Family Planning in Pakistan: A Site of Resistance At present, - - PDF document

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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.

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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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and Rashid 2008). Pakistan became heavily implicated in this conflict. Pakhtuns in Pakistan share a language and culture with Pakhtuns in Afghanistan, the Durand line, an artificial British imposed border, is the only separation between these two groups. Additionally, the reigning President, Zia ul-Haq, had assumed power in Pakistan through a military coupe, and was using Islamic ideology to support his tenure (Stern 2000). He complied with USA policies in the region to solidify his reign. The USA mobilized Islamic ideology and access to resources to ensure the Pakistani government’s compliance (Stern 2000). Not only did this mobilization include the procurement of Pakistani military and government support, but also Pakistan opened its borders to an influx of Afghan refugees. The majority of the refugees sought refuge in Khyber Pakhtunkhwa because of cultural congruence (Centlivres and Centlivres-Demont 1988). Pakistanis are very aware of the history of involvement of the USA in Pakistani politics. In one study investigating conspiracy theories in Pakistani populations, respondents spoke of ‘American’ support for Zia ul-Haq during the Cold War, and support for the Afghan mujahedeen for the last thirty years(Jamil and Rousseau 2011). They saw this earlier support as precursors to the US- led war on terror. Moreover, many Pakistanis strongly believe that the USA protects its interests in the area using covert, back door operations(Jamil and Rousseau 2011). They accuse ‘America’ of ongoing financial support of Al Qaeda(Iqtidar 2014). In the early 2000s, when American intervention once again began in Afghanistan, another wave of Afghan of refugees entered Pakistan to escape the violence. As the conflict escalated, the insecurity and violence spilled over from Afghanistan into Pakistan(O'Loughlin, Witmer et

• al. 2010). Since the early 2000s, Pakistan has experienced increasing insecurity, with concurrent

economic instability. An estimated 80,000 Pakistanis have been killed through terrorism between 2004 and 2013(Responsibility 2015). The majority of these deaths occurred in Pakhtun populations in the federally administered tribal areas and Khyber Pakhtunkhwa(Responsibility 2015). To further complicate the situation, the ongoing conflict has sparked pre-existing ethnic

• tensions. The increasing conflict centered in Khyber Pakhtunwa and FATA has resulted in the

propagation of the Pakhtun terrorist stereotype. Pakhtuns in Pakistan are often profiled as extremists and targeted by police, most recently demonstrated by the recent release of police memos describing these prejudicial practices(Ali and Jabeen 2017). Suspicions remain regarding the involvement of the USA in Pakistan and its vested interests in the area. These suspicions are supported by events such as the Raymond Davis Affair in 2011 where a private security contractor killed two men in Lahore, resulting in a diplomatic incident between the US and Pakistan. This incident brought into question the role of USA forces in Pakistan and the conflict in the region(Iqtidar 2014). The USA has a long history of interference in Pakistani politics, including economic and political support of two military dictatorships with the Pakistani military complex being the largest recipient of US aid (Iqtidar 2014). Pakistanis are resistant to USA interference as demonstrated by public protests against drone strikes, the naming of the CIA station chief in a lawsuit, and the refusal of USA civilian aid packages(Yusuf 2011). A recent PEW global opinion study found that 74% of Pakistanis call ‘America an enemy’, marking a 5% increase from previous studies(Kohut 2012). Pakistani governmental institutions are suspected of tacitly approving USA involvement, and these suspicions breed wariness of US institutions. Mistrust in Pakistani governmental institutions is advanced by a lack of honesty and forthrightness by its representatives. The involvement of Blackwater, an American security consulting firm, in Pakistan is a demonstration

• f this complexity(Iqtidar 2014). Interior Minister Rehman Malik outright denied the

