Anaya Javed & Khizra Jamil Khan

At first glance, the Falahi Markaz (Welfare Center) has the unremarkable presence of a government facility in a military neighborhood, with a vocational training center and a small Montessori bustling with quiet activity. Yet, beyond these familiar spaces, tucked discreetly within the building, lies the Family Welfare Center providing family planning services to the local population. Near the entrance, a man sits silently, his presence unobtrusive yet purposeful. He is there in case another man visits, though such instances are rare since the targeted audience is mostly female¹.

Further inside, Saima, an experienced Family Planning Field Worker (FPFW) sits with her leather register, greeting women with a practiced script: Bachay hain? Kitnay? Shaadi ko kitna arsa hogaya hai? Kabhi waqfa karney ka socha? (Do you have children? How many? How long has it been since you got married? Have you ever thought about spacing your children?). Her posture was calm and collected, perfected through years of witnessing pain and suffering. Beneath this composed demeanor lies a gendered, emotionally demanding role, one that is shaped by the intersections of bureaucratic mandates and cultural expectations.

We take a closer look at the everyday realities of family planning work in Lahore, where emotional labour, gender expectations, and institutional structures come together to shape a deeply feminized workforce. Through ethnographic fieldwork and theoretical insights from Judith Butler, Arlie Russell Hochschild, and others, we explore how trust-building, so essential to the success of Pakistan’s family planning initiatives, relies heavily on the emotional labour of women. FPFWs carry not just contraceptives, but the weight of care, patience, and resilience, often without recognition. Their roles demand more than technical knowledge; they require a constant performance of empathy and composure. Despite the presence of a male FPFW, the burden of this trust-building process through carefully sustained interpersonal interactions falls on female FPFWs.

In Lahore, family planning work was primarily undertaken by the former Population Welfare Department (PWD). However, from March onwards, family planning has been integrated within the mandate of a unified Health & Population Department. Currently, family planning services are delivered within Family Welfare Centers situated across Lahore. Each center typically employs four to five staff members, including a Family Planning Officer, male and female field workers (FPFWs), an assistant, and occasionally a psychologist and/or a gynecologist. Apart from the male FPFW, all other staff members are women, making family planning workforce immensely female-dominated.

The FPFWs play a dual role: conducting door-to-door outreach to promote state-led family planning initiatives and supporting the Family Planning Officer in servicing the walk-in clients at the centers.

Trust-building is a key element of family planning work in Lahore, which demands that FPFWs convey both their personal integrity and the credibility of state-led initiatives through their behavior. Therefore, FPFWs like Saima are emotional laborers molded into ideal caregivers. Emotional labor, a concept explored by Arlie Russell Hochschild, involves carefully managing one’s feelings to maintain a composed and approachable exterior². Maintaining appropriate behavior on the field and in centers makes their work emotionally intense, requiring a consistent balance between professionalism and empathetic engagement. This labour, though an institutional requirement, remains naturalized through normative gendered expectations of society, where emotional labor is frequently associated with a woman’s intrinsic attributes³⁴⁵.

Judith Butler argues that gender is not an inherent trait or truth but only comes into existence through a stylized repetition of acts⁶. We argue that female FPFWs are not inherently predisposed to care work; rather, they are conditioned to perform it through repetitive training that consistently emphasizes khush ikhlaaqi (a pleasant demeanor) and sabr (patience) when engaging with clients, even in the face of harsh refusals or resistance to family planning services. Women are not selected for these roles merely due to availability; they are recruited because their emotional engagement achieves what mere documents and pamphlets cannot: fostering trust, communicating sensitive information, and negotiating the intimate landscape of reproductive health.

Additionally, traditional gender roles further reinforce the feminization of family planning work, where it is mostly women who visit the centers and answer doors during household visits. Consequently, it is the female FPFW who must initiate and carry the conversations, including the management of refusals and enduring verbal insults if any. Saima recalled that their training often framed their work as Insaaniyat ki Khidmat (service to humanity) and advised all FPFWs to disregard any hostility. While this cultivated learned patience, it conceals the significant emotional toll on these women. Saima maintains calmness in the face of hostility, suppressing her true feelings to uphold the expected demeanor. This eventually results in a classic case of emotional dissonance, which refers to a disconnect from one’s own feelings. Reflecting on her emotional restraint, Saima said:

“Mujhey aaj tak yaad hai jab mein pehli dafa field mein gayi thi aur itni badtameezi hoyi thi merey saath. Uss waqt toh mein kuch nahi bol payi lekin mujhey woh cheez aaj tak yaad hai.” (I still remember the first time I went into the field, and I was met with so much hostility. I could not say anything then, but I remember the experience to this day).

