Chapter 1

INTRODUCTION AND METHODOLOGY

 

The Pakistan Reproductive Health and Family Planning Survey (PRHFPS) was conducted in 2000-01 by the National Institute of Population Studies (NIPS), Islamabad. The PRHFPS was undertaken not only in the four provinces of Pakistan, but also in the Northern Areas and Azad Jammu and Kashmir. Technical direction was provided by a Steering Committee comprising experts from NIPS, Pakistan Institute of Development Economics (PIDE), Federal Bureau of Statistics (FBS), Population Council, Ministry of Population Welfare and Ministry of Health. In addition, members of the Advisory Committee of NIPS also provided valuable suggestions at the design stage of research protocols.

This preliminary report contains selected key findings from the four provinces of Pakistan. A detailed report on the findings of the survey will be published later in 2001. Separate reports on the findings of the survey covering Northern Areas and Azad Jammu and Kashmir will also be published during 2001. Throughout the report, findings from the PRHFPS have been compared with the findings of previous surveys conducted in Pakistan in regard to fertility and contraceptive prevalence such as the 1975 Pakistan Fertility Survey (PFS), the 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS), the 1990-91 Pakistan Demographic and Health Survey (PDHS), the 1994-95 Pakistan Contraceptive Prevalence Survey (PCPS) and the 1996-97 Pakistan Fertility and Family Planning Survey (PFFPS). Since this survey has collected data on all components of reproductive health for the first time at the national level its comparison to pilot studies undertaken in the past has also been made, in particular with District Jhelum report (Hakim et.al; 1999).

1.1       Objectives

 

The survey collected data on reproductive health, fertility and family planning and their determinants in order to provide policy makers and programme managers with information useful for evaluating and improving the programme relating to reproductive health and family planning. The specific objectives of the survey are to assess:

1.    Fertility level and differentials;

2.    Contraceptive level and differentials;

3.    Safe motherhood: Antenatal and postnatal care, obstetric care, anaemic cases, prevalence/identification of obstetric emergencies and experiences with service delivery, pregnancy losses, breast-feeding practices;

4.    Infant and child mortality and perceived causes;

5.    Immunisation of children and expectant mothers;

6.    Suspected cases of RTIs/STDs and awareness of these problems among women;

7.    Maternal morality, and

8.    Prevalence of infertility

 

1.2       Sample

A national sample of 7332 households was drawn from the country covering Punjab, Sindh, NWFP and Balochistan. The sample design was developed by the FBS, Government of Pakistan. The universe consisted of all urban and rural areas of four provinces of Pakistan and Federal territory of Islamabad as defined in 1998 Population Census, excluding FATA and military restricted areas, which comprise 4 percent of the total population. The urban and rural samples consisted of 3240 and 4092 households respectively.

A sampling frame was drawn by the Federal Bureau of Statistics in mid-2000 using the 1998 census list of clusters in rural areas and similar updated information for urban areas. The basic design proposed was a two-stage stratified sample with area units at the first stage and households at the second.

The FBS uses a standard stratification scheme at the area stage of sampling. The first step was to stratify by urban/rural. In the urban sector, Major Urban and Other Urban formed sub-strata. In PRHFPS, there were 12 major urban areas. They were Lahore, Gujranwala, Multan, Faisalabad, Rawalpindi, Sialkot and Sargodha from Punjab, Karachi and Hyderabad from Sindh, Peshawar from NWFP, Quetta from Balochistan and Islamabad, the capital of Pakistan. All other cities and towns are classified as Other Urban. The blocks within the cities and towns of the urban sub-strata were stratified into high, medium and low-income areas. In the rural sector, villages were stratified by provinces and districts. The next step was to select 180 urban blocks in the urban sample and 187 villages, dehs and mouzas in the rural sample. Thus there were a total of 367 area units or Primary Sampling Units (PSUs).

Staff from the regional and field offices of the FBS prepared household lists in each selected cluster. From these lists 22 households per cluster were selected randomly in rural areas and 18 in urban areas. Two rural clusters contained fewer than 22 households, and in these cases all the households found were included in the sample. Thus the rural sample contained 22 fewer households than intended.

In each selected household a list was prepared of all the household members, who were usual residents in the household at the time of survey (de jure members). From this list, ever-married women aged 15-49 years were identified for the detailed interview. Details of the sample design, including expected and actual coverage of the sample in urban and rural areas in each of the four provinces is shown in table 1.1.

In order to obtain provincially representative information, households in Balochistan were over-sampled while those in more populous provinces, particularly Punjab, were under sampled. These unequal probabilities of selection have been corrected by weighting households according to the sample design. Weighting factors for every cluster have been obtained from FBS and applied to obtain representative estimates for the national, provincial and urban/rural populations. Unless otherwise stated, the results presented in this report are based on the weighted figures.

 

Table 1.1

Coverage of Sample Areas (PSUs), Households and Ever-Married

Women Aged 15-49, by Province and Residence (Unweighted)

 

 

Table 1.1 shows the un‑weighted data and it can be seen that Punjab, as the most populous province, has 49.2 percent of the sample while Balochistan, the least populous, has 9.6 percent. Sindh and NWFP have 25.5 and 15.7 percent of the sample households respectively.

