Pakistan is the fifth most populous country in the world. Yet the country's greatest demographic challenge is not simply the size of its population, but the pace at which it continues to grow. With finite resources, Pakistan faces increasing pressure to provide quality healthcare, education, employment opportunities, housing, and social protection to a rapidly expanding population.
Family planning is not merely a demographic intervention; it is a proven public health and development strategy that improves maternal and child health, reduces poverty, promotes women's empowerment, and contributes to sustainable economic growth. However, these benefits can only be realised when governments are able to meet the population's demand for quality services.
A major concern in Pakistan is that a substantial proportion of couples who wish to delay or avoid pregnancy are unable to do so. Nearly one in five married couples has an unmet need for family planning, often because they lack access to reliable information, affordable services, quality counselling, or a choice of modern contraceptive methods. This gap results in millions of unintended pregnancies every year, many of which end in unsafe abortions or contribute to preventable maternal and newborn morbidity and mortality.
The barriers to family planning are not solely related to service availability. Perceived social disapproval remains one of the most significant obstacles preventing couples from adopting contraception. These perceptions are reinforced by social norms shaped by low literacy, poverty, limited access to accurate information, traditional family structures, and deeply embedded cultural practices that are often mistakenly attributed to religion. Similarly, preferences for large families are frequently influenced by social expectations, economic insecurity, and misinformation about birth spacing rather than by religious doctrine.
Overcoming these barriers requires more than expanding service delivery. It demands sustained, evidence-based social and behaviour change communication that addresses the underlying beliefs and attitudes influencing reproductive decisions.
Recognising these challenges, the Waqfa campaign was launched by the Mir Khalil-ur-Rahman Foundation (MKRF), with technical support from the Population Council and financial support from the UK Foreign, Commonwealth & Development Office (FCDO). The campaign was specifically designed to address the social and behavioural barriers that contribute to Pakistan's high unmet need for family planning. Drawing upon extensive formative research, behavioural science, and pilot-tested messages, the campaign received endorsement from senior policymakers and government stakeholders before its implementation. The campaign has received the full support of the provincial governments and the Ministry of National Health Services, Regulations and Coordination, which has taken full ownership of the initiative.
At the heart of the campaign is the concept of Waqfa or birth spacing, presented not as a limitation on family size but as an act of parental responsibility. By framing birth spacing as a life-saving practice consistent with Islamic teachings and grounded in compassion for the family, the campaign successfully addresses one of the most persistent misconceptions surrounding family planning. It emphasises healthier pregnancies, safer births, improved child survival, and stronger families.
The campaign also connects individual well-being with national development. It conveys the message that healthier, well-spaced families contribute to healthier communities and a more prosperous Pakistan. (Pakistan ki Baqaa).
Another important feature of the Waqfa campaign is its emphasis on interpersonal communication between spouses. Decisions regarding reproductive health are most effective when they are made jointly, based on mutual understanding and accurate information.
A distinguishing strength of the Waqfa campaign has been its comprehensive approach to stakeholder engagement. Message development was informed by consultations and interactions organised by the Population Council with religious scholars, security experts, healthcare professionals, economists, human rights experts, and environmentalists, ensuring that campaign messages reflected diverse perspectives. The concept of Waqfa has been endorsed by the Islamic Ideology Council as permissible in Islam.
The campaign has maintained a strong focus on demand generation, recognising that expanding the availability of family planning services alone is insufficient unless individuals and couples are motivated to seek them.
To maximise reach and reinforce consistent messaging, the campaign has employed a wide range of communication platforms, including electronic and print media, digital platforms, and social media. According to the third party midline evaluation, the Waqfa campaign has contributed to reducing barriers to family planning by improving knowledge, addressing misconceptions, and fostering positive attitudes toward birth spacing.
Evidence-based communication initiatives such as the Waqfa campaign demonstrate that when accurate information, community engagement, and religiously endorsed messaging are brought together, meaningful and sustained behaviour change is achievable. However, behaviour change is a gradual process that requires sustained effort. It is therefore critical that behaviour change communication initiatives be maintained over the long term to reinforce key messages, sustain individual and community-level behaviour change, and ultimately contribute to broader social norm transformation.
—The writer is Country Director Population Council
At the heart of the campaign is the concept of Waqfa or birth spacing, presented not as a limitation on family size but as an act of parental responsibility that protects the health and well-being of mothers and children.
