1 Family Planning in Pakistan: A Site of Resistance At present, Pakistan with a population of 207 million is the world’s sixth most populous country. (National Institute of Population Studies 2013, Statistics 2017). The Pakistani state has framed addressing population growth as an essential element of economic sustainability and prosperity. The country launched its family planning program in the 1960s, making it a pioneer among developing countries. Sixty years later, the program has proved unable to increase contraceptive uptake. At present, the contraceptive prevalence rate (CPR) currently stands at 35%, compared to 62% in Bangladesh, and 56% in neighbouring India(International 2007, National Institute of Population Studies 2013, National Institute of Population Research and Training 2014). A large body of literature has sought to understand the stagnated CPR. Most of the discussion has focused on ‘ cultural ’ barriers, varying political support, and service delivery failures(Cleland, Bernstein et al. 2006, Sathar 2013). Underlying this body of literature is an assumption that Pakistani citizens are not using contraceptives because of a lack of access, and a lack of service provision by the government. Family planning in Pakistan has been, and continues to be, a priority of multilateral agencies and Western powers. Foreign support for family planning in Pakistan has been two- fold; financial and political. Pakistan’s family planning program is heavily funded by foreign bodies such as the United Nations, World Bank, and U.S. Agency of International Development (USAID) (Hardee and Leahy 2008). Additionally, Pakistan has been a signatory on several international agreements where it has committed to increasing family planning use, including the International Conference on Population Development Manifesto (1994), the Millennium Development Goals (2000), and the London Summit on Family planning (2012) (Cleland, Bernstein et al. 2006). The USA is the most visible donor promoting family planning in Pakistan, providing both financial and technical resources (Khan 1996). From its onset, family planning in the region has been coloured by the colonial discourse (Schoen 2005). The conversation about smaller family size began in colonial India in the 1920s when Indian economists gathered to discuss the negative impacts of uncontrolled population growth (Schoen 2005). In 1935, Margaret Sanger, the first individual to travel abroad with the goal of promoting family planning, arrived in colonial India to further the family planning agenda (Schoen 2005). Western support has fed into suspicions of an ulterior motive underlying family planning programming in Pakistan. The Pakistani government ’ s silence on this matter has failed to address the anxieties of the people. This article argues that family planning in Pakistan is a discursive site where resistance to Western intervention manifests. It contends that the aspirations, beliefs, and needs of the people these programs aim to target are missing from the family planning discussion in Pakistan. The Population Apparatus: Mobilizing against Uncontrolled Population Growth Uncontained population growth was first problematized by Thomas Malthus (Greene 1999). His work posited that the planet was unable to sustain its current rate of population growth, and that agriculture limitations would lead to food shortages. Greene argues that Malthusian rationality formed the basis for the creation of a governing apparatus (which he terms the population apparatus), to address the population crisis(Greene 1999). The governing apparatus is best understood through the lens of Michel Foucault’s approach to governmentality.
2 The goal of a government is to ensure the welfare of its population by improving its wealth, health, and living conditions through whatever means necessary (Foucault, Burchell et al. 1991). One way governments achieve this goal is by identifying behaviours that need adjustment. The governing apparatus then motivates individuals to regulate this behaviour. Through the governing apparatus, power is executed over a population. Although the state uses power to achieve its aims, power is not centralized in the state. Instead, power generates a discourse that is held to be true by every level of society and cannot be traced to a single source(Cooper 1994). The population apparatus, Ronald Greene argues, has framed population crisis as a threat to development and modernization(Greene 1999). The over-reproducing body is viewed as a threat to financial stability in the West, and modernization in Latin America, Africa, and Asia(Greene 1999, Basnyat and Dutta 2011). Poor and racialized bodies, in particular, are considered dangerous and in need of control (Weisbord 1975, Greene 1999, Nelson 2003, Schoen 2005, Ahluwalia 2007, Basnyat and Dutta 2011). In many cases, the discourse targets these groups through coercive and forced sterilization (Weisbord 1975, Nelson 2003, Schoen 2005, Ahluwalia 2007). The population apparatus seeks, therefore, to regulate reproduction as an apparatus of biopower. The body itself is transformed into the place for resistance and transformation(Foucault 1990). The theoretical underpinnings of this article are informed by Foucault’s work on governmentality and biopower, which operate from the perspective that the reproductive body is a discursive site where power manifests. In doing so, I locate this paper within a body of literature that has used Foucault to unpack systems of power and domination. Despite its limitations (Cooper 1994, Young 1995, Sawicki 1996, McKee 2009), it creates a useful framework to understand how power is mobilized through technologies of the self. The article mobilizes Foucault’s theories to highlight normalizing practices enforced by systems of domination. More specifically, it focuses on how the population apparatus, as a mechanism of biopower, regulated the reproductive body in Pakistan. This article focuses on unpacking how family planning was constructed as a discursive site. Ethnographic work collected over thirteen months in Nashpatai Kalay in Khyber Pakhtunkhwa informs this article. I employ empirical data to demonstrate and unpack how, in Pakistan, family planning is a site where anti-Western sentiment is manifested. The article will do so by first resituating family planning within a greater political context that includes a complex history of Western intervention in the region, and citizen mistrust in the Pakistani state. Then it will demonstrate how this history, and the close association of family planning with the West, constructed family planning as the site where these sentiments manifested. Lastly, it will unpack how our respondents ’ ethnic and class positionality nuanced their understanding of family planning. The paper sequentially describes the numerous landscapes with which our respondents contended such as political contestations, elitism, and classism which were mutually effective in influencing their birth control decisions. The West in Pakistan A complex history of Western involvement in the region fuels skepticism of the intentions of the West. Pakistan is a postcolonial state that gained its independence in 1947 from the British, a time period within the living memory of some Pakistanis. Less than three decades later, the region once again became the focus of the West when in 1970s, Afghanistan became the arena for the “Great Game” between Russia and the United States of America (USA)(Rubin
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