At the core of these crises is unbridled population growth in the province, which has the potential to undermine the very roots of society. The traditional approach of policymakers in Balochistan is to draw comparisons between the population and the vast mineral wealth, landscape, and resources of the province. This viewpoint originates from a purely political standpoint, where the National Finance Commission (NFC) grants a heavy weightage, 82.98%, to the population for a share in the divisible pool. This casts a dark shadow on the consequences of population growth on women, children, and their basic human rights. In fact, the human rights-based approach to family planning is a systematic process to ensure that attention to human rights principles pertaining to family planning is rooted in all program phases (UNFPA).

A cursory glance at the data shows that the population of the province in 1951 was 1.2 million, which has grown to 14.89 million in 2023, reflecting a more than tenfold increase. The population in urban areas was 28% in 2017 against 72% rural, which has become 31% in 2023 against 69% rural. Poor law and order, unemployment, intermittent drought, and the adverse effects of climate change are pushing the rural population to shift to urban areas, presenting another heavy challenge for the government.

Studies show that a lack of reproductive health (RH) and family planning (FP) results in poor health indicators, such as high maternal mortality, child mortality, infant mortality, and malnutrition. There is a vicious cycle of high child mortality and lack of family planning leading to high fertility rates and maternal deaths. High child mortality is not only a cause but also a consequence of a lack of family planning. This vicious cycle can be broken by adopting family planning.

As a consequence, as many as 298 mothers die in 100,000 live births in Balochistan, 1100 women die annually due to pregnancy-related causes, 29,000 children under age 5 die annually, 40% of children are underweight, 16% suffer from wasting, and around 52% suffer from stunting. Moreover, approximately half of the mothers and children are deficient in vitamin A, zinc, and iron (NNS – 2019 & PDHS 2017-18). There are other factors too, but one of the major causes is the lack of reproductive health and family planning services.

Addressing the rapid population growth and demographic transitions while responding to prevalent anti-family planning arguments, it is crucial to recognize that Balochistan grapples with a pressing issue of water scarcity. We should not be complacent with the abundance of other natural resources; water stands as the most invaluable and irreplaceable of them all. The water table, in the last two to three decades, has dropped to an alarmingly low level. The reasons are persistent drought for more than a decade, the influx of Afghan refugees after the USSR intervention in Afghanistan, excessive groundwater mining, and mismanagement of water for irrigation and agricultural development. The situation is likely to worsen due to the introduction of cheap solar technology, which brings to mind the book “The Plundered Planet” by Paul Collier, Professor of Development Economics and Public Policy at Oxford University, wherein he expounds the formula: Natural Resource + Technology – Regulation = Plunder. In our case, the cheap solar tube well technology is causing water plunder, which is sure to result in the tragedy of the commons. Therefore, we need to plan and balance the population and natural resources, particularly water, to attain sustainable development.

Given the dismal situation at hand, Balochistan requires a unique and all-encompassing approach to address the issue of population growth. The core mandate of reproductive health services lies with the Population Welfare Department. However, to increase the contraceptive prevalence rate from the current 19 percent to the maximum, a coordinated and multi-sectoral approach is required to protect the lives of mothers and newborns. The family planning program needs to be recognized as a basic human right with universal availability of contraceptives. Eligible couples should not worry about which method to choose or where to avail contraception. Access to free contraception should not be an issue for eligible couples as it has been noted that despite having a desire, the lack of access to contraceptives thwarts the objective of family planning.

In this regard, the functional integration of all the departments focused on reproductive health will be of great help in improving access. Therefore, the Population Welfare Department (PWD) has planned to shift Family Welfare Centres (FWCs) to health facilities, such as district headquarters hospitals (DHQs), RHCs, and even Basic Health Units (BHUs), providing space availability, which is likely to help balance the demand and supply gap.

Moreover, the Lady Health Workers (LHWs), about 7000 in number, are a very potent institutional arrangement being engaged. The Population Welfare Department has introduced a new concept of community-based Family Welfare Workers (CBFWWs), who will be hired on a contract basis, primarily to cover the areas not served by LHWs in the province. Another potential force is the Community Midwives (CMWs), trained under the MNCH program to ensure Basic EmONC Services, who will be mobilized for demand generation and providing Postpartum Family Planning (PPFP).

PPFP is defined as the start of a modern method of contraception as soon as possible after childbirth and the continued use of this or another method for at least two years for optimal timing and spacing of pregnancies (WHO). The Population Welfare Department, with technical support from Pathfinder International, has developed and approved the Postpartum Family Planning (PPFP) & Post Abortion Family Planning (PAFP) Policy, which aims to embed family planning in all health facilities and private hospitals where deliveries are conducted to prevent unwanted pregnancies for the safety of women and children.

Above all, family planning is a promotional health strategy where service providers must generate a demand for contraception to draw the attention and interest of clients/eligible couples in adopting any family planning method. In this regard, community mobilization and awareness are key components that can change the perception and approach towards the objectives of family planning. The involvement of media in awareness and demand creation has also been well planned. For behavior change, it has been planned to recruit a large number of social organizers to engage men in family planning. Moreover, the education department has advocated including RH/FP-related topics in the curriculum and textbooks.

“The writer is the Secretary of Population, Balochistan.”