Pakistan's population growth: the need for action

Despite the existence of a national family planning program that dates to 1965 Pakistan has not seen a reduction in the fertility rate. One of the poorest countries in the world, Pakistan has 1 of the highest population growth rates in the world at about 3.0% annually. For over 2 decades, the average woman in Pakistan has given birth to more than 6 children. At the current fertility rate, the country's current population of 120 million will increase to over 150 million by the year 2000, and it will increase to 280 million by 2020. And even if today every woman were to begin having only 2 children, the population would still reach 160 million before leveling off. But reducing fertility in Pakistan will prove difficult. One of the leading obstacles is the low status of women. Few women in Pakistan have advanced education or professional jobs. Only 1/4 of those women without education or who are not working have any knowledge concerning contraception. Family size and composition also fuel the high rate of fertility. On the average, women desire 5 children (the fact that women average more than 5 suggests an unmet need for contraception). And due to social, cultural, and economic conditions, Pakistanis generally prefer male offsprings. Islamic opposition to family planning has also contributed to the continued high rates of fertility. Finally, administrative and management weaknesses have hindered Pakistan's family planning program. In order to overcome these obstacles, Pakistan will have to enlist the commitment of political, religious, and community leaders. The status of women will have to be improved, and the attitudes of people will need to change.     

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services.MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers.ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth.ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.     

Trends in Self-reported Spontaneous Abortions: 1970–2000

Little is known about how the miscarriage rate has changed over the past few decades in the United States. Data from Cycles IV to VI of the National Survey of Family Growth (NSFG) were used to examine trends from 1970 to 2000. After accounting for abortion availability and the characteristics of pregnant women, the rate of reported miscarriages increased by about 1.0% per year. This upward trend is strongest in the first seven weeks and absent after 12?weeks of pregnancy. African American and Hispanic women report lower rates of early miscarriage than do whites. The probability of reporting a miscarriage rises by about 5% per year of completed schooling. The upward trend, especially in early miscarriages, suggests awareness of pregnancy rather than prenatal care to be a key factor in explaining the evolution of self-reported miscarriages. Any beneficial effects of prenatal care on early miscarriage are obscured by this factor. Differences in adoption of early-awareness technology, such as home pregnancy tests, should be taken into account when analyzing results from self-reports or clinical trials relying on awareness of pregnancy in its early weeks.     

Educational efforts in the implementation of rural family planning programs in East Pakistan

The pilot family planning studies reported in this paper were conducted in a rural area adjacent to the city of Dacca in East Pakistan. It reports the preliminary findings of action-research in the implementation of educational efforts to reach rural villagers of a developing country.Preliminary analyses of the records identify two significant educational problems: (1) most of the villagers (85-90 percent of the couples) who initially accepted contraceptives do not truly adopt and become continuing users and (2) the continuing users (10-15 percent of the initial users) are generally characterized by large families. (Later data show an even lower percentage of continuing users.)The field activities in the development of various educational approaches to family planning are described. Three separate geographic areas (from 15,000 to 20,000 population) were each approached in a different way, varying in the number and educational qualifications of the workers and in the degree of involvement of village leadership. Preliminary analyses of field records indicate that these variations of approach apparently have little effect on the percentage of the population willing to accept contraceptive supplies.It is the opinion of the writers that more intensive educational efforts are necessary at the village level to develop social support for continuing use of contraception and to gain adoption of contraception by younger married couples primarily for spacing of births.The impact of introduction of the IUCD in populations where condoms and foam tablets have been available for one to two years has also been reported. Preliminary findings indicate that the IUCD encourages adoption by previous non-users and may increase the over-all percentage of contraceptive users.     

