Key Social Norms Take-aways Social expectations appear more influential than women’s personal attitudes in shaping contraceptive intentions in Pakistan. The findings suggest that even when explicit opposition to contraception is uncommon, subtle disapproval, gendered expectations, and deference to husbands and extended family can constrain women’s reproductive choices. Programs should therefore address family and community expectations alongside gender power relations and women’s decision-making autonomy rather than focusing solely on individual attitudes.

Objectives To examine how attitudes, subjective norms, and perceived behavioral control influence women’s intentions to use contraception in Pakistan and assess the usefulness of the Theory of Planned Behavior for understanding reproductive decision-making in a collectivist, patriarchal context.

Methods This quantitative, cross-sectional study analyzed nationally representative 2017–2018 Pakistan Demographic and Health Survey data from 13,335 non-pregnant women aged 15–49. Partial least squares structural equation modeling was used to test relationships between contraceptive-use intention and attitudes, subjective norms, and perceived behavioral control, while accounting for demographic and socioeconomic factors. Subjective norms were operationalized using perceived partner opinions and religious teachings regarding contraception; perceived behavioral control captured women’s contraceptive decision-making autonomy and access to health services.

Results Subjective norms were significantly negatively associated with contraceptive intention (β=−0.056, p<0.001), while perceived behavioral control was positively associated with intention (β=0.091, p<0.001). Personal attitudes were not significantly associated with intention. Only 2.9% of husbands opposed contraception and 5.85% of women perceived religion as a barrier, while 52% of women had autonomy over reproductive decision-making. Education and family planning knowledge were also positively associated with contraceptive intention. Conclusions: Women’s contraceptive intentions in Pakistan are shaped more strongly by social expectations, gender power dynamics, autonomy, and structural constraints than by their individual evaluations of contraception. Family planning programs should move beyond individually focused approaches by engaging husbands, in-laws, and other influential community members, strengthening women’s agency and joint decision-making, improving access to services, and addressing misinformation.