Women’s decision-making and contraceptive use in Pakistan: an analysis of Demographic and Health Survey data

Figures & data

Figure 1. Derivation of the analytic sample from the 2017–18 PDHS

Table 1. Characteristics of the analytic sample (n = 12,676)

	%	Weighted n
Contraceptive use
None	61.8	7,833
Traditional	10.3	1,308
Modern	27.9	3,535
Condom	9.9	1,249
Female sterilisation	9.2	1,170
Injections	3.3	422
IUD	2.8	359
Pill	1.9	244
Other	0.7	91
Household decision-making (# of decisions)
0	33.4	4,238
1	12.3	1,555
2	9.1	1,154
3	12.2	1,545
4	33.0	4,184
Contraceptive decision-making
Mainly respondent	8.6	1,094
Mainly husband, partner	10.7	1,362
Joint decision	77.2	9,788
Other	3.4	432
Age in 5-year groups
15–19	3.9	493
20–24	13.7	1,732
25–29	19.7	2,500
30–34	20.0	2,541
35–39	18.8	2,378
40–44	12.6	1,595
45–49	11.3	1,437
Education
No education	47.4	6,008
Primary	16.6	2,105
Secondary	22.3	2,829
Higher	13.7	1,734
Currently working
No	84.3	10,686
Yes	15.7	1,990
Control over own earnings
No earnings	84.7	10,730
No control	1.5	185
Joint control	6.4	810
Sole control	7.5	947
Own house or land
No	96.1	12,182
Yes	3.9	490
Household wealth quintile
Poorest	18.5	2,340
Poorer	21.6	2,734
Middle	20.9	2,649
Richer	19.6	2,485
Richest	19.5	2,468
Residence
Rural	66.1	8,385
Urban	33.9	4,292
Region
Punjab	43.7	5,535
Sindh	19.2	2,439
Khyber Pakhtunkhwa	12.7	1,613
Balochistan	4.1	522
ICT Islamabad	0.7	94
FATA	1.5	191
Azad Jammu & Kashmir	11.5	1,459
Gilgit Baltistan	6.5	824
Husband's/partner's age
15–19	0.6	78
20–24	5.3	676
25–29	14.7	1,858
30–34	17.3	2,197
35–39	18.7	2,371
40–44	14.9	1,892
45–49	14.6	1,856
50–54	8.2	1,042
55–59	3.6	459
60–84	1.9	246
Husband's/partner's educational attainment
No education	27.4	3,467
Primary	15.3	1,935
Secondary	37.1	4,697
Higher	20.3	2,576
Number of living children
0	12.3	1,565
1	12.7	1,616
2–3	33.0	4,178
4–5	26.8	3,397
6–14	15.2	1,921
Age at first marriage
10–14	8.5	1,078
15–17	26.0	3,295
18–20	30.7	3,887
21–24	23.5	2,973
25–47	11.4	1,444
Fertility desires
Wants within 2 years	27.3	3,457
Wants after 2 + years	12.6	1,595
Wants, unsure timing	9.8	1,235
Wants no more	46.8	5,930
Declared infecund	3.5	447
Permission to seek medical advice/treatment
Not a big problem	78.0	9,887
Big problem	22.0	2,790
Distance to seek medical advice/treatment
Not a big problem	55.1	6,984
Big problem	44.9	5,693
Household type
Nuclear	60.9	7,717
In-laws	33.6	4,257
Other extended	5.5	702
Household size (# of household members)
1–4	15.1	1,912
5–9	57.2	7,250
10+	27.7	3,515

Table 2. Covariates associated with the use of traditional or modern contraception: results of multinomial logistic regression (n = 12,676)

