide.
The PPIF programme was designed in light of evidence of an unmet demand for contraceptives, as seen in the extraordinarily high incidence of abortions in Punjab that government clinics were not addressing. This demand will increase manifold if the provinces address infant mortality and stunting, the other determinants of the demand for children. Increased participation of women in the labour force, by pursuing labour-intensive export-led growth as Bangladesh did, will also help enormously in lowering the fertility rate.
It is hard to predict where the recent public discussion on more provinces will go, but it does provide an opportunity to address the perverse incentives in the NFC award, especially those regarding population growth. As to religious opposition to population planning, Dr Chowdhry had the best answer: “We gave employment to daughters of mosque maulvis in the population programmes and they became supporters.”
The writer is executive director, CDPR, and former dean and professor of economics, Lums.
Published in Dawn, August 31st, 2025
August 31, 2025
DAWN
ISHAQ Dar’s visit to Dhaka promises a reset in our relationship with Bangladesh. This is a welcome development. We would do well to enter this new phase of the relationship with some humility. We may have improved our international profile in defence capability, but economically there is still much to be done — and indeed learnt from Bangladesh. A critical area for emulation is population management. A recent meeting of experts chaired by Prime Minister Shehbaz Sharif clearly brought home the threat posed by rapid population growth. It was agreed that it is akin to running fast to stay in the same place, and that we need to get off this awful treadmill as soon as possible.
Several years ago, Dr Zafarullah Chowdhry, who was to Bangladesh health what Prof Muhammad Yunus is to microfinance, was invited to Lahore by then chief minister Shehbaz Sharif. In his speech, Dr Chowdhry said that Bangladesh had benefited from Ayub Khan’s family planning programme. With half our population growth now, clearly Bangladesh learnt much while we unlearnt.
Population growth is determined by the fertility rate (the number of children born to a woman of child-bearing age) which, in turn, is driven by the contraceptive prevalence rate. Thus, the desire to have fewer children manifests itself in the desire to use contraceptives. With twice Bangladesh’s population growth, our contraceptive prevalence rate is half. Programmes to manage population growth thus have to focus on increasing the contraceptive prevalence rate.
Fertility rate is the highest (contraceptive prevalence rate the lowest) among relatively low-income women, as children are future breadwinners. Thus, if infant mortality is high, more children will help ensure that some survive. If stunting is high because of malnutrition, poor cognitive skills and a low future income stream, households will want more children. Both these factors will matter more if women do not work. On all these counts, we measure poorly against Bangladesh.
Reducing the demand for children requires the provinces to get their act together since nearly all of the policy levers affecting infant mortality and stunting are in their remit. And yet, we have designed the National Finance Commission award such that the population size determines the provincial share in the divisible pool. This incentivises provinces to have more children. The provinces say all the right things about population growth but have no real commitment to actually do something about it.
Reduced demand for children shows up in fewer births if there is an adequate supply and take-up of contraceptives. Provincial population programmes have focused on supplying contraceptives but there is a widespread view that government clinics are failing in this. They are hard to reach, and given the social norms governing sexual practices, women of child-bearing age do not wish to be seen looking for them. This results in the poor take-up of contraceptives, ie, there is an unmet demand.
Punjab tried a different approach to address the unmet demand for contraceptives. Then chief minister Shehbaz Sharif set up, under Section 42 of the Companies Ordinance, the Punjab Population Innovation Fund (PPIF). It was placed under the direction of an independent board that worked with private clinics (in close proximity to households) to provide family planning services. A pilot in district Rahim Yar Khan was designed to motivate low-income women of child-bearing age, identified using the BISP database. A voucher was given to defray the cost of travel to private family clinics. The pilot was evaluated to show an impressive increase in the use of contraceptives. Further evaluation by the World Bank has now resulted in the programme being replicated all over Punjab. It should be scaled up countrywide.
The PPIF programme was designed in light of evidence of an unmet demand for contraceptives, as seen in the extraordinarily high incidence of abortions in Punjab that government clinics were not addressing. This demand will increase manifold if the provinces address infant mortality and stunting, the other determinants of the demand for children. Increased participation of women in the labour force, by pursuing labour-intensive export-led growth as Bangladesh did, will also help enormously in lowering the fertility rate.
It is hard to predict where the recent public discussion on more provinces will go, but it does provide an opportunity to address the perverse incentives in the NFC award, especially those regarding population growth. As to religious opposition to population planning, Dr Chowdhry had the best answer: “We gave employment to daughters of mosque maulvis in the population programmes and they became supporters.”
The writer is executive director, CDPR, and former dean and professor of economics, Lums.
Published in Dawn, August 31st, 2025
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