Abstract:
This study establishes trends in the use of
contraception, describes regional, residence,
education, and wealth-based differentials in
contraceptive use over time, and identifies
factors associated with contraceptive use. We
use data on currently married women from four
demographic and health surveys conducted in
Pakistan between 1990-91 and 2017-18. We
contrast patterns in modern contraception
with traditional contraception, and examine
specific modern contraceptive methods.
We find that gains in contraceptive use
largely accrued before 2006-07 and stalled
since 2012-13, with the modern method mix
largely unchanged since 1990-91. Condoms (9%)
and female sterilization (8%) dominate, with
other modern methods lagging in prevalence
(<3%).
This study also finds prominent differentials
in contraceptive use. Modern contraceptive
use is higher among urban women, more
educated women, and women from wealthier
households. Regional differentials have
become more pronounced over time and are
particularly sizable for female
sterilization. Wealth and educational
differentials have largely narrowed over
time.
Region, education, and wealth remain
important correlates of modern contraceptive
use, even after controlling for other
factors, as does the number of living
children and, for female sterilization and
IUDs only, women’s working status. The
husband’s characteristics do not factor
strongly in women’s modern contraceptive use.
Contraceptive decision-making is more
pertinent to women’s modern contraceptive use
than household decision-making, and is
inhibited when husbands are the primary
decision maker of contraceptive decisions. In
contrast, joint decision-making facilitates
overall modern contraceptive use and the use
of condoms in particular. Contraceptive use
is reduced when the decision is made by
someone other than the woman or her husband.
Furthermore, modern contraceptive use
(particularly condoms and female
sterilization) is reduced when women live in
an extended household. Our study finds that
women’s use of contraception increases with
increasing intensity of desire to delay or
avoid a birth. Nonetheless, more than half of
women who want no more children and nearly
three-quarters of women who want a delay of
at least 2 years are not using any modern
method of contraception. A sizable proportion
of women who want no more children rely on
short-acting, reversible methods.
This study finds support for expanding
services population-wide, in combination with
targeting disadvantaged population subgroups,
expanding the range of available methods, and
combining service improvements with promoting
women’s empowerment, gender equity, and
social behavior change initiatives targeted
to men and other family members.