Contraception: the time is now!

Bangladesh, Indonesia and Iran have experienced significant declines in fertility rate

Dr Baqar Hasnain July 29, 2023
The writer takes interest in humanism and futurology. He has an MS from Houston and DDS from Nashville, Tennessee. He can be reached at


Just a little bigger than Texas and half the size of Iran, Pakistan is the fifth most populous country in the world. Its population grows at an annual rate of 1.9% which is more than twice the global average of 0.8%. The question is: why? Is it lack of education or lack of family planning or lack of easy access to contraceptives? Is it patriarchy (a social system in which men hold positions of power and privilege and decision-making, and women are expected to be subservient to the male authority figures)? Is it the culture? Is it the clergy? The simple answer is: all of the above. The rate of contraceptive prevalence (any method of contraception including the traditional methods) in Pakistan is 34%, compared to 67% in India, 63% in Bangladesh and 77% in Iran. More strikingly, only 17% of married women in Pakistan use modern contraceptives for family planning, according to an NIH study in 2021. Modern contraceptives as well as professional counseling on the use of these contraceptives must be made available to all married couples whether they live in small towns or in big cities. Family physicians and registered nurses should be trained to provide education to both men and women about pregnancy spacing and to decrease the number of unwanted pregnancies. It is our collective obligation to ensure reproductive health and reproductive rights for our citizens.

Bangladesh, Indonesia and Iran have experienced significant declines in fertility rate (average number of children per woman). In 1985, fertility rate in Bangladesh was 5.5, but by 2022, it was down to 2.1. The reasons for such rapid decline include: 1. Family planning programmes, 2. Education of women (the greater the education level of a woman, the smaller the family size), 3. Improved socioeconomic conditions, and 4. Higher use of contraceptives. The last mentioned factor, the higher use of contraceptives, was directly proportional to the education level of both husband and wife.

Contraception, or birth control, has been used since ancient times. Unfortunately, traditional methods of family planning are not effective. Half the time they don’t work. These methods include basal body temperature method, calendar-rhythm method, herbal medicine and withdrawal. Modern contraceptives, far more effective, include: 1. Surgical sterilisation (tubal ligation for a woman or vasectomy for a man), 2. IUD or Intra-Uterine Device (hormonal IUDs or copper IUDs), 3. Subdermal implants, 4. Oral contraceptives (the ‘pill’), 5. Condoms and diaphragms, 6. Contraceptive injection. The efficacy and safety of these modalities must be discussed with your physician and in family planning programmes.

But here is the problem: none of this will ever be possible in our ultraconservative male-dominant society unless we educate and empower women — something which simply means to give our girls and women the opportunity to pursue their desired goals and careers. We can no longer afford to confine women to the kitchen and the bedroom. Patriarchy must come to an end. It is not enough for men to open the door for women or to get up when they enter the room; it is time to empower them. “As women achieve power,” says Sandra Day O’Conner, an associate justice of the US Supreme Court, “the barriers will fall. As society sees what women can do, as women see what women can do, there will be more women out there doing things, and we’ll all be better off for it.”

Quite regrettably, people of Pakistan have been distracted by politics of personalities. News media and social media have sensationalised, even glamourised, political cults so much so that we are unable to see or discuss real problems. Overpopulation is the elephant in the room. We must face up to it. The time is now!

Published in The Express Tribune, July 29th, 2023.

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