Iud retention in West Pakistan and methodology of assessment

In 1967 there was a sample survey of women who had had IUD insertions in West Pakistan during the first 18 months of the Pakistan National Family Planning Program which began in July, 1965. The 12 month retention rate, including reinsertions, per 100 respondents was 56. Certain gross relationships between respondent characteristics and IUD retention were found. Respondents age 35+ and with 5+ living children and respondents who had insertions within two months postpartum had relatively high retention rates. Respondent characteristics associated with low retention rates included: age 35+ with 0–4 living children; reasons other than family planning reported as reasons for insertion; less than one-half hour travel time required to obtain insertion; not informed at time of insertion about side-effects of IUD; and insertion during last six months of 1966. Consistency of response was evaluated by reinterviewing a sample of respondents. The significance of the 43 percent non-response rate was evaluated by making further attempts to interview a sample of non-respondents.     

Dynamic Reflections of Crimes,Quasi Democracy and Misery Index in Pakistan

Massive increase in crimes has coexisted with rising inflation and high unemployment for the last couple of decades especially during democratic governments in Pakistan. In this paper, we explore the relationship between crime rate, misery index and democracy in Pakistan from 1975 to 2013. Granger causality test proposed the unidirectional causality running from misery index to crime rate in Pakistan. Estimating the crime function via Pasaran’s conditional error correction model, we found the significant long run equilibrium relationship between Okun’s misery index and crime rate which implies that rising inflation and unemployment rate are the major driving forces towards increasing crime rates in Pakistan. Finally, empirical evidence from Okun’s misery index suggested that people are three times more miserable in quasi democratic periods than that of dictatorship. The Barrow’s misery index model verifies that people are twice worsening in quasi democratic periods. Likewise, reported crimes are nearly twice during quasi democracy than quasi dictatorship. The crime model provided the evidence that people during quasi democratic governments are more likely tending towards crime as compared to quasi dictatorship during the study period in Pakistan. This implicitly advocates the fact that half hearted efforts and ill structured apparatus of democracy can augment the tendency of crime and misery rather than solution of such concerns of the economy.     

How female education affects reproductive behavior in urban Pakistan

Although Pakistan remains in a pretransitional stage (contraceptive prevalence of only 11.9% among married women in 1992), urban women with post-primary levels of education are spearheading the gradual move toward fertility transition. Data collected in the city of Karachi in 1987 were used to determine whether the inverse association between fertility and female education is attributable to child supply variables, demand factors, or fertility regulation costs. Karachi, with its high concentration of women with secondary educations employed in professional occupations, has a contraceptive prevalence rate of 31%. Among women married for less than 20 years, a 10-year increment in education predicts that a woman will average two-fifths of a child less than other women in the previous 5 years. Regression analysis identified 4 significant intervening variables in the education-fertility relationship: marriage duration, net family income, formal sector employment, and age at first marriage. Education appears to affect fertility because it promotes a later age at marriage and thus reduces life-time exposure to the risk of childbearing, induces women to marry men with higher incomes (a phenomenon that either reduces the cost of fertility regulation or the demand for children), leads women to become employed in the formal sector (leading to a reduction in the demand for children), and has other unspecified effects on women's values or opportunities that are captured by their birth cohort. When these intervening variables are held constant, women's attitude toward family planning loses its impact on fertility, as do women's domestic autonomy and their expectations of self-support in old age. These findings lend support to increased investments in female education in urban Pakistan as a means of limiting the childbearing of married women. Although it is not clear if investment in female education would have the same effect in rural Pakistan, such action is important from a human and economic development perspective.     