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involvement of Blackwater in Pakistan, yet several months later while visiting Pakistan, US Defence Secretary Robert Gates admitted that Blackwater was operating in Pakistan with government permission(Iqtidar 2014). Access to foreign funding also has been a means through which the West has interfered in Pakistani policies. Foreign funding, in particular US funding, has been, and continues to be, a reflection of geopolitical interests in the region(Fielden 1998, Epstein and Kronstadt 2013). Since Pakistan’s creation, the US has pledged $30 billion in direct aid. Two-thirds of this funding was post 2001, when Pakistan became a key ally in the war against terror (Epstein and Kronstadt 2013). The US has used funding to ensure Pakistan’s cooperation and assistance in offensives in the region. Any action by the Pakistani government that is not in alignment with foreign interests is met with the withholding of foreign funds(Epstein and Kronstadt 2013). Aid from the USA has primarily focused on military operations, with a small portion going to humanitarian aid. USAID is the primary channel through which humanitarian aid has been funnelled into the country, supporting literacy, education, and health programs(Zaidi 2011). More recently, it has focused its efforts on sustainable development within the tribal belt(Zaidi 2011). Much of its efforts, have focused on addressing the questionable reputation and image of the US in Pakistan. However, these efforts have proven futile as drone attacks and military offensives contributing to civilian causalities in the region continue to undermine the US’s reputation(Zaidi 2011). Mistrust in USA actions in the region calls into question the intentions of any USA funded programming. Continued misuse of these programs for surveillance and intelligence further undermines these

• programs. The recent CIA use of a polio vaccination campaign as a ploy to locate Osama Bin

Laden served to verify fears about the neutrality and altruistic nature of US funded health programs(Lenzer 2011). The Pakistani Family Planning Program The West has a long history of promoting family planning in developing countries. It was part of a colonial and imperialist initiative to try to curb a perceived dangerous population growth(Schoen 2005). The fear gained traction after World War II and a belief that developing countries were especially vulnerable to communism because of economic instability and resource shortages incited by excessive population growth(Schoen 2005). The containment of communism became intricately linked to addressing uncontrolled population growth in developing countries(Schoen 2005). Western countries also began to recognize the economic potentialities of developing countries as untapped export markets(Greene 1999). These countries viewed the economic development of the developing countries as contingent on controlling their demographic growth, so they placed family planning at the forefront(Greene 1999). Local elites supported family planning efforts because many subscribed to the Western ideology around modernization and economic development, and sought to benefit from these developments(Schoen 2005). Foreign funding has played a pivotal role in funding and shaping family planning programming in Pakistan(Khan 1996). For instance, the USAID backed Family Advancement for Life and Health (FALAH) Program has funnelled $60.4 million USD for family planning into Pakistan(General 2010). The program has focused its efforts on rural populations, aiming to increase demand and improve family planning services in the public and private sector. USAID programs have also pushed the government to adopt specific methods such as emergency contraceptives(Khan, Shaikh et al. 2008).

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Pakistan’s family planning program has reflected the rhetoric and mandate of the global population apparatus with its emphasis on controlling population growth as an essential component of economic success and modernization(Hakim and Miller 2001). Uncontrolled population growth is framed as primarily an issue with the rural, uneducated and poor. Research in the field has supported this approach, by constructing the poor as a barrier to modernization and economic progress and as a group whose behaviour needs to be modified(National Institute

• f Population Studies 2013). The Pakistani state has launched numerous family planning

initiatives programs in the country, often targeting the poor. The largest is the government’s national Lady Health Worker program, which hires women residents to provide family planning and basic health services within villages(Douthwaite and Ward 2005). Family planning in Pakistan is mainly accessed through government services, with 45.6% of users obtaining their contraceptives through government services, and 35% using the private medical sector(National Institute of Population Studies 2013). The most commonly used contraceptive methods are condoms (8.8%), female sterilization (8.7%), and withdrawal (8.5%)(National Institute of Population Studies 2013). The Pakistani method-mix starkly contrasts with the global method mix, where the preferred methods are female sterilization, IUD, and the pill(Division 2011). Methods A critical ethnography in Nashpatai Kalay in Khyber Pakhtunkhwa, Pakistan informs this

• study. The main economic activity in the village was agriculture. Many of the villagers cultivated

sugar cane, maize, and wheat. Villagers rented the lands under the ijara system, where individuals pay a set yearly fee to the landowner. Nashpatai Kalay had no gas access, and residents burned twigs, leaves, or dung patties to cook their food. Electricity was intermittent, especially during the summer months. The closest rural health centre was approximately a 20 to 25-minute walk. All the villagers were ethnically Pakhtun with the majority belonging to the Mohmand tribe. The data was collected over a period of 13 months between September 2013 and April

• 2015. AA conducted the data collection with two research assistants (one male and one female),

both of whom had a background in qualitative research and/or community based participatory

• work. AA conducted a brief training session with the research assistants on the study objectives

and data collection techniques. Upon arriving in Nashpatai Kalay, we (AA and the research team) met with a village elder to solicit their advice and support, the elder acted as our point of reference in Nashpatai

• Kalay. The elder’s endorsement of our presence assuaged the villager’s fears about our
• intentions. Additionally, having the elder’s buy-in provided security during the data collection.

The elder and his wife acted as a key conduit of information between the community and us. For instance, when there was a death in the village the elder’s wife was the first to inform us so that we could pay our respects in a timely manner. We collected data in two concurrent phases. Phase 1 focused on understanding the hierarchy and dynamics of village life. Participation observation was the primary method used. The research team took on the role of ‘participant as observer,’ focusing on engaging in village life while observing and understanding the village context(Green and Thorogood 2004). Our first

• rder of business was to explain our presence in the village, many participants were unfamiliar

with higher education and the research process. As such, we explained that we were in Nashpatai Kalay to understand their health concerns. They found it unusual that someone from a high

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socioeconomic status would spend time in the village. We explained that we hoped to learn from the villagers so that we could share this information with government bodies who were often unfamiliar with village life. Many villagers were confused as to how the data would be used, so the analogy of a book was employed to illustrate how the information would be shared. They were assured that their names and the name of the village would not be included in any

• documents. The villagers were also invited to speak to the local elder about our presence or if

they had any other questions. Building relationships, trust, and acceptance in the village allowed the research team to create a context where participants felt comfortable discussing sensitive issues. During phase 1, a total of 242 participant observation notes were recorded. The research team also identified the participants for inclusion within phase two. Phase 2 focused on unpacking family planning decision-making. The study included 76 participants (41 female, and 35 male). Participants were selected purposively with a consideration for their family planning use, socioeconomic status, religiosity, and family size preference. The research team interviewed the participants’ a minimum of two times, each interview lasting between two to six hours. Information was gathered about the respondents’ social status, family dynamics, and stressors. The respondent’s family planning decisions were contextualized within the local, national, and global context within which they made decisions. All interviews were conducted in in the local language, Pakhto. AA conducted the female interviews and due to gender norms the male research assistant conducted the male interviews. All interviews were recorded and transcribed verbatim by AA in Pakhto written in roman text. Excerpts were translated into English as needed to include in documents shared with other members of the research team during data analysis. Latent content analysis(Mayan 2009) was conducted using a social constructivist approach(Elliott 2005, Miall, Pawluch et al. 2005). As a critical ethnographer, our theoretical perspective was informed by critical theory. Critical theory believes all thought and language are ideological, and that individuals fail to recognize the role

• f ideology in their behaviour (Thomas 1993, Kincheloe and McLaren 2011, Madison 2011). The

research objectives guided the analysis. AA coded the data identifying distinct ideas and conceptions, while considering the intent of respondent’s comments within their context. Later, AA conducted axial coding which considered the relationships between codes from which categories emerged. Lastly, the categories were brought together to generate the themes that informed this article (Mayan 2009). Atlas TI was used to manage the data. AA, as an individual of Pakhtun ancestry, operated from an insider-outsider position. As an insider to a community AA was required to engage with the research subject in a way that one does not have to when an outsider. AA’s positionality helped create rapport and allowed for a deeper investigation of the research topic(Krieger 1985). For instance, AA found that she was introduced with the moniker ‘brother-less’, however, she did not face the same stigma as other sonless or brother-less individuals. This allowed her to probe and unpack the interrelationship between sons, wealth, and power. Operating from an insider-outsider position necessitated an especially reflexive approach(Taylor 2011). As an insider-outsider, the politics of representation were especially important for AA as she is responsible to multiple audiences (Abu-Lughod 2006). Several efforts were made to ensure the analytical rigor of the analysis. Firstly, data was collected in two rounds. The first visit to the village was for a total of nine months, after which preliminary analysis was conducted. The second round of data collection was a total of four months, during which the emerging results were verified with the respondents and further

