The Tribune - Spectrum

Sunday, May 14, 2000
Lead Article


While the Indian Punjab in general cannot boast of a robust record in the performance of its social sectors like health care, education, population control and empowerment of women, the Pakistan Punjab’s record in these sectors has been much worse, in several instances, poorer than even the most impoverished areas of the world, says Sultan Shahin.

BOTH India and Pakistan have been moving on the path of economic progress with a reasonably high degree of success for developing countries. Unquestionably, the states of Punjab in the two countries have contributed significantly towards this progress. But economic growth is not an end in itself and is meaningful only if it brings about social development.

While India in general cannot boast of a robust record in the performance of its social sectors like health care, education, population control and empowerment of women, Pakistan’s record in these sectors has been much worse, in several instances poorer than even the most impoverished nations of the world. Within the two countries, a comparative study of the states of Punjab further reinforces the fact that economic growth and social prosperity are completely unrelated aspects of Pakistan’s economy.

Photo:Om Prakash QadianLiteracy is perhaps the most significant index of social development in a developing country as all other sectors are dependent on the success in this sector. While the state of education in Pakistani Punjab is actually poorer than the rest of Pakistan, Indian Punjab has recorded one of the highest literacy rates in India. The literacy rate in Indian Punjab in 58.5 per cent, more than double the rate for Pakistani Punjab (24.5 per cent). Male literacy in Indian Punjab, at 65.7 per cent, is about double the rate in Pakistani Punjab -- 33.5 per cent. In terms of female literacy, Indian Punjab is almost three-and-a-half times better with 50.4 per cent compared to Pakistani Punjab’s 14.4 per cent.

More interesting is the urban-rural comparison. Indian Punjab’s urban literacy is 67.1 per cent to Pakistani Punjab’s 43.1 per cent. Urban male literacy is 72.9 per cent here compared to 51.5 per cent in the latter, while urban female literacy is 60.3 per cent and 33.2 per cent respectively. The Indian Punjab also scores over the other in terms of rural literacy. The average rates for the two are 42.6 per cent and 17.3 per cent. Rural male literacy in Indian Punjab is 50.5 per cent compared to Pakistani Punjab’s 26.4 per cent. Rural female literacy in Indian Punjab is 33.5 per cent, almost five times the rural female literacy in Pakistani Punjab at 7.4 per cent.

  Extending the comparisons from state level to the national level, the average literacy rate in the whole of Pakistan is a poor 35.7 per cent compared to India’s 49.9 per cent. World Bank figures show that Pakistan’s literacy rate is even lower than that of sub-Saharan Africa countries like Ghana and Nigeria. School enrolment rates in Pakistan are less than half of the average in India.

It is also quite futile to talk of a single literacy rate for Pakistan as there are glaring disparities within the country along gender, class and regional lines. Female literacy rates in Pakistan have remained less than half the male literacy rate since independence, and the difference has widened over the decades. While male literacy has grown from 17 per cent to 45.1 per cent between 1951 and 1991, the progress in female literacy has been much more gradual, from 8.6 per cent to 20.9 per cent in the same period.

The urban-rural bias in literacy rates in Pakistan is even more sharp. The average urban literacy in Pakistan, according to the latest figures available, is 43.4 per cent compared to just 14.8 per cent in the rural areas. Urban male literacy of 51.5 per cent is more than double the rural male literacy of 23.1 per cent. But the biggest gap is between urban and rural female literacy — 33.7 per cent to just 5.5 per cent. The rural female literacy rate of 5.5 per cent is also the lowest in the world.

Other averages like enrolment and drop-out further underline the dismal state of female education in Pakistan. The primary school enrolment rate for girls is 15 per cent below the overall enrolment rate and 8 per cent less than secondary enrolment. Girls moving from primary to secondary schools in 1987 were 9 per cent less than boys, implying a higher dropout percentage for girls. A primary factor behind this is lower school availability and accessibility for girls. Whether or not a school is available in the same or nearby village is claimed to account for one-third of the large gender gap in schools.

The distance to a school may not be the most critical factor for boys, but for girls, and especially for those in the rural areas, this makes all the difference between a literate and a non-literate status.

