Nearly one in five couples in Pakistan want to plan their families but cannot. The reasons are painfully familiar: lack of access to services, limited contraceptive choices and costs families cannot afford.
The consequences are devastating. Unwanted pregnancies too often end in unsafe abortions – an estimated 3.8 million every year, according to the Population Council – almost all because couples were denied the means to prevent them in the first place.
Pakistani women, on average, are having 3.6 children when they would prefer 2.9. That ‘extra’ child is represents added strain on families, on mothers’ health and on a country already struggling to provide education, jobs and healthcare. Too many or too closely spaced pregnancies are deadly: nearly one-third of Pakistan’s 11,000 annual maternal deaths are linked to such pregnancies.
Behind these statistics lies a harsh reality: family planning is not just a health issue; it is also a mirror of our society’s inequities. The burden of unmet need falls disproportionately on the poor, who are least able to afford private services and most dependent on under-resourced public facilities. Denied access to contraception, these families face more unplanned pregnancies, larger household sizes and mounting financial strain – locking them deeper into poverty with every generation.
The picture is even starker when viewed across provinces. In Balochistan, for instance, women face the highest unmet need for family planning and, not coincidentally, the highest maternal mortality rates in the country. This stark disparity underscores how unequal investment and access to services have carved out a geography of disadvantage, where a woman’s place of residence can dictate not just her opportunities, but her very survival.
This is why World Contraception Day matters. It is not simply about methods or services but about empowering couples to make informed, voluntary choices about their future. For Pakistan, that means urgent action to improve universal access, affordability and availability of family planning.
Public-sector facilities, where most of the poor go, remain plagued by shortages, limited staff, and inconvenient timings. The private sector, with nearly 100,000 general practitioners across the country, remains largely untapped. Yet, Population Council research shows that training private physicians and linking them to contraceptive supply chains, while offering vouchers to low-income families, can dramatically expand access.
Choice must lie with couples, but that requires a system ready to provide them with both short- and long-acting contraceptive options, delivered through both public and private facilities, including in remote areas.
We know what has worked before. In the 1990s, the Lady Health Worker program revolutionised family planning, counseling women at their doorsteps and involving families in decision-making. But years of policy drift and underfunding have weakened this once-successful initiative. Revitalising and expanding it is essential.
Affordability also matters. The prime minister’s decision to remove duties and taxes on contraceptives was a welcome step. The real test is timely implementation so that products reach households that need them most. Family planning vouchers linked to social protection programmes like the Benazir Income Support Program could further reduce barriers for the poorest women.
Information is another missing link. Young couples often lack guidance on where to seek services or why family planning matters. Other Muslim countries, such as Iran, have successfully introduced premarital counseling. Pakistan should consider similar approaches, alongside broader community engagement, to normalise conversations about reproductive health.
Importantly, religious barriers are no longer an excuse. The Council of Islamic Ideology has affirmed that birth spacing is permissible in Islam, reinforcing that family planning is a safeguard for women and children. The message is clear: ensuring contraceptive access is not only a development priority but a human rights imperative.
At its core, family planning is about balance (or tawazun) between families’ resources and the nation’s resources. Giving couples the means to decide when and how many children to have will strengthen households, ease pressure on public services and put Pakistan on a firmer path to prosperity. Most importantly, it will uphold the health, dignity and well-being of millions of women and families across the country.
The writer is a senior director at the Population Council of Pakistan.