Fertility trends in Pakistan--the decline that wasn't

The own-child method of fertility estimation was applied to data from 4 successive household surveys in Pakistan--the 1973 Housing, Economic, and Demographic Survey; the 1975 Pakistan Fertility Survey; the 1979 Population, Labor Force, and Migration Survey; and the 1981 Census. Results suggest large fertility oscillations 8-15 years before each survey, a sharp decline during the next 6 years, and a slight upturn in the year preceding the survey. However, when the 4 data sources are analyzed together, it becomes clear that the reported fertility declines are spurious. In fact, the results indicate that Pakistan's total fertility rate actually increased in the 2 decades preceding the 1981 Census, from slightly under to slightly above 7 children/women. This pattern is apparent when fertility data are aggregated over calendar years, allowing the tendency for errors from age misreporting to cancel one another out. Whatever fertility decline may have occurred has been confined to the very small group of Pakistan women with more than a primary education. It appears that births were misplaced away from the survey date, because of a pattern of exaggerations of children's ages that increases with age, thereby underestimating fertility in the 5-year period just before the survey. This analysis points to the value of juxtaposition of trends from multiple data sources. It further suggests a need for serious attention to family planning program performance in Pakistan if the Government's goal of achieving a birth rate of 36/1000 by 1988 is to be achieved.     

The effect of child mortality experience on subsequent fertility: in Pakistan and Bangladesh

Summary This paper presents an empirical analysis of the effects, behavioural and biological, of child mortality experience on subsequent fertility in two South Asian Islamic nations. Data for the investigation came from retrospective pregnancy histories of 2,910 currently married women interviewed in the Pakistan National Impact Survey (1968-69) and from longitudinal vital registration data (1966-2070) of 5,236 women residing in a rural area of Bangladesh collected by the Cholera Research Laboratory. The aim of this study was to assess the importance of the child-replacement motivational response to child death experience after biological effects have been controlled adequately. A common approach employed previously has been to examine cumulative fertility according to child death experience. In Pakistan and Bangladesh, a consistently positive relationship was demonstrated between the number of children ever born and the number of child deaths. This method, however, did not exclude the inverse relationship, the influence of fertility on mortality, nor did it dissect out behavioural from biological effects. Utilizing a measure of subsequent fertility, live-birth-to-live-birth intervals, the study further illustrated another common pitfall. Since the risk of infant death, which leads to shorter birth intervals, is associated with the mother's reproductive history, women with child mortality experience are more likely to experience shorter intervals because of the biological effect of subsequent infant death. Behavioural influences may, therefore, be observed by considering only those birth intervals in which the first-born child survives to the end of the interval. With these limitations controlled, very few, if any, behavioural influences were noted in the Pakistan and Bangladesh data. Median birth intervals in Pakistan varied between 35-43 and 41-42 months, increasing with parity. Within each parity group, no consistent difference was observed between women with and without previous child loss. In Bangladesh, the median birth interval for all women with a surviving infant was 37-2 months. This was shortened to 24-31 months by an infant death. When intervals with infant deaths were excluded, little or no behavioural influence was detected among women of the same parity, but with varying levels of previous child loss. Even without behavioural effects, elimination of infant mortality in Bangladesh would reduce fertility by prolonging the average period of post-partum sterility. In the Bangladesh setting, however, the size of the effect was only about four per cent. This modest effect, more-over, was counterbalanced by an overall increase of net reproduction by seven per cent due to better survivorship of infants.     

Policies for fertility reduction: focus on Asia

Fertility can be affected by many factors. Over the long run, socioeconomic development has a decisive effect on reducing fertility. But in the short run, its effects are mixed. Providing greater educational opportunities, particularly for women, typically leads to lower fertility. Urban fertility tends to be much lower than rural fertility since urban residents have better access to information and health care. To the degree that governments are able to extend the reach of the modern sector to rural areas, they may be able to reduce fertility without encouraging urban growth. The effects of income on fertility are mixed: given sufficient time, higher incomes lead to lower fertility; but rising incomes in developing countries can, in the short run, increase fertility. Socioeconomic development factors, however, have less effect on fertility than do fertility dynamics at the individual level. Age at marriage, duration of breastfeeding, and use of contraceptives have important implications for fertility reduction policies. The contribution of of these factors to fertility control have been analyzed for a number of Asian and Pacific countries. Breastfeeding plays a key role in controlling fertility in Pakistan, Nepal, Bangladesh, and Indonesia. Later marriages compensate for lower breastfeeding levels in controlling fertility in other Asian and Pacific countries. The contribution of contraception to fertility control varies from 2% in Nepal to as much as 28% in Thailand. A low total fertility rate is almost always the result of relatively widespread use of contraceptives. Fertility rate reduction in India, Thailand, Indonesia, and Korea in he 1970s can largely be explained by increases in contraceptive usage.     

