Ayesha Javeed
PAKISTAN’S population debate is often reduced to a familiar set of figures: how fast the country is growing, how many schools and jobs will be needed and whether public services can keep pace. These questions matter. But population policy is about more than managing numbers. It is also about ensuring that women and couples can make informed reproductive choices through access to accurate information, respectful counselling and a full range of family planning methods.
Dhok Hassu, a dense urban neighborhood in Rawalpindi, provides a small but useful window into this larger issue. In 2017, the Akhter Hameed Khan Foundation (AHKF) conducted a household survey involving 1500 ever-married women. Just over one-quarter of the women surveyed were currently using a family-planning method. Among those users, nearly two-thirds said the decision was made jointly with their husbands, about one-quarter said their husbands decided and fewer than one in ten said they decided themselves.
At first glance, joint decision-making appears encouraging. It suggests that many couples discuss family planning together. Yet the methods they chose tell a more complicated story. A male contraceptive method was by far the most common choice when husbands made the decision and was also the leading choice when couples decided jointly. Women who decided themselves were more likely to use injectable contraceptives or pills.
This does not mean one method is better than another or that every joint decision is unequal. The commonly preferred male method is affordable, reversible and widely available. The real issue is whether couples were offered a full range of options and whether the final choice reflected the woman’s health needs, preferences and circumstances.
That question matters in underserved urban communities. Families may live near health facilities but still face costs, limited privacy, irregular supplies, fear of side effects or discomfort discussing contraception. Awareness may be high, while genuine choice remains narrow.
Family-planning programs should, therefore, measure more than the number of users. They should ask whether women and men received clear information about different methods, whether women could seek confidential counseling and whether providers supported informed choices rather than promoting whichever method was easiest to supply.
Men should be engaged as informed and responsible partners, but women must also be able to express their preferences freely. Couple-based counseling can help, but it should not replace private and respectful services for women. Frontline health workers need the time, training and reliable supplies to explain options, address concerns and support continued use.
Dhok Hassu is only one neighborhood and its experience cannot represent all of Pakistan. But it raises a national question: are family-planning programs simply helping people use contraception or helping them make informed choices?
Pakistan’s population future will be shaped not only by policies announced in Islamabad, but also by the quality of conversations taking place in homes, clinics and communities. Success should be measured not only by how many people use contraception, but by whether every woman and couple has the knowledge, support and freedom to choose.
—The writer is Research Associate, Research and Development Solutions (RADS), Islamabad.
