Social Change-the Foundation of Development

Remarks by Dr. Nafis Sadik
to the Asia Society, New York on the
50th Anniversary of Pakistan's Independence

March 13, 1998

Mr. President, Ladies and Gentlemen,

In assessing Pakistan's development prospects for our second 50 years of independence, the best service I can do for the country is to be quite frank. The fact is that we have fallen far behind other Asian countries, and even countries in our own region. The decisions needed to correct the situation would be a challenge for any country: for Pakistan they involve a drastic change in the way political leaders, planners, economists and businessmen think about development, and in the order of their priorities. Short-term fixes will not help us: we need to pay attention to the fundamentals.

The most important of these fundamentals is social development, that is investment in Pakistan's human capital, and in particular its women. Experience, including the experience of the Asian tigers, shows us that social development is the basis as well as the outcome of sustainable economic growth. Social development is not a "desirable option" for Pakistan: it is a necessity.

At Independence Pakistan's economy started more or less even with other countries in the region. All our efforts since then have left us lagging behind. In 1950 the Republic of Korea had about the same GNP per head as Pakistan. Today Korea's GNP is $7,670; ours $476. That is a difference of 1,611 per cent. The current difficulties of the Asian tiger economies should not make Pakistan feel complacent. They have no doubt lost a great deal of ground: but if their fundamentals are sound, they will make up the lost ground relatively quickly. Pakistan still has to take the first steps towards stable long-term economic growth.

One of the reasons for Pakistan's slow and erratic economic development is its low rate of social investment compared with international norms and the practice of other countries in the region. For example, Pakistan's investments in health and education were 1 and 1.6 per cent of government expenditures respectively in 1990, compared with 4.8 and 11.2 per cent in Bangladesh. Despite a much lower income per head in Bangladesh, contraceptive prevalence was 47 per cent in 1995.

The benefits of development have never reached very far into Pakistan's society. For example, Pakistan is producing more food now than at any time in its history, and food production has more than kept pace with population growth. Yet 38 per cent of children are underweight for their age.

Despite the promises of successive development plans, in 1996 the National Institute for Population Studies reported that only 55 per cent of the population have access to health facilities, only 55 per cent have safe drinking water, and only 24 per cent have sanitation.

In 1993-94, there was, on an average, one doctor for every 1,918 persons, one hospital bed for 1,548 persons, and one nurse serving a population of 5,969. The shortage of service providers and supplies is even more acute in rural areas.

Infant mortality in Pakistan remains well above the world average at 85 per 1000 and life expectancy is low at 62 years. Only one in three births have a trained health worker in attendance. Maternal mortality is needlessly high: 340 women die for every hundred thousand live births.

Male literacy is 50 per cent; but for women only 24 per cent. Fewer than a third of Pakistan's girls are at school and only 56 per cent of boys.

In Pakistan, fertility is at 5.5 children per woman, the highest in South Asia except for Afghanistan and Bhutan. Only 12 per cent of couples use modern methods of family planning.

One result of this neglect of the social sector has been rapid population growth. At independence, Pakistan was the 13th most populous country in the world, with 32.5 million people; in 1996 it was seventh, with a population of 140 million. Pakistan's population growth rate is now one of the highest in Asia at 2.7 per cent: at independence we added a million people every year or so; today we are adding a million every three months. No conceivable development plan can sustain such a rate of population growth. If we are to meet the challenges of the 21st century, Pakistan must put slowing population growth at the head of its list of priorities.

We have discovered by experience, including the example of the East Asian tiger economies, that successful programmes to slow population growth are based on the ability of individual men and women to make decisions in favour of smaller families. That in turn is based on moves towards gender equality, on education for all and on good health services; including family planning programmes which are consistent in their support for reproductive health and reproductive choices.

Gender Inequality

Inequality between the sexes has held back Pakistan's development from the outset. At every economic level in Pakistan, what resources exist are not equitably distributed between men and women, girls and boys. Girls are less welcome in our families than boys. There are many congratulations for the birth of a boy, but we don't hear so much rejoicing when a girl is born.

