Pakistan's extremely high rate of population growth is caused by a falling death rate combined with a continuing high birth rate. In 1950 the mortality rate was twenty-seven per 1,000 population by 1990 the rate had dropped to twelve (estimated) per 1,000. Yet throughout this period, the birth rate was fortyfour per 1,000 population. On average, in 1990 each family had 6.2 children, and only 11 percent of couples were regularly practicing contraception.

In 1952 the Family Planning Association of Pakistan, an NGO, initiated efforts to contain population growth. Three years later, the government began to fund the association and noted the need to reduce population growth in its First Five-Year Plan (1955-60). The government soon combined its population planning efforts in hospitals and clinics into a single program. Thus population planning was a dual effort led by the Family Planning Association and the public sector.

In the mid-1960s, the Ministry of Health initiated a program in which intrauterine devices (IUDs) were promoted. Payments were offered to hospitals and clinics as incentives, and midwives were trained to treat patients. The government was able to attract funding from many international donors, but the program lost support because the targets were overly ambitious and because doctors and clinics allegedly overreported their services to claim incentive payments.

The population planning program was suspended and substantively reorganized after the fall of Mohammad Ayub Khan's government in 1969. In late December 1971, the population was estimated at 65.2 million. In an attempt to control the population problem, the government introduced several new programs. First, the Continuous Motivation System Programme, which employed young urban women to visit rural areas, was initiated. In 1975 the Inundation Programme was added. Based on the premise that greater availability would increase use, shopkeepers throughout the country stocked birth control pills and condoms. Both programs failed, however. The unmarried urban women had little understanding of the lives of the rural women they were to motivate, and shopkeepers kept the contraceptives out of sight because it was considered mannerless to display them in an obvious way.

Following Zia ul-Haq's coup d'état in 1977, government population planning efforts were almost halted. In 1980 the Population Division, formerly under the direction of a minister of state, was renamed the Population Welfare Division and transferred to the Ministry of Planning and Economic Development. This agency was charged with the delivery of both family planning services and maternal and child health care. This reorganized structure corresponded with the new population planning strategy, which was based on a multifaceted community-based "cafeteria" approach, in cooperation with Family Welfare Centres (essentially clinics) and Reproductive Health Centres (mostly engaged in sterilizations). Community participation had finally became a cornerstone of the government's policy, and it was hoped that contraceptive use would ris828 ise dramatically. The population by 1980 had exceeded 84 million.

In preparing the Sixth Five-Year Plan (1983-88), the government projected a national population of 147 million in the year 2000 if the growth rate were to be a constant at 2.8 percent per year, and of 134 million if the rate were to decline to the desired 2.1 percent per year by then. By the Seventh Five-Year Plan (1988-93) period, the multipronged approach initiated in the 1980s had increased international donor assistance and had begun to enlist local NGOs. Efforts to improve maternal and child health were coupled with education campaigns. Because of local mores concerning modesty, the government avoided explicit reference to contraceptive devices and instead focused its public education efforts on encouraging couples to limit their family size to two children.

The key to controlling population growth, according to activists in the women's movement, lies in raising the socioeconomic status of women. Until a woman's status is determined by something other than her reproductive capabilities, and especially by the number of sons she bears, severe impediments to lowering population growth rates will persist.

Data as of April 1994