Pakistan is a clear outlier within the South Asian region for having the highest population growth rate close to three percent, compared to 1.1 percent for South Asia as a whole. The key question here is whether this high population growth is the result of weak demand for population control measures or the lack of such measures. Evidence from the Pakistan Demographic and Health Survey 2017–18 points to both. According to its estimates, there exists not only a high preference for children with women, idealising four children and men five on average, but also a high rate of unmet need for contraception, meaning that access to contraceptive services has been quite limited. In this context, it is reasonable to attribute Pakistan’s policy failures in managing its high population growth to family planning initiatives that have inadequately balanced demand- and supply-side factors.
But this was not always the case. The 1990s were a highly successful decade for Pakistan in terms of family planning policy implementation. Policies under the Social Action Programme (SAP) led to a decline in the total fertility rate from 6.8 children per woman in the 1980s to 4.8 children per woman in the early 2000s.
Among the successful supply-side interventions of this period were community outreach schemes, such as the Village-Based Family Planning Workers Scheme, which later evolved into the more elaborate Lady Health Workers Programme, officially known as the Prime Minister’s Programme for Family Planning and Primary Health Care, as well as a highly successful media campaign on family planning. These supply-side interventions helped create effective demand for family planning services by raising awareness of contraceptive use and improving access to such services for households in targeted communities across Pakistan.
However, Pakistan lost this momentum, particularly after the passage of the 18th Amendment to the Constitution in April 2010, which resulted in the dissolution of the Ministry of Population Welfare and the transfer of population control policy to provincial Population Welfare Departments. This shift created coordination failures both horizontally and vertically across and within provinces. Moreover, the 7th National Finance Commission (NFC) Award of July 2010, which allocated 82 percent of provincial revenue shares based on population, further weakened provincial incentives to adopt proactive family planning policies. These two major policy shifts, though not directly related to family planning, had significant consequences: they effectively disincentivised provinces from continuing the aggressive supply-side interventions of the 1990s in managing population growth.
Pakistan’s demographic transition towards replacement levels has stagnated, and the country continues to perform poorly on human development and gender parity indicators
Consequently, since the 2000s, this lack of focus on family planning policies, combined with deep and worrying structural trends, has exacerbated the situation. Research in Pakistan@2050: Demographic Change, Future Projections, and Development Opportunities shows that Pakistan’s demographic transition towards replacement levels has stagnated, and the country continues to perform poorly on human development and gender parity indicators.
The cultural shift seen elsewhere, where families prioritise the quality rather than the quantity of children, is largely absent in Pakistan. Women continue to lag in all aspects of empowerment, including access to education and opportunities to translate acquired skills into employment. This was identified as a key factor in Bangladesh’s demographic transition.
It is not the case that Pakistan has entirely avoided programmes similar to those implemented in Bangladesh. The Punjab Female Secondary School Stipend Programme, modelled on Bangladesh’s experience and aimed at reducing fertility through expanded female education, has been successfully running in Punjab since 2004 and has been replicated in other provinces.
However, despite such interventions, female educational attainment remains significantly lower than that of males across all provinces. Even though educational attainment for females has increased at the secondary level nationwide, and at post-secondary levels in Punjab and Khyber Pakhtunkhwa, as highlighted in the study titled Dynamics in Educational Outcomes by Gender: Evidence from Pakistan whether this progress is translating into higher labour force participation and greater female agency remains an open question. Overall, female labour force participation in Pakistan remains low across all levels of education.
Thus, the channels through which demand-side norms for smaller family sizes might emerge remain extremely weak. Unless these structural factors are addressed across and within each province, a meaningful discourse on the importance of smaller families is unlikely to materialise at the community or household level. To conclude, the biggest failure in Pakistan’s population management policies does not lie solely in low demand or insufficient supply of contraceptives, but in the absence of a holistic discourse that centres on human development, particularly women’s empowerment, as the primary driver of change.