According to a recent research report, Pakistan is now the world’s fifth most populous country with a population of 220 million, which works out to a 2.4% annual growth since 1998.

There is more bad news ahead. The UN’s projection is that Pakistan will become the third most populated country in the world by the year 2050. Experts say that in view of the limited resources available, such a high population growth rate has serious implications for the future wellbeing of the Pakistani people. It is relevant to mention here that Pakistan’s ranking is 149 among 188 countries in the first global assessment of countries’ progress towards the United Nations’ health-related Sustainable Development Goals (SDGs). The ranking shows our abysmal performance in the health and other sectors. Among other things, overpopulation lies at the root of Pakistan’s failure to reach SDGs goals as a whole.

In 1960 Pakistan’s population was 46 million. But due to lack of family planning measures, it rose to 190 million in 2015 – a 400 percent jump. The latest census results have confirmed the worst fears about Pakistan’s ticking time bomb. Because of runaway population growth, there is a shortage of everything. All plans for provision of jobs, houses, transport, schools, hospitals come to naught, and the poverty index and deprivation of the lower strata of society relentlessly increases.

Rising population has not only put tremendous pressure on the existing resources but also put in jeopardy the prospects of future growth. The country is experiencing growing scarcity of food and water, while basic health, education, housing and related facilities are proving increasingly inadequate to meet the needs of the people. The factor of overpopulation is also the root cause of unemployment, land fragmentation, overcrowding and proliferation of katchi abadis, poverty, crime and environmental degradation. Rolling blackouts, dwindling water supplies and electricity and natural gas shortages are incontrovertible proof of a worsening equation between the country’s growing population and available resources.

Given Pakistan’s high birth rate, the urban population is expected to double in the next 20 years causing more and more forests to be cut to make way for new human settlements. Figures show that deforestation is continuing apace at the alarmingly high rate of 2.5 percent which has no precedent anywhere in the world. Environmental degradation is a natural offshoot of overpopulation. Falling water tables due to excessive pumping, lack of sewerage facilities, over-motorization and emission of monoxide gas and increasing numbers of factories gobbling up green fields have increased the pace of environmental degradation.

The problem of overpopulation becomes even more serious in an era of shortage of safe drinking water and climate change due to the depletion of the ozone layer. Other forms of environmental pollution associated with population are marine pollution, noise pollution, depletion of agrarian resources, etc. The alarming situation in the water sector is a prime example of the dangers posed by unchecked population growth. At the time of independence in 1947, water availability was 5,000 cubic meters per capita but it has now declined to about 1,000 cubic meters. The annual water demand is expected to exceed availability by 100 billion cubic meters by 2025, if not earlier. All projections show that Pakistan will be a water-scarce nation in the next few years.

A high birth rate is also the cause of poor nourishment and inadequate healthcare suffered by a majority of the population. Recent studies suggest that lack of proper nourishment and health care has led to a situation where children grow up without attaining their full mental and physical capacity. Experts believe that if conditions don’t improve, we would soon reach a point where food and medical care would not be available to a large proportion of the country’s population.

There is little dispute that our family planning approach has failed to achieve its targets. Many blame religious beliefs and cultural impediments. But there are other factors involved. India and Bangladesh have a population growth rate of 1.2% and 1.1%, respectively. Other Muslim countries like Iran, Malaysia and Saudi Arabia have growth rates of 1.2%, 1.5% and 2.2%, respectively. But our growth rate is the highest.

As is well known, future population growth depends on fertility rates, depicting average number of children born alive to a woman during her lifetime. Pakistan’s fertility rate stands at 3.8, according to the Demographic and Health Survey 2012-13. And there is not much difference across provinces, with Punjab at 3.8 and Sindh and Khyber-Pakhtunkhwa at 3.9. Balochistan does have a higher fertility rate of 4.2 but due to its small population size, it has little bearing on our national fertility rate. India and Bangladesh, on the other hand, have fertility rates of 2.4 and 2.14, respectively, whereas Iran, Malaysia and Saudi Arabia are at 1.68, 1.93 and 2.71, respectively. Needless to say, due to our poor healthcare service delivery, our population growth would have been even higher. Average life expectancy in Pakistan is merely 66 years, as compared to 72 for Bangladesh, 74 for Malaysia and Saudi Arabia and 75 for Iran. If we somehow improve our life expectancy to Bangladesh’s or Iran’s level, our population growth rate would be much higher.

The question is: How can fertility rates be lowered? Through increasing contraceptive prevalence rates (CPR), which depict percentage of women who are currently using at least one method of contraception. According to the last reported figures, CPR in Pakistan stands at 35% amongst married women of reproductive age, compared to an average of almost 53% for South Asia and 77% for Iran. One in every five women wants to space her next birth or stop childbearing entirely but is not using contraception, depicting a very high unmet need. Assuming that married women of reproductive age represent 16% of total population, there are 6.6 million women with unmet need out of a total of over 33 million. Adding 3.3 million more using traditional contraceptive methods, we can very well understand that a large part of our failure can be attributed to non-availability of services.

A recent Population Council report on low modern contraceptive use in Pakistan and neighbouring countries blamed supply-side factors, including poor access to services and lack of counselling and technical knowledge of unmotivated providers as primary reason behind low uptake of contraceptives. Given our poor track record with family planning, there is a need to adopt out-of-the-box  solutions.

Punjab is the first province to realise the limitations of existing family planning service delivery and has established the Punjab Population Innovation Fund to address the unmet need in rural, poor and un-served areas.  Looking at the past trend, we’ll touch 450 million by 2050, but even if we assume that our growth has slowed down to 2%, we’d still be at 400 million.

The problem of high population growth calls for new policy measures by the government to comprehensively deal with the issue. The need is not only to increase the budgetary allocation and treat family planning as part of the overall health care program, but also to create a new public-private partnership framework under which civil society activists and NGOs  work in close cooperation with the government departments to provide  better health services to the people.