Objective This paper explores the demand for family planning services amongst the urban poor in Pakistan. Methods A household population survey was conducted amongst 5338 ever-married women in six urban study sites in Punjab and Sindh. In addition, 40 focus group discussions were conducted across the six sites. Interviews were also conducted with community leaders and service providers in each of the sites. Results Women reported a high approval of contraceptive use (78%) but a low uptake of modern methods of family planning (21%). Their husband’s play an important role deciding whether to adopt a family planning method. Husband’s approval increases with parity, particularly after the second child. Some women conceal their use of contraception from their husband. Just over half of the women stated that their last pregnancy was mistimed or unwanted. 62% of currently married women desire to either space or limit future births. 47% of this demand is currently being satisfied. Total unmet need for family planning was 39%, with unmet need for limiting (23%) being greater than the unmet need for spacing (16%). The unmet need for limiting is greatest amongst older women (35+), those with no formal education and women of parity four and above, whilst unmet need for spacing births is greatest amongst women under 25 years, women with secondary or higher education and those with lower parity. Conclusions Although approval of family planning is high across all study sites (78%), there exists a high level of unmet need for family planning. The low levels of contraceptive use and the large numbers of unwanted pregnancies point to the need to provide quality accessible family planning services in these six urban areas. There exists unmet need for both the spacing and limiting of births, and the extent of each of these varies by women’s age, parity and education. Family planning services thus need to provide a range of quality methods of family planning that can allow women to either limit or space births, and need to focus services to the individual needs of women with differing socio-demographic characteristics.