The DHS Program

Calverton, MD - In Pakistan, 1 in 89 women will die of maternal causes, according to the 2006-07 Pakistan Demographic and Health Survey (PDHS). Among women age 12 to 49, complications of pregnancy and childbirth are the leading cause of death, accounting for 20 percent of all deaths for women of childbearing age. The National Institute of Population Studies recently released the final report of the 2006-07 PDHS at a ceremony in Islamabad.

The survey findings also show that under-five mortality has decreased by roughly 20 percent since 1990, while the infant mortality rate has declined by about 15 percent. Still, one in every eleven children in Pakistan dies before reaching his or her fifth birthday, and more than half of these deaths occur during the first month of life. The PDHS is one of the largest household-based health surveys ever conducted in Pakistan. Teams collected data from a nationally representative sample of more than 95,000 households

More key findings from the 2006-07 PDHS final report are highlighted below.

Maternal Mortality Measured
One of the goals of the 2006-07 PDHS was to obtain reliable information about maternal mortality. Results from the PDHS show that women age 25 to 29 are especially at risk for maternal death. Nearly two out of five deaths for this age group are from pregnancy-related causes. Postpartum haemorrhage is the leading direct cause of maternal deaths, followed by puerperal sepsis and eclampsia. Obstetric bleeding (postpartum and antepartum) is responsible for one-third of all maternal deaths.  

Balochistan has by far the highest proportion of women dying from complications of pregnancy, childbirth, and puerperium (the time immediately after delivery). Rural women are more likely to die of pregnancy-related causes than urban women (23 percent compared to 14 percent).

Cancer, tuberculosis and other infectious diseases are the next most important causes of death among women of reproductive age. Younger women are more likely to die from infectious diseases (20 percent), not including tuberculosis, than older women.

Maternal Care Improves Slightly
The percentage of women making four prenatal visits, as recommended, increased from 16 percent in 1996 to 28 percent in 2006-07. Nearly two-thirds (61 percent) of women in Pakistan had at least one prenatal visit with a skilled provider, most often from a doctor (56 percent). Educated women are twice as likely as women with no education to get prenatal care from a skilled provider (96 percent compared to 50 percent).

However, one-third of pregnant women, do not get any prenatal care at all, according to the PDHS. Of these women, the majority (73 percent) do not think it is necessary, 30 percent think prenatal checkups cost too much money, and 8 percent say the health facility is too far away.

Only one-third of Pakistan's births occur in health facilities-11 percent in the public sector and 23 percent in private sector facilities. By contrast, two-thirds of births occur at home. Home births are considerably more common in rural areas (74 percent) than urban areas (43 percent).

Fertility Declines; Family Planning Use Steady
Fertility has decreased steadily since 1984, when the total fertility rate (TFR) or the average number of children per woman was 6.0. Today, a woman in Pakistan will have 4.1 children, on average. Urban women have 3.3 children, on average, compared to 4.5 children per rural woman. As in other countries, fertility also varies by the mother's level of education. Women with no education have 4.8 children compared to women with secondary education, who have 3.1 children.

The contraceptive prevalence rate is 30 percent, roughly the same as it was in 2003 (32 percent). While 96 percent of married women know about modern methods, only one in five (22 percent) currently married women uses a modern method, most often female sterilization (8 percent) and condoms (7 percent). Modern method use in Pakistan lags behind neighboring countries with 49 percent of married women in India and 47 percent in Bangladesh using modern methods.

Infant and Child Mortality Rates Decrease
Pakistan's infant mortality rate, 78 deaths per 1,000 live births, has declined since 1990-91 when the PDHS showed it was 91 deaths per 1,000 live births. Compared to other South Asian countries, however, children in Pakistan are more likely to die in the first year of life, according to the new PDHS. Pakistan's infant mortality rate is higher than the rates in Nepal (48), India (57), and Bangladesh (65).

The under-five mortality rate is 94 deaths per 1,000 live births, down from 117 deaths per 1,000 live births in the period 1986 to 1990. Children living in rural areas are at greater risk for death than those living in urban areas. The under-five mortality rate is 28 percent higher in rural than urban areas.

More than Half of Children Lack Immunizations
Nearly half (47 percent) of Pakistani children ages 12-23 months have all the recommended vaccines; 6 percent of children do not have any vaccinations. Children are least likely to get their third DPT vaccine, their Polio 0 vaccine (given at birth), and their measles vaccine. Compared to children in other South Asian countries, Pakistani children are less likely to be fully vaccinated. In Nepal, 83 percent of children have all their vaccinations and in Bangladesh 73 percent of children are fully vaccinated. In India, by contrast, 44 percent of children are full vaccinated.

Children whose mothers have no education are far less likely than children whose mothers have higher education to be fully immunized (38 percent versus 71 percent). The percentage of children who are fully vaccinated also varies by province, ranging from a high of 53 percent of children in Punjab to a low of only 35 percent of children in Balochistan.