Pakistan 2017-18 Pakistan - Demographic And Health Surveys

Pakistan 2017-18Pakistan2017-18Demographic and Health SurveyDemographic andHealth Survey

PAKISTANDEMOGRAPHIC AND HEALTH SURVEY2017-18National Institute of Population StudiesIslamabad, PakistanThe DHS ProgramICFRockville, Maryland, USAJanuary 2019

The 2017-18 Pakistan Demographic and Health Survey (2017-18 PDHS) was implemented by the NationalInstitute of Population Studies (NIPS) under the aegis of the Ministry of National Health Services, Regulationsand Coordination, Islamabad, Pakistan. ICF provided technical assistance through The DHS Program, a projectfunded by the United States Agency for International Development (USAID) that provides support and technicalassistance in the implementation of population and health surveys in countries worldwide. Support for the surveywas also provided by the Department for International Development (DFID) and the United Nations PopulationFund (UNFPA).Additional information about the 2017-18 PDHS may be obtained from the National Institute of PopulationStudies, Ministry of National Health Services, Regulations and Coordination, National Institute of Health (NIH),Park Road, Chak Shahzad, Islamabad, Pakistan; telephone: 92-51-9255937; fax: 92-51-9255932; internet:www.nips.org.pk.Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD20850, USA; telephone: 1-301-407-6500; fax: 1-301-407-6501; email: info@DHSprogram.com; internet:www.DHSprogram.com.Cover photo: “Blue Hour at Pakistan Monument” 2016 by Muhammad Ashar [CC BY-SA 4.0], fromWikimedia CommonsISBN: 978-969-9732-04-1Suggested citation:National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. Pakistan Demographic and HealthSurvey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF.

CONTENTSTABLES AND FIGURES . ixFOREWORD .xviiACKNOWLEDGEMENTS . xix2017-18 PAKISTAN DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL ADVISORYCOMMITTEE . xxiCONTRIBUTORS TO THE REPORT . xxiiiACRONYMS AND ABBREVIATIONS . xxvREADING AND UNDERSTANDING TABLES FROM THE 2017-18 PAKISTANDEMOGRAPHIC AND HEALTH SURVEY (PDHS) . xxixSUSTAINABLE DEVELOPMENT GOALS INDICATORS .xxxviiMAP OF PAKISTAN . xxxviii1INTRODUCTION AND SURVEY METHODOLOGY . 11.1Survey Objectives . 11.2Sample Design . 21.3Questionnaires . 31.4Anthropometry . 41.5Pretest . 41.6Training of Field Staff . 41.7Fieldwork. 51.8Data Processing . 61.9Response Rates . 62HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 92.1Drinking Water Sources and Treatment . 92.2Sanitation . 102.3Exposure to Smoke inside the Home . 112.3.1 Other Housing Characteristics . 112.4Household Wealth . 112.4.1 Household Durable Goods . 112.5Hand washing . 122.6Household Population and Composition . 122.7Children’s Living Arrangements and Parental Survival . 132.8Birth Registration . 142.8.1 Registration with NADRA . 152.9Education . 152.9.1 Educational Attainment . 152.9.2 School Attendance . 163CHARACTERISTICS OF RESPONDENTS . 333.1Basic Characteristics of Survey Respondents. 333.2Education and Literacy . 343.3Mass Media Exposure . 353.4Employment . 363.5Occupation. 363.6Health Insurance Coverage and Safety Net . 373.7Tobacco Use . 383.8Knowledge Concerning Tuberculosis. 383.9Knowledge Concerning Hepatitis . 38Contents iii

