Muhammad Iftikhar Ul Husnain

Correlates of preferences for home or hospital confinement in Pakistan: evidence from a national survey

BackgroundDespite the pregnancy complications related to home births, homes remain yet major place of delivery in Pakistan and 65 percent of totals births take place at home. This work analyses the determinants of place of delivery in Pakistan.MethodsMultivariate Logistic regression is used for analysis. Data are extracted from Pakistan Demographic and Health Survey (2006–07). Based on information on last birth preceding 5 years of survey, we construct dichotomous dependent variable i.e. whether women deliver at home (Coded=1) or at health facility (coded=2).ResultsBivariate analysis shows that 72% (p≤0.000) women from rural area and 81% women residing in Baluchistan delivered babies at home. Furthermore 75% women with no formal education, 81% (p≤0.000) women working in agricultural sector, 75% (p≤0.000) of Women who have 5 and more children and almost 77% (p≤0.000) who do not discussed pregnancy related issues with their husbands are found delivering babies at home. Multivariate analysis documents that mothers having lower levels of education, economic status and empowerment, belonging to rural area, residing in provinces other than Punjab, working in agriculture sector and mothers who are young are more likely to give births at home.ConclusionA trend for home births, among Pakistani women, can be traced in lower levels of education, lower autonomy, poverty driven working in agriculture sector, higher costs of using health facilities and regional backwardness.

Decision-making for birth location among women in Pakistan: evidence from national survey

BackgroundPakistan ranks 149th in the maternal mortality ratio (MMR) and has failed to keep pace with other countries in the region, except Afghanistan, with respect to health indicators. Home deliveries are linked to a higher risk of maternal death; therefore, discouraging home deliveries is imperative to improve maternal health. This study provides a holistic view and analyses factors affecting home birth decisions within the context of maternal socio-demographic characteristics in Pakistan.MethodsThe study exploits the latest data from the Pakistan Demographic and Health Survey (2012–2013), which includes a nationally representative sample of 13,558 women aged 15–49xa0years. However, the sample was reduced to 6977 women who had given birth in the 5 years preceding the survey. Statistical techniques, including bi-variate and multivariate logistic regression, were used to analyse the data. The dependent variable was dichotomous and coded as 0 for home deliveries and 1 for deliveries at a health facility. The dependent variable was constructed based on information regarding the most recent birth in the 5xa0years preceding the survey.ResultsThe study reveals that giving birth at home is highly prevalent among mothers in Pakistan (Baluchistan, 74%; Khyber-Pakhtunkhwa, 53%; Gilgit Baltistan, 46%; Punjab, 45% and Sindh, 34%) because of their difficulty obtaining permission to visit a health facility, financial barriers, the distance to health facilities and transportation. Substantial variation is observed when geo-demographic characteristics are considered. Higher home childbirth rates have been recorded in rural areas compared with those in urban areas (OR 1.32; pu2009≤u20090.000). The likelihood of home birth is highest (OR 2.67; pu2009=u20090.000) among women in Baluchistan province and lowest (OR 0.48; pu2009=u20090.000) among mothers in Punjab province. After controlling for all odds ratios and demographic characteristics, the parents’ education levels remain a significant factor (pu2009=u20090.000) that affects women’s decisions to deliver at home rather than at a health facility.ConclusionThe study findings provide a better understanding of why women prefer to give birth at home. These results can help policymakers to introduce appropriate interventions to increase the number of deliveries at health facilities. These findings are expected to reduce maternal and neonatal mortality in Pakistan.

A Household Level Analysis of the Pakistan–Malaysia Free Trade Agreement

Pakistan and Malaysia have a significant bilateral economic relationship. The Pakistan–Malaysia Free Trade Agreement (FTA) was signed in 2007, and was implemented in 2008. Pakistan’s volatile exports to Malaysia never achieved a sustainable period of growth. Trade balance has not achieved significant changes even after 9 years of implementation of the agreement. With this backdrop, this study first quantifies the current FTA between Pakistan and Malaysia and then suggests changes that could be made to improve the outcome for Pakistan. A new global economic trade model is adapted to include more detailed information on Pakistan’s labor and household groups into the Global Trade Analysis Project (GTAP) database. This allows for a more detailed analysis of the impact of the FTA on Pakistan at the household level. The results show that there is win–win scenario for both Pakistan and Malaysia if both are able to renegotiate the current FTA to get the same tariff concession as awarded to each other’s trading partners.

Is health care a luxury or necessity good? Evidence from Asian countries

This study investigates long run relationship between health care expenditure and real income in fifteen selected Asian countries over the period 1995–2014 using the panel cointegration tests and controlling for cross-sectional dependence through unobserved common correlated factors (UCFs). The results show that health care expenditure and income are cointegrated. It is found that the income elasticity scales down when UCFs are controlled, which implies that ignoring UCFs produces biased and inconsistent estimates. The Mean Group and Common Correlated Effects Mean Group estimates reveal that long run income elasticity of health care is less than unity for the entire panel, indicating that health care is a necessity good in Asian countries. Within the sample, income elasticity for South Asian Association for Regional Cooperation countries and Association of Southeast Asian Nations countries is also less than unity. However, many of the previous studies report income elasticity greater than unity. The difference between the results we found in our study compared to previous work could be attributed to the use of estimation methodology and the sample analyzed. Overall, health care has been found a necessity good in Asian countries in the long run.

Robustness of geography as an instrument to assess impact of climate change on agriculture

Purpose n n n n nThe empirical literature on climate change and agriculture does not adequately address the issue of potential endogeneity between climatic variables and agriculture, which makes their estimates unreliable. This paper aims to investigate the relationships between climate change and agriculture and test the potential reverse causality and endogeneity of climatic variables to agriculture. n n n n nDesign/methodology/approach n n n n nThis study introduces a geographical instrument, longitude and latitude, for temperature to assess the impact of climate change on agriculture by estimating regression using IV-two-stage least squares method over annual panel data for 60 countries for the period of 1999-2011. The identification and F-statistic tests are used to choose and exclude the instrument. The inclusion of some control variables is supposed to reduce the omitted variable bias. n n n n nFindings n n n n nThe study finds a negative relationship between temperature and agriculture. Surprisingly, the magnitude of the coefficient on temperature is mild, at least 20 per cent, as compared to previous studies, which may be because of the use of the instrumental variable (IV), which is also supported by an alternative robust measure when estimated across different regions. n n n n nPractical implications n n n n nThe study provides strong implications for policymakers to confront climate change, which is an impending danger to agriculture. In designing effective policies and strategies, policymakers should focus not only on crop production but also on other agricultural activities such as livestock production and fisheries, in addition to national and international socio-economic and geopolitical dynamics. n n n n nOriginality/value n n n n nThis paper contributes to the growing literature in at least four aspects. First, empirical settings introduce an innovative geographical instrument, Second, it includes a wider set of control variables in the analysis. Third, it extends previous studies by involving agriculture value addition. Finally, the effects of temperature and precipitation on a single aggregate measure, agriculture value addition, are separately investigated.