| Author(s) |
National Institute of Population Studies, Islamabad, Pakistan MEASURE DHS, ICF International, Calverton, Maryland, USA |
| Date |
2013-12-01 |
| Country |
Pakistan |
| Language |
English |
| Description |
This report summarizes the findings of the 2012-13 Pakistan Demographic and Health Survey (PDHS), conducted under the aegis of the Ministry of National Health Services, Regulations and Coordination and implemented by the National Institute of Population Studies (NIPS). ICF International provided financial and technical assistance for the survey through USAID/Pakistan. The PDHS is part of the worldwide Demographic and Health Survey program, which is designed to collect data on fertility, family planning, and maternal and child health. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID and the government of Pakistan. |
| Table of contents |
TABLES AND FIGURES ................................................................................................................................. vii
FOREWORD .................................................................................................................................................... xiii
ACKNOWLEDGMENTS ................................................................................................................................. xv
TECHNICAL ADVISORY COMMITTEE ................................................................................................... xvii
CONTRIBUTORS TO THE REPORT ........................................................................................................... xix
ABBREVIATIONS ........................................................................................................................................... xxi
MILLENNIUM DEVELOPMENT GOAL INDICATORS ......................................................................... xxiii
MAP OF PAKISTAN ..................................................................................................................................... xxiv
1 INTRODUCTION ................................................................................................................................. 1
1.1 History and Physical Features of Pakistan ................................................................................. 1
1.2 Population ................................................................................................................................. 2
1.3 Objectives of the Survey ............................................................................................................ 3
1.4 Organization of the Survey ........................................................................................................ 3
1.5 Survey Implementation .............................................................................................................. 4
1.5.1 Sample Design ............................................................................................................. 4
1.5.2 Questionnaires ............................................................................................................. 4
1.5.3 Training ....................................................................................................................... 5
1.5.4 Fieldwork ..................................................................................................................... 6
1.5.5 Field Supervision and Monitoring ............................................................................... 6
1.5.6 Field Problems and Challenges .................................................................................... 7
1.5.7 Data Processing ........................................................................................................... 7
1.6 Response Rates .......................................................................................................................... 8
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ........................................ 9
2.1 Household Characteristics .......................................................................................................... 9
2.1.1 Water and Sanitation .................................................................................................. 10
2.1.2 Housing Characteristics ............................................................................................. 12
2.1.3 Household Possessions .............................................................................................. 13
2.2 Socioeconomic Status Index .................................................................................................... 14
2.3 Hand Washing .......................................................................................................................... 15
2.4 Household Population by Age and Sex .................................................................................... 16
2.5 Household Composition ........................................................................................................... 19
2.6 Birth Registration of Children Under Age 5 ............................................................................ 20
2.7 Registration with NADRA ....................................................................................................... 21
2.8 Children’s Living Arrangements and Orphanhood .................................................................. 22
2.9 Educational Attainment and School Attendance ...................................................................... 23
2.9.1 Educational Attainment of the Household Population ............................................... 24
2.9.2 School Attendance Ratios .......................................................................................... 26
2.10 Migration Status ....................................................................................................................... 29
2.11 Household Possession of Mosquito Nets ................................................................................. 32
2.12 Indoor Residual Spraying Against Mosquitoes ........................................................................ 33
2.13 Anti-Mosquito Actions ............................................................................................................ 34
3 CHARACTERISTICS OF RESPONDENTS .................................................................................... 37
3.1 Characteristics of Survey Respondents .................................................................................... 37
3.2 Educational Attainment ............................................................................................................ 38
3.3 Literacy ................................................................................................................................... 40
3.4 Access to Mass Media .............................................................................................................. 43
3.5 Employment ............................................................................................................................. 45
3.6 Occupation ............................................................................................................................... 48
3.7 Type of Employment ............................................................................................................... 51
3.8 Use of Tobacco ........................................................................................................................ 52
3.9 Knowledge Concerning Tuberculosis ...................................................................................... 54
3.10 Knowledge Concerning Hepatitis ............................................................................................ 57
4 MARRIAGE ........................................................................................................................................ 61
4.1 Current Marital Status .............................................................................................................. 61
4.2 Polygyny ................................................................................................................................. 62
4.3 Age at First Marriage ............................................................................................................... 64
