In the labour rooms of Pakistan’s overcrowded hospitals, amidst beeping monitors and rusted stretchers, lies a human rights crisis that is too often ignored. Women— exhausted, anaemic, barely adults— are brought in for their third or fourth deliveries, their bodies failing, their will subdued, their consent absent. During my gynaecology rotation, I saw this pattern not once, but daily: women whose lives revolve around reproduction, but whose voices are absent from decisions about their own bodies.
According to the Pakistan Demographic and Health Survey (PDHS) 2017–18, 35 percent of women in Pakistan are married before the age of 18, and 8.6 percent before the age of 15. These aren’t just numbers— they’re the stories of millions of girls pulled from classrooms and thrust into marriage, their childhood stolen by social pressure, poverty, and patriarchal tradition. As soon as these girls become wives, the expectation is clear: start producing children, year after year.
What follows is a tragic cycle. These young women often live in rural or impoverished areas where adequate prenatal care is a luxury they cannot access. Most do not receive even the minimum four antenatal checkups recommended by WHO. In many cases, they do not get a single ultrasound during their entire pregnancy— no anatomy scans, no foetal assessments, no detection of placental abnormalities, no identification of foetal distress.
They rarely receive essential supplements like iron, folic acid, or calcium, even though over 51 percent of pregnant women in Pakistan are anaemic. This leads to increased risk of preterm births, intrauterine growth restriction (IUGR), maternal exhaustion during labour, and poor foetal outcomes. Without access to blood transfusions or emergency obstetric care, many die preventable deaths—alone, silenced, and forgotten.
According to UNICEF, maternal mortality in Pakistan stands at 186 per 100,000 live births, but in remote regions, the actual figure is likely much higher. Women deliver at home, often assisted by untrained dais (birth attendants), without access to sterile instruments or life-saving medication. Complications like postpartum hemorrhage, eclampsia, and sepsis go untreated. Women bleed out in silence, their deaths labelled as fate instead of systemic failure.
Even after childbirth, the neglect continues. There is virtually no postnatal care. The mother is sent home within hours— sometimes even minutes— of delivery, expected to resume household chores and childcare with a body that has just endured unimaginable trauma. There is no monitoring for infections, no counseling for postpartum depression, no nutritional support for breastfeeding, and no follow-up for surgical complications if they had a C-section. These women are left to recover— if at all— on their own, with no time or space for healing.
Psychologically, the impact is profound. Studies show that 30 percent to 37 percent of postpartum women in Pakistan experience clinical depression, yet the concept of maternal mental health is still taboo. Women exhibiting symptoms of anxiety or depression are often labeled as “ungrateful” or “overly sensitive,” blamed for their own distress, or even abused further for expressing it. There are no structured mental health services in public maternal care systems, and private therapy is unaffordable for most.
This emotional neglect runs parallel with blatant violations of bodily autonomy. A woman’s opinion is almost never considered when decisions about pregnancy are made. Only 34 percent of married women in Pakistan use contraception, and 17 percent report unmet needs for family planning. Many are actively discouraged— or forbidden— from using contraceptives by husbands or in-laws. Cultural myths (such as birth control causing infertility or being religiously forbidden) continue to circulate, with no effective public health counter-narratives.
The reproductive suffering of women in Pakistan is not cultural. It is not inevitable. It is not ordained. It is engineered—by systems of neglect, by silence, by deliberate inaction. It is time to call it what it is: reproductive abuse, and it is destroying the health of women and the future of our nation.
As a result, women are forced into repeated, unspaced pregnancies that wear down their bodies. Uterine rupture, pelvic organ prolapse, vesicovaginal fistulas, and chronic pain syndromes become lifelong complications. Even worse, societal pressure for male offspring leads to even more forced pregnancies. Women who bear daughters are taunted, neglected, and abused. In some areas, sex-selective abortions, though illegal, are secretly practiced. In others, the woman is simply pressured to “keep trying” until a boy is born— regardless of what it costs her.
The media adds fuel to this fire. Pakistani dramas frequently glorify the image of the “sacrificing mother” who endures all suffering for her family. Rarely do we see female characters who speak up for their reproductive rights, reject early marriage, or opt for family planning. On the rare occasion that such a character exists, she is often villainized—portrayed as disrespectful or immoral. Our media reinforces the narrative that a woman’s silence, fertility, and endurance are her only virtues.
And the damage is generational. Children born into these cycles of abuse face their own battles. 38 percent of Pakistani children under five are stunted, and 17.7 percent are wasted, as per UNICEF. Malnourished, under-stimulated, and emotionally neglected, these children are often pushed into child labour to support their large families. They miss school, miss meals, and miss the chance to break free from the circumstances they were born into. One generation of reproductive abuse births another generation of social vulnerability.
In tribal belts and some urban slums, children grow up seeing their mothers as overburdened, underappreciated, and broken. Sons internalize patriarchy; daughters inherit trauma. The cycle repeats— because no one intervenes at the source.
This is not just a women’s issue. It is a national development crisis. A country where women are too sick to work, too mentally drained to parent effectively, and too socially constrained to seek help cannot prosper. Every mother lost to childbirth, every child born into malnutrition, every girl forced into early marriage is a failure of the state— and of all of us.
What is urgently needed is a fundamental restructuring of how we treat reproductive health and female autonomy in Pakistan. First, the legal marriage age of 18 must be strictly enforced across all provinces, without exceptions. Violations should carry tangible legal consequences, and this must be paired with aggressive awareness campaigns that explain why early marriage is so damaging, not just to the girl, but to the whole community.
Equally critical is the need to guarantee universal access to antenatal and postnatal care. Every pregnant woman should receive at least four prenatal checkups, one mandatory ultrasound, and free iron-folic acid supplements from local health units. After childbirth, she must be entitled to a minimum standard of postnatal care— monitoring for infections, support for breastfeeding, and counseling for postpartum mental health.
We must also expand access to contraception and family planning services, offered free of cost and without stigma at every public healthcare facility. This includes not just the availability of contraceptives, but active and culturally sensitive counseling— especially for men and mothers-in-law, who often hold the power in household decisions. Public health messaging through media, mosques, and community networks must debunk the myths and religious misinformation that currently plague contraceptive use.
Simultaneously, maternal mental health services must be made integral to reproductive healthcare. We cannot treat a woman’s physical body and ignore her emotional wellbeing. Hospitals and clinics should offer mental health screening, support groups, and access to trained professionals. Educating medical staff to recognize postpartum depression and respond with compassion must be a national priority.
In addition, mass media must be held accountable for its role in perpetuating toxic narratives around womanhood. The state and civil society should work together to fund and support programming that promotes strong, autonomous female characters, educates the public on reproductive rights, and celebrates informed motherhood rather than forced martyrdom.
Finally, we must implement transparent digital tracking systems to ensure that maternal health budgets are actually used for their intended purpose. Every rupee allocated for maternal health should be traceable, auditable, and spent on the ground—not lost in bureaucratic pockets. Corruption in healthcare financing is not just theft; it is complicity in death.
The reproductive suffering of women in Pakistan is not cultural. It is not inevitable. It is not ordained. It is engineered—by systems of neglect, by silence, by deliberate inaction. It is time to call it what it is: reproductive abuse, and it is destroying the health of women and the future of our nation.
Let us not remain silent. Not as doctors. Not as citizens. The uterus is not a battlefield. It is time to listen to the women who have endured far too much—for far too long.