All 367 primary sampling units (PSUs) selected were successfully covered, in all the provinces and areas. In total 7332 households were selected of which 6857 were located and visited, indicating a response rate of 93.5 percent. This represents a household coverage of 96 percent in Punjab, 90 percent in Sindh, 97 percent in NWFP, and 86 percent in Balochistan.

In the located households a total of 7411 eligible women were identified of whom 6579 were successfully interviewed, giving a response rate of 89 percent. The response rate was highest in NWFP (92 percent), followed by Balochistan (90 percent), Sindh (89 percent) and Punjab (87 percent). Reasons for non-response at household level are given in table 1.2.

Table 1.2

Results of Household Interviews by Province and Residence (Unweighted)

 

The non-response was largely because of the absence of eligible women at the time of survey. Very few women however, refused to be interviewed (table 1.3).

Table 1.3

Results of Individual Interviews by Province and Residence (Unweighted)

 

 

1.3       Questionnaire

The PRHFPS questionnaire has two parts: a Household Schedule and a Woman’s Questionnaire. The household schedule collects information on background characteristics of the household and demographic characteristics of all usual household members. The main purpose of the household schedule was to identify ever-married women, age 15-49, who were eligible for detailed interview using the woman’s questionnaire.

Assistance in questionnaire design was solicited from a wide range of experts. The topics covered in the questionnaire were background characteristics; reproduction; adolescents; prenatal, obstetric and postnatal care; women health, contraception; pregnancy and breastfeeding; marriage; fertility preferences and socio-economic factors. Based on the past experience, special care went into the design of the questionnaire. The questionnaire was comprehensively pre-tested in the field before printing and use. The questionnaire was translated into major languages of the country (Urdu, and Sindhi).

1.4       Selection of Field Staff

Keeping in view the importance of the survey, special care was taken in the selection of staff for project management, supervision, quality control, data collection, data entry, analysis and report writing. The Director, NIPS being a qualified and experienced demographer, was designated as Project Director. A Senior Fellow of NIPS, having vast experience was identified as Principal Investigator. Another experienced Fellow of NIPS, was identified as Deputy-Principal Investigator. One qualified and experienced mid-level professional of NIPS was designated as Office Coordinator to assist the Project Director and Principal Investigator. Four mid-level professionals of NIPS, were identified as Provincial Coordinators.

A total of 21 teams were constituted for the field work in Pakistan. Each team had a male supervisor and 3 female interviewers.

All supervisors possessed at least Master degree, while all enumerators possessed at least Bachelor degree along with relevant language, domicile etc. Supervisors and Interviewers were recruited strictly on merit from local areas of the provinces. So field staff (supervisors and interviewers) included Punjabi, Sariaki, Sindhi, Urdu, Pushto, Hindko, Balochi and Brohi speaking languages. The Project Director and Principal Investigator personally conducted interviews of all supervisors and enumerators to ensure selection of best entry.

1.5       Training

A four-week each three training programmes were conducted, at Abottabad, Lahore, and Karachi for provincial field staff. All field coordinators, field supervisors and interviewers belonging to respective provinces, attended the training sessions. Staff members from NIPS, FBS and Regional Training Institutes of Population Welfare conducted the training sessions. The training was mainly conducted by the core staff involved in the survey. However, guest lecturers from FBS, Regional Training Institutes and Population Welfare Training Institute of the M/o of population Welfare, Sociology department of the Punjab University and individual experts also delivered lectures on various aspects of the survey. The field staff for Balochistan province, attended training at Karachi, while staff of Northern Areas and Azad Jammu and Kashmir attended training at Abottabad.

The training programme was conducted through lectures, discussions, role play and practice interviews in the field. All the questions in various sections of the questionnaire were discussed in detail and instructions were communicated when needed. The Executive Director and Director, NIPS personally monitored and visited training sessions at the three locations.

1.6       Data Collection

After the training was completed satisfactorily, the survey was conducted by 21 field teams between October 2000 and January 2001. Eight teams were deployed in Punjab, five in Sindh and four each in NWFP and Balochistan. Each survey team comprised of one male supervisor and three female interviewers. Female interviewers obtained information on household schedule and women questionnaire. Male supervisor was responsible for quality of data and also responsible for survey logistics. Provincial co-ordinator was responsible for management of the survey in the province.

1.7       Data Management and Analysis

All the completed questionnaires were sent to the National Institute of Population Studies, Islamabad for editing, data entry and processing. The Office Coordinator was responsible for receiving the questionnaires of each cluster in NIPS, organising the system of manual editing of the questionnaires and coordinating with the Programmer for data entry. Seven Editors were deployed to undertake technical editing of the questionnaires under the supervision of the Deputy Principal Investigator. The data entry and checking was programmed and supervised by the Programmer of NIPS, using UN-DESD programme PC-Edit (version 4.1). Four trained data entry operators carried out the job. Tabulation for this report was performed using SPSS version 7.5, and MS Access 97 was used for additional data checking and for computation of the fertility and child mortality rates.