4.4 Differentials in Age at First Marriage ...................................................................................... 65
4.5 Consanguinity .......................................................................................................................... 65
4.6 Recent Sexual Activity ............................................................................................................. 67
5 FERTILITY ......................................................................................................................................... 69
5.1 Current Fertility ....................................................................................................................... 70
5.2 Fertility Trends ......................................................................................................................... 71
5.3 Children Ever Born and Children Surviving ............................................................................ 73
5.4 Birth Intervals .......................................................................................................................... 74
5.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility ..................................................... 75
5.6 Age at First Birth ..................................................................................................................... 77
5.7 Teenage Fertility ...................................................................................................................... 78
6 FERTILITY PREFERENCES ............................................................................................................ 81
6.1 Desire for More Children ......................................................................................................... 81
6.2 Desire to Limit Childbearing by Background Characteristics.................................................. 83
6.3 Ideal Family Size ..................................................................................................................... 85
6.4 Fertility Planning ..................................................................................................................... 88
6.5 Wanted Fertility Rates ............................................................................................................. 89
7 FAMILY PLANNING ......................................................................................................................... 91
7.1 Knowledge of Contraceptive Methods ..................................................................................... 92
7.2 Ever Use of Family Planning Methods .................................................................................... 93
7.3 Current Use of Contraceptive Methods .................................................................................... 94
7.4 Differentials in Contraceptive Use by Background Characteristics ......................................... 95
7.5 Trends in Current Use of Family Planning .............................................................................. 96
7.6 Timing of Sterilization ............................................................................................................. 97
7.7 Sourceof Contraception ........................................................................................................... 97
7.8 Use of Social Marketing Contraceptive Brands ....................................................................... 99
7.9 Informed Choice ...................................................................................................................... 99
7.10 Side Effects of Family Planning Methods .............................................................................. 100
7.11 Treatment for Side Effects ..................................................................................................... 101
7.12 Contraceptive Discontinuation Rates ..................................................................................... 103
7.13 Reasons for Discontinuation of Contraceptive Use ............................................................... 103
7.14 Knowledge of Fertile Period .................................................................................................. 104
7.15 Need and Demand for Family Planning Services .................................................................. 105
7.16 Future Use of Contraception .................................................................................................. 108
7.17 Exposure to Family Planning Messages ................................................................................. 108
7.18 Contact of Nonusers with Family Planning Providers ........................................................... 111
7.19 Lady Health Worker Services ................................................................................................ 112
7.20 Satisfaction with Family Planning Service Outlets ................................................................ 113
7.21 Reasons for Not Visiting Family Planning Service Outlets ................................................... 114
8 INFANT AND CHILD MORTALITY ............................................................................................. 117
8.1 Assessment of Data Quality ................................................................................................... 118
8.2 Levels and Trends in Infant and Child Mortality ................................................................... 119
8.3 Socioeconomic Differentials in Childhood Mortality ............................................................ 121
8.4 Demographic Differentials in Mortality ................................................................................. 123
8.5 Perinatal Mortality ................................................................................................................. 124
8.6 High-Risk Fertility Behavior.................................................................................................. 126
9 REPRODUCTIVE HEALTH ........................................................................................................... 129
9.1 Antenatal Care ....................................................................................................................... 130
9.1.1 Number and Timing of Antenatal Visits .................................................................. 132
9.2 Components of Antenatal Care .............................................................................................. 133
9.3 Tetanus Toxoid Vaccinations ................................................................................................. 135
9.4 Place of Delivery .................................................................................................................... 136
9.5 Assistance during Delivery .................................................................................................... 138
9.6 Postnatal Care ........................................................................................................................ 140
9.6.1 Timing of First Postnatal Checkup for Mother ........................................................ 140
9.6.2 Provider of First Postnatal Checkup for Mother ...................................................... 141
9.7 Newborn Care ........................................................................................................................ 142
9.7.1 Provider of First Postnatal Checkup for Newborn ................................................... 144
9.8 Problems in Accessing Health Care ....................................................................................... 145
10 CHILD HEALTH ............................................................................................................................... 147
10.1 Child’s Weight and Size at Birth ........................................................................................... 148
10.2 Vaccination Coverage ............................................................................................................ 149
10.3 Vaccination by Background Characteristics .......................................................................... 150
10.4 Trends in Immunization Coverage ......................................................................................... 152
