Family planning in Pakistan: A site of resistance

As the population of Pakistan has increased beyond 200 million, it is evident that the country's family planning program has been unable to sufficiently expand contraceptive use. To understand the obstacles, researchers have tended to focus on service delivery failures, 'cultural' barriers and varying political support. However, a small body of literature documents citizen's suspicions of an ulterior motive underlying Pakistan's family planning program. Often dismissed as unfounded conspiracies, a gap in our knowledge is the role these beliefs might be playing in the failure of the program. Using a critical ethnographic approach, we conduced 242 observations of daily life, 109 informal and 197 in-depth interviews with 41 women and 35 men living in a village in Khyber Pakhtunkhwa. Data were collected between September 2013 and April 2015 and analysed using latent content analysis. Our respondents viewed Western support for family planning as confirmation of their suspicions of the program's hidden agenda. Western military intervention in the region complicated their beliefs about the potential altruistic nature of foreign support for the family planning program. Awareness of rampant corruption among Pakistani government officials had fractured their trust in the state while contributing to the notion that the government was complicit with foreign interference. These considerations coupled with the fact that the priorities of Pakistani Family Planning program did not align with the reality of their lives contributed to the skepticism of family planning. For our respondents, resisting family planning and its ideology was a means to resist the perceived violence inflicted by the West and the complicity of the Pakistani government. These findings signal how geopolitics influence the use of family planning services. By demonstrating the importance of embedding perceptions of family planning programs in their local and global contexts, these findings suggest potential areas for future research in the field.