	Traditional contraception (ref: none)				Modern contraception (ref: none)
	Unadjusted RRR	p-value	Adjusted RRR	p-value	Unadjusted RRR	p-value	Adjusted RRR	p-value
Household decision-making
# of decisions	1.15	***	0.99		1.13	***	0.98
Contraceptive decision-making (ref: mainly respondent)
Mainly husband	1.72		1.90	*	0.44	***	0.46	***
Joint decision	5.14	***	5.64	***	1.50	***	1.84	***
Other	<0.01	***	<0.01	***	0.03	***	0.03	***
Age (ref: 15–19)
20–24	4.13	***	1.79		2.52	***	1.12
25–29	6.30	***	1.61		4.13	***	0.95
30–34	11.31	***	1.74		6.74	***	0.86
35–39	11.18	***	1.30		7.11	***	0.63
40–44	11.76	***	1.11		7.63	***	0.56	*
45–49	7.76	***	0.68		4.67	***	0.32	***
Education (ref: none)
Primary	1.45	**	1.13		1.40	***	1.39	***
Secondary	1.97	***	1.33	*	1.47	***	1.53	***
Higher	2.51	***	1.61	**	1.76	***	2.17	***
Working (ref: not working)
Yes	1.04		1.58	*	1.24	**	1.37	*
Control over earnings (ref: no earnings)
No control	0.89		0.82		0.21		0.82
Joint control	1.19		0.86		1.46	***	1.06
Sole control	0.75		0.50	**	0.97		0.72
Own house or land (ref: no)
Yes	2.01	***	1.58	*	1.62	**	1.42
Household wealth quintile (ref: poorest)
Poorer	1.97	***	1.96	***	1.44	***	1.70	***
Middle	3.50	***	3.76	***	1.89	***	2.53	***
Richer	4.16	***	4.25	***	2.05	***	2.83	***
Richest	5.95	***	5.06	***	2.36	***	3.04	***
Residence (ref: rural)
Urban	2.41	***	1.62	**	1.50	***	1.04
Region (ref: FATA)
Punjab	1.68	*	0.80		2.43	***	1.63	*
Sindh	0.86		0.46	**	1.90	**	1.51
Khyber Pakhtunkhwa	1.04		0.71		1.85	**	1.62	*
Balochistan	0.70		0.44	*	0.99		0.80
ICT Islamabad	1.83	*	0.69		3.41	***	2.08	**
Azad Jammu & Kashmir	1.07		0.56		1.41		0.91
Gilgit Baltistan	1.43		1.24		2.89	***	2.60	***
Husband’s age (ref: 15–19)
20–24	6.31	**	1.87		4.57	*	1.91
25–29	9.85	***	1.52		7.69	***	1.76
30–34	15.55	***	1.57		11.85	***	1.86
35–39	20.83	***	1.60		15.89	***	1.87
40–44	26.08	***	1.69		21.21	***	2.05
45–49	23.94	***	1.62		19.99	***	2.03
50–54	22.40	***	1.42		14.98	***	1.36
55–59	12.89	***	0.92		11.97	***	1.21
60–84	16.06	***	1.51		10.59	***	1.37
Husband’s education (ref: none)
Primary	1.16		0.77		1.25	*	0.96
Secondary	1.55	***	0.93		1.16		0.92
Higher	2.23	***	1.04		1.51	***	0.95
Age at first marriage (cohabitation) (ref: 10–14)
15–17	0.92		0.94		0.97		1.07
18–20	1.23		1.12		0.89		0.99
21–24	1.20		1.06		0.89		1.07
25–47	1.11		1.17		0.62	***	1.00
Number of living children
	1.70	***	2.41	***	1.96	***	2.64	***
Permission to go seek medical advice/treatment (ref: no problem)
Big problem	0.67	***	0.86		0.71	***	0.83
Distance to seek medical advice/treatment (ref: no problem)
Big problem	0.65	***	1.02		0.72	***	0.98
Household type (ref: nuclear)
In-laws	0.60	***	0.77		0.48	***	0.60	***
Other extended	0.49	***	0.59	*	0.33	***	0.41	***
Household size
# of household members	1.22	***	1.10		1.29	***	1.22	**

p-values *<0.05, **<0.01, ***≤0.001, ns  =  not significant (p  >  0.05).

Table 3. Covariates associated with the use of selected modern methods of contraception