Our girl children are more likely to be malnourished than boys. They are less likely to be taken to hospital when they are sick, and they are more likely to die in infancy. Girls are much less likely to go to school than boys, and much more likely to leave school early. They get married earlier than boys and start having children while they are still in their teens. Although they work very hard, inside the home and out, they can expect recognition for only one of their activities; the bearing and raising of boy children. In Pakistan, mother of many sons is admired and has status in her community. Compared with her all other women are inferior, including for example professionally-qualified women such as myself. Even now I find that I would be considered much more successful in my own country if I had had several boy children ­ as well as becoming an Under Secretary-general of the United Nations.

If these are the attitudes educated women find among their own friends and acquaintances, consider how it must be for poor women. Most women's opportunities and even their aspirations are strictly limited by the expectations of their fathers, their husbands ­ and their mothers-in-law. Many women are hardly aware that they have rights outside the family.

This not only leads to limitations on women's participation in the wider world, it also means that oppression and violence within the family goes unpunished or even unnoticed. Women have to take whatever their husbands and their husbands' families choose to give them, good or bad. Neither their birth families nor the law will intervene.

We suffer in fact from a long history of domination and discrimination against women. There is no justification for this either in our religion or in the traditions of the past: those who use religion or tradition to somehow justify the subjection and oppression of women and the crass neglect of their needs are simply wrong.

They are wrong on three counts-first because it is an offence against human rights to condemn women to a life of childbearing, poor health, menial tasks, mental oppression and physical violence; second, because it amounts to a systematic neglect of half of Pakistan's human resources; and third because it means that fertility, family size and population growth are all far higher than they should be.

At independence, and for some years afterwards, our health services were admired and copied. Beginning in 1965, our early efforts in family planning were an example to other countries in the region. But we have lost direction and impetus. Governments have gone back and forth between different policies, and no one has come forward to state unequivocally that Pakistan needs and must have lower fertility, smaller families and slower population growth. No government has been willing to accept or even discuss the implications ­ that old attitudes towards women, the family, the poor and the rural populations must be discarded. It is not so much the people of Pakistan who are backward, as its rulers. Pakistan's political classes must catch up.

At the 1994 International Conference on Population and Development, held in Cairo, Pakistan was among 179 nations which agreed that investment in people-promoting equity and equality for women, investing in health and education, and strengthening civil society-is the key not only to social progress and meeting international standards of human rights, but to slower and more balanced population growth. Many countries have acted on this understanding.

Here is where development meets human rights, and here lies the challenge to Pakistan. To meet the challenge it is essential that we act now to put social investment at the top of our policy and development agenda. We must provide basic social services for all, and we must provide them in a way that promotes rather than stifles choice. Social development, no less than political development, depends on the ability to choose, and the existence of real choices.

Leaders at all levels must speak out on this matter, and they must also act forcefully to secure the social changes that will promote slower population growth. They must work against preference for sons and promote equality within the family. They must encourage and involve men in supporting the empowerment of women, and increase awareness of the contributions made by women. They must point out that our religion opposes any kind of violence towards women, and that it promotes the concept of parental responsibility: that parents should plan for the number of children they can support and bring up: and that young people should be taught about reproductive and sexual health and how to become responsible, caring adults.

Such a change may not be easy. It may involve in some cases questioning long-held beliefs and attitudes, especially towards women and the poor. It may mean giving up the habits of a lifetime, but it must be done, because in the end Pakistan's future depends on all its people: and it will depend as much on its women as its men.