In a way these distressing literacy rates are not very surprising. Education has never been a priority issue in Pakistan, as is evident from the extremely low expenditure budgeted for this sector. It was as low as 1.4 per cent of the GNP in the early 70s, and remained around 1.5 per cent between 1975 and 1985. Since then it has increased to 2.3 per cent, but is still nowhere near the requirement.

Population growth is perhaps the basic malaise behind all other ills facing both India and Pakistan. While India has registered an annual growth rate of 2.2 per cent (itself not very creditable), according to the last census, Pakistan’s growth rate has been as high as three per cent per annum. This rate has been prevalent since the early ’70s and has led to the quadrupling of the country’s population from the time of Independence. In fact, the last census in Pakistan was held in 1981, and if reports in the Pakistani media are to be believed, the annual growth rate may have neared 3.5 per cent in the last decade. A telling figure here is that of contraceptive usage, which is just 14 per cent in Pakistan as compared to 43 per cent in India. This is a direct fallout of lack of education.

The reasons for a high growth rate of the population in Pakistan are many. Apart from extreme poverty and social insecurity, Pakistani society continues to suffer from early marriage of women and their poor education. Almost 50 per cent of women in Pakistan are married before the age of 20, enormously increasing the chances of conception. In fact, the average fertility of women (number of live births per woman) in Pakistan is a high 6.1 compared to India’s 3.7. Another factor is poor education of women. There is abundant evidence internationally that well-educated women, being career-oriented, generally bear fewer children. The rate of contraceptive usage is also quite high among educated women.

According to a 1991 survey, only two-fifth of Pakistani women knew of major contraceptives, and less than a quarter of these actually used them. The reasons cited by them ranged from the husband preference’s to their cost and even a simple lack of conviction regarding their usefulness. Also about 30 per cent of college graduates reported using contraceptives, as compared to 8.5 per cent of uneducated women.

Along with India, Pakistan was one of the earliest countries to recognise the significance of population control and began formulating measures and policies as early as the 1960s. However, these policies have undergone frequent changes in the country with changing political leadership. In the period 1965-73, the population programme relied mainly on the use of traditional midwives (dais) to motivate the population, distribute contraceptives etc. Zulfiqar Ali Bhutto’s government in 1973 introduced a mechanism called the ‘continuous motivation system’, which was meant to be implemented by well-trained couples rather than dais.

The programme suffered a setback in 1977 under the banner of the ‘Islamisation’ programme of General Zia-ul-Haq, and was discontinued. It was only after 1988, when democratic forces began to re-emerge in the country that population control measures were restarted. Expenditure on population control has also remained on the lower side in Pakistan, averaging about 0.06 per cent of the GNP.

The health sector in Pakistan defies all logic. Access to health facilities (hospitals, nursing homes and health centres) is just 55 per cent, as compared to 65 per cent for India. The average calorie intake in Pakistan measures 2,316 per person per day, while in India it is is 2,395 per person per day. The infant mortality rate in Pakistan is 8.8 per cent as compared to India’s 8.0 per cent. Access to water resources is only 68 per cent in Pakistan, as compared to India’s 78 per cent.

An interesting fact emerged from a table released by the Government of Pakistan a few years back listing the main causes of deaths in the country. Almost 64 per cent of the deaths in Pakistan are caused by infectious parasitic diseases. Diseases like malaria and tuberculosis account for another 10.5 per cent and 5.5 per cent respectively, taking the toll of all infectious diseases to 75 per cent, i.e., three-fourth of all

deaths in Pakistan. In rural areas, the situation is worse and it is the infectious diseases that account for almost 80 per cent of the deaths.

What is the reason for this high incidence of deaths due to infectious diseases? Access to water resources and sanitation is inadequate in urban areas, and almost non-existent in rural areas. Resources that are available are unhygienic and contaminated due to the lack of upkeep.

Only around 52 per cent of the country’s population has access to drinking water. While in urban areas drinking water is available to 80 per cent of the people, it is as low as 45 per cent in rural areas. Proper sanitation facilities are available to just 22 per cent of the people. In urban areas the figure is 53 per cent, but in rural areas it is only 10 per cent. In fact, as late as 1985, sanitation facilities were absolutely nil in rural Pakistan. It is not a surprise that diseases such as typhoid, cholera, intestinal infections, malaria, tuberculosis etc have such a high incidence in the country.

The above figures also reveal a deep-rooted urban bias in the health sector of Pakistan. Even though 60 per cent of Pakistan lives in rural areas, an overwhelming section of medical personnel and health facilities are located only in cities. For example, 85 per cent of all practicing doctors work in the cities, which comes to a doctor-population ratio of 1:1801. The rural doctor-population ratio happens to be a pathetic 1:25829. Similarly, only 23 per cent of the hospitals in the country are located in rural areas and only 8,574 hospital beds (18 per cent of the total) for a population of 80 million.

The health budget in Pakistan is less than 1 per cent of the GNP. Out of this, more than four-fifth gets allocated to urban-based curative health facilities at the expense of rural health programmes. An important reason for a lack of trained medical manpower in rural areas is the lack of facilities. Even if some well-intentioned doctors want to serve in rural areas, the abysmal conditions force them to change their mind. The government’s approach to the whole issue can be gauged from the fact that though it ‘urges’ doctors to go to rural areas, it actually pays them less than their colleagues at equivalent positions in urban health centres.

Even in urban areas the health facilities are largely restricted to use by the upper sections of society and are beyond the reach of those living in slums and katchi abadis, Pakistan’s rate of urbanisation is around 4.8 per cent per annum, largely due to migration from rural areas. Punjab, in fact, has recorded the highest urbanisation rate among all the provinces and today more than 56 per cent of Pakistan’s total urban population resides in Punjab.

Under the impact of this large-scale migration, slums and katchi abadis constitute a large section, around 40 per cent nationwide of Pakistan’s urban populace. Health centres and other medical facilities are non-existent in these settlements. Sanitary provisions and water accessibility are also practically non existent in several instances, even sewerage and filth-disposal systems have not been provided. Under such extreme conditions, it is no wonder that three-fourth of the deaths in the country are caused by infectious diseases.

The low status of women in Pakistani society is already evident from our discussions on population welfare and education sector. Observations made by Pakistani economist S Akbar Zaidi in Issues in Pakistan’s Economy provided some further clues:

* Pakistan has the lowest sex rations in the world: in 1985 there were 91 women for every 100 men, down from 93 in 1965.

* According to studies conducted in 1989, Pakistan was one of only four countries in the world where men lived longer than women.

* Primary school enrolment rates for girls are among the ten lowest in the world.

* While the incidence of ill-health and premature death among the poor of both sexes is very high in Pakistan, women and girls are the worst affected.

* Pakistan’s maternal mortality rate is the highest in South Asia and great than all other Muslim countries, essentially due to birth-related problems. This is compounded by the very high prevalence of babies with low birth-weight — only three countries in the world have a higher percentage of such babies than Pakistan.

* Only 13 per cent of the labour force is constituted of women, substantially below the 36 per cent average for all low-income countries.

According to a table released by the Government of Pakistan in 1995, tremendous male-female disparities persist throughout the country. The percentage of female population is lower than male population at all age levels: female population is 94 per cent of male population in the age-group 0-14 years, 91 per cent in the age-group 15-49 years, 83 per cent between 50-59 years and just 73 per cent for the group above 60 years.

Female child mortality (1-4 years) is 166 per cent of male child mortality. Just 80 per cent of females as compared to males undergo full immunisation. On all indices of literacy, female averages remain only half as high as males. The greatest disparities are evident in the work force. The number of female professionals is only 18 per cent of male professionals in Pakistan. At administrative and managerial levels, their employment is just 2 per cent of their male counterparts.

The discrimination meted out to women in Pakistani society has wide-ranging implications for the country as a whole. As economist Giovanni Cornia observes in Tariq Banuri’s Just Adjustment: Protecting the Vulnerable and Promoting Growth, the unsatisfactory social and economic development record in Pakistan depends to a very large extent on the low status of women in society, on their low level of literacy, on their restricted access to basic services, and on a pervasive gender bias in the access to economic resources which is the source of a severe inter-sex and intra-house hold income inequality.