Fertility patterns in Pakistan: a comparative analysis of family planning trends across different geographic regions

<bold>Introduction</bold>:<bold> </bold>Family planning includes a wide range of services, such as counseling, contraception, and support to couples. Evidence shows that developing countries have a high degree of inequality in contraception use and prevalence. Reasons for these inequalities include cultural barriers such as traditional preferences and a desire for larger families and lineage, especially in rural areas. The primary objective of this research was to examine the updated contraceptive method preferences of couples in rural and urban regions of Pakistan and how these translate to family planning practices among the different provinces.<br /> <bold>Methods</bold>: A secondary survey analysis using the Pakistan Demographic and Health Survey 2019 survey data was conducted. The dataset included 15 143 women sampled proportionally from the provinces, including Gilgit Baltistan and Azad Jammu and Kashmir. The unit of analysis was 'women' from the individual survey dataset. Age, type of residence (rural, urban), division, education level, and language were used to evaluate access to family planning and contraception services. The c(2) test assessed the relationship between dependent and independent variables. Multivariate logistic regression analysis was then performed to see the likelihood of contraceptive use among women.<br /> <bold>Results</bold>: Of the women in the sample, 55% were from rural areas and 50% were without formal education; 51.7% of these women were using or practicing any form of contraception method. The most common method used was condoms (9.2%), followed by injectables (6.2%). Regression analysis showed that women aged 15-19 years were less likely (odds ratio (OR)=0.71, 95% confidence interval (CI)=0.51-1.01) to use contraception when compared to the reference group. The likelihood of contraceptive use was higher in urban areas (OR=1.53, 95%Cl=1.39-1.69). Noticeably, contraceptive use was less likely in uneducated women (OR=0.62, 95%Cl=0.56-070). Punjab province had the highest contraceptive prevalence (34.3%), whereas Baluchistan had the lowest (6.9%). The use of contraception in urban and rural populations was similar in all provinces except Sindh and Gilgit Baltistan. In urban and rural areas, women in the age group 30-35 years who use contraception show a prevalence of 21% and 22% respectively.<br /> <bold>Conclusion</bold>: The study highlights suboptimal use of contraceptives and the existence of high levels of inequalities among the regions. There is a need for the implementation of focused educational initiatives and counseling interventions along with prioritization of accessibility and affordability of contraceptive methods among women in lower socioeconomic regions.