By Rafiullah Mandokhel
Quetta (Parliament Times): On a chilly winter morning, 34-year-old Bakhtawar is desperate for her turn in the crowded waiting area under the open sky at a rural health facility.
The typical tribal mother is cradling her youngest ailing infant while her two other barefoot children are playing close by her. She is the mother of eleven children in total; however the rest are at home with her 58-member extended family on the outskirts of Zhob.
Bakhtawar like many other poverty-stricken mothers here, is heavily dependent on this government-run facility in northern Balochistan. Although it was established for a smaller population, but as the population grew, now it is no longer capable of delivering quality health services to this marginalized community.
“Our village comprises nearly a thousand households, with a population of around ten thousand people. Sometimes we are sent back home empty-handed because the pharmacy runs out within a few working days,” she laments.
Bakhtawar’s story is far from unique; across this poverty-stricken province, thousands of women with large families face similar hardships. For families like Bakhtawar’s, the strain is immediate and relentless.
Balochistan, covering nearly 44% of the country’s landmass, is under rapid population growth. Its impact is evident on families, health services, education, and basic infrastructure in every nook and corner. The pressure is felt not only in the cities but in villages as well, which are expanding rapidly with each passing year.
The official population data shows that Pakistan’s population reached around 255 million in 2025, making it the world’s fifth-most populous country. Balochistan recorded the highest provincial population growth rate, estimated at about 3.2 per cent annually. Separately, its total fertility rate stands at 4.0 births per woman, compared to the national average of 3.6.
“The rapid population growth, fueled by poverty, is creating a humanitarian strain,” explains Population officer, Haseeb Mandokhel, adding, “If current fertility and growth trends continue that outpacing development, Balochistan’s population could increase to around 35 million by 2050,” he warns.
Syed Aman Shah, the District Support Manager at PPHI (People’s Primary Healthcare Initiative), says hundreds of patients, mostly women and children, visit this facility on a daily basis, where Bakhtawar gets her child treated. The staff has left no stone unturned to ensure the healthcare facilities; however, the steadily growing number of patients with each passing day poses a major challenge for them to respond effectively.
The Pakistan Maternal Mortality Survey shows that Balochistan records a maternal mortality ratio of 298 deaths per 100,000 live births, the highest in the country. The infant mortality rate stands at 66 per 1,000, while the under-5 mortality rate is 78 per 1,000. The indicators are highlighting poor child survival outcomes.
Moreover, contraceptive use among married women also remains low. The Pakistan Demographic and Health Survey claims that there is about 20% contraceptive prevalence for Balochistan, considered the lowest as compared to the national coverage.
Mothers like Bakhtawar often give birth at home with no official record. Her last delivery was also attended by an elderly traditional birth attendant, who has been attending delivery cases for a decade. This situation is underscoring the scarcity of maternal health services in rural Balochistan.
Health experts believe that birth spacing could significantly improve maternal and child health without conflicting with cultural or religious norms. Yet, in the hilly Balochistan, such services always remained scarce and inaccessible.
“Despite the visible strain, family planning remains a sensitive and misunderstood issue. Male dominance, cultural barriers and misinformation prevent many women from accessing such services,” Haseeb laments.
Bakhtawar’s story doesn’t end here. Only two out of her eleven children go to a private school in town.
“The rest of my children are out of school because we cannot afford their fee and transportation burden. Let alone when they get sick. They are left at the mercy of Allah,” she regrets.
The impact of rapid population growth extends beyond healthcare into education. In a government-run primary school on the outskirts of Zhob, 120 students cram into a single classroom. Some sit cross-legged on the hard and cold floor, while the rest lean against the dirty walls. A single teacher for this overcrowded classroom is standing with a piece of white chalk in his dust-stained fingers, as there is no space left even for his chair to sit on. The majority of these grade one students in the heart of the town share torn textbooks with other poor and unfortunate classmates.
“I spend one hour merely checking their attendance, let alone teaching them. This is no longer teaching but a crowd and noise control responsibility,” the teacher Dawood Khan admits.
According to the Pakistan Economic Survey 2024–25, Balochistan’s literacy rate stands at around 42%, the lowest rate in the country. The dropout rate in the province is the highest in the country, a factor that undermines the quality of education.
UNICEF data indicates that Balochistan has one of the highest proportions of out-of-school children in Pakistan. An estimated 3.5 million children, nearly 69?% of the provincial school-age population, are out of school. Gallup Pakistan reveals that 41% of households in Balochistan reported no child attending school. This situation paints a grim picture.
Educationists are of the view that large families stretch household resources thin, food portions shrink, healthcare is delayed, and education becomes optional. High fertility coupled with poverty fuels dropouts, early marriages, and child labor. For Bakhtawar, sending her children to school is a choice shaped by harsh constraints rather than preference.
Education experts warn that rapid population growth is eroding hard-won literacy gains, perpetuating cycles of deprivation in districts like Zhob, where infrastructure has already lagged for decades.
A recent report by the Pakistan Population Council reveals that 17 out of the 20 poorest and most deprived districts in Pakistan are in Balochistan, and unfortunately Zhob is one among the vulnerable districts. The report describes these districts as grappling with extreme poverty, poor infrastructure, lack of basic amenities, limited economic opportunities and year-long water scarcity.
Water scarcity is not a distant threat but one of routine chores for Bakht Noor, a housewife living in a remote village in Zhob. She and her minor children walk nearly two kilometers daily to fetch water for drinking and cooking, returning with half-filled containers and pots. Another mother of seven in Gustoi village shares a similar ordeal.
“Each year, due to the groundwater depletion, the wells dry up,” adding, “With the growing number of households and wells in the village, the water is also depleting at an alarming level,” she explains.
“Our marginalized communities in Balochistan are paying the highest price,” says Quttab Khan Afaqi, who has been working in the development sector with the Balochistan Rural Support Programme for over a decade.
“Health facilities are overcrowded, classrooms are packed, forests are vanishing, malnutrition is rampant, and water scarcity is worsening. Cities are expanding without planning, the dropout rate is soaring, poverty is deepening, and even our bazaars are becoming more congested. Unchecked population growth underlies all of this,” he notes.
For districts like Zhob and neighborhoods where Bakhtawar and Noor live, this is not just a statistic. It is seen in overcrowded classrooms, long hospital queues, dried-up wells, empty water containers, and extended families struggling to survive. Behind every number is a family like Bakhtawar’s; born too many, served too little, yet still optimistic for change.___The writer is a Balochistan-based freelance journalist and member of the Media Coalition Group at the Population Council. He can be reached at: