Fertility and family planning trends in Karachi, Pakistan

Context: In Pakistan, total fertility rates are high, contraceptive prevale nce is low and there is widespread disagreement over whether fertility has begun to decline. It is likely that any drop in births in Pakistan will be seen initially among urban, middle-class women. Methods: A cross-sectional survey of 3,301 households in urban Karachi coll ected information on the reproductive history and family planning knowledge and practices of 2,651 ever-married women aged 54 or younger. Birth-cohort analysis was used to identify time trends in fertility and use of modern c ontraceptives. Results: Respondents had more education and higher socioeconomic status tha n the national average. Their total fertility rate was 3.0 lifetime births per woman, the general fertility rate was 98.3 births per 1,000 women aged 15-49 and the crude birthrate was 23.2 births per 1,000 population. As rece ntly as 1976, the TFR among the sample population had been 5.7 births per w oman. Forty-two percent of married women aged 15-49 currently used a modern contraceptive method. Among women born in 1950-1954, 64% had ever used con traceptives, compared with 37% of women born in 1940-1944. The most commonl y used contraceptive method among current users was the condom (40%), follo wed by tubal ligation (27%) and the IUD (12%). Overall, 53% of users obtain ed their method at pharmacies or markets, and 24% used private hospitals or clinics. Some 71% of currently married, nonpregnant respondents reported h aving achieved their desired family size. Conclusions: Among a relatively well-educated middle-class population in ur ban Karachi, there is a strong trend toward declining fertility and increas ing utilization of contraceptives. However, considerable unmet need for fam ily planning is still evident.