Publications Summary

Document Type
Working Papers
Recommended Citation
Naz, Lubna, Khadija Malik Bari, Junaid Alam Khan. 2023. Women’s Autonomy and Unintended Pregnancy among Reproductive Age Women in Pakistan. DHS Working Papers No. 195. Rockville, Maryland, USA: ICF.
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Publication Date
August 2023
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Background: Unintended pregnancies may have detrimental consequences for women’s well- being and reproductive health, particularly in lower to middle-income countries. Women’s involvement in household decision-making, particularly related to their health, is considered instrumental in promoting contraceptive use and other determinants of unintended pregnancy. This study aims to contribute to the existing body of knowledge on women’s reproductive health by exploring if women’s autonomy within the household helps prevent unintended pregnancy in Pakistan. Methods: To explore the association between women’s autonomy and pregnancy intendedness, this study posits a direct relationship between women’s autonomy and pregnancy intendedness, and a moderating role of women’s autonomy in the relationship between contraceptive use and perceived pregnancy intendedness. A sample of 8,228 married women age 15–49 who have experienced a pregnancy in the five years before the survey was extracted from Pakistan Demographic and Health Survey 2017–18. The dependent variable was pregnancy intendedness, which was categorized into planned, mistimed, and unwanted. A chi-square test was used to validate the association of each explanatory variable with pregnancy intendedness. The study then employed a multinomial logit model to compare the risk of mistimed and unwanted pregnancies among reproductive age women relative to the planned pregnancies. To capture the moderating role of women’s decision autonomy, an interactive effect of life-time contraception and women’s autonomy was estimated in the final model along with all covariates. Results: The bivariate analysis found a significant association between women’s autonomy and pregnancy intendedness at the 5% significance level, except for high autonomy. After accounting for other factors, the analysis shows that women’s autonomy and pregnancy intendedness are not significantly associated. The interactive influence of women’s autonomy and contraceptives was found to be insignificantly associated with pregnancy intendedness. The relative risk of mistimed and unwanted pregnancies were more prevalent pregnancies among women who ever utilized contraceptives, had terminated a pregnancy, had more sons, and belonged to wealthy families. The husband’s education was inversely associated with unintended pregnancy. Conclusion: The study concluded that women’s autonomy and the interactive effect of women’s autonomy and contraceptive use on pregnancy intendedness are not significant in Pakistan when other factors are considered. This may be due to data limitations, particularly those related to biased gender norms and patriarchal values in the construction of women’s decision autonomy. The study results call for more in-depth investigation into social norms and patriarchal values that govern women’s reproductive behavior in Pakistan.


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