Asia-Pacific Population Journal - Volume 25, Issue 1, 2011

Pakistan has lagged behind other nations with regard to several indicators of development, including primary school enrolment, infant and maternal mortality rates, and the availability of basic infrastructure (Easterly, 2003). The nation’s fertility transition experience has also differed from that of other countries. Until the early 1990s, the total fertility rate in Pakistan remained above six births per woman, even as total fertility in less developed countries as a whole had declined from 6.0 to 3.8 between 1960 and 1990 (United Nations, 2007). A “stubborn resistance to change” in fertility behaviour (Sathar and Casterline, 1998, p. 773) was attributed to a historically ineffective national population programme (Hakim, 2001; Robinson, Shah and Shah, 1981). Low levels of education, restricted household and social roles for women, conservative views about family planning and underinvestment in rural development were also thought to hinder the impetus to limit family size (Sathar and Casterline, 1998; Shah and Cleland, 1993).

India embarked on its new economic policy, popularly known as the liberalization of the Indian economy, in 1991. The basic features of the new economic policy were a reduction in government expenditures in order to reduce fiscal deficit, an opening up of the economy for export-oriented growth, the removal of government control and licensing, and a push for private participation to enhance competition and efficiency. Both supporters and critics of the new economic policy believed that economic reforms would increase internal migration. Proponents believed that the new impetus would boost the economy and job opportunities, leading to increased pull factors conducive to accelerated rural-to-urban migration. By contrast, the opponents of this policy were of the view that economic reforms would adversely affect the village and cottage industries and impoverish rural populations, leading to increased rural-tourban migration (Kundu, 1997). Although there was considerable success in achieving economic growth, from 2 to 3 per cent of growth in gross domestic product in the pre-reform era to over 6 per cent during the period 1991-2001, the impact of this enhanced growth on internal migration in general and rural-to-urban migration, in particular, has not been assessed. The latest census of 2001 reveals several interesting results in relation to internal migration, its regional pattern and the contribution of rural-to-urban migration to urban growth, as discussed by Bhagat and Mohanty (2009). They argue that the push factor has not significantly influenced internal migration. As a result, it appears inaccurate to state that the poor and disadvantaged are migrating more than those that are more well off.

The sharp dip in fertility rates in recent years, combined with falling mortality rates over the last four decades, is leading to an increase in the absolute and relative size of the elderly population in developing countries (Rajan, Sarma and Mishra, 2003). It has been observed that the speed of population ageing is very fast in some countries of South and South-East Asia (Population Reference Bureau, 2006). As a result, issues related to ageing are becoming important in those countries (Liebig and Rajan, 2003).

Different studies on variations of cause-specific mortality provide different policy implications and suggestions. Some findings mirror existing health care and services. Costantini and others (2000) concluded that differences in proportions of cancer patients dying at home across 13 provinces in Italy could not be explained by the known determinants, suggesting inappropriate hospital admission in the terminal phase of cancer. A study on geographical variations in breast cancer mortality in older American women by Goodwin and others (2002) suggested ways to improve the quality of breast cancer care. Some studies suggest further research in specific areas.