2010年-世界发展银行全球_Fertility_Decline_in_Pakistan_1980-2006___A_Case_Study_55页_1mb

Summary of Fertility Decline in Pakistan 1980-2006

Core Content

This case study by the World Bank examines the fertility decline in Pakistan from 1980 to 2006, analyzing the political, economic, and social factors that influenced this change, as well as the role of government and private sector family planning programs. The report highlights the progress made and the persistent challenges that have limited the effectiveness of population policies.

Main Points

Fertility Trends

• The total fertility rate (TFR) in Pakistan declined by approximately 40% from the 1980s to the early 2000s, from over 6.5 children per woman to an estimated range of 3.8–4.1.
• The decline started in the late 1980s and continued through the 1990s and early 2000s, but progress has since stalled.
• Contraceptive prevalence increased from 12% in 1990–91 to 30% in 2006–07, but has remained relatively stagnant since then.

Proximate Determinants of Fertility

• Marriage and Sexual Union: The mean age at marriage for women increased from 20.2 in 1981 to 22.3 in 2003, and the proportion of women aged 15–19 who were never married rose from 71% to 87%. However, these changes did not trigger a significant fertility decline until the late 1980s.
• Contraceptive Use: Contraceptive prevalence is closely linked to education, wealth, and urban residence. Female sterilization is the most widely used method, but it is often used only after multiple births, making it less effective for reducing fertility rates.
• Induced Abortions: Despite being illegal, induced abortions are common in Pakistan, with an estimated 2.9% of women aged 15–49 undergoing them annually. These may have played a role in fertility reduction, especially in the context of high unmet contraceptive need and low contraceptive effectiveness.
• Breastfeeding Duration: Exclusive breastfeeding is a significant factor in postpartum infecundability, but its impact on fertility decline appears to be less than expected.

Socio-Economic and Cultural Influences

• Child Mortality and Family Size: A decline in child mortality has contributed to a smaller desired family size, thus indirectly influencing fertility rates.
• Female Education: Higher levels of education among women are associated with lower fertility rates and greater contraceptive use.
• Women's Labor Participation: Women who are more economically active tend to have fewer children and are more likely to use contraception.
• Religion and Cultural Norms: Religious opposition and cultural prohibitions, such as restrictions on women's mobility, have hindered the effectiveness of family planning programs.
• Spousal Communication: Improved communication between spouses has played a role in increasing contraceptive use and reducing fertility.
• Gender Inequality: Persistent gender disparities in education, employment, and social status have limited the impact of family planning initiatives.

Government and Private Sector Programs

• Government Programs: The government initiated family planning programs in the 1990s, including the Lady Health Worker Program (LHWP) and the Village-Based Family Planning Worker scheme. These programs aimed to bring family planning services directly to women, overcoming geographic and socio-cultural barriers.
• Private Sector and NGOs: The Greenstar Network, a private sector initiative, has been a major provider of modern contraceptives, accounting for 30% of their use in the country. Donor-supported NGOs and private sector efforts have also contributed to the growth of contraceptive use.
• Government Financing: Despite some improvements, government financing of population programs has been limited, and there is a need for increased investment to meet the high level of unmet contraceptive need and to accelerate fertility decline.

Key Information

• Population and Economy: Pakistan is the world's sixth most populous country with a GNI per capita of $800 in 2006. It has a Muslim majority (97%) and a complex administrative structure with four provinces and four territories.
• Fertility Decline: The decline in fertility was not uniform across regions and provinces. Punjab and Sindh showed the highest contraceptive use, while Balochistan had the lowest.
• Unmet Need: About 25% of currently married women in Pakistan have an unmet need for contraception, which is a significant barrier to further fertility reduction.
• Challenges: Despite progress, socio-cultural constraints, particularly related to religion, gender, and regional differences, have limited the effectiveness of family planning programs. These constraints need to be addressed to achieve sustainable fertility decline.
• Innovations: The introduction of community-based family planning programs and social marketing initiatives has been instrumental in increasing access to family planning services and contraceptive use.

Conclusion

The fertility decline in Pakistan between 1980 and 2006 was driven by a combination of socio-economic and cultural factors, as well as the expansion of family planning services. While progress has been made, particularly in the 1990s, the country still faces significant challenges in reducing fertility further due to persistent socio-cultural barriers. Addressing these barriers and improving the delivery of family planning services will be essential for achieving the Millennium Development Goals and continuing the fertility decline trend.