Raheela, my housekeeper for ten years, appeared visibly fatigued today. At age 26, a mother of three, the weight of her responsibilities was etched on her weary face.

As I sipped my Sunday morning tea, I couldn’t ignore the worry lines on her forehead and the beads of sweat clinging to her skin. Her movements were sluggish, burdened by anxiety. As she dusted, her hand inadvertently brushed against a vase, shattering the moment’s tranquillity. Her eyes, filled with apology and fear, mirrored the silent struggles of countless women like her across Pakistan.

Raheela’s story encapsulates a broader societal challenge confronting many young women in Pakistan: the lack of access to family planning resources coupled with the overwhelming pressures of social expectations. The result is oft-repeated pregnancies and economic strain, which impact both their health and their capacity to manage work and caregiving duties.

This challenge extends beyond Raheela’s individual experience. Pakistan’s soaring population growth rate, which has risen from 2.4 per cent in 2017 to 2.6pc in 2023, exacerbates concerns like hers. With three children in seven years of marriage, Raheela fears for the future. She worries that the ever-increasing inflation will make it increasingly difficult to afford necessities such as nutritious food, thus hindering her children’s development and education.

Raheela’s plight underscores the urgent need for increased access to family planning resources and economic support for families like hers. However, Pakistan lags far behind its South Asian neighbours in this regard.

About 26.3pc of married Pakistani women want to prevent pregnancy but lack access to family planning methods

Modern contraceptive use in Pakistan lags at a stagnant 30pc, compared to India (58.6pc), Bangladesh (56.2pc), and even Iran (47pc). A staggering 26.3pc of married Pakistani women want to delay or prevent pregnancy but lack access to family planning methods. This unmet need is significantly higher than neighbouring countries — India at 17.5pc, Bangladesh at 15.2pc, and Iran at 19.1pc).

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Cultural desires for sons and family pressure for large families collide with limited access to family planning services and knowledge about contraception. The situation is worsened by low education levels and poverty, restricting women’s or couple’s control over family size.

A 2012 study revealed a startling statistic: about 46pc of Pakistan’s nine million pregnancies in the same year were unintentional. Of these, over 2.25m, a significant number, resulted in abortions.

Additionally, emergency contraceptive pills are reported to be the most commonly sold contraceptive method in Pakistan. This exposes a growing problem of unwanted pregnancies. There’s a crucial need to educate people about safe and effective family planning methods.

The repercussions of Pakistan’s booming population extend beyond individual households. The strain on resources such as education, healthcare, and clean water is becoming increasingly untenable.

Shockingly, a recent Unicef study revealed that a staggering 22.8m children aged five to 10 in Pakistan, accounting for 44pc of that age group in the total population, are not enrolled in school. This educational gap threatens to widen further with unchecked population growth.

Additionally, the lack of access to necessities such as clean water and proper sanitation further compounds the challenges faced by millions of Pakistanis. Over 20,000 children under the age of five die annually from preventable diarrheal diseases due to inadequate sanitation facilities.

Furthermore, the dream of affordable housing in Pakistan is fading for many. Increasing urbanisation coupled with land speculation, rising construction costs, and poor planning have left a significant portion of the population struggling to secure decent living conditions.

The lack of affordable housing disproportionately affects low-income families like Raheela’s. The cramped apartment, already bursting at the seams with three young children, would only become more strained with each additional pregnancy. Unhealthy living conditions reduce their quality of life and make it difficult to afford nutritious food, healthcare, and education for their children, hindering their development at a crucial stage.

Raheela’s story serves as a distressing reminder of the multifaceted challenges posed by Pakistan’s growing population. Limited access to family planning resources and a lack of awareness about reproductive health options make it difficult for families to plan for their future.

These challenges and broader issues like education, healthcare, sanitation, and housing demand a multipronged approach and comprehensive response. Family planning, or population management, is not receiving the priority it deserves. It must be recognised as a cornerstone for a brighter future, not just an isolated health agenda.

Increased funding for family planning, educational campaigns to dispel myths about contraception, and empowering women through access to education and economic opportunities are some of the crucial steps.

Policymakers and stakeholders must understand and recognise the urgency of this situation and take immediate action to address these interconnected issues, ensuring a better future for all Pakistanis.

The writer is a political economist with a degree from the London School of Economics and Political Science. She is currently employed in Pakistan’s development sector.

Published in Dawn, The Business and Finance Weekly, May 13th, 2024