Family Planning in Asia and the Pacific - International Council on ...

Figureto have <strong>the</strong> highest total fertility rates. At <strong>the</strong> time ofits <strong>in</strong>ception, Pakistan’s TFR of 6.6 births per womanfell between India’s TFR of 5.9 <strong>and</strong> that of <strong>the</strong> IslamicRepublic of Iran’s TFR of 7 births per woman, <strong>and</strong> was <strong>the</strong>same as Bangladesh’s TFR (see Figure 2). All countries <strong>in</strong><strong>the</strong> region experienced high fertility until <strong>the</strong> late 1960s,at which po<strong>in</strong>t India’s fertility levels started to decl<strong>in</strong>egradually but consistently. Bangladesh, which was mak<strong>in</strong>gheavy <strong>in</strong>vestments <strong>in</strong> family plann<strong>in</strong>g programmes, was <strong>the</strong>next to follow, with its TFR beg<strong>in</strong>n<strong>in</strong>g to decl<strong>in</strong>e rapidly by<strong>the</strong> early 1980s. Even Iran stepped up its family plann<strong>in</strong>gefforts by <strong>the</strong> late 1980s <strong>and</strong> started experienc<strong>in</strong>g a veryrapid decl<strong>in</strong>e <strong>in</strong> its TFR.Estimates of Pakistan’s fertility rates have been <strong>the</strong>source of much disagreement <strong>and</strong> debate, with reportedTFRs diverg<strong>in</strong>g by almost one birth per woman for agiven period (Sathar <strong>and</strong> Zaidi, 2009). Despite issuesregard<strong>in</strong>g exact levels of fertility, it is now widely acceptedby demographers <strong>and</strong> government officials alike thatPakistan’s fertility decl<strong>in</strong>e began as late as <strong>the</strong> beg<strong>in</strong>n<strong>in</strong>gof <strong>the</strong> 1990s. Currently, Pakistan’s TFR rema<strong>in</strong>s morethan one birth higher than that of India <strong>and</strong> Bangladesh,<strong>and</strong> about two births higher than that of Iran, which hasreached replacement-level fertility despite hav<strong>in</strong>g startedits programme just as late. Previous projections – <strong>the</strong>Population Policy 2002 – estimated that Pakistan wouldreach replacement around 2020; however, given currenttrends, that estimate has been revised, <strong>and</strong> fertility isprojected to reach replacement some 10 years later thanexpected, accord<strong>in</strong>g to <strong>the</strong> proposed Population Plan2010.Fertility regulationFigureContraceptive prevalenceNot surpris<strong>in</strong>gly, <strong>the</strong>re was hardly any fertility controlwith<strong>in</strong> marriage before <strong>the</strong> late 1980s <strong>and</strong> marital fertility<strong>in</strong> Pakistan did not experience a significant decl<strong>in</strong>e. CPRrema<strong>in</strong>ed below 10 per cent throughout most of <strong>the</strong> 1970s<strong>and</strong> 1980s, <strong>and</strong> reached 12 per cent only <strong>in</strong> 1991 when <strong>the</strong>fertility transition began (Sathar <strong>and</strong> Zaidi, 2009).The 1990s saw a dist<strong>in</strong>ct departure from this trend, withCPR doubl<strong>in</strong>g to 24 per cent <strong>in</strong> a six-year period (PFFPS,1996-1997) <strong>and</strong> reach<strong>in</strong>g 28 per cent by <strong>the</strong> end of <strong>the</strong>decade (National Institute of Population Studies, 2001).An important report showed an <strong>in</strong>crease to 32 per cent<strong>in</strong> contraceptive use among currently married women <strong>in</strong>2003 (National Institute of Population Studies, 2007).However, <strong>the</strong> latest DHS (2006/07) <strong>in</strong>dicates stagnation<strong>in</strong> contraceptive use, with CPR fall<strong>in</strong>g slightly to 30 percent (see Figure 3) (National Institute of PopulationStudies <strong>and</strong> Macro <strong>International</strong> Inc., 2008). In <strong>the</strong> early1990s contraceptive use rose at <strong>the</strong> rate of 2 per cent perannum; however, this rate fell by half to about 1 per cent ayear <strong>and</strong> has recently gone even lower.It is important to note that, unlike current use ofcontraception, ever use of contraception has <strong>in</strong>creasedsteadily over <strong>the</strong> last two decades (see Table 1). Ever use<strong>in</strong>creased from 21 per cent at <strong>the</strong> start of <strong>the</strong> transition <strong>in</strong>1991 to 34 per cent <strong>in</strong> 2001 <strong>and</strong> f<strong>in</strong>ally to 49 per cent <strong>in</strong>2007, <strong>in</strong>dicat<strong>in</strong>g a higher per annum <strong>in</strong>crease s<strong>in</strong>ce <strong>the</strong> turnof <strong>the</strong> century (2.5% vs. 1.3% per annum <strong>in</strong> <strong>the</strong> 1990s).The stagnation <strong>in</strong> CPR is more apparent <strong>in</strong> urban areass<strong>in</strong>ce <strong>the</strong> differential between urban <strong>and</strong> rural CPR hasgone from 1:5 <strong>in</strong> 1991 to 1:2 <strong>in</strong> 2007. Dur<strong>in</strong>g <strong>the</strong> 1990s,3Current <strong>and</strong> ever use of contraception, 1991-2007%3640434921282428323012181991 1994 1997 2001 2003 2007206