Human Capital Outflow and Economic Misery: Fresh Evidence for Pakistan

This paper visits the impact of economic misery on human capital outflow using time series data over the period of 1975–2012. We have applied the combined cointegration tests and innovation accounting approach to examine long run and causal relationship between the variables. Our results affirm the presence of cointegration between the variables. We find that economic misery increases human capital outflow. Foreign remittances add in human capital outflow from Pakistan. The migration from Pakistan to rest of world is boosted by depreciation in local currency. Income inequality is also a major contributor to human capital outflow. The present study is comprehensive effort and may provide new insights to policy makers for handling the issue of human capital outflow by controlling economic misery in Pakistan.

     

The Determinants of Child Health in Pakistan: An Economic Analysis

This paper estimates linear structural models using LISREL and employs MIMIC models to find out factors determining child health in Pakistan. A distinction has been made in permanent and transitory health states that lend support to Grossman’s (1972) stock and flow concepts of health. The paper addresses the issue of health unobservability and finds out that latent variables using MIMIC models best represent underlying child health states. To overcome problems of poor income data, factor analysis is applied to extract measures of housing and durables as indicators of socio-economic well-being of children in Pakistan. The results of the study show that child health states, both permanent and transitory, are affected significantly by factors such as parental education, socio-economic conditions, and health care variables.     

Ethnic Diversity,Social Exclusion and Economic Determinants of Crimes: A Case Study of Pakistan

The eventual objective of social disciplines is to ensure the existence of peaceful and prosperous societies through the provision and protection of property rights for all segments of society. The deprived and socially excluded persons attempt to violate the formal rules and informal norms of the society. Developing countries have been facing rapidly increased number of violators of rules and norms, causing to higher crime rate which confronts multifarious ethnic problems, religion, multi-lingual problems. The case of Pakistan dose not varies when our study consider socioeconomic causes of crimes i.e. ethnic diversity and social exclusion. Present study is a contribution in this blistering issue, particularly in case of Pakistan. Therefore, our study explores the socioeconomic determinants of crime rate in Pakistan, by using bound testing and auto regressive distributive lag technique for the data period of 1970–2015. The estimated results reveal that ethnic diversity, social exclusion and deterrence have positive and significant impact on property, violence crime rates, and on overall crimes in Pakistan. While per capita income and population density, both have negative and significant impact on property and violence crimes.     

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.     

Neo-natal and post-neo-natal mortality in a rural area of Bangladesh

Abstract An analysis of neo-natal and post-neo-natal mortality in 132 villages (population of 117,000) of Matlab thana indicates the following: (i) Neo-natal deaths accounted for 60% of the infant mortality rate of 125. This proportion was unexpectedly high since previous research had maintained that in countries with infant mortality rates over 100, neo-natal deaths account for less than one-third of all infant deaths. Since the present findings on the proportions of neo-natal deaths correspond exactly with results from an earlier registration system in East Pakistan, it is suggested that the long-accepted proposition, 'less developed' areas are characterized by lower proportions of neo-natal deaths than 'more developed' areas, be re-examined. (2) The infant death rate accounts for 36% of all deaths in the population. If the infant death rate were reduced by half the result would be a decrease in the current crude death rate from 16 to 13. Although this reduction would appear to be small, in the context of a current high growth rate of 3% (from 1966-67 to 1968-69) it exerts a sizeable impact. For example, it would take a reduction of eight points in the crude birth rate of 46 just to achieve a growth rate 2·5% under these circumstances. Obviously, continued efforts in death control without an effective birth control programme will perpetuate high rates of growth. (3) Neo-natal and post-neo-natal mortality exhibited the -expected 'U' shaped pattern with parity, and generally varied as expected with age and family size, except in the oldest age group and largest family size where the risk was smaller than in the preceding groups. An explanation for these findings is presented, based on the effect that births to high-parity women with low child mortality have upon the total neo-natal and post-neo-natal mortality rates. It was found that these births exhibit a much lower mortality risk than births to women of comparable parities and higher child mortality, and that their numbers account for the lower risk to the births in the oldest age group and largest family size. It was concluded that women with a combination of high parity and low child mortality most probably represent a group with superior socio-economic and or health conditions which contribute to the lower risk of neo-natal and post-neo-natal death.     

