According to the World Fertility Report 2024 by the United Nations, Pakistan’s fertility rate has declined from 6 births per woman in 1994 to 3.6 in 2024. The total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children by the specified year’s age-specific fertility rates.

The receptionist of the top fertility clinic in Islamabad running for over twenty-five years disclosed that she registers over 10-12 new couples on daily basis facing issues with fertility while around 50–56 come every day for follow-ups.

Doctor Shaheen Javed, an assisted reproductive technology specialist, busted a myth in Pakistan that the majority of fertility problems are often associated with. In her experience based on her practice of over twenty-five years, she has gathered, “30% of females have the issue while 30% men do and in 30% cases, it is both the parties while the rest of the 10% causes remain unexplained. Almost everyone wants to have children. The ones who can, have the privilege of deciding either way but once someone knows they can’t, the feeling of deprivation makes them want children desperately.”

“Pakistani women face a number of health concerns such as poly-cystic ovarian syndrome, tubal blockages, endometriosis, premature ovarian failure, issues with ovarian reserves and certain infections while men’s semen sample is often compromised.

While women eat quite unhealthy junk food these days, it impacts their health but once they start focusing on their health, fix their diet, and lose the unnecessary fat that keeps them unhealthy, things start looking good for them, whereas the male factor now has become quite prevalent.”

Interestingly, Dr Shaheen notes that climate change has a devastating impact on the semen sample of men that gets compromised.

“There are many jobs that are stressful for men both mentally and physically. I have seen that truck drivers mostly suffer from infertility because of their vocation. They drive for long hours and throughout the year, end up sitting behind an engine in a heated temperature which in turn affects the quality of their sperm. Furthermore, we have seen a surge in semen sample deterioration after COVID-19”

“While we suggest keeping your diet healthy and lifestyle active, we have realized the utmost significance of mental health when it comes to fertility. Stress and mental health issues impact one’s reproductive health. These days, people are working in high-stress environments that they carry in their mind, body, and home so I would advise people to take care of their mental health along with their emotional health”

There also needs to be awareness that when single or married girls or boys are diagnosed with a disease like cancer, they can come and get their eggs frozen or utilize the facility of sperm banking before starting chemotherapy so that in the future, they can have their options open when wanting to have children.

Alarmingly, Dr Shaheen disclosed how lives have become so stressful for couples due to their work or other stresses that many a times they will come directly to the fertility clinic without even having tried naturally,

“I suggest young couples should visit clinics as soon as they suspect infertility but when we are sure that everything is normal and healthy, we suggest stabilizing the marriage before moving towards extending the family. Marriage maturity needs to be an utmost priority whereas family planning needs to come after 2 years of marriage, ideally.”

Despite Pakistan’s fertility rate dropping by nearly half, the population continues to grow at an alarming rate. But why? The answer lies in the numbers. Although the average number of children per woman has decreased from six to around three, this is still above the replacement rate. As a result, Pakistan’s population remains a ticking time bomb, with each woman still bearing more than three children on average.

Rabia Zafar, Director (of Research & Survey) of the National Institute of Population Studies (NIPS), comments “Pakistan’s fertility rate is indeed declining, but the population continues to rise because the existing large population base means even a lower birth rate still results in a significant number of new births each year, coupled with factors like decreasing mortality rates and a relatively young population structure; essentially, the population momentum is still high despite the fertility decline.”

The couples I spoke to asked for anonymity and expressed how both partners were struggling with fertility issues. While, women complained that all doctors body-shame and fat-shame them deeming their weights - which fell in the healthy BMI category -  the problem suggesting painful, expensive, and intrusive procedures, there seemed to be no research or knowledge to deal with the male factor. Men are told to eat clean and exercise while women are told to undergo several procedures. Dr Shaheen agreed that the focus of the world’s research is on female fertility while near to no expertise exists to take care of men in that regard.

Family planning and adoption need to be the nation’s priority for population control, however, the rise in fertility and health issues may prove to be another ticking time bomb in the near-future concerning the health of Pakistan.