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• probed. Secondly, extended immersion in the village allowed for a rich and deep understanding
• f the participants and daily life in Nashpatai Kalay. During the analysis stage, special attention

was given to which voices were silenced and which universalized, striking a fine balance between losing a voice and giving one too much power (Madison 2011). Peer debriefing throughout the analysis process with the research team and co-author ensured that points of views were not over or underemphasized. Lastly, detailed field notes were also maintained that documented decisions that were made and concepts that emerged throughout the data collection process. Both the University of Alberta Health Research Ethics Board and the National Bioethics Committee in Pakistan provided ethics approval. Verbal consent for interviews and recordings were obtained before interviews commenced. Consent was also reconfirmed before the research team left the village. All personal identifiers from the data were removed and the name of the village was changed. Results Lack of resonance of the logic underlying family planning in Pakistan Our data suggest our respondents understanding of ideal family size was not aligned with the global population apparatus and Population priorities of the Pakistani state. The global population apparatus has constructed Pakistan as a site of uncontrolled population growth. The Pakistani state concurs with this and its family planning programs promote small family size with slogans such as “do bachi hain achi” (two kids are best) and “chota khandan, khushala Pakistan” (smaller family, happy Pakistan). These slogans were accessible on the radio and television, and some participants even had seen them on pamphlets. Awareness of these slogans was widespread. The dominant discourse constructed the uncontrolled reproduction of the villagers as problematic for the Pakistani state and the residents of Nashpatai Kalay, as poor, rural dwelling individuals with low levels of education, exemplified the targets of Pakistani family planning programming. For our respondents, however, this logic was tenuous. They doubted the connection between a small family and national prosperity. Our respondents believed that their reproductive potential could contribute to the betterment of Pakistan. They instead felt Pakistan needed to be protected from any shortages that potentially could occur. Underlying this perspective were fears about the insecurity in Pakistan. The ever-present threat of a terrorist attack was a lived reality for the residents of Nashpatai Kalay. This sense of insecurity played a central role in the lives of

• ur respondents, and influenced how they understood the global political context within which

the population apparatus promoted family planning. Our respondents believed Pakistan was in the midst of a serious conflict, as Rafiullah demonstrated when asked about what is underlying Pakhtuns’ preference for larger family size: Yes, people will say there are lots of them. People will say it’s a big nation. If there are a lot and there is a bomb, or something, the country will stay free. That’s why we say “why should we shut down our ‘machine?’” We’ll just continue to have [children].

• Middle aged male

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Our respondents believed they could contribute to supporting Pakistan by maintaining its population size. This perspective was in stark contrast to the national discourse that associated a smaller family size with national prosperity. Our respondents also demonstrated little confidence in government reports about the inability of the country to support so many citizens. The potential resource shortages that concerned the government were not the realities of our

• respondents. Some framed governmental concern about scarcity as a lie to encourage citizen

compliance. If 180 million people can be fed by the country, your seven/eight children can’t be fed? But we say that’s it. Four children that’s it. Look at your means.

• Middle aged male

The lack of resonance of the logic underlying family planning programming in Pakistan furthered theories about the deception in family planning programs. The focus on family planning by external bodies felt disconnected from the lived realities of our respondents. They saw a small family as removed from their existence and misaligned with their priorities. Having smaller families was undertaken by others; in the West, in cities, and the rich, but not in the

• village. Our respondents’ positionality complicated their acceptance of the ideology of small

family size. For our respondents, family planning was not a pressing concern since family planning knowledge and access in the village was almost universal. Our respondents believed the focus on family planning by the government, NGOs, and foreign actors was reflective of an ulterior plan. Perceptions of Western interference in Pakistan The ongoing conflict in Pakistan, and the associated uncertainty of life, were reluctantly accepted aspects of life for our respondents. The conflict permeated their lives, presenting itself as a point of discussion in the village. Men acted as the key source of information, since their ease of mobility allowed them access to public spaces where they could discuss current issues. They shared what they learnt with the women in their households. Our respondents understanding of the conflict was reflective of deep-seated resentment about the interference of Western agents in Pakistan. The legacy of Western interference spanned the lifetime of many of

• ur respondents. The violence in the region and its escalation directly correlated with American
• intervention. Generally, our respondents accepted that America would go to any lengths to

achieve its aims. Among these aims was the destruction of Islam. The certainty that America was capable of deceit and dishonesty complicated the perspective of our respondents regarding the

• ngoing conflict with the Taliban.

