PAKISTAN is currently ranked as the sixth most populous country in the world with an estimated population of 188.2 million people. With current projection growth estimates, the population will grow to over 210m people by the year 2020.

Meanwhile, Pakistan ranks 47th among the poorest countries in the world, slightly ahead of neighbouring Bangladesh but several places behind India and even wartorn Iraq.

Although recent economic markers show some improvements, the situation remains fragile. Pakistan`s recent upgradation to 129 (133rd in 2013) out of 147 countries evaluated by the World Economic Forum (2014) shows a slight recovery, but it remains at the bottom of the table even when compared to neighbouring SAARC countries.

Most alarming is the performance in the area of health and education which ranks lowest among the countries covered. Infant mortality is ranked at 137, which is the highest outside sub-Saharan Africa, combined with one of the lowest school enrolment rates in the world.

Pakistan`s resources in terms of economic output and infrastructure are currently inadequate but are stretched further by the high population growth. The country`s population is expected to double by the year 2050 to almost 350m people.

The problems include a weak economy, corruption, lack of education and, the most decried issue, terrorism. Studies have repeatedly linked the lack of resources as well as terrorism to uncontrolled population growth. Shortages of power, water, gas, insufficient school places, hospital beds as well as unemployment are a direct result of the ever-expanding population. Pakistan`s economy is a long way from absorbing the 3m or so young, unemployed Pakistanis each year that it needs to.

While some schools of thought view a large population as an asset and cite China as an example, what is often overlooked is the quality of manpower. China`s robust family planning programmes not only slowed down a galloping population growth but also provided the foundation for the economic robustness ofthe country.

According to global health organisations, the world`s 1.3 billion women between the ages of 15 and 45 years experienced more than 1.2bn pregnancies in the years 19952000. Of these, 300m pregnancies were unintended.Fourhundredthousandofthese resulted in maternal deaths largely due to complications in labour or unsafe abortions.

In Pakistan, most women see abortions or tubal ligation (sterilisation) as the most common means of family planning.

Estimates show that one in four pregnanciesis unwanted. The largest numbers of abortions, predictably, occur in rural areas and the reasons are largely socio-economic.

Almost 71pc of the women interviewed in rural Pakistan stated that their last child was either unwanted or not wanted so soon.

Only an estimated 35pc of married women use contraception of some kind. Not only is this far lower when compared to other countries such as Iran and Turkey at 71pc, and Bangladesh and Egypt at 60pc, it also neglects theestimated20mPakistaniwomen who are either unaware of their choices or too afraid to come forward (married women) or excluded from reproductive health counseling (unmarried women) thereby perpetuating the cycle. While the official statistics talk about the unmet needs of 6m married women in Pakistan of reproductive age, they overlook the fact that almost 49m are of reproductive age (15-50 years).

Pakistan is a country with scarce resources and yet its population explosion has not been addressed on the war footing it deserves.

Pakistan needs to shed its inhibitions, andactively engage with specific target groups.

With a mean population of 19.5 years with 51pc young males in the decision-making role, this segment needs to be the focus of behavioural change.

This in no way means abandoning the older age groups but certainly rethinking and refocusing on appropriateand constant messaging is required.

Already, the country`s resources are strained to breaking point. When unemployment rises to over 8m youth in 2050, according to the current trajectory, the survival of Pakistan itself will be at stake.

Interestingly, recent studies have shown that religion plays a smaller role in presentday Pakistan in the family planning decisionmaking. Behavioural change is critical, as is awareness of options. In today`s world, women should not die due to unsafe abortions. Family spacing for anything up to 10 years is a common but under-utilised option in Pakistan.

Greater use of modern contraception, the advantages of smaller families, the health benefits of family spacing and the education and empowerment of women have been instrumental in reducing the fertility rates in many countries. Pakistan needs to follow suit. • The writer works for a non-profit organisation in the field of reproductive health.