4MARRIAGE AND SEXUAL ACTIVITY . 674.1Marital Status. 674.2Polygyny . 684.3Age at First Marriage. 694.4Consanguinity . 694.5Age at First Sexual Intercourse . 704.6Recent Sexual Activity . 715FERTILITY . 835.1Current Fertility . 845.2Children Ever Born and Living . 855.3Birth Intervals . 865.4Insusceptibility to Pregnancy. 865.5Age at First Birth . 885.6Teenage Childbearing . 886FERTILITY PREFERENCES. 1016.1Desire for Another Child . 1016.2Ideal Family Size . 1036.3Fertility Planning Status . 1046.4Wanted Fertility Rates . 1047FAMILY PLANNING . 1137.1Contraceptive Knowledge and Use . 1147.2Source of Modern Contraceptive Methods . 1167.3Informed Choice . 1177.4Discontinuation of Contraceptives . 1177.5Demand for Family Planning . 1187.5.1 Decision Making about Family Planning. 1207.5.2 Future Use of Contraception . 1207.5.3 Exposure to Family Planning Messages in the Media . 1207.6Contact of Nonusers with Family Planning Providers. 1217.7Postpartum Counselling on Family Planning . 1227.8Men’s Attitude towards Contraceptive Use . 1228INFANT AND CHILD MORTALITY . 1458.1Infant and Child Mortality . 1468.2Biodemographic and Sociodemographic Risk Factors . 1468.3Perinatal Mortality . 1488.4High-Risk Fertility Behaviour . 1499MATERNAL HEALTH CARE . 1559.1Antenatal Care Coverage and Content . 1569.1.1 Skilled Providers . 1569.1.2 Timing and Number of ANC Visits . 1579.2Components of ANC Visits . 1579.3Protection against Neonatal Tetanus . 1589.4Delivery Services. 1589.4.1 Institutional Deliveries . 1589.4.2 Skilled Assistance during Delivery . 1609.4.3 Delivery by Caesarean Section . 1619.5Postnatal Care . 1629.5.1 Postnatal Health Check for Mothers . 1629.5.2 Postnatal Health Check for Newborns . 163iv Contents

9.69.5.3 Newborn Care Practices . 1639.5.4 Pregnancy Outcomes . 164Problems in Accessing Health Care . 16410CHILD HEALTH. 18310.1Birth Weight . 18410.2Vaccination of Children. 18410.3Symptoms of Acute Respiratory Infection . 18710.4Fever . 18810.5Diarrhoeal Disease. 18910.5.1 Prevalence of Diarrhoea and Treatment-seeking Behaviour. 18910.5.2 Feeding Practices . 19010.5.3 Treatment of Diarrhoea . 19010.5.4 Knowledge of ORS Packets . 19210.6Treatment of Childhood Illness . 19210.7Disposal of Children’s Stools . 19211NUTRITION OF CHILDREN AND WOMEN . 20911.1Nutritional Status of Children. 20911.1.1 Measurement of Nutritional Status among Young Children . 21011.1.2 Data Collection . 21111.1.3 Malnutrition Prevalence in Children . 21111.2Infant and Young Child Feeding Practices . 21211.2.1 Initiation of Breastfeeding . 21311.2.2 Exclusive Breastfeeding. 21311.2.3 Reasons for Not Breastfeeding or Stopping Breastfeeding . 21511.2.4 Median Duration of Breastfeeding . 21511.2.5 Complementary Feeding . 21511.2.6 Minimum Acceptable Diet . 21611.3Micronutrient Intake and Supplementation among Children. 21711.4Nutritional Status of Women . 21811.5Micronutrient Supplementation And Deworming During Pregnancy . 21912MALARIA . 23312.1Ownership of Insecticide-treated Nets. 23412.2Household Access to and Use of ITNs . 23512.3Use of ITNs by Children and Pregnant Women . 23612.4Use of Antimalarial Drugs . 23613HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 24513.1HIV/AIDS Knowledge, Transmission, and Prevention Methods . 24613.2Knowledge about Mother-to-Child Transmission . 24713.3Discriminatory Attitudes towards People Living with HIV . 24813.4Coverage of HIV Testing Services . 24813.4.1 Awareness of HIV Testing Services and Experience with HIV Testing . 24913.5Self-reporting of Sexually Transmitted Infections . 24913.6HIV/AIDS-related Knowledge and Behaviour among Young People . 24913.6.1 Knowledge . 24913.6.2 First Sex . 25013.6.3 Coverage of HIV Testing Services . 25013.7Knowledge of Treatment of HIV . 250Contents v

