“Allah will provide for us,” says Saima’s husband when she broaches the topic of protection. A maid taking care of three of her own kids and four step children, Saima is distraught at the prospect of having more mouths to feed.

After her second C-section surgery, she tried to convince the doctor to give her an operation that would sterilise her but the doctor refused without the husband’s consent. The husband, miles away in another city, refused to take any calls while his wife was in labour. He did not want to be held liable for the cost of his wife’s delivery which was being borne by Saima’s family.

In 2019-20, the annual modern contraceptive prevalence rate in Pakistan was 41pc according to the Pakistan bureau of statistics. By this statistic, six out of ten couples are having unprotected intercourse. And we wonder at the population rate.

These numbers are not driven by ‘Western’ influences and consensual relationships in metropolitan areas. According to UNICEF, Pakistan has nearly 19m child brides. The UN children’s agency estimates that around 4.6m were married before the age of 15 and 18.9m before they turned 18.

Over 2012 to 2019, while the unmet need for contraceptives has remained mostly stagnant indicating women are unable to access the protection that they require, unintended pregnancies increased by 313,000.

In Pakistan, the number of estimated unintended pregnancies has risen to 4.2m of which 2.2m end up in unsafe abortions, which result in serious, long-term negative health effects including infertility and maternal death. With the current total fertility rate of 3.45, every fourth child in the country dies because of lack of nutrition and birth spacing, horrific statistic estimated by The Challenge Initiative.

Married adolescents, aged 15-19, have a contraceptive prevalence rate of just 10pc, as per UNFPA. But of course, men are not robots and cannot be expected to accommodate protection for their teen wives, regardless of the impact on her health and future education and economic opportunities.

Published in Dawn, The Business and Finance Weekly, February 20th, 2023