No, some people say they [attackers] were Taliban. Look, would Taliban commit such an atrocity? Suicide bombers? I think its Americans. They want to ruin our country. Eliminate Muslims.

• Middle aged female

Our respondents understanding of the ongoing conflict in Khyber Pakhtunkhwa contained many

• contradictions. They were not active supporters of the Taliban and in many cases their families

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had actively opposed Taliban forces. Their perspective of the conflict, however, was coloured by a denial to accept the grotesque nature of Taliban violence. Our respondents did not consider the Taliban an external insurgency. Instead they were viewed as a local force at odds with the

• government. Framing the Taliban as a local group rooted in the Pakhtun community carried

assumptions about their behaviour. Our respondents believed that they would adhere to certain war ethics, which included avoiding attacks on children and women. At the same time, Taliban attacks, such as their attack at the Army Public School (APS) in Peshawar in December 2014, threatened to shatter this perspective. Many subscribed to a theory postulating that an outside force was committing some of the violence in the region to defame the Taliban. From this perspective, our respondents could both acknowledge the violence committed by the Taliban but also dispel their discomfort with attacks they believed were inconceivable. Often, the outside party accumulating the blame for the especially grotesque attacks was the American government and its agents, because they believed to be capable of extreme violence to achieve their ends. Innocent lives lost in overhead bombing only affirmed the widely-held belief that the Americans devalued local lives. W: No, they just give a bad name to Muslims, they also have given a bad name to Taliban. Now when they bomb from overhead in the planes they don’t only kill Taliban right? AA: Yes, other people die, right? W: Before in Buner, in Swat, they started bombing, and people had to move. When people left Swat, there was this woman, and she said her husband was injured there. She spent a few days in the madrassah then left. She filled a drum and left like that. People are ruined by events like this, right? There was a palpable level of denial and unwillingness to acknowledge that the Taliban was responsible for all the violence ascribed to them. Our respondents could not reconcile the notion that their ‘own’ people (the Taliban) could commit such horrible acts against their ‘own’ (the Pakistani people). This skepticism was not indicative of pro-Taliban sentiment. Rather it was reflective of a deep-rooted distrust of the dominant discourse explaining unrest in Pakistan. Our respondents resisted the dominant discourse by developing their own understanding of the actions of the Taliban. Their explanations included indictments against the West for committing these acts, and the Pakistani government, for its complicity. Suicide bombers? Taliban would kill Muslims? Taliban have a bad reputation, but Taliban, its like, Taliban spend their lives learning to live like the Prophet, why would they do this? People say the government said this and government said that, but up until this moment the government hasn’t even found out who is doing these explosions. Who are these suicide bombers? They don’t even know that. What do they know then?

• Middle aged female

Our respondents held suspicions of the West so strongly that they were convinced the West was in some way responsible for the carnage and the conflict, which absolved the Taliban of some of the responsibility. This perspective adds fuel to the idea that Taliban are justified in their fight against American forces.

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Mistrust in Pakistani government Our respondents believed an essential enabler of Western intervention in Pakistan was government complicity. The Pakistani government was viewed as an exclusionary institution that sustained and reinforced, class differentials in Pakistan. The state’s top-down approach to governing excluded the rural, poor, and uneducated. This political hegemony created a dynamic within which villagers were solely the recipients of governmental mandates, without any means to question the policy discourse. This exclusion from the state’s decision-making space greatly deepened their mistrust of the Pakistani government. Mistrust in the Pakistani government manifested heavily in discussions of the ongoing conflict in the region. Our respondents doubted that the government accurately reported the number of casualties in the wake of terrorist attacks. They also were unconvinced as to who was responsible for the violence and instability in the region. Distrust of the Pakistani government was so deeply rooted that some individuals expressed a belief that the Pakistani government was complicit in attacks on its population. They viewed the Pakistani government’s inability to capture and exact justice on the perpetrators of acts of terror as symptomatic of a willingness to abdicate responsibility. Our respondents believed the Pakistan government officials were vulnerable to financial enticement by foreign actors. They were aware of the widely-reported corruption among Pakistani government officials. The numerous scandals of political leaders caught lining their pockets continued to undermine their trust in the government. Our respondents’ critiques of corruption were aimed at every level and type of government official. They believed the corruption of high level officials meant they could be hired by America to support their agenda. There's that Bhutto, that Zia ul Haq, and the people before, those faithful to America. They started their own things. America weakens Islam, and on the other side us Pakhtuns, we're greedy and they use “dollars” to divide. We can't control ourselves with money. It’s just like that.

