Two years ago, in a government healthcare setting at the periphery, I encountered a 29-year-old mother of three who had been driven to a life-threatening, unsafe abortion by an untrained practitioner because she had no access to contraception.
Her story is not an anomaly in Pakistan. It is a chilling microcosm of a far wider national crisis. Her tragic experience highlights a fundamental failure of our state and society to safeguard the most basic right of its women: bodily autonomy.
The latest figures from the United Nations Population Fund paint a bleak picture: nearly half of all women globally are denied the right to make independent decisions about their own bodies. In some low and middle-income countries, a mere 7.0 per cent of women of reproductive age can decide on contraception or healthcare access without external pressure.
World Contraception Day, being observed today (September 26), is thus more than a global event; it is a resonant call to action for Pakistan, where political instability, fragmented policies and service delivery gaps continue to deny millions of women the power to choose.
Pakistan, with a population of 240 million and an annual growth rate of 2.55 per cent, appears to be on a perilous path. At this pace, the population will surge to 383 million by 2050. This swelling demographic pressure is straining our already overburdened health systems and social infrastructure, significantly contributing to high maternal mortality rates and adolescent pregnancies. The Pakistan Demographic and Health Survey 2017-18 reveals a total fertility rate of 3.6 births per woman, nearly one child more than women themselves desire (2.9).
At the centre of this lies the abysmal 34 per cent contraceptive prevalence rate (CPR). This is the grim backdrop against which nearly 2.2 million unsafe abortions occur every year. The consequences are far reaching, but not irreversible. Addressing the 17.8 per cent unmet need for planned parenthood could raise contraceptive prevalence rate to 60 per cent by 2030, a move that would not only save countless lives and reduce unsafe abortions but also ease the immense pressure on our schools, job markets and finite natural resources.
The devolution of reproductive health services to the provinces, while promising local ownership, has in practice resulted in fragmentation and weak coordination. Over a decade later, the CPR has risen by a paltry four percentage points. Without stronger intergovernmental collaboration, predictable financing and laser-like focus on service quality, Pakistan will remain trapped in a cycle of unmet needs and tragic outcomes.
The problem is not just a lack of awareness, but a profound failure of access. In many districts, public facilities routinely run out of contraceptive supplies. Nearly 65 per cent of married couples use no contraceptive method.
Expanding access is also an economic necessity. Evidence shows that every dollar spent on reproductive health yields an estimated $120 in returns, boosting GDP and advancing the Human Development Index. To address this crisis, political will must be demonstrated. Provinces must expedite the passage of pending legislation on reproductive health and early marriage. Premarital counselling on parenthood should be institutionalised and the 18 per cent sales tax on contraceptives must be removed. The Pakistan Population Fund should also be operationalised to ensure uninterrupted supplies.
A multi-pronged forward-thinking strategy needs to be adopted, including strengthening community-based services through Lady Health Workers and midwives, partnering with the private sector and encouraging local production of contraceptives. Religious leaders must be engaged to build community acceptance, while mass media campaigns must be fully utilised to effectively counter the misinformation that plagues the debate on population control.
Ultimately, empowering women and girls with the autonomy to plan their families is a matter of national survival and renewal. With 67 per cent of the nation under the age of 30, our demographic future hangs in the balance. We must act now to turn today’s burden into a tomorrow’s dividend.
The writer is a consultant obstetrician and gynaecologist. She can be reached at: drhadia88gmail.com