In contrast, when asked about encountering hostility in the field, Asif, the male FPFW, described his tolerance as a strategic decision aimed at eliciting guilt from citizens. While both male and female FPFWs display patience, the way their experiences are articulated reveals differing emotional burdens. For instance, regarding instances of misbehavior in the field, Asif remarked:

“Koyi gaali galoch shuru karde, limit cross karde, humari self-respect bhi hoti hai” (If someone starts using abusive language and crosses the line, our self-respect is also at stake).

This demonstrates an assertion of personal boundaries, which was remarkably absent in Saima’s experience. Female workers, in stark contrast, are expected to remain silent and composed, such that they often internalize the emotional strain while past encounters continue to haunt them. These dynamics also persist within the centers, where women primarily approach female FPFWs not only for contraceptives or reproductive advice, but also for intimate concerns such as miscarriages, son preference, and marital conflict. Saima, therefore, is not merely a fieldworker managing the center, she further becomes a counselor and an educator. Her labor is essential to advancing the state’s family planning agenda yet remains profoundly undervalued and emotionally taxing.

While there is an attempt to increase male involvement in family planning to increase contraceptive uptake, the role of male FPFWs remains symbolic and often reinforces gender roles. In a center we visited, the male FPFW, who was hearing and speech impaired, held a largely symbolic position with limited responsibilities. Despite being unable to communicate with clients or intervene in instances of verbal hostility, his presence was deemed essential. He stood behind the female FPFW not for operational support, but as a symbol of protection and a physical embodiment of masculine authority, legitimizing the space in which female FPFWs operated. This dynamic was echoed in Saima’s experience with her male counterpart. Both female FPFWs we interviewed remarked:

“Aadmi peechay khara rehta hai. Uss se confidence milta hai.” (The man stands behind us, and that gives us confidence).

The male FPFW can occupy this symbolic role precisely because masculinity often remains “unmarked for public scrutiny,” enabling his presence to function as a generalized signifier of authority⁷. His role is less defined by action and more by the cultural meanings ascribed to his body: izzat (honor), surveillance, and moral compliance. This position aligns with what Butler describes as “culturally intelligible” masculinity: a role legible and legitimized within patriarchal social norms, reinforcing male authority even in feminized spaces of care⁸. Additionally, male FPFWs primarily engage in outreach activities within male-dominated public spaces like markets, where they interact directly with male heads of households who typically make decisions about contraceptive use. Unlike female FPFWs, they are not burdened with navigating issues of consent or managing emotional disclosures. Thus, the emotional labor remains minimal in their roles, surfacing only in brief moments of visible frustration.

In Pakistan, this gendered nature of emotional labor is deeply entrenched within the postcolonial, patriarchal bureaucracy established after Independence, where female health workers undertake fieldwork, trust-building, and education while remaining chronically underpaid and undervalued. While female FPFWs shoulder the emotional and educational burdens of this work, male FPFWs occupy symbolic roles that reinforce legitimacy within patriarchal public spaces, rather than advancing meaningful male engagement in reproductive health. By foregrounding the performative and affective dimensions of emotional labor, we have illustrated how gendered scripts continue to govern state-led health interventions, often at the cost of the very women whose efforts make them possible.

1.  Framurz K. Kiani, “Motivation and Involvement of Men in Family Planning in Pakistan,” The Pakistan Development Review 42, no. 3 (Autumn 2003): 197–217.
2. Arlie Russell Hochschild, The Managed Heart: Commercialization of Human Feeling (Berkeley: University of California Press, 1983), 7.
3. Bellas, Marcia L. “Emotional Labor in Academia: The Case of Professors.” The ANNALS of the American Academy of Political and Social Science 561, no. 1 (January 1999): 96–110. https://doi.org/10.1177/000271629956100107.  
4. Guy, Mary Ellen, and Meredith A. Newman. “Women’s Jobs, Men’s Jobs: Sex Segregation and Emotional Labor.” Public Administration Review 64, no. 3 (May 2004): 289–98. https://doi.org/10.1111/j.1540-6210.2004.00373.x
5. Meier, Kenneth J., Sharon H. Mastracci, and Kristin Wilson. “Gender and Emotional Labor in Public Organizations: An Empirical Examination of the Link to Performance.” Public Administration Review 66, no. 6 (November 2006): 899–909. https://doi.org/10.1111/j.1540-6210.2006.00657.x
6. Butler, Judith. Gender Trouble: Feminism and the Subversion of Identity, 1990 [2007], 178.
7. Butler, Gender Trouble, 57.
8. Butler, Gender Trouble, 68.