• Elderly male

The sentiment that the government would sell out its citizens for financial remuneration undermined the faith that our respondents had in the government. There was little belief that the government would work to protect the interests of its citizens. Family Planning as a Discursive Site The West and Family Planning Our data suggests that there was an essential gap between the ideal family size conceptualized by our respondents and the Pakistani state and the global population apparatus. This gap coupled with our respondents’ mistrust in the intentions of the West and the Pakistani state constructed family planning as the site of resistance to the West. Resistance to the West was predicated on the long history of USA involvement in the

• region. Our respondents overwhelmingly believed that the military involvement of the USA in

local politics meant that the USA and West could not be trusted. Mistrust called into suspect anything associated with the USA, including the Pakistani government itself. This mistrust laid the foundations of a belief that family planning was an attempt by US and other Western

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governments to reduce Muslim populations. Our respondents heavily critiqued the Pakistani government for adhering to Western values and rejecting Islam. The Pakistani government’s fertility policies have been, and continue to be, anti-natalist. The policies contrasts strongly with the pro-natalist cultural and religious values of its citizens. Our respondents understood the tension between these two values as evidence that family planning was transplanted American ideology. RA: On one side there is the government’s policy. On the other side, we’re Muslim. So, do we listen to Islam or what? M: You need to go in the middle. If you don’t listen to Islam, you are ruined. You will go to hell. But you live in the country, you must listen to the government. It’s mandatory. On one side is religion on the other is the government policy. Go in the middle. RA: Middle how? M: If you don’t listen to Islam you will be ruined, but you must listen to the government’s rules. But I think this country, la illah ila allah [Muslim declaration of faith], was made in Islam’s name, so it should have Islamic rules. If it had Islamic laws then there wouldn’t be this problem. There wouldn’t be stealing, wouldn’t be anger, right? It’d be different. This is a Western government and Western ideas are in effect. Our respondents concerns echoed the rhetoric of the global population apparatus, which frames uncontrolled population growth in developing countries as threatening. Our respondents, however, reframed the perceived danger of their population growth as a testament to their power. They believed the Muslim (and Pakistani population) was capable of disrupting global systems

• f domination, specifically the Western-backed systems of domination and oppression. More

importantly, our respondents saw this power as located in the large size of the population. They believed that the West (and specifically America) felt threated by this powerful force and aimed to weaken it by controlling its growth. Promotion of family planning was motivated by a fear of Muslim ascendency. As the enemy of Islam, America’s goal was to harm and suppress Islam. W1: America is ruining our country. W2: They are our enemies. America is our enemy. They are our biggest enemy. W1: Look at the mess they have made for people.

• RA. So then how many [children]?
• M. We had a teacher, at that time family planning was just being introduced in the village, and

he told us to have a lot of children because these other countries are trying to ensure that there is no one born that will defeat them. RA, Like Muhammed bin Qasim, Tariq bin Ziyaad,[historical Muslim conquerors of South Asia] like that?

• M. Yes, have lots [of children] so a person like that is born.

Ideological resistance to Western interference was universal amongst our respondents, and deeply embedded in the psyche of our respondents. Family planning was the site where this resistance manifested.

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Resistance Within the village, resistance took on multiple, albeit subtle, forms. Our respondents did not have access to the discursive technologies of power, including the production of their own

• narrative. Instead, they mainly relied on everyday forms of resistance. Our respondents were in

two groups; those who actively resisted family planning, and those who took on a passive

• approach. For those who were actively resisting this ideology, resistance often manifested as a

reconceptualization of how to control fertility. No, no, the other day the NGO people came and my wife told them that yes there are ways [to have fewer children] but not the ways that YOU tell us to.