	Condom (ref: no modern method)		Female sterilisation (ref: no modern method)		Injectables (ref: no modern method)		IUD (ref: no modern method)		Pill (ref: no modern method)		Other (ref: no modern method)
	Adjusted RRR	p-value	Adjusted RRR	p-value	Adjusted RRR	p-value	Adjusted RRR	p-value	Adjusted RRR	p-value	Adjusted RRR	p-value
Household decision-making
# of decisions	0.99		1.04		0.98		0.95		0.79	***	0.92
Contraceptive decision-making (ref: mainly respondent)
Mainly husband	1.29		0.58	*	0.12	***	0.18	**	0.16	***	0.11	***
Joint decision	2.95	***	1.49		0.99		1.27		1.10		0.50	*
Other	<0.01	***	0.11	***	<0.01	***	<0.01	***	<0.01	***	<0.01	***
Age (ref: 15–24)
25–29	0.68	**	9.08	***	0.75		0.88		1.00		0.48
30–34	0.44	***	14.83	***	0.66		0.69		0.93		0.33
35–39	0.34	***	14.72	***	0.35	**	0.59		0.43	*	0.16	**
40–44	0.22	***	17.52	***	0.24	***	0.42		0.31	**	0.20	*
45–49	0.09	***	12.70	***	0.18	***	0.17	***	0.20	**	0.04	**
Education (ref: none)
Primary	1.73	***	1.24		1.29		1.55		1.03		0.38	*
Secondary	1.83	***	1.26		1.17		1.84	**	0.92		0.59
Higher	2.60	***	1.32		1.72		2.01	*	1.31		1.79
Working (ref: not working)
Yes	0.94		1.44	*	1.27		1.92	*	0.70		1.01
Control over earnings (ref: no earnings)
No control	0.85		0.68		1.48		0.91		0.72		0.72
Joint control	1.19		1.09		0.92		1.07		1.24		0.96
Sole control	1.00		0.78		0.79		0.59		1.44		0.52
Own house or land (ref: no)
Yes	1.54	*	1.04		0.69		1.26		1.37		2.65
Household wealth quintile (ref: poorest)
Poorer	2.60	***	1.54	*	1.45		1.84	*	1.13		1.02
Middle	4.28	***	1.85	***	1.64	*	1.81		1.64		1.98
Richer	4.90	***	2.19	***	1.11		2.37	**	1.31		0.91
Richest	4.94	***	2.21	***	0.52		2.56	*	2.04		1.36
Residence (ref: rural)
Urban	1.04		0.84		0.86		0.97		0.65		1.43
Region (ref: FATA)
Punjab	1.73	*	8.93	***	0.50		4.09	***	0.34	**	65.49	***
Sindh	1.39		9.41	***	0.98		2.06		0.96		179.78	***
Khyber Pakhtunkhwa	2.31	***	3.73	**	1.77		3.04	*	0.64		14.64	*
Balochistan	1.52		1.94		0.51		0.80		0.68		42.55	***
ICT Islamabad	2.72	***	8.46	***	0.51		6.23	***	0.57		136.00	***
Azad Jammu & Kashmir	1.16		4.17	**	0.66		2.58	*	0.13	***	56.24	***
Gilgit Baltistan	1.28		4.43	**	2.88	*	14.68	***	1.46		64.08	***
Husband’s age (ref: 15–29)
30–34	1.20		1.19		0.71		1.24		0.77		0.81
35–39	1.19		1.01		0.87		1.45		0.90		0.56
40–44	1.11		1.49		0.80		1.35		1.41		0.75
45–49	1.09		1.57		0.56		1.20		1.73		0.77
50–54	0.61		1.17		0.69		0.64		0.53		0.14	**
55–59	0.78		1.05		0.38	*	0.55		1.12		0.28
60–84	0.27	*	1.25		0.47		0.52		0.17	*	1.00
Husband’s education (ref: none)
Primary	1.20		1.04		0.90		0.89		1.25		0.67
Secondary	1.27		0.86		0.73		0.72		1.27		0.62
Higher	1.35	*	0.80		0.58	*	0.62		1.97	*	0.41
Age at first marriage (cohabitation) (ref: 10–14)
15–17	1.52	*	0.85		1.46		1.38		0.99		1.06
18–20	1.66	**	0.70	*	0.96		1.34		0.98		0.58
21–24	1.95	***	0.58	**	2.36	***	1.34		0.84		1.41
25–47	2.44	***	0.48	**	1.13		0.72		0.99		1.45
Number of living children
	2.17	***	2.05	***	2.68	***	2.76	***	2.30	***	3.24	***
Permission to go seek medical advice/treatment (ref: no problem)
Big problem	0.67	**	0.89		1.09		1.03		1.18		0.42	*
Distance to seek medical advice/ treatment (ref: no problem)
Big problem	1.07		0.90		1.21		0.95		0.68		1.31
Household type (ref: nuclear)
In-laws	0.61	***	0.48	***	0.78		0.66		0.84		0.73
Other extended	0.40	***	0.40	**	0.33	**	0.60		1.15		0.66
Household size
# of household members	1.19		1.17		1.20		1.15		1.19		1.43

Results of a multivariable multinomial logistic regression (n = 12,676).

p-values *<0.05, **<0.01, ***≤0.001, ns = not significant (p > 0.05).