Knowledge, Approval and Communication About Family Planning as Correlates of Desired Fertility Among Spouses in Pakistan

ily planning services and methods represent only a means to a predetermined end. It is indeed difficult to demonstrate empirically that family planning programs have played a significant role in reducing desired fertility. Critics have noted the important contribution that the availability of family planning services makes to reducing unwanted fertility,3 but what of the role of family planning programs in creating ideational change, first by bringing about awareness of fertility control and second by promoting the advantages of smaller families—and potentially kindling a desire to have fewer children? Family planning programs have largely achieved the first precondition to family planning use* by fostering an awareness of the individual’s power to control what was previously considered destiny, fate or “up to God.”4 In addition to increasing knowledge of and access to methods, programs typically stress the advantages of family planning to parents, children and society as a whole. Bangladesh is a case in which the desire to have fewer children is unlikely to have arisen solely from social and economic development.5 One should perhaps not conclude that because family planning programs tend to be strongest in countries with low levels of wanted fertility,6 such programs are entirely demand-driven.7 Many family planning programs do not passively supply services, but actively Naushin Mahmood is senior research demographer at the Pakistan Institute of Development Economics, Islamabad. Karin Ringheim is a Western Consortium for Public Health fellow in the Office of Population, U. S. Agency for International Development (USAID), Washington, DC. The original research on which this article was based was supported by a small grant from Macro International, Inc., through a contract awarded by USAID. Permission to use the Pakistan Demographic and Health Survey data was granted by the Pakistan National Institute of Population Studies. The opinions expressed in this article are solely those of the authors and do not necessarily represent those of USAID or of the Pakistan Institute of Development Economics. The authors wish to thank Fred Arnold for his thoughtful comments. Knowledge, Approval and Communication About Family Planning as Correlates of Desired Fertility Among Spouses in Pakistan