• Middle aged male

This reconceptualization included favouring traditional methods, such as withdrawal. Our respondents framed withdrawal as the Islamic, or Sunnah (the way of the prophet) method describing it in language that situated it within the cultural context as opposed to other methods that were foreign imports. Another classic example of this resistance was a local religious leader who had changed a billboard that said to have two kids, to 200 kids. The majority of our respondents undertook a more passive approach to resistance. The passive approach group utilized ‘weapons of the weak’--a term coined by James C. Scott that describes everyday resistance in terms of pilfering, foot-dragging, evasion, feigned ignorance, and false compliance(Scott 1985). Our respondents were well aware of the expected response regarding their fertility goals. Thy had learnt to respond to inquiries around family size by saying that they did not desire more children. False compliance was a commonly executed strategy. This group’s approach to resistance was more ideological and centered around concerns of Muslim demographic vulnerability. Despite their family planning use, they would express concern that they were contributing to decreasing the Muslim population. Anxieties around demographic vulnerabilities so strongly resonated that they extended to attitudes towards polio vaccinations and regional violence. Our respondents framed family planning as a continuation of the violence in the region and another means through which the goal of suppressing the population could be realized. …nowadays, they shoot people, kill people. Even the police are killed. And they are our

• children. They are killing our children. Who are members of the police? Aren’t they our

children? if my son isn’t in it, her son isn’t in it, someone else’s son isn’t in it, then where will the police come from?

• Elderly female

Identity Politics: Being Poor and Pakhtun Although family planning was the discursive site where resistance to the West manifested, the positionality of the respondents affected their experience of their subjugation. Our respondents lived at the intersections of poor, Pakhtun, Muslim, and Pakistani. These multiple identities influenced their experience of the population apparatus, and in turn, their understanding of family planning. As the poor, the population apparatus constructed their reproductive behaviour as especially problematic for the State and requiring regulation. Family

13

planning messaging and slogans played an important role in creating and sustaining norms that problematized large family size. This messaging mobilized the language of fiscal responsibility, the poor who opted for a large family were irresponsible, uneducated, and ignorant. Family planning messaging built on class politics in the country that infantilized the poor, blaming them for their poverty(Greco 1993, Makoni 2012). The state believes they must be advised and educated. Today was my first visit to the village, I have not yet hired my research team and so my aunt accompanied me to ensure that I did not face any issues ... S* works for my grandfather, and he and T* are showing me the basics of the village. We went with S* to his house to meet his wife, A*. She was a sweet woman, with a few little ones around. When my aunt joked about there being so many little ones around, she mentioned she had stopped having more kids. My aunt made another joke as we exited saying she better not hear she’s pregnant again. (Fieldnotes excerpt September 12, 2013) The wealthy and elite reproduced the rhetoric of the population apparatus in their interactions with the poor. Limited bodily autonomy was ascribed to the poor, and the fertility practices of this group transformed into a site of public discourse. The paternalistic approach to the poor was both reflective of both deep-seated prejudices about class by the elites, and the rhetoric of the global population apparatus. The state, elites, as well as local and international family planning policy makers and programmers, critiqued intimate reproductive decisions of the poor. Our respondents’ Pakhtun identity also provided a lens through which they understood themselves in Pakistani and global politics. According to them, family planning was a way that the West targeted not only Muslims and Pakistanis, but also the Pakhtun people. As Pakhtuns,

• ur respondents felt subjugated under Pakistan’s policies, which they believed created limited

economic opportunities and development in Khyber Pakhtunkhwa. Such sentiments are reflective of strong ethnic divisions that underlie Pakistani identity. Pakistani national identity is

• precarious. Pakistan was envisioned amidst fears of a united India in which Muslims were to be

marginalized(Lieven 2011). This Muslim identity was used as the uniting force underlying Pakistani identity. This Islamic identity, however, has proved to be insufficient to unite Pakistan. Ethnic lines fragment the country and the ongoing conflict contributed to their experience as being disenfranchised. Our respondents experienced the population apparatus as an extension of the subjugation of the Pakhtun people. America and Russia are after them. It’s because if there are no Pakhtuns then there is nothing. Look, only one group, Pakhtuns, have stood up to America, no Punjabis, no Sindhis, no one.