14DISABILITY . 26314.1Disability by Domain and Age . 26314.2Disability among Adults by Other Background Characteristics . 26415WOMEN’S EMPOWERMENT . 26915.1Married Women’s and Men’s Employment . 27015.2Control over Women’s Earnings . 27015.3Control over Men’s Earnings . 27115.4Women’s Control over Their Own Earnings and Those of Their Husbands . 27215.5Women’s and Men’s Ownership of Assets . 27215.6Ownership of Title or Deed for House and Land . 27315.7Ownership and Use of Bank Accounts and Mobile Phones . 27315.8Women’s Participation in Decision Making . 27415.9Attitudes toward Wife Beating . 27515.10 Attitude towards Negotiating Safer Sexual Relations with Husband . 27615.11 Ability to Negotiate Sexual Relations with Husband . 27715.12 Women’s Empowerment Indicators . 27815.13 Current Use of Contraception by Women’s Empowerment . 27815.14 Ideal Number of Children and Unmet Need for Family Planning by Women’sEmpowerment. 27815.15 Reproductive Health Care by Women’s Empowerment . 27915.16 Early Childhood Mortality and Women’s Empowerment . 27915DOMESTIC VIOLENCE . 30316.1Measurement of Violence . 30416.2Women’s Experience of Physical Violence . 30416.2.1 Perpetrators of Physical Violence . 30516.3Experience of Sexual Violence . 30516.3.1 Prevalence of Sexual Violence . 30616.3.2 Perpetrators of Sexual Violence . 30616.4Experience of Different Forms of Violence . 30616.5Marital Control by Husband . 30616.6Forms of Spousal Violence. 30716.6.1 Prevalence of Spousal Violence . 30716.6.2 Onset of Spousal Violence . 31016.7Injuries to Women due to Spousal Violence . 31016.8Response to Violence . 31016.8.1 Help Seeking among Women Who Have Experienced Violence . 31016.8.2 Sources for Help . 31116.8.3 Reasons for Seeking Help . 31116.8.4 Reasons for Not Seeking Help . 31117MIGRATION . 32717.1In-migration and Immigration . 32817.1.1 Incidence of In-migration and Immigration . 32817.1.2 Duration of Continuous Residence . 32917.1.3 Most Recent Place of Residence Prior to Current Residence . 32917.1.4 Direction of In-migration . 32917.1.5 Reasons for In-migration . 33117.2Out-migration . 33217.2.1 Out-migration within Pakistan . 33217.2.2 Direction of Movement among Out-migrants . 33317.2.3 Reasons for Out-migration within Pakistan . 334vi Contents

17.317.4Emigration . 334Remittances . 335REFERENCES . 345APPENDIX AA.1A.2A.3A.4SAMPLE DESIGN . 347Introduction . 347Sample Frame . 347Sample Design and Implementation . 348Sample Probabilities and Sampling Weights . 352APPENDIX B ESTIMATES OF SAMPLING ERRORS . 355APPENDIX C DATA QUALITY TABLES . 381APPENDIX D ACCESS TO SERVICES IN RURAL COMMUNITIES . 397APPENDIX E PERSONS INVOLVED IN THE 2017-18 PDHS. 401APPENDIX F QUESTIONNAIRES . 405Household . 407Woman's . 429Man's . 493Biomarker. 515Community. 521Fieldworker . 531Contents vii

TABLES AND FIGURES1INTRODUCTION AND SURVEY METHODOLOGY . 1Table 1.1Results of the household and individual interviews . 72HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9Table 2.1Household drinking water . 18Table 2.2Availability of water . 19Table 2.3Household sanitation facilities . 19Table 2.4Household characteristics. 20Table 2.5Household possessions . 21Table 2.6Wealth quintiles . 22Table 2.7Handwashing. 23Table 2.8Household population by age, sex, and residence . 24Table 2.9Household composition. 25Table 2.10Children’s living arrangements and orphanhood . 26Table 2.11Birth registration of children under age 5 . 27Table 2.12Registration with NADRA . 28Table 2.13.1Educational attainment of the female household population . 29Table 2.13.2Educational attainment of the male household population . 30Table 2.14School attendance ratios. 31Table 2.15Reasons for children dropping out of school . 32Figure 2.1Figure 2.2Figure 2.3Figure 2.4Figure 2.5Figure 2.63Household drinking water by residence . 10Household toilet facilities by residence . 10Household wealth by residence .

Cover photo"Blue Hour at Pakistan : Monument" 2016 by Muhammad Ashar [CC BY-SA 4.0], from Wikimedia Commons ISBN: 978-969-9732-04-1 Suggested citation: National Institute of Population Studies (NIPS) [Pakistan] and ICF. 2019. Pakistan Demographic and Health Survey 2017-18. Islamabad, Pakistan, and Rockville, Maryland, USA: NIPS and ICF.