The Onset of Fertility Transition in Pakistan

Recent trends in fertility and contraceptive prevalence indicate that the marital fertility transition in Pakistan, which has been anticipated for three decades, has begun in the 1990s. Before that decade, the total fertility rate had exceeded six births per woman for at least three decades, and fewer than 10 percent of married women practiced contraception. The most recent survey data, collected in 1996–97, show a total fertility rate of 5.3 births per woman and a contraceptive prevalence rate of 24 percent. Underlying this development are macroeconomic trends that have led to widespread economic distress at the household level, and social changes that have diluted the influence of extended kin and resulted in greater husband–wife convergence in reproductive decisionmaking. The more-direct causes of declining fertility are a crystallization of existing desires for smaller families along with a decline in family size desires and a reduction in the social, cultural, and psychic costs of contraception. Improvements in family planning services (their density and quality) have contributed little to the onset of fertility decline but could be decisive in sustaining the decline over the next decade. Other obstacles to contraceptive use, including fear of health side effects and perceptions that husbands are opposed, must also be overcome in order for contraceptive practice to become more widespread and the decline in fertility to continue. Over the long term, progression to replacement-level fertility will require a substantial decline in the demand for children. This material may not be reproduced in any form without written permission from the authors. Fertility in Pakistan has shown a stubborn resistance to change. Because of sharp declines in mortality in the post–World War II period, the population of Pakistan was growing at the rate of 2.7 percent per annum around 1960. In response to concern about rapid growth, a national policy of slowing population growth was articulated in the 1960s, with a program of family planning services as the main tool (Government of Pakistan 1965). During its first two decades, however, the program appeared to have had scant impact on fertility: the total fertility rate (TFR) continued to hover between six and seven births per woman throughout the 1970s and 1980s, and the population growth rate approached 3 percent per annum (Sathar 1993). Repeated assertions that marital fertility decline was underway proved to be illusory. In this paper we present empirical evidence from multiple and independent studies carried out in the past eight years demonstrating that marital fertility decline has finally begun in Pakistan. The decline is gentle but nevertheless represents a genuine break from the past, most notably because of the increasing use of modern contraception for the purpose of limiting family size. The slight declines in overall fertility prior to 1990 were due almost entirely to increases in age at first marriage (United Nations 1993). With a population of 130.5 million in 1998 (Population Census Organization 1998), Pakistan is the world’s seventh most populous country. According to UN projections, it will become the third most populous by the year 2050. It is one of only eight countries as of the mid-1990s with a population in excess of 25 million in combination with a TFR in excess of five births per woman (UN 1996). Pakistan stands apart from its populous neighbors in South Asia, all of which (with the exception of Nepal) experienced substantial declines in fertility prior to 1990 and therefore show markedly lower fertility in the mid-1990s (estimated TFRs in 1995 are 2.2 for Sri Lanka, 3.4 for India and Bangladesh, and 5.4 for Nepal). These comparisons raise questions about which factors have precipitated and sustained fertility transition in the region, in particular the contribution of family planning programs (Shah and Cleland 1993). Some analysts credit the 4 rapid and, by many criteria, early fertility decline in Bangladesh to the effectiveness of the family planning program (Cleland et al. 1994). Pakistan’s program, by comparison, has repeatedly been criticized for poor management and the low quality of the services offered to the majority of its clients (Robinson et al. 1981; Rukanuddin and Hardee-Cleaveland 1992; United Nations n.d.). An alternative, and not necessarily contradictory, argument is that the motivation to limit fertility did not crystallize in Pakistan before the 1990s, and therefore responsibility for the late transition cannot be placed entirely on an indecisive population policy and inadequate family planning services (Sathar 1993). This paper offers an update on fertility transition in Pakistan. We first review the evidence suggesting that important changes are underway. The paper next describes the large-scale social and economic changes that have motivated the recent changes in reproductive behavior. We then examine the more-direct causes of these changes and the constraints on further changes. We conclude by speculating about the prospects for further declines in fertility in Pakistan. STATUS OF THE FERTILITY TRANSITION Numerous fertility surveys indicate that the TFR remained above six births per woman throughout the 1980s (see Table 1). Significantly, all estimates for the 1990s for the first time fall below 6.0 births per woman. The direct estimate of the TFR for 1986–91 from the 1990–91 Pakistan Demographic and Health Survey (PDHS) is 5.4. This is almost certainly an underestimate, judging from the evidence from reinterviews conducted with a subsample of PDHS respondents. The reinterview data suggest that roughly 10 percent of births were omitted (Curtis and Arnold 1994). Adjusting for this through the Gompertz relational model, Juarez and Sathar (forthcoming) estimate that the TFR was probably around 6.1 for the period 1986–91, a figure that is consistent with the Pakistan Demographic Survey estimate for 1992 of 5.8 (Federal Bureau of Statistics 1997). The estimate Table 1 Trends in fertility in Pakistan: Total fertility rates, by decade and survey