Key Social Norms Take-aways This study highlights that unmet need for family planning (UMNFP) in Pakistan is shaped not only by individual or household characteristics but also by gendered social norms embedded within patriarchal decision-making. Husbands’ opposition to contraception, male control over reproductive decisions, and perceived religious prohibitions were among the strongest predictors of UMNFP. The discussion emphasizes that shifting social norms around male authority and promoting shared decision-making are essential for increasing contraceptive uptake. Community and religious leaders are identified as key actors for changing norms, engaging men, and fostering greater acceptance of women’s reproductive autonomy.

Objectives To examine how husbands’ attitudes toward contraceptive use influence unmet need for family planning among married women of reproductive age in Pakistan, while accounting for women’s and husbands’ socioeconomic characteristics and other determinants.

Methods This quantitative study analyzed secondary data from the nationally representative Pakistan Demographic and Health Survey (PDHS) 2017–2018. After excluding missing data, 12,113 married women aged 15–49 years were included. Binary logistic regression assessed associations between UMNFP and demographic, socioeconomic, and social norm-related variables. Social norms were captured through measures of husbands’ opposition to contraceptive use, perceived religious prohibition against contraception, and who made decisions about contraceptive use (woman versus husband), alongside education, employment, wealth, and age.

Results Approximately 51.6% of women experienced UMNFP. Women whose husbands opposed contraception had more than twice the odds of UMNFP (OR=2.35), and women whose husbands were the primary decision-makers regarding contraceptive use had significantly higher odds of UMNFP (OR=1.34). Perceived religious prohibition was also associated with greater unmet need, although its influence was weaker than husbands’ opposition. Older age, employment, and higher household wealth were associated with lower odds of UMNFP, while primary education among women and husbands was associated with higher odds compared with no education. The findings underscore that male attitudes and household power dynamics are stronger predictors of unmet need than religious beliefs alone.

Conclusions Husband’s attitudes toward contraception are a critical determinant of unmet need for family planning in Pakistan. The authors conclude that behavior change efforts should address restrictive gender norms by promoting joint decision-making, increasing women’s participation in reproductive choices, engaging men in family planning, and partnering with community and religious leaders to shift norms supporting equitable contraceptive decision-making. Broader investments in women’s education, employment, and public awareness are also recommended to reduce unmet need for family planning.