• Elderly male

The positionality of the our respondents complicated their understanding of family

• planning. Although family planning was a symbol for the West, class and ethnicity nuanced their

experience of their subjugation. Discussion Fertility is, by its nature, very political, and deeply embedded within the politics of identity(Yuval-Davis 1994). Family planning controls and limits the reproductive potential of a

14

community, determining how a population of a nation or community looks. The family planning discourse in Nashpatai Kalay was a mobilization against a global population apparatus that frames the reproduction of certain populations as problematic. The resistance demonstrated in Nashpatai Kalay is analogous to the resistance to family planning in many Muslim countries. Algeria strongly opposed family planning as a part of an imperialist project, as did Iran by framing family planning as part of a Western plot(Roudi-Fahimi 2004). Both countries have since implemented family planning programs(Roudi-Fahimi 2004). These perspectives are symptomatic of a global context where Muslims feel they are subject to global inequities and abuses of power. As seen in Nashpatai Kalay, many Muslims view family planning as a plot by external multilateral agencies and foreign powers that seek to limit their populations(Bowen 2004, Roudi-Fahimi 2004). Resistance in the Muslim world is reflective of not only a resistance to Western interference but also to the Western hegemony. Historically, many groups have mobilized fertility in political struggles and conflicts: pro-natalist behaviour as a form of resistance among Palestinians in Israel(Kanaaneh 2002), the coercive sterilization of Romani women across Europe(Portugese 1998), and the promotion of eugenic ideology and policies in the United States and other Western countries(Portugese 1998, Panu 2009). The framework of biopower describes how the body is transformed into a site of resistance(Foucault 1990). In Nashpatai Kalay, our respondent’s fertility took on a similar political dimension as they resisted family planning. For our respondents, resisting family planning and its ideology was a means to resist the violence inflicted by the West and the complicity of the Pakistani government. Family planning to limit or control reproduction in Pakistan has been a means through which the Pakistani state and Western actors have enacted power. The Pakistani state dually exists as both the site upon which foreign powers enact power, and the site where the government mobilizes power. Officials mobilize power to influence the behaviour of their country’s citizens, particularly the reproduction of certain segments of the population. Class- based sensibilities are an essential aspect of how the state mobilized power. In the family planning discourse, individuals such as those in Nashpatai Kalay have been doubly targeted. On the one hand, they have been targeted as the rural, poor, and uneducated by the Pakistani state;

• n the other, as disenfranchised residents of the third world by Western actors. The construction
• f the ‘poor’ as in need of intervention was an essential aspect of the population apparatus

legitimizing itself(Ahmed 2016). The population apparatus has constructed their bodies as dangerous potentialities that must be controlled(Basnyat and Dutta 2011). The ruling elites of Pakistan play a key role in maintaining the population apparatus. The Pakistani elites subscribe to Western ideology, particularly that which links population control to modernization and progress within the country. In the elites’ perspective, family planning is as an essential element

• f ensuring the prosperity of Pakistan in the future. The top-down approach has allowed little

space for those individuals to converse with the categorization and labels that have been forced

• nto them. Our respondents pushed back against the global population apparatus that framed

their reproduction as dangerous, reframing their population growth as a means to enact their

• power. Their resistance was a reflection of their feelings of marginalization, inability to effect

change, and asymmetrical political discourse. Revisiting the exclusionary nature of governmental institutions could serve to increase the credibility of family planning programming in Pakistan. The anxieties surrounding Western interference in Pakistan exhibited by the residents of Nashpatai Kalay, were reflective of widely-held anxieties of the people in Pakistan. Overwhelmingly, the Pakistani people believe the intervention of foreign powers, even with

15

government support, is an affront to Pakistani sovereignty(Lieven 2011). The West’s close ties to Pakistan’s family planning program has undermined the program’s efforts. In Pakistan, family planning has become synonymous with USA intervention with large implications for contraceptive uptake. If USA operations continue in Pakistan, then the resistance to any USA programming will also continue to persevere. Decreasing the visibility of the USA in this programming could help facilitate increasing family planning use. However, Pakistani family planning programming has not engaged with the concerns of the individuals targeted by family planning programming. Their sentiments are often dismissed as misconceptions and conspiracies(Mir and Shaikh 2013). Too little value has been given to the prevalence of what are labelled ‘conspiracy theories’ within Pakistan. Dismissing these theories does not allow for an in-depth understanding of the political context and structural and systemic issues that have contributed to these theories. This article locates resistance to family planning within its complex political and historical history, and calls on Pakistani family planning policy and programming to center the concerns and voices of the citizens it seeks to target.

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