What's behind Pakistan's family planning stigma?

Sardar Jan Muhammad Khilji, a 50-year-old resident of Quetta, the capital of Pakistan's western province Balochistan, is proud to have many children: he is said to have welcomed his 60th child in January. Khilji confirmed he has fathered these children with three wives but refused to discuss further details with DW.

Mastan Khan Wazir, a resident of North Waziristan, Pakistan's tribal area bordering Afghanistan, told DW that he has 22 kids in total, some of whom have died. The 70-year-old said he still feels young and wants a fourth wife. 

All of his wives are from the same tribe, he said. One of his wives is the widow of his younger brother, who died in India-administered Kashmir while fighting Indian troops.

"I want to have more kids because they can fight the infidels and enemies," he said. "I am proud to have over a dozen kids."

Wazir said he keeps his three wives separate from each other: one is in North Waziristan, another is in Dera Ismael Khan and the third wife is in Rawalpindi. "If I keep them together, they will quarrel," he said.

Despite having so many children, Wazir said family planning teams never visited his area. "Even if they had come, nobody would have listened to them," he said. "They cannot prevent us from having more kids, it is given by God."

Pakistan's growing population

Pakistan is the fifth most populous country in the world: its population reached around 231.4 million people in 2021, according to the World Bank.

In 2022, the United Nations Population Fund calculated Pakistan's fertility rate be about 3.3 children per woman.

The conservative Islamic nation has one of the highest birth rates in the world, with 22 births per 1,000 people.

The World Population Review estimates the country will reach its peak population in 2092, with 404.68 million people.

What's driving families to have more children?

Yasmin Lehri, a former assembly lawmaker from Balochistan, believes a desire to have more male children is one of the factors motivating Pakistanis to have many kids. In tribal society, having boys is a symbol of status and power, she told DW, adding that families with more children wield more power and influence.

"Men will continue producing kids until they have baby boys," Lehri said. "Some marry twice or thrice if they don't have sons from first and second wives."

Lawmaker Kishwar Zehra, meanwhile, said some families believe having more children can boost their income. "That is why they have more and more kids, forcing boys to work in factories or workshops and girls at people's houses," she said.

Rukhsana Anwar, central president of the National Programme Health Employees Association in Punjab, sees religious clerics as the biggest hurdle to family planning. Most female health workers encounter pushback because clerics argue that family planning is anti-Islamic, she told DW. As a result, Anwar added, family planning carries a social stigma.

However, the political party Jamiat Ulema-e-Islam refutes the suggestion that clerics are responsible for preventing efforts aimed at controlling population growth. Muhammad Jalal-ud-din, a leader of the party, told DW his party did not believe in forcing people to have family planning.

"Clerics don't oppose family planning," he said. "Anyone who wants to do it can do so, but people should not be told or forced to carry out family planning if they don't wish."

Women face burden in population rise

Due to an economic crisis, Pakistan's government — including its population department — are short on funds, and state employees have reported delays in receiving their salaries.

Anwar, from the National Programme Health Employees Association, told DW the government has not been providing contraceptives to female health workers. "The relevant government departments have no pills, injections and not enough condoms, they say they don't have funds," she said.

The health worker said Islamabad is more focused on preventing maternity-related deaths.

"We don't say preventing such deaths is not necessary, but controlling population growth is also important," Anwar said.

Tipu Sultan, a Karachi-based health expert and former president of the Pakistan Medical Association, believes authorities are not taking family planning seriously.

"There are now vested interests who want this population growth issue to stay here because it could help them get perks and privileges and money from international donors," he said.

Women in Pakistan bear the brunt of birthing and raising large families, facing health issues as a result.

Citing the Pakistan Nutrition Survey of 2018, statistics from UNICEF's Pakistan Maternal Nutrition Strategy report estimate that 14.4% of women of reproductive age are underweight, 24% are overweight, 13.8% are obese, 41.7% are anemic and 22.4% have a vitamin A deficiency.

"I have seen extremely frail women with frequent pregnancies," Sultan said. "Weak women give birth to weak children, adding to the army of malnourished children, which results in stunted growth as well."

Edited by: Sou-Jie van Brunnersum