Meeting The Unmet Need

It is encouraging that the government has announced plans to increase expenditure in the social sector, though the projected increases are still modest. Already, more than a quarter of married women in both rural and urban areas have an unmet need for family planning. As a first step, Pakistan must make reproductive health services, including family planning, accessible to these women through the primary health-care system without delay. This calls for innovation and imagination: for example, the plan to train 33,000 village health workers to provide primary health and family planning services is a hopeful initiative, but it must be matched by an overall shift in the management of the health services, to respond more closely to users' needs. Decentralized management accountable to local authorities rather than a centralized bureaucracy will be a step in the right direction.

Users and potential users need information and education about reproductive health and family planning, which will further increase demand for services. To meet the growing demand we must involve not only the government services but women, women's organizations, and other groups. We must promote men's participation in reproductive health programmes and insist that they assume responsibility for their sexual and reproductive behaviour. We must assure the highest quality of care in providing information and services, and make available as wide a range as possible of safe and effective modern methods of family planning;

Investing in Education

Education is a basic human right, but it is also a fundamental building block of sustainable development. To improve the quality of education overall, we should look carefully at imbalances and differences in quality between what is available in urban and rural areas, richer and poorer neighbourhoods; and in public and private sectors.

Education is important for everyone, but it has a special significance for women. Education empowers women in multiple ways. Educated women know their rights and have the confidence to claim them. They are likely to marry later and have smaller families: they know the importance of health care and how to seek it for themselves and their children. They can work outside the home: but most importantly they can use their education to enrich their lives.

In Pakistan, as in many other developing countries, young girls have many responsibilities-child care, housework, marketing or work around the farm-which prevent them from attending school. We need to look very critically at this use of girls as unpaid labour and ask not only whether the country can afford to waste their potential, but what sort of lives these girls should expect..

We should be clear: there is nothing in the Qu'ran or in our culture which says that girls should be kept at home working while their brothers go to school. Closing the gender gap in education must be a first priority. Beyond this, we must accept that the Qu'ran does not impose constant childbearing as a duty on women: in fact the Prophet advised that parents should have only the number of children they could responsibly bring up. Many Muslim countries have based a successful population policy on that understanding. Pakistan should be prepared to do it too. Such a change will require much discussion and debate ­ but most of all it requires that we accept the need for change.

Conclusion

Successful social development depends not simply on providing services, but on inviting participation. Successful policies respond directly to the needs of ordinary people, for health, education, employment and a more secure existence. Successful social development demands a much higher level of political participation at all levels, and more involvement of women in business, the professions, politics and government. It calls for strong non-governmental organizations, and a willingness on the part of government to accept that NGOs have an important part to play in the civil society. It demands on the part of government a willingness to innovate, to adapt and to respond. It calls for strong national institutions and dedicated professionals to staff them. Above all it calls for leadership, the sort of leadership which can express our common desire for development for all our people. If Pakistan can meet that standard, then the promise of independence will finally be achieved.



Dr. Nafis Sadik has been the Executive Director of the United Nations Population Fund (UNFPA) since her appointment in 1987, when she became the first woman to head a major voluntarily funded program of the United Nations.

A native of Pakistan, Dr. Sadik received her medical degree from Dow Medical College in Karachi and completed further studies at Johns Hopkins University. Before joining the UNFPA, Dr. Sadik served as a civilian medical officer in charge of women's and children's wards in various Pakistani armed forces hospitals and was the Director of Planning and Training at the Pakistan Central Family Planning Council.

In June 1990, the Secretary-General of the United Nations appointed Dr. Sadik Secretary General of the 1994 International Conference on Population and Development (ICPD). She also served as the President of the Society for International Development (SID) between 1994-1997.

In 1976, Dr. Sadik was the first woman to receive the Hugh Moore Award for her leadership in the family planning field as well as her leadership in encouraging other women to find careers in the population field. This achievement has been followed by several honorary degrees and numerous international awards, the most recent of which is the Paul Harris Fellow, and an honorary degree of Doctor of Science from Long Island University both in 1997.

Dr. Sadik has written numerous articles for leading publications in the family planning, health, and population and development fields, the most recent of which is Making a Difference: Twenty Five Years of the UNFPA Experience, 1994.