AYESHA, a 25-year-old mother of three, walks two kilometres each time she needs family planning or maternal health services. Her story is not unique; it is a daily reality for millions of Pakistani women. In a country of more than a quarter billion people, still growing at 2.1 per cent annually, access to basic reproductive health services remains a struggle. Pakistan’s total fertility rate stands at 3.5 births, far above the global average of 2.4 and one of the highest in South Asia. Sixteen per cent of married women still lack access to family planning, and the contraceptive prevalence rate has stalled at around 32pc.

Pakistan has achieved important gains, improving reproductive health services, and addressing gender-based violence (GBV) more systematically as a result of long-standing partnerships with global development actors; yet the landscape of international cooperation is shifting rapidly, putting these hard-won gains at risk.

The reduced footprint of USAID, a key partner of UNFPA and largest supporters, has left a major gap in funding, technical expertise, and innovation. UNFPA itself faces tightening global funding at a time when Pakistan’s needs are still expanding. Many traditional donors have already reduced their official development assistance for the coming years. All this is happening while Pakistan experiences 3.5m unintended pregnancies annually; 61pc of this end in induced abortion, often unsafe and always preventable. Also, Pakistan along with Nigeria, India and the DRC accounts for nearly half of all maternal deaths globally. Gender inequality compounds these challenges where Pakistan ranks 148th out of 148 countries. This reflects structural barriers that limit women’s autonomy, restrict their economic participation, and impede their access to education and health services.

Global priorities are shifting; the Social Summit 2025 discussions revolved around ageing, long-term care, declining fertility, and changing partnership norms highlighting an emerging misalignment between global focus and high-fertility countries like Pakistan. The divergence is worrying. As the global agenda shifts towards anxieties of ageing societies, the risk is that Pakistan’s high-fertility challenges, described by the finance minister as an existential threat, may be deprioritised.

As I enter my fourth year leading UNFPA’s support to Pakistan, I am more convinced than ever that the country’s future rests on two pillars: women and youth. Nearly 66pc of Pakistan’s population is under 30, representing a demographic opportunity unmatched in the region. But this opportunity will only be realised if young people receive quality education, relevant skills, and pathways to meaningful economic and civic participation. For women, the ability to exercise reproductive rights, live free from violence, and access economic opportunities will shape Pakistan’s social and economic trajectory. Modest investments in family planning, maternal health, GBV prevention and response, youth development, and gender equality will have generational consequences, influencing not only individual lives but stability, prosperity, and global competitiveness.

Despite the challenges, Pakistan has stre­ngth and resilience, strong institutions, com­­-mitted partners, and a dynamic young population that provide a foundation for transformation. To sustain and accelerate prog­r­e­­ss, Pakistan needs to deepen nat­ional owne-rship of its development agenda. This requ­i­res increased domestic investment in reproductive health, maternal care, gender equa­lity, GBV, and youth dev­elopment. Rights-based approaches must remain central, even as global po­­litics trend more conser­vative and threa-t­­en to erode deca­d­­es of progr­ess. En-g­aging the private sector, phi-lan­th­ro-pic actors, and reg­ional peers is bec­o­ming a necessity. Further, the inclusion of marginalised groups, including trans­gender, is esse­ntial not only for justice but also for social cohesion.

Global shifts risk Pakistan’s social development.

Above all, policymaking must be driven by demographic intelligence, data and evidence. Countries that place women and youth at the centre of development consistently achieve more resilient, equitable, and prosperous outcomes.

Pakistan’s priorities and needs are clear; yet there is a lot of talk that is not honoured with work, executive decisions and financing. As global tides shift, the responsibility to protect rights, expand essential services, and support the most vulnerable falls to the national leadership and collective resolve. UNFPA’s commitment to Pakistan remains steadfast. This is not a moment for hesitation; it is a moment for bold and evidence-based action.

Pakistan has the talent, the institutions, and moral imperative to seize this moment. Will the nation rise, guided by justice, dignity, and the promise of a Pakistan that realises its fullest potential? Pakistan Zindabad.

The writer is UNFPA representative in Pakistan.

Published in Dawn, December 8th, 2025