Women, Population and Sustainable Development in South Asia.

• Author: Sadik, Nafis

Introduction

According to the recently released 1996 revision of the official United Nations population estimates and projections, at mid-1996, world population stood at 5.77 billion persons.(1) Between 1990 and 1995, the world population grew at 1.48 percent per annum, with an average of 81 million persons added each year. This is considerably slower than the 1.72 percent per annum growth rate of the 1975 to 1990 period. Additionally, the annual increment is notably less than the 87 million persons added each year between 1985 and 1990.(2)

In South Asia--Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka--the population exceeded 1.2 billion people in 1996, which is more than one-fifth of humankind. Table 1 presents selected population and socio-economic indicators for countries in South Asia. The sharp decline in South Asia's death rates in the post-Second World War era has been accompanied by a much slower reduction in birth rates. As a consequence, the region's population has grown rapidly, adding significantly to its large population base. This rate of growth continues to challenge and constrain the ability of governments to improve the quality of life, with the result that South Asia has the bulk of the world's poor in its midst as well as the highest concentration of need for reproductive health (RH) and family planning (FP) information and services. Therefore, the provision of comprehensive reproductive health services, the empowerment of women, improved education for girls and a commitment to gender equality and equity will be critical to achieving sustainable development.

Table 1: Selected population and Socio-economic indicators for countries in South Asia

Country Population Crude Birth Infant Mortality (thousands) Rate Rate (per 1000 1995 Estimates (Per 1000 live births) population) 1990-95 Estimates 1990-95 Estimates Afghanistan 19,661 49.7 163 Bangladesh 118,229 26.7 91 Bhutan 1,770 41.6 117 India 929,005 27.5 78 Maldives 254 41.6 60 Nepal 21,456 39.6 96 Pakistan 136,257 39.4 85 Sri Lanka 17,928 18.6 18 Country Total Illiteracy Rate (percent)(*) GNP Per Capita ($U.S.)(*) Total Male Female Afghanistan 68.5 52.8 85.0 Not available Bangladesh 61.9 50.6 73.9 220 Bhutan 57.8 43.8 71.9 180 India 48.0 34.5 62.3 310 Maldives 6.8 6.7 7.0 500 Nepal 72.5 59.1 86.0 170 Pakistan 62.2 50.0 75.6 410 Sri Lanka 9.8 6.6 12.8 540 Source: United Nations, World Population Prospects: The 1996 Revision (New York: United Nations, 1996).

(*) Adult Illiteracy Rate (UNESCO) and GNP Per Capita (World Bank database) - in UNESCO, World Education Report 1995. (A person defined as illiterate is unable both t8 read and write a short simple statement on everyday life with understanding.)

It is clear that on the eve of the 21st century the countries of South Asia face several challenges in the area of population and sustainable development. According to the Programme of Action, which emerged from the 1994 International Conference on Population and Development (ICPD), sustainable development is defined as, inter alia,

long-term sustainability in production and consumption relating to all economic activities including industry, energy, agriculture, forestry, fisheries, transport, tourism and infrastructure in order to optimize ecologically sound resource use and minimize waste. Macroeconomic and sectoral policies have, however, rarely given due attention to population considerations. Explicitly integrating population into economic and development strategies will both speed up the pace of sustainable development and poverty alleviation and contribute to the achievement of population objectives and an improved quality of life of the population.(3) At the 1994 ICPD, representatives from 179 countries, including those of South Asia, agreed on and endorsed a Programme of Action delineating population and sustainable development objectives and goals for the next 20 years. These include: sustained economic growth in the context of sustainable development; improvement of education, especially for girls; gender equality; reduction in infant, child and maternal mortality; and the provision of universal access to RH services, which include FP and sexual health. The Programme of Action, firmly anchored in a human rights framework, underscores the centrality of the human person as the subject of development, emphasizing that, "people are the most important and valuable resource of any nation," and, "the right to development is a universal and inalienable right and an integral part of fundamental human rights."(4) Key to this approach is the empowerment of women, gender equality and equity, reproductive rights and reproductive health. The new paradigm that emerged at the ICPD marks a distinct shift from a focus on demographic targets to a focus on people-centered development.

