Pakistan's Birth Rate Not Declining as Quickly as Expected

The 2013 Pakistan Demographic and Health Survey (DHS) results were released this week, but the report seemed not to attract much attention. This is both strange and unfortunate. Pakistan is the world's 6th most populous nation, and UN Population Division projections suggest that it will still be 6th by mid-century. However, those projections estimate that even now the total fertility rate in Pakistan has declined from 6 children each all the way into the 1990s to 3.2 children each now. The US Census Bureau's projections suggest an even lower birth rate. The problem is this: The 2013 Pakistan DHS revealed that the TFR is 3.8, not 3.2. Yes, it is coming down, but not very fast, especially considering that infant and child mortality rates--while still among the highest in the world--are declining. Women start having children young, and are very unlikely themselves to use contraception until relying on sterilization after reaching (or exceeding) the number of children wanted.

The proportion of currently married women who are currently using any method of contraception rises with age from only 10 percent among women age 15-19 to 48 percent among age 35-39. The use of contraception then declines for women who are 40 years and above. The most popular method among women under 35 years is condoms, followed by the withdrawal method; among women age 35 and above, female sterilization is the most widely practiced method. 

These low levels of contraceptive use among younger women, in particular, are somewhat at odds with the survey finding that men and women alike are interested in at least delaying, if not avoiding, additional births. This suggests that there is a nearly classic case in Pakistan of an unmet need for birth control. This is typically the result of governmental ambivalence, if not antagonism, to the provision of fertility control methods.

The UN medium variant projections suggest that Pakistan will add more than 80 million people between now and 2050, whereas the high fertility projection suggests the addition of 120 million, but even that high variant assumes lower fertility than was found in the latest DHS survey. Back to the drawing board, I think. The future is going to be a bit different than we thought.