The end of rapid increase in the use of oral anovulants? Some problems in the interpretation of time series of oral use among married women

Several problems in the interpretation of time series of oral anovulant usage are discussed, among them the shifting marriage-duration distribution over time. Standardization fails to negate the conclusion that the rate of increase in the proportion of women using orals has slackened since January 1966. Separate analyses by duration-specific rates of use and by marriage cohorts show that the two factors sustaining the initial spectacular growth rate in the use of orals-the ever—higher initial use rates of new marriage cohorts and the rapid adoption of orals among earlier cohorts at later durations—have lost their sustaining force. Further analysis indicates that concern over the pill as a health hazard is a major deterrent to substantial increase in oral usage. A final distribution of women by risk status with respect to oral use, and current and prospective oral use, shows that under present circumstances the maximum oral use rate will be considerably less than unity.     

Women's frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study

BackgroundWith evidence of offspring harms and concern for younger women's drinking behaviours, this study uses a hospital cohort to trend the use and changes in women's reported alcohol consumption.AimsTo examine (i) the trend of women's reported alcohol consumption over time, (ii) whether any increases in the frequency of alcohol consumption prior to a pregnancy are accompanied by increases in the frequency of alcohol consumption in pregnancy and (iii) the characteristics of women consuming alcohol at these times.MethodsMidwives collected routine data on 19,699 women between 2001 and 2006. Data on women's alcohol use prior to pregnancy and at their pregnancy-booking visit were analysed using a non-parametric test for trend and with bivariate and multivariate tests adjusting for possible confounders.FindingsThe proportion of women reporting at-least weekly alcohol use prior to pregnancy was 25.4% and 5.9% at their pregnancy-booking visit. A significant linear increase over time (p < 0.001) was found in the rate of women aged 20 years and older reporting at-least weekly alcohol use prior to pregnancy. Tertiary-educated women were more likely to consume alcohol at-least weekly prior to pregnancy. Women aged less than 20 years were less likely to report at-least weekly alcohol use at both time points. Having more children and Asian ethnicity were associated with a lower risk of at-least weekly alcohol use at these times.ConclusionThe majority of women reduce their alcohol consumption once they learn they are pregnant, with some evidence this trend may have increased in recent years.     

Some aspects of the relationship between the levels of infant mortality and fertility in the ESCAP region

The death of a child within the first year of life is a crucial factor in fertility decisions in a developing country. The infant mortality rate gives a close, inverse indication of the socioeconomic conditions of a country. This paper presents studies by Brass, Rutherford, Chowdhury, Khan and Chen, Agrawal, Iskander and Jones, in summary/abstract form. It concludes that the probabilities of survival are poorer for births of older women and/or higher parities. Early child deaths may increase the total period of exposure to the risk of conception. A lower infant and child mortality norm calls for fewer births to meet the needs for survivors. Child replacement motivational response seems to be strongest with the birth immediately following a death event. Agrawal analyzed the interval between successive births of 1107 women of Patna, Pakistan, according to the age of mother and sex and fate of the previous child. He observed that if a child died shortly after its birth, often a new pregnancy began within a short interval. The interval between 2 consecutive live births when the previous child was male and alive was greater than when the previous child was female and alive. The interval between 2 births was reduced if the child died in infancy and specially if this was a male child.