Demographic Demons of Pakistan

picture_DrAnisKaziThe Pakistan Demographic and Health Survey (PDHS) is part of the world wide Demographic and Health Surveys (DHS), which are conducted in over 90 countries since the past thirty years. The DHS is undertaken with the objective to provide reliable estimates of fertility, family planning, maternal and child health, nutritional status, women empowerment, domestic violence and amongst other things awareness about diseases such as hepatitis and HIV/AIDS.

The 2012-13 PDHS launched earlier this year was the third of such a survey conducted in Pakistan since 1991. Compiling this report was no easy task. Amidst perennial resource scarcity, lack of capacity and threats to the teams collecting in areas where the state has little or no writ, the National Institute of Population Studies has done commendable work. What the report says about the 6th most populous nation on the planet is alarming.

A nationally representative sample of around 13000 households was interviewed. A quick snapshot shows that the average Pakistanis household consists 6.8 people with a large proportion, nearly 40%, under 15 years of age.

Some revelations from the report are as follows:

  • 9 out of 10 married women do not own a house or any land.
  • 57% of women (ever-married women between the ages of 15-49 years) have never attended school while 29% of men have never attended school.
  • 49% is the literacy in women while 67% of the men are literate.
  • 40% of women interviewed experienced some sort of violence.
  • As far as maternal health care is concerned, only 73 % women were provided with antenatal care (care during pregnancy) by a skilled provider, while only 48% delivered in a health facility.
  • 36 women die every day in the country because of pregnancy.
  • Only 35% of women are using contraceptives (26% modern method and 9% traditional method).
  • Less than 20% of (ever married) women and 37% men had knowledge that HIV prevention can be augmented by using condoms and limiting sex to one uninfected partner.
  • In terms of spousal violence, 44% experienced emotional violence, 42% physical violence and 50% physical and emotional violence.
  • The vaccination coverage is dismal, with a national coverage of only 54%. A further breakdown reveals 29% in Sindh and only 16% in Baluchistan. Furthermore, 5% of children between the ages of I and 2 years haven’t received any vaccination at all.
  • Children nutritional status shows that 45% of children are stunted.
  • 30% are underweight for their normal age. 11% are wasted (severe process of weight loss, which is often associated with acute starvation and/or severe disease).
  • The national fertility rate at 3.8 is still way off the 2.1 bench mark set in the MDG’s.
  • Less registration of births makes the water murkier. While NADRA registrations are ever increasing, with 83% registered above 18 years, only 23% have ‘B’ form below 18.

The ticking bomb has exploded. Nobody needs global standards to assess how bad the situation is. The inequity needs to be addressed. The population needs sensitization, for health is everybody’s business. We need to clear the mist around jargons and make this more palatable for people to help themselves and the people around them. We are going nowhere by leaving women and children behind. We need to push harder for improved mother and child care. We need to ask ourselves, what we are unfolding if a undernourished teenage girl is married off and subsequently has a child to be responsible for, soon after. How long would implications of this single event last? Do we have a quick fix for the fall outs? Do we still need a consensus on prioritizing quality care. Two million youth enter the job market every year; capitalizing on the demographic dividend cannot be over emphasized. We need a greater investment in health care, to make healthier citizens, as tomorrow things will be more complex than today. National priorities need to be aligned for this.

Dr. Anis Kazi
The author is a public health professional based in Islamabad. A medical doctor by training, he graduated from the London School of Hygiene and Tropical Medicine, where he was involved in research around polio in Pakistan. He has interests around social determinants of health, Universal Health Coverage and health sector reforms, and is presently working as Senior Manager, Policy Advocacy and Research at Heartfile, NGO-Health think tank.



  1. naheed batool says

    “We need a greater investment in health care, to make healthier citizens, as tomorrow things will be more complex than today. National priorities need to be aligned for this.”

    This will not work until or unless we pay due care to awareness and other social determinants.

    • Anis says

      Yes, you are right. Investments in terms of money, time, energy and effort need to be made concurrently in all social sectors because of their interdependence.

  2. Rita Robert says

    Moreover, community participation should be encouraged in all the aspects and at all levels so as to provide quality care according to community interests and to make all the programs successful. Health care professionals should also work hard to work in the limited resources.

    • Anis says

      Community ownership and participation is the key to success for any successful program, give the program is tailored to their needs and requirements. your second point is very interesting. we see health workers working in very difficult and demanding situations the world over. In Pakistan, health workers have lost their lives to terrorism as well. These are difficult times and motivation of health workers need to be kept up with approriate incentives put in place.

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