10.5 Prevalence and Treatment of Symptoms of ARI .................................................................... 153
10.6 Prevalence and Treatment of Fever ........................................................................................ 155
10.7 Prevalence of Diarrhea ........................................................................................................... 157
10.8 Diarrhea Treatment ................................................................................................................ 158
10.9 Feeding Practices during Diarrhea ......................................................................................... 160
11 NUTRITION OF CHILDREN AND WOMEN ............................................................................... 163
11.1 Nutritional Status of Children ................................................................................................ 163
11.1.1 Measurement of Nutritional Status among Young Children .................................... 164
11.1.2 Data Collection ........................................................................................................ 165
11.1.3 Measures of Child Nutritional Status ....................................................................... 165
11.2 Breastfeeding and Complementary Feeding .......................................................................... 168
11.2.1 Initiation of Breastfeeding ....................................................................................... 168
11.3 Breastfeeding Status by Age .................................................................................................. 170
11.4 Duration of Breastfeeding ...................................................................................................... 172
11.5 Types of Complementary Foods ............................................................................................ 173
11.6 Infant and Young Child Feeding (IYCF) Practices ................................................................ 174
11.7 Micronutrient Intake among Children .................................................................................... 177
11.8 Nutritional Status of Women ................................................................................................. 180
11.9 Micronutrient Intake among Mothers .................................................................................... 181
12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR ................................. 185
12.1 Knowledge of AIDS ............................................................................................................... 186
12.2 Knowledge of HIV Prevention Methods ................................................................................ 186
12.3 Comprehensive Knowledge about AIDS ............................................................................... 188
12.4 Knowledge of Mother-to-Child Transmission of HIV ........................................................... 191
12.5 Accepting Attitudes toward Those Living with HIV and AIDS ............................................ 192
12.6 Knowledge about Testing for HIV ......................................................................................... 194
12.7 Self-Reporting of Sexually Transmitted Infections (STIs) .................................................... 195
12.8 Prevalence of Medical Injections ........................................................................................... 197
13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES .......... 199
13.1 Employment and Form of Earnings ....................................................................................... 200
13.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s Earnings ....................... 201
13.3 Control over Husbands’ Earnings .......................................................................................... 202
13.4 Women’s and Men’s Ownership of Selected Assets .............................................................. 204
13.5 Women’s Participation in Decisionmaking ............................................................................ 206
13.6 Attitudes toward Wife Beating ............................................................................................... 210
13.7 Women’s Empowerment Indicators ....................................................................................... 213
13.8 Current Use of Contraception by Women’s Empowerment ................................................... 213
13.9 Ideal Family Size and Unmet Need by Women’s Empowerment .......................................... 214
13.10 Reproductive Health Care by Women’s Empowerment ........................................................ 215
13.11 Infant and Child Mortality and Women’s Empowerment ...................................................... 216
14 DOMESTIC VIOLENCE .................................................................................................................. 219
14.1 Valid Measures of Domestic Violence ................................................................................... 219
14.1.1 Use of Valid Measures of Violence ......................................................................... 219
14.1.2 Ethical Considerations in the 2012-13 PDHS .......................................................... 220
14.1.3 Subsample for the Violence Module ........................................................................ 221
14.2 Experience of Physical Violence ........................................................................................... 221
14.3 Perpetrators of Physical Violence .......................................................................................... 223
14.4 Violence during Pregnancy .................................................................................................... 223
14.5 Marital Control by Husband................................................................................................... 224
14.6 Forms of Spousal Violence .................................................................................................... 226
14.7 Spousal Violence by Background Characteristics .................................................................. 227
14.8 Violence by Spousal Characteristics and Women’s Empowerment Indicators ...................... 229
14.9 Recent Spousal Violence ....................................................................................................... 231
14.10 Onset of Spousal Violence ..................................................................................................... 231
14.11 Physical Consequences of Spousal Violence ......................................................................... 232
14.12 Help-Seeking Behavior by Women Who Experience Violence ............................................. 232
REFERENCES ................................................................................................................................................ 235
APPENDIX A ADDITIONAL TABLES ..................................................................................................... 241
APPENDIX B SAMPLE DESIGN AND IMPLEMENTATION .............................................................. 245
B.1 Introduction ............................................................................................................................ 245
B.2 Sample Frame ........................................................................................................................ 245
B.3 Sample Design and Implementation ...................................................................................... 246
B.4 Selection Probabilities and Sample Weights .......................................................................... 248
APPENDIX C ESTIMATES OF SAMPLING ERRORS .......................................................................... 251
APPENDIX D DATA QUALITY TABLES ................................................................................................ 263
APPENDIX E PERSONS INVOLVED IN THE SURVEY ....................................................................... 269
APPENDIX F QUESTIONNAIRES ........................................................................................................... 273 |
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