Fertility patterns in Pakistan: a comparative analysis of family planning trends across different geographic regions

Introduction: Family planning includes a wide range of services, including counseling, contraception, and support to couples. Evidence shows that developing countries showcase a high degree of inequality in contraception usage and prevalence. Reasons for these inequalities include cultural barriers, such as traditional preferences and desires for larger families and lineage, especially in rural areas. The primary objective of this research is to examine the updated contraceptive method preferences of couples in rural and urban regions and how these translate towards family planning practices among the different provinces.
Methods: A secondary survey analysis using The Pakistan Demographic and Health Survey 2019 survey data was conducted. The data set included a sample of 15,143 women sampled proportionally from the provinces, including Gilgit Baltistan and Azad Jammu and Kashmir. The unit of analysis was ‘women’ from the Individual survey data set. Age, type of residence (rural, urban), division, education level, and language were used to evaluate access to family planning and contraception services. The chi-square test assessed the relation between  dependent and independent variables. Following, multivariate logistic regression analysis was performed to see the likelihood of contraceptive usage among women.
Results: The sample included 55% of women from rural areas and 50% without formal education. 51.7% of these women were using or practicing any form of contraception method. The most common method used was Condoms (9.2%), followed by Injectables (6.2%). Regression analysis showed that women aged 15-19 years were less likely (OR = 0.71, 95% CI = (0.51, 1.01)) to use contraception when compared to the reference group. The likelihood of contraceptive usage was higher in urban areas (OR = 1.53, 95% Cl = 1.39, 1.69). Noticeably, contraceptive usage was less likely in uneducated women (OR = 0.62, Cl = 0.56, 070). Punjab province had the highest contraceptive prevalence (34.3%) whereas Baluchistan had the lowest (6.9%). The use of contraception in urban and rural populations was more or less similar in all provinces except for Sindh and Gilgit Baltistan. In urban and rural areas, women of the age group 30-35 years who use contraception show a prevalence of 21% and 22% respectively.
Conclusions: The study highlights sub-optimal usage of contraceptives and the existence of high levels of inequalities among the regions. There is a need for the implementation of focused educational initiatives and counseling interventions along with prioritization of accessibility and affordability of contraceptive methods among women in lower socioeconomic regions.
Keywords: Family Planning Services, Contraceptive Methods, Inequalities, Maternal Health Services, The Pakistan Demographic and Health Survey.