Reaping the DiviDenD OvercOming Pakistan’s DemOgraPhic challenges Edited by Michael Kugelman Robert M. Hathaway This publication is a collaborative effort between the Woodrow Wilson International Center for Scholars’ Asia Program and the Fellowship Fund for Pakistan. www.wilsoncenter.org/asia http://fffp.org.pk/ Reaping the DiviDenD OvercOming Pakistan’s DemOgraPhic challenges Essays by: Sohail Agha Shahid Javed Burki Mehtab S. Karim Saba Gul Khattak Shazia Khawar Michael Kugelman Population Reference Bureau and National Committee for Maternal and Neonatal Health (Pakistan) Zeba A. Sathar Moeed Yusuf Edited by: Michael Kugelman Robert M. Hathaway ©2011 Woodrow Wilson International Center for Scholars, Washington, D.C. Available from : Asia Program Woodrow Wilson International Center for Scholars One Woodrow Wilson Plaza 1300 Pennsylvania Avenue NW Washington, DC 20004-3027 www.wilsoncenter.org ISBN: 1-933549-68-8 The Woodrow Wilson International Center for Scholars, established by Congress in 1968 and headquartered in Washington, D.C., is a living national memorial to President Wilson. The Center’s mission is to commemorate the ideals and concerns of Woodrow Wilson by providing a link between the worlds of ideas and policy, while fostering research, study, discussion, and collaboration among a broad spectrum of individuals concerned with policy and scholarship in national and international affairs. Supported by public and private funds, the Center is a nonpartisan institution engaged in the study of national and world affairs. It establishes and maintains a neutral forum for free, open, and informed dialogue. Conclusions or opinions expressed in Center publications and programs are those of the authors and speakers and do not necessarily reflect the views of the Center staff, fellows, trustees, advisory groups, or any individuals or organizations that provide financial support to the Center. The Center is the publisher of The Wilson Quarterly and home of Woodrow Wilson Center Press, dialogue radio and television, and the monthly news-letter “Centerpoint.” For more information about the Center’s activities and publications, please visit us on the web at www.wilsoncenter.org. Jane Harman, President and Director Board of Trustees Joseph B. Gildenhorn, Chair Sander R. Gerber, Vice Chair Public Members: Melody Barnes, designated appointee from within the Federal Government; Hon. James H. Billington, Librarian of Congress; Hillary R. Clinton, Secretary, U.S. Department of State; G. Wayne Clough, Secretary, Smithsonian Institution; Arne Duncan, Secretary, U.S. Department of Education; David Ferriero, Archivist of the United States; James Leach, Chairman, National Endowment for the Humanities; Kathleen Sebelius, Secretary, U.S. Department of Health and Human Services Private Citizen Members: Timothy Broas, John Casteen, Charles Cobb, Jr., Thelma Duggin, Carlos M. Gutierrez, Susan Hutchison, Barry S. Jackson Contents Pakistan’s Demographics: Possibilities, Perils, and 5 Prescriptions Michael Kugelman Demographic Doom or Demographic Dreams: 32 Pakistan at the Crossroads Zeba A. Sathar Pakistan on the Move: Family Planning, Reproductive 46 Health, and Development in Pakistan Population Reference Bureau and National Committee for Maternal and Neonatal Health (Pakistan) Historical Trends in Pakistan’s Demographics and 56 Population Policy Shahid Javed Burki A Society on the Precipice? Examining the Prospects 76 of Youth Radicalization in Pakistan Moeed Yusuf Full Circle: Pakistan: The Next Generation Report 106 and the Perspective of Pakistani Youth Shazia Khawar | 1 | Pakistan’s Demographic Scenario, Past and Present: 121 Population Growth and Policies, with Lessons from Bangladesh and Iran Mehtab S. Karim The Challenges of Population Policy and Planning in 145 Pakistan Saba Gul Khattak The Role of the Private Sector in Reproductive Health 160 Service Delivery in Pakistan Sohail Agha Recent Asia Program Publications 176 Information About Woodrow Wilson Center Pakistan 182 Scholar Program | 2 | glossary CBR Crude birth rate CPR Contraceptive prevalence rate CSM Contraceptive social marketing DFID UK Department for International Development FATA Federally Administered Tribal Area GDP Gross domestic product GNI Gross national income GNP Gross national product ICPD International Conference on Population and Development IMCC Inter-Ministerial Coordination Committee ISI Inter-Services Intelligence IUD Intrauterine device LeT Lashkar-e-Taiba LHWs Lady Health Workers MDG Millennium Development Goal MoYA Ministry of Youth Affairs MQM Muttahida Qaumi Movement NCMNH National Committee for Maternal and Neonatal Health NFC National Finance Commission NGO Nongovernmental organization NGR Next Generation report | 3 | NVM National Volunteer