Growing population of Pakistan and the unmet need for family planning

Abstract

According to the last population census conducted in Pakistan (2023) the population of Pakistan is 241.9 million, making it the sixth most populous country in the world. Pakistan’s population is increasing, while available resources are limited. Despite six decades of government and private sector rural health care initiatives, Pakistan has one of the highest fertility rates and the lowest contraceptive use rate among all its neighbours (1). The use of modern contraceptives method among married women aged 15-49 is 25%, while 17% women have an unmet need for family planning (UMNFP) (2). Unmet need for family planning refers to the situation where women who desire to avoid or delay pregnancy are not using any contraception. This includes women who either want no more children or want to delay their next child for at least two years but are not using any contraceptive method.

Various factors contribute to UMNFP, especially in low- and middle-income countries; these include limited access to contraceptive methods, fear of side effects, household income, employment status, and most importantly, education. Women’s education, particularly the completion of primary and secondary education is strongly linked to lower fertility rate as it empowers women to make informed decisions about family planning and reproductive health (3). Additionally, cultural factors such as religious constraints, men’s decision-making power over women’s finances, and women’s social dependency on their husbands also influence their preferences and behaviour related to reproduction. Despite an increase in contraceptive use over time, there is still a significant gap in knowledge regarding contraception and antenatal care (4). This knowledge gap coupled with limited access to family planning services contributes to higher fertility rates and poor maternal health care outcomes.

The UMNFP in Pakistan can be fulfilled by improving access to information and services related to contraception and by addressing social and cultural barriers. These include opening of family planning clinics that are easily accessible and promoting programs providing information about family planning and the use of modern contraceptive methods. Apart from women’s own education, their husband’s education can also reduce the likelihood of overall UMNFP because fertility decisions in any household can be a joint decision made by women and their husbands (5) , therefore, husbands should be educated about how a women’s body is affected by conception and this education can be beneficial for overall reproductive health of family.