Unintended pregnancies remain an important reproductive health concern in Pakistan, particularly given high fertility rates and low contraceptive use. This study examines how past fertility intentions and contraceptive use influence subsequent pregnancy experiences. Data from 1,874 women in union aged 15–49 from the Longitudinal Panel Study: Performance Monitoring for Action (PMA) Framework (2020–2022) were analyzed. Fertility intentions were measured by women’s desire to delay or limit pregnancies, and contraceptive use was recorded as use of any method. Results indicate that women who previously expressed a desire to delay pregnancy still experienced subsequent pregnancies, and those using contraception were less likely to report unintended pregnancies. Specifically, 47% of women in round 2 and 81% in round 3 who wished to delay pregnancies reported a subsequent pregnancy, while 40% and 43% of contraceptive users in the baseline and midterm periods, respectively, experienced fewer unintended pregnancies. These findings highlight the need to strengthen women-focused family planning programs, improve access to effective contraceptive methods, and provide counseling tailored to women’s reproductive goals.