Shy / silent users of contraceptives in Pakistan.

This study examines the hypothesis that shy, silent users of contraceptives in Pakistan underreport contraceptive usage. Data were obtained from the 1984-85 and 1994-95 Contraceptive Prevalence Surveys, the 1990-91 Demographic and Health Survey, and a Punjab 1993 survey. The data were reorganized to indicate the number of women who were fecund but did not have a birth within the preceding 5 years before the surveys. 698,864 women in 1984-85 did not have children and did not report contraceptive use, or 5.9% of total respondents. If these women were added to the contraceptive prevalence rate (CPR), it would rise from 7.6% to 13.5%. The higher CPR is consistent with the observed total fertility rate of 5.95. Shy or silent users were 11.9% in 1990-91 and 11.3% in 1994-95. The revised CPRs are 23.7% and 29.1%, respectively. In 1993, a follow-up survey among non-users in Punjab province showed that CPR increased from 13% in 1990-91 to 18% in 1993. Withdrawal was the most widely used method, followed by the condom and female sterilization. The increase in CPR is attributed to more open reporting among shy or silent users. Revised CPRs that include shy or silent users were consistent with total fertility rates in all 3 nationally representative surveys. Typically shy or silent users were older by about 2.3 years than current users, but had similarly aged husbands. Shy or silent users had longer duration of marriage, greater illiteracy, and less contraceptive knowledge about methods and sources. Shy or silent women had lower children ever born rates than current users.