Population Control is a Governance Problem, Not a Clinical Issue.

Naeem Afzal

Several years ago, Dr. Zafar-Allah Chowdhry—who was to Bangladesh’s health sector what Muhammad Yunus is to microfinance—was invited to Lahore by the then chief minister of Punjab, Shehbaz Sharif, for a discussion on population planning in Bangladesh. During the conversation, he remarked, “Bangladesh learned from Ayub Khan’s population planning program. Truly, Bangladesh learned the lesson while we unlearned.”

In the twenty-first century, it is now an indisputable fact that excessive population growth in a constrained socio-economic environment has negative effects. In 1958, the President of the United States, John F. Kennedy, remarked, “In this age of plenty, the standard of living for much of the world is declining. The rich are getting richer; the poor are getting poorer. Among the chief causes of economic deprivation, excessive population growth is at the top.”

In scholarly research, the theory of population management is complex and multidimensional. Eminent economists differ in their views on controlling population growth. Lant Pritchett prefers improving the socio-economic profile of women over expanding family planning efforts. Ijaz Nabi, a professor of economics at LUMS, offers a mixed approach, combining both supply-side and demand-side changes. Dr. Mahbub-ul-Haq, meanwhile, views population management through the lens of sustainable development. As he put it, “Population is a development problem, not a clinical one.”

The trajectory of population growth in Pakistan is quite depressing. At the time of independence, the population of what was then West Pakistan stood at 33 million. According to the Economic Survey 2026, it has reached 250 million. During Ayub Khan’s era, Pakistan implemented a successful population planning program, and the country maintained a respectable growth rate of 6 percent. In Zia’s era, population governance faced a serious setback due to the so-called “Islamization” of governance and the influence of the clergy. Between 1990 and 1995, the growth rate plunged to 4 percent, but the fertility rate remained at 2.5 percent. According to scholars, this correlation reveals an interesting phenomenon.

Despite the falling growth rate, poor households continued to have more children, because poor people consider children—particularly male children—as future breadwinners.

Therefore, in this scenario, economists claim that population control is a developmental problem, not a clinical one. Indeed, planning-level interventions are vitally important, but they become effective only as the socio-economic profile of society improves. According to Mahbub-ul-Haq, the renowned development economist, population planning works sustainably only when people are empowered enough to make decisions about their own lives. In his view, merely distributing condoms in a poor village will not reduce people’s desire to have more children in Pakistan. In Pakistan, research shows that after nineteen years of family planning efforts, only six percent of couples were using contraceptives—condoms or oral pills.

As Mahbub-ul-Haq put it, “Merely distributing condoms in a poor village will not work.”

The population growth rate is determined by the fertility rate—the number of children born per woman of child-bearing age. The fertility rate, in turn, is determined by a range of factors: social, religious, cultural, and others. Importantly, the desire to reduce the fertility rate manifests itself in the desire to use contraceptives. To some extent, this is true — but on a wider scale, scholars disagree with it.

As Lant Pritchett put it, “Social, cultural, and religious factors are more powerful in determining population growth.”

Based on the preceding discussion, the following are suggestions for Pakistan to control its excessive population growth.

First, Pakistan must raise the standard of living for women and pursue their overall empowerment in society. Sadly, Pakistan scores dismally low on the gender inequality index, ranking only above Afghanistan. The participation of women in the workforce has remained miserably low, at only 22 percent. Only empowered women can make conscious, rational decisions about their lives.

What emerges from this debate is not a dispute over numbers but over the nature of the problem itself. Pakistan’s population has grown nearly eightfold since independence, yet the instinct of successive governments has too often been to treat this as a matter of clinics, condoms, and contraceptive targets rather than a matter of governance, opportunity, and the standing of women in society. Bangladesh’s trajectory offers an uncomfortable lesson precisely because it did not follow this instinct. It built on Ayub Khan’s early planning success rather than abandoning it to clerical politics, and it invested in the socio-economic empowerment of women rather than treating family planning as a standalone clinical campaign. Pritchett, Nabi, and Mahbub-ul-Haq disagree on method, but they converge on this deeper point: fertility decisions are downstream of dignity, security, and opportunity, not of contraceptive availability alone. Until Pakistan’s policymakers accept that population is a governance problem rather than a clinical one, every planning intervention will remain a palliative rather than a cure.