Movement PBF Performance-based financing PGR Population growth rate PIA Pakistan International Airlines PRB Population Reference Bureau PSDP Public Sector Development Program PSI Population Services International RH Reproductive health Rs. Rupees SAP Social Action Program TFR Total fertility rate TTP Tehreek-i-Taliban Pakistan UNFPA United Nations Population Fund WHO World Health Organization YPF Young Parliamentarians Forum | 4 | pakistan’s Demographics: possibilities, perils, and prescriptions Michael KugelMan n July 11, 2010, Pakistani Prime Minister Yousaf Raza Gilani delivered a speech in Islamabad to commemorate World OPopulation Day. He announced that in order to highlight the crucial connection between demographics and economic growth, 2011 would be designated “Population Year” in Pakistan. “All hopes of development and economic prosperity would flounder if we as a nation lose the focus and do not keep [the] population issue in the spotlight,” he declared.1 Hopefully that spotlight comes with a long shelf life. Pakistan faces acute population challenges. If they are to be overcome, they will need to be illuminated for far more than a year. Yet, there are exciting opportunities here as well. A long-term approach to managing the challenges presented by Pakistan’s burgeon- ing population, if accompanied by effective policies and sustained imple- mentation, could spark a monumental transformation: one that enables the country to harness the great promise of a large population that has usually been viewed as a hindrance to prosperity. Indeed, demographers contend that Pakistan’s young, growing, and rapidly urbanizing popula- tion can potentially bring great benefits to the country. If birth rates fall substantially, and if young Pakistanis are properly educated and successfully absorbed into the labor force, then the nation could reap a “demographic dividend” that sparks economic growth, boosts social well-being, and promotes the rejuvenation of Pakistan. Michael Kugelman is program associate for South Asia at the Woodrow Wilson International Center for Scholars. | 5 | Michael Kugelman THE YOUNG AND THE RISING Because Pakistan has not conducted a census since 1998, estimating the country’s total population size is a highly inexact science. The Pakistani government lists the current figure at about 175 million people, while the United Nations believes the number is closer to 185 million. However, while the precise figure may be in doubt, the population’s rapid rise is not. Though no longer increasing at the 3 percent-plus rate seen in the 1980s, Pakistan’s population is still growing at a 2 percent pace. According to the UN Population Division’s latest mid-range de- mographic projections, released in 2009, the population will rise to 335 million by 2050. More than 60 million people are expected to be added in just the next 15 years.2 This explosive increase, however, merely represents the best-case scenario, and will prevail only if the country’s fertility rates drop from the current average of about four children per woman to two. Should fertility rates remain constant, the UN estimates the population could exceed 450 million by 2050, with a total population of nearly 300 million as early as 2030. Pakistan’s population is not only large and growing, but also very young, with a median age of 21. Currently, two-thirds of Pakistanis are less than 30 years old.3 As a percentage of total population, only Yemen has more people under the age of 24. Additionally, given that more than a third of Pakistanis are now 14 years old or younger, the country’s population promises to remain youthful over the next few decades.4 In the 2020s, the 15-to-24 age bracket is expected to swell by 20 percent.5 Pakistan’s under-24 population will still be in the majority come 2030. And as late as 2050, the median age is expected to be only 33.6 Pakistan’s demographic profile contrasts with what is happening in much of the rest of the world. Sub-replacement level fertility rates (about two births per woman) prevail not only throughout the developed world, but also across much of Southeast Asia, the Middle East, and Latin America. As one commentator has noted, “the twenty- first century’s hallmark [demographic] trend appears to be a fertility implosion.”7 South Asia, along with sub-Saharan Africa, is one of the last regional bastions of youthful, rapidly proliferating populations. Yet even within South Asia, Pakistan stands out. Excluding Afghanistan, | 6 | Pakistan’s Demographics: Possibilities, Perils, and Prescriptions of all the member states of the South Asian Association for Regional Cooperation—Bangladesh, Bhutan, India, Maldives, Nepal, and Sri Lanka—Pakistan has the highest population growth, birth, and fertility rates; the youngest