This article focuses on the following key issues that countries in South Asia must address to achieve sustainable development: population growth; migration and urbanization; poverty eradication and the provision of basic social services for all; empowerment of women; gender equality and equity,(5) including special attention to the girl child;(6) and reproductive health, family planning and sexual health, including HIV/AIDS prevention. Undoubtedly, in each country the policies and programs to meet these challenges will be shaped by national priorities and particularities. However, any effective strategy will require development partnerships between governments, nongovernment organizations (NGOs), multilateral and bilateral agencies, the private sector and civil society Increased resource mobilization and strong advocacy at all levels will also be required for population and sustainable development.

Fertility in South Asia(7)

While fertility reductions in South Asia have been slower than in certain other regions, Table 2 shows that there have been some impressive recent changes. Sri Lanka is the only South Asian country that has completed the transition to replacement level fertility--that is to approximately two children per woman. Its fertility decline began in the 1950s, largely as a result of the rise in the marriage age, and subsequently through a fall in marital fertility as a result of increased contraceptive use, particularly female sterilization. Sri Lanka's fertility transition, like that in the Indian state of Kerala, appears to have been facilitated by a relatively equitable distribution of wealth and welfare benefits, the high status of women and high levels of female literacy.

Table 2: Total Fertility Rates in South Asian Countries: 1970 - 1995

Country 1970-75 1980-85 1990-95 Afghanistan 7.14 6.90 6.90 Bangladesh 7.02 6.15 3.40 Bhutan 5.90 5.89 5.89 India 5.43 4.47 3.39 Maldives 7.00 6.80 6.80 Nepal 6.30 6.10 5.42 Pakistan 7.00 6.50 5.51 Sri Lanka 4.00 3.25 2.20 Source: United Nations, World Population Prospects: The 1996 Revision (New York: United Nations, 1996).

In the mid-1990s, women in Bangladesh and India were having between three to four children on average as shown in Table 2. The remarkable relatively recent fertility decline in Bangladesh since the early 1980s contrasts sharply with the much steadier change that has occurred in India. In India, however, national trends in aggregate fertility levels conceal state variations. Thus, for example, whereas fertility in the southern states of Kerala and Tamilnadu is near replacement level, women in poorer states, such as Bihar and Uttar Pradesh, are still bearing approximately five or more children. The areas where fertility has declined most are those where social progress has been greatest. Relatively high adult female literacy, later age at first marriage, low child mortality together with active family planning programs are characteristics of states where fertility is lowest. In Pakistan and Nepal during the mid-1990s, women were having between five and six children on average. Although fertility levels are higher than those prevailing in the other South Asian countries, there is evidence of some recent decline, which is consistent with a small rise in the age of women at first marriage. Key factors in the persistence of high fertility in both countries appear to be a large need for reproductive health and family planning (RH/ FP) information and services, the low status of women, and low levels of female education.

To remedy the situation and meet the need for quality RH/FP, governments of countries in South Asia are beginning to implement integrated RH/FP programs. For example, Pakistan has already trained and deployed 30,000 (of an anticipated 100,000) Lady Health Workers to increase coverage and enable a larger number of rural people to have access to RH/FP services. These workers are in addition to 12,000 village-based workers already in place. Nepal, too, has developed a national primary health care outreach strategy to ensure universal access to quality RH/FP services. Although survey data indicate that by the mid-1990s knowledge of contraception was very widespread among women in Bangladesh, India and Sri Lanka, contraception is less well known among the populations of Nepal and Pakistan where the programs have had less impact. As might be expected from trends in levels of fertility the use of contraception has been uneven. Sri Lanka has long been, and remains, significantly ahead of the other countries in the level of contraceptive use.

Indeed, Sri Lanka, with its strong family planning program and history of investing in health and education, represents a population success story. It has low infant and maternal mortality rates, high contraceptive prevalence rate (66.1 percent), a high female literacy rate (83.1 percent) and low population growth rate (1.3 percent).(8) In the light of the ICPD Programme of Action, Sri Lanka is broadening its program perspective to a comprehensive reproductive health approach and increasing its emphasis on such issues...