The Silent Struggle for Reproductive Autonomy in Pakistan
A striking United Nations report has revealed a concerning reality in Pakistan: approximately two-thirds of women across the nation possess no autonomy when making decisions about their reproductive health. This statistic highlights a profound societal issue that extends far beyond mere numbers, touching the lives of countless women who navigate complex cultural expectations daily.
Personal Encounters with Societal Expectations
Fizza Abbas, a Pakistani writer, recently shared her personal experience that illustrates this broader pattern. During a routine medical consultation for a urinary tract infection, her gynaecologist's questioning took an unexpected turn. After confirming her marital status and learning she had no children, the doctor's tone shifted noticeably as she asked, "Bachay tou chaihiye na aap ko?" (You do want children, right?).
"What shocked me more was my own response," Abbas recalls. "I found myself mumbling 'Ji, ji, bilkul' (Yes, yes, of course) despite my true feelings. Later, I felt furious with myself for crumbling under that subtle pressure."
The Cultural Landscape of Motherhood
In Pakistan, a woman's value is frequently measured against her ability and willingness to become a mother. This cultural mindset manifests in numerous ways:
- Casual use of derogatory terms like baanjh (infertile) even when women simply choose to delay childbearing
- Open declarations of child-free living being viewed as selfish or threatening
- Constant questioning from relatives and strangers about reproductive timelines
- Unsolicited recommendations for fertility clinics, religious figures, traditional healers, and even therapists
Abbas describes an encounter with a driver who, upon learning she had no children, began invasive questioning about her and her husband's reproductive health. Despite multiple attempts to change the subject, he persisted, eventually offering the contact details of a traditional healer who had "fixed someone with the same problem."
Media Representation and Political Discourse
This pro-natalist perspective permeates Pakistani media and political spheres. Television dramas frequently portray child-free women as cursed, manipulative, or pitiable characters. Political leaders have reinforced this narrative, with former prime minister Imran Khan once remarking, "I disagree with the western concept of feminism; it has completely degraded the role of a mother."
Such statements create a false dichotomy between feminism and motherhood while suggesting a woman's worth is intrinsically tied to her reproductive capacity.
Healthcare and Policy Implications
The UNFPA's State of World Population 2025 report confirms that reproductive autonomy remains elusive for most Pakistani women. Despite this reality, the country lacks comprehensive national policies or public discourse supporting women who choose to remain child-free.
Fertility is predominantly viewed as something to be promoted and managed rather than questioned. While urban, privileged women like Abbas face significant pressure, those in rural areas often confront even more intense expectations amid rigid gender roles and limited access to contraception or reproductive education.
Even in urban healthcare settings, married women rarely receive contraceptive counselling that centres personal choice. Women who experience miscarriages frequently face blame directed at their diets, careers, or travel habits, with the common refrain "Naukri chhor do" (Just quit your job) urging them back into traditional reproductive roles.
A Personal Journey of Decision-Making
Abbas's own relationship with motherhood has evolved significantly. Growing up in a matriarchal Karachi household, she initially envisioned balancing a medical career with family life. "Marriage wasn't my fairytale but motherhood was always part of the plan," she explains, describing detailed fantasies about children's names, school selections, and meaningful conversations.
However, as she navigated multiple professional roles as an author, poet, and journalist, Abbas realised she couldn't provide the emotional presence a child deserves. Her husband shared similar reservations, questioning the ethics of bringing children into a world facing multiple crises and climate collapse. Together, they decided that if they ever wanted to care for children, they would explore adoption, orphanage volunteering, or godparent roles instead.
Societal Reactions and Personal Resilience
This decision provoked strong reactions from others. A cousin suggested, "You just do the deed, I'll raise the baby," treating motherhood as a transactional arrangement rather than a lifelong commitment. Others offered spiritual interventions including taweez-gandey (amulets and threads), replicas of religious garments, and mannat ki mehndi (devotional henna art) invoking Shia traditions.
Abbas faced accusations of being "too career-driven," a "radical feminist," or "too westernised." When she developed ovarian cysts and watched friends who had once vowed to remain child-free announce pregnancies, she experienced feelings of abandonment and doubt.
"When my period came, I'd stare at the blood and wonder: could that have been a baby?" she confesses, revealing the emotional complexity of her journey.
A Global Perspective on Reproductive Choice
Abbas recognises she is not alone in her experience. Worldwide, increasing numbers of women are choosing child-free lives after careful consideration rather than selfishness. While declining birth rates in countries like the United States, United Kingdom, and Japan are often framed as crises, many women find fulfilment through alternative paths.
"I may never hold a child who shares my blood, but I hold space for thought, for love, for stories, and for the kind of care that isn't always visible but still deeply felt," Abbas reflects. "I no longer see myself as lacking. I see myself as whole."
Her journey represents a quiet revolution against cultural expectations. If she were to encounter that gynaecologist again today, she knows her response would differ. She would state calmly but firmly: no, she doesn't want children – and that's perfectly acceptable.
