At 21, Syeda Bibi looks like a child from afar, with her slender frame, long dark hair braided back, and cheeks still full. Yet up close, her rough hands and the etched lines of stress on her face tell a different story. Her chaddar frames weary eyes as she watches her daughters, both under the age of three, play together. Her husband is away, constructing houses in a new gated community not even 15 kilometers from their own run-down dwelling. Leaning on the concrete doorway of their makeshift house, she pulls back the sheet across the entrance to keep an eye on her daughters while she makes chai. Their carefree laughter is a joy Syeda Bibi can no longer remember.
Born into a poor family with one sister and four brothers, she hadn’t even finished matriculation when marriage was brought up, and at 17, she was married off. Ten months later, she gave birth to her first child, a daughter.
Her husband insisted on trying again. Another daughter. Again, he said. He needs sons to take over for him as he grows older, and the physical labor takes its toll on his joints.
Urban slums are seldom served by public or private sector programs.
Stories like Syeda Bibi’s highlight the urgent need to expand family planning and some of the reasons why the Contraceptive Prevalence Rate (CPR) has stagnated. Pakistan, the fifth most populous country in the world, is growing at 2.4 percent per annum. CPR has hovered at 30-35 percent for the last two decades, notably below that of most of our neighbors. Currently, only 8.22 million Pakistani couples use modern Family Planning (FP) methods, with approximately 4.94 million women receiving contraceptive services last year. That means to meet the FP2030 goals an additional 13.7 million users must start using Family Planning. This requires more than just increasing services through government initiatives, private sector programs, or social marketing outlets. Large-scale change demands strategic planning at both provincial and district levels. Addressing cultural barriers to family planning involves collaboration across education, women’s economic inclusion, and skills and vocation programs. This would shift the perspective from seeing women solely as wives, mothers, or caregivers to recognizing them as integral contributors to society.
Syeda Bibi’s body is still recovering from pregnancy and labor. She rubs absentmindedly at the stretch marks lining her waist, feeling the dull ache. It has been a year since she gave birth, and she does not know if her body can withstand another pregnancy. Some days she considers taking matters into her own hands, going against her husband’s wishes, and visiting the basic health unit in the next Mohalla over that sells cheap contraceptives. But it’s too far, and she has no means of transport or anyone to watch her children.
This touches on the second issue of increasing family planning in Pakistan: accessibility. To increase family planning services 14-fold, the most cost-effective and sustainable approach is to utilize outreach workers to connect impoverished rural and urban communities to permanent facilities. Urban slums are seldom served by public or private sector programs, resulting in millions of missed opportunities for counseling and demand generation for family planning among couples like Syeda Bibi and her husband. Furthermore, investing in family planning yields significant returns; for every dollar spent, the Return on Investment (ROI) is substantial, saving $30-50 on maternal-child mortality and providing $60-100 in long-term benefits from economic growth.
Syeda Bibi represents millions of women and young girls across Pakistan who have the potential to change the landscape of the country but do not know how to harness it or are held back. Unless we act today, there is a high probability that Syeda Bibi’s daughters will face the same fate.
The writer is CEO (Akhtar Hameed Khan Foundation)