Chapter 6

FERTILITY PREFERENCES, UNMET NEED AND REASONS

FOR NON-USE

While Chapters 4 and 5 examined some of the socio-economic and service-related determinants of fertility and contraceptive use, it is also important to consider factors which relate more closely to contraceptive decisions. There may be socio-economic reasons for these decisions, and clearly the availability of family planning services is crucial, but it is worth considering also the number of children a woman wants to have, both overall and taking into account the number of children she already has.

This chapter analyses fertility desires, reasons for non-use of contraceptives and unmet need for family planning.

6.1       Desire for More Children

When planning how to increase use of contraceptives in a population it is important to remember that a significant proportion of that population will not want to use family planning under any circumstances because they wish to have another child without delay. The relationship between provision of family planning services and use of contraception is a complex one. It is often claimed that for a rural population, not exposed to health or family planning services, desire to use contraceptives is inevitably low due to lack of awareness of their benefits or even existence. Hence, as family planning services expand their outreach, it is likely that they will also have some negative impact on the desire for children by spreading awareness of the means to limit family size through the population.

The figures in table 6.1 show the percentage of currently married women in the PRHFPS who want no more children according to a number of background characteristics such as education, age, number of living children, urban/rural residence and province. It should be noted that couples who are sterilized are automatically classified as wanting no more children. Desire for more children is strongly associated with age and number of living children. About 43 percent of the women with 3 living children want another child, but only 14 percent of those with 5 children want to continue childbearing. Since age and parity are highly correlated, much the same pattern is observed with age. About 60 percent of 25-29 year olds still want another child, but this figure drops to 21 percent for the 35-39 year olds.

Table 6.1

 

Percent Distribution of Desire for More Children, Among Currently Married

Women, by Background Characteristics

 

^* Including any current pregnancy

Looking at the proportion of women wanting no more children, we see a clear divide between urban and rural populations. The desire for more children does not vary much between provinces, but there is a clear differential in the proportion of women who do want to stop childbearing. The difference between the two is explained by different proportions of women with a fatalistic attitude. This is particularly strong in Balochistan, where nearly 16.4 percent of currently married women indicated that their attitude to whether or not to have another child is ‘Up to God’. Apart from the women with a fatalistic approach to childbearing, most women stated a clear preference whether or not to have another child with only 1.1 percent being undecided.

 

6.2       Unmet Need

Table 6.2 shows the extent to which the desire to limit family size has changed over time, by comparison with data collected in the PDHS, PCPS, PFFPS and PRHFPS.

Table 6.2

 

Trends in the Percentages of Currently Married Women who Want no

More Children by Number of Living Children

 

 

 

The PCPS, 1994-95 survey has tended to report higher levels of desire for no more children than the PCPS 1984-85, PDHS 1990-91, PFFPS 1996-97 or PRHFPS 2000-01. These differences may be due to differences in question wording, and make it difficult to decide whether attitudes are changing. However, there is an increase between the PCPS 1984-85, and from the PDHS 1990-91 to PRHFPS 2000-01, and so it seems reasonable to argue that the proportion of women wanting no more children is increasing. When comparing the change in fertility preference since the early 1990s, it is clear that, among women with two living children, there is no rise in the proportion wanting to stop. From family size of three children onwards, the desire to stop childbearing has shown increase over the last ten years.

The next set of data examines differences in contraceptive use, according to whether or not a woman wants any more children and the desired timing of the next child (table 6.3). This gives an indication of unmet need and also allows us to consider the extent to which family planning is being used for spacing purposes. The Pakistan family planning programme has traditionally been oriented towards an emphasis on family limitation over birth spacing. Recent programme policy changes are trying to encourage women to use family planning to improve maternal health by increasing the interval between two births. Where women express a desire to have more children but are current users of contraception, there is an indication that they are using family planning to space their births.

Table 6.3

Percentage of Currently Married Women With Unmet Need, Met Need and

Total Demand for Family Planning Services, by Selected

Background Characteristics

 

 

Table 6.3 is based on all currently married women. Women are classified as having a need for family planning if they have expressed a desire to have no more children (they wish to limit their family size) or if they wish to delay their next child for two years or more (a need for birth spacing). If they are current users of contraception they are considered to have a met need for family planning; otherwise they have an unmet need. Thus of all 6370 currently married women in the sample, 20.9 percent have expressed a desire for no more children and are current users of contraception, 6.7 percent want to delay the next birth and are currently using some method. Thus, for 27.6 percent of the currently married women need for contraception is met (they are current users and do not want another child immediately). From amongst the all currently married women, 33.0 percent do not want another child immediately or any time in the future but are not using a method indicating magnitude of an unmet need for family planning. Among these, 20.9 percent would require for limiting and 12.1 percent for spacing. In total, 60.6 percent of the currently married women have a demand for family planning, and of these 27.6 percent are current users, so their need is satisfied. Even among the 20-24 year olds the total demand for family planning is about 45 percent and this rises to 77 percent for women 40-44 year old. At lower parities (1-2 children) and younger ages the demand for spacing is higher compared to limiting, but with higher parities (3 or more children) or from age 35-39, women predominantly want to limit rather than space childbirth. The demand for limiting as well as spacing is higher among urban women. Although demand for child spacing methods is similar across the provinces, less than one-third (29 percent) of Balochi women want to limit their families, whereas 44 percent of Punjabi women want to stop childbearing. The demand for family planning increases with educational level but the correlation of met need for family planning with education is even stronger. This indicates both a smaller family norm among the better educated and a greater ability to act on fertility preferences.

6.3    Reasons for Non–use

Table 6.4 shows the main reasons for non-use given by respondents who have never used any method, with the urban-rural and provincial differentials. Wanting more children was the main reason given for non-use, cited by about 41 percent women who had never used a method. These include women who have no children or they are recently married (18 percent) and those who have not yet completed their desired family size (23 percent). The other most important reasons for never-use mentioned were natural spacing (15.6 percent), husband/other opposed (9 percent) and religion (7 percent). Religious reason is more prominent after desire for more children among Balochi women. Husbands opposition is more prominent among urban women compared to rural women. In smaller provinces and rural areas non availability of family planning facility has also been noted a visible reason which need attention.

Table 6.4

 

Percent Distribution of Currently Married Never-Users According to Reason for

Non-use of Family Planning, by Residence and Province