30 years of ICPD 1994: Pockets of inequality persist 

The year  2024 commemorates the thirtieth anniversary of the International Conference on Population and Development (ICPD)  held in Cairo, Egypt. It was recognized as an event of significant importance where 179 governments pledged to prioritize sexual and reproductive health and rights (SRHR)  as fundamental to sustainable development. However, it is crucial to undertake a thorough examination and scrutiny of the progress made over these three decades.

Was it characterized by age-specific and class-specific interventions? Was it adhering to the principles of equity, equality, diversity, inclusivity, and accessibility, in actuality? How much was it beneficial for women in general and those from ostracized communities? Are women in conflict zones even aware of the strides made in the name of global health? Furthermore, it is important to assess whether the expenditure on capacity building, professional development, and travel for bureaucrats within UN systems and other civil arenas correlates directly with the outcomes achieved. How often have civil society consultative meetings on International Conference on Population and Development (ICPD) discourses included individuals from non-elite backgrounds representing various countries and cultures? These challenging and uncomfortable questions remain largely unaddressed and are often overlooked, even by high-profile journalists invited to the launch of the UNFPA flagship project—the annual report on the state of the population.

Notwithstanding the shortcomings and imperfections, this report remains a much-awaited product and contains a wealth of eye-opening information that too often leads to the disheartening and troubling conclusion that overall progress is now in peril.

The annual report on the State of the World Population 2024 by UNFPA, entitled, “Interwoven Lives, Threads of Hope: Ending Inequalities in Sexual and Reproductive Health and Rights,” has emphasized the necessity of an inclusive future. Statistics revealed persistent discrimination obstructing wide-ranging improvements in sexual and reproductive health for women and girls globally.

In the span of a generation, the world has witnessed a reduction of one-fifth in unintended pregnancy rates, a one-third decline in maternal mortality rates, and the enactment of laws against domestic violence in over 160 countries. Millions of women and girls still face significant challenges, with decisive indicators either rusting or regressing. For instance, maternal mortality rates have remained unchanged since 2016, and women’s bodily autonomy is waning and weakening in many countries.

According to Dr. Natalia Kanem, UNFPA Executive Director, disparities within societies and health systems are widening despite these achievements. States have yet to adequately prioritize reaching those who are furthest behind.

In Pakistan, the situation is exacerbated by peculiar demographic challenges and a failing population program. Mainstream media’s portrayal of population issues is too infrequent and whatever is there often lacks depth and understanding, resorting to coercive solutions like China’s one-child policy without considering context or consequences. In most TV programs, the participants mainly consist of those who impose serious conflicts of interest (COI), and the well-celebrated freedom of media in Pakistan appears to be at its lowest ebb in such discussions.

When tackling Pakistan’s population challenges, it’s essential to acknowledge that it’s not merely a medical or health issue but predominantly a human rights concern.  For instance, the persisting son preference is leading to various forms of abuse against women. Among these abuses, the lack of access to contraceptives and the inability to make decisions about the number of children and spacing should also be included. Moreover, the underperformance of population departments and the conflict of interest in healthcare provision remain unaddressed. Women’s empowerment is key to enabling them to make informed reproductive choices.

Every 50 minutes, a woman in Pakistan dies due to pregnancy complications, with rural areas facing greater challenges in accessing timely healthcare. Progress in addressing these issues has been persistently sluggish with projections indicating that Pakistan may only achieve zero maternal deaths after 122 years and fulfill family planning needs after 93 years if the current pace persists.

This deplorable projection will fail to elicit a proportionate response in Pakistan for the following reasons, each of equal value and weightage:

1. There is an elite capture in civil society and politics. Elites decide where to focus and how much attention to allocate to any social and gender issue.
2. The elitism and lack of sustainability models in the widely popular culture of social entrepreneurship are also harming the cause rather than aiding it.
3. Despite some resources being allocated to SDGs, population, and related development issues, the media shows neither genuine interest nor invests in comprehending the multidimensional Program of Action of ICPD.
4. The lack of accountability, meritocracy, and obvious nepotism and networking not only in public sectors but also in international aid, technical, and UN agencies has compromised the quality of human capital.
5. In Pakistani society, SGBV, GBV, VAWGC, and Violence Against TG people are still considered normative, and except for some selective short-term and sensational Twitter trends or social media posts, no significant action is taken even on reported cases of violence. In this milieu and mindset, preventable maternal deaths do not create any reason for concern. Cultural realities are even more hostile, as a widower is seen as an opportunity, and giving women and girls into marriage, no matter how mismatched, is considered perfectly normal.
6. There is no serious and inclusive discourse on SRHR in local Pakistani languages.

Despite these challenges, Pakistan’s provincial governments and legislators, with rare exceptions, have failed to grasp the urgency of the situation or revisit with an intersectionality lens, commitments made at ICPD 1994. Who will take the lead in addressing issues related to SRHR, family planning, and youth empowerment? This question remains unanswered, highlighting the need for urgent action and leadership to tackle the politics of the population in Pakistan.

A business-as-usual approach will not suffice for Pakistan’s population issues; surgical solutions are needed. Dr. Luay Shabaneh, UNFPA’s country representative in Pakistan, has consistently emphasized the importance of empowering youth and women and addressing structural inequalities in healthcare access.

Sadly, I do not see a singular civilian face or entity that is capable and powerful enough to conduct damage assessment and mitigation. At the risk of evoking speculations, skepticism, and spite, I would once again assert that our respected COAS must investigate the politics of the population, which has transformed a serious threat into a circus. It is, indeed, a matter of national interest. Pakistan requires an implementable policy and the elimination of ceremonial activities for an effective program. Perhaps it is time to establish an independent commission on Population without the inclusion of the usual suspects.