DETERMINANTS OF HORMONAL AND NON-HORMONAL CONTRACEPTIVE USE AMONG WOMEN ATTENDING RHS-A CLINICS IN KARACHI
Authors: Mehnaz Khan Sadia, Yousuf Sheikh Imran
DOI: 10.5281/zenodo.17285232
Published: October 2025
Abstract
<p><em>Pakistan, the seventh most populous country in the world, faces significant demographic challenges due to rapid population growth and persistently high fertility rates. With an annual growth rate of 2.6% and a total fertility rate of 4.8, women in Pakistan on average give birth to five children over their reproductive lifetime. This growth is largely attributed to a youthful population structure, with approximately 56% of the population under the age of 25. A unique demographic concern in Pakistan is the inverse sex ratio, with 111 men for every 100 women, primarily driven by the high number of maternal deaths during pregnancy and childbirth. Maternal mortality remains critically high, ranging between 360 and 600 deaths per 100,000 live births, while about 15% of pregnancies result in complications that pose long- and short-term health consequences.</em></p> <p><em>High fertility has been consistently identified as a strong predictor of maternal mortality. The cycle of high fertility, maternal deaths, and adverse pregnancy outcomes perpetuates health inequities and undermines socio-economic progress. Evidence from demographic transition theory suggests that improvements in health and living conditions initially reduce mortality rates, followed by declines in fertility as the need for large families diminishes under better socio-economic circumstances. In Pakistan, however, this transition is slow, with declining infant and child mortality contributing only modestly to fertility reduction. Consequently, families continue to rely on larger family sizes as a buffer against child mortality, sustaining the high fertility trend.</em></p> <p><em>Addressing these interrelated challenges requires a multipronged approach that strengthens maternal health services, improves access to family planning, and invests in female education and empowerment. Efforts to lower fertility and improve reproductive health outcomes are essential not only to reduce maternal morbidity and mortality but also to promote sustainable population growth and socio-economic development in Pakistan</em></p>
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