Fertility transition in Pakistan: neglected dimensions and policy implications

Abstract

This research addresses some of the neglected non-program dimensions related to stagnant fertility transition in Pakistan. Previous research identified a range of factors influencing fertility in Pakistan, particularly the effect of distortions in reported ages, fertility inhibiting variables, timing of first marriage and first birth, and birth intervals. The literature provides evidence that there is no systematic analysis of these dimensions particularly at the regional levels. This research addresses these dimensions by evaluating the fertility and reproductive health data in particular using the cross-sectional data from the 1990 and 2006 Pakistan Demographic and Health Survey, and 2000-01 Pakistan Reproductive Health and Family Planning Survey.

Based on the application of relevant demographic and statistical techniques, the study demonstrates evidence of clear discrepancies in age reporting among married females across the seven geographic regions. This had influence on the estimated marital fertility rates which tend to be significantly higher when the reporting effects were adjusted. The analysis of fertility inhibiting factors reveals that timing of marriage and contraceptive use are crucial determinants associated with fertility reduction in Pakistan. By far, the strongest factor driving increase at first marriage in Pakistan is the level of female education which tends to vary significantly across different geographic regions. The analysis of the duration between marriage and first conception shows rather unexpected complex hazard functions with two peaks suggesting the behaviour of two different groups of women: those adhering to the traditional pattern in which conception take place soon after marriage; and those who postpone conception after marriage. Punjab, Baluchistan and urban regions are ahead of the fertility transition at the national level, confirming the effect of longer birth intervals. Based on the analysis of the proximate determinants framework, it can be concluded that Pakistan has entered the early third phase of the fertility transition. Urban Punjab and Baluchistan have also showed convergence to the third phase of the fertility transition. Breastfeeding and amenorrhea have emerged as significant determinants of birth interval duration.

The results of this study highlight various areas for programme intervention and policy development. There is a dire need for a policy to improve the levels of female literacy and education especially in poorly developed regions which are in the second phase of fertility transition. A cost-effective intervention would be using mass media, for example radio broadcasting as the medium to disseminate reproductive health and family planning information. Pakistan needs specific policy interventions aimed at empowering girls with education for delaying marriage and encouraging contraceptive use. In formal education programmes, the syllabus should include the introduction to contraception, sexual health education as well as information on sexually transmitted diseases.

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Identifiers

ORCID for Andrew Hinde: orcid.org/0000-0002-8909-9152

ORCID for Sabu S. Padmadas: orcid.org/0000-0002-6538-9374

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