Minhaj ul Haque

Schooling Opportunities for Girls as a Stimulus for Fertility Change in Rural Pakistan

This paper tests Caldwells mass schooling hypothesis in the context of rural Pakistan. His hypothesis was that the onset of the fertility transition is closely linked to the achievement of “mass formal schooling” of boys and girls. Punjab and Northeast Frontier Provinces (NWFP) were selected for this study because they appear to be on the leading edge of the demographic transition--a transition that has only recently begun--as suggested by rapid recent increases in contraceptive practice. The study covered a range of rural villages or communities with very different socioeconomic and schooling conditions in order to examine the effects of both school access and quality on family-building behavior in Pakistan. The study concludes that gender equity in the schooling environment as measured by the number of public primary schools for girls in the community or by the ratio of the number of girls’ schools to boys’ schools has a statistically significant effect on the probability that a woman will express a desire to stop childbearing and by extension on the probability that she will operationalize those desires by practicing contraception. Indeed the achievement of gender equity in primary school access in rural Punjab and NWFP could lead to a 14-15 percentage point rise in contraceptive use in villages where no girls’ public primary school currently exists and an 8 percentage point rise in villages with one primary school for girls. This is entirely supportive of the Caldwell argument that mass schooling is an important determinant of fertility change particularly when girls are included. It would appear that fertility change will be more difficult and will come much more slowly when girls are left behind. (authors)

The effect of traditional birth attendant training on maternal and neonatal care.

To determine whether traditional birth attendants (TBAs) trained via the “SMART Dai” method were superior to untrained TBAs in knowledge and practice regarding maternal and newborn care.

The constraints of distance and poverty on institutional deliveries in Pakistan: evidence from georeference-linked data.

While institutional deliveries in Pakistan have risen substantially over the last few years, the change has mainly occurred among the wealthy and those with access to services in urban areas. We assess the influence of economic and geographic access to health facilities on institutional deliveries by linking household survey data and georeferenced distance to facilities equipped to provide services for obstetric care in nine districts in Pakistan. Multilevel mixed-effect logistic regression analyses show that the net effect of an increase in distance to a facility by 1 kilometer is to decrease the odds of an institutional delivery by 3 percent. In contrast, household wealth and availability of at least basic emergency care within 10 kilometers substantially increase the odds of an institutional delivery. These effects are more pronounced in rural areas than in urban areas. Disadvantages faced by poor rural women can be minimized by upgrading existing facilities at district and subdistrict levels to provide comprehensive emergency care and by facilitating transportation of poor rural women directly to these facilities when they experience life-threatening complications of childbirth.

Operations Research on the Female Village-Based Family Planning Worker Program of Pakistan

This article presents the results of a number of operations research studies (OR) of family planning services provided by a new cadre of female village-based family planning workers in Punjab Province, Pakistan. This cadre of workers, recruited nationwide, has been trained to visit women in their villages to provide information and family planning services. The studies were conducted as part of a broad program of technical assistance to the Government of Pakistan. Surveys investigated the quality of their training as well as attitudes among clients to the new program. They found that the program is developing well but there is room for improvement, particularly in counseling and training. Additional field studies are ongoing and recommendations for change have been incorporated in training and supervision. The program is expanding on a national scale.