Page 85 - GHES-3-1

Global Health Economics and
Sustainability
Impact of socio-demographics on MMR, TFR, & FP in Pakistan

A possible explanation for this disparity is that societies, education tends to be uniformly and inversely
health outcomes are closely linked with human capital related to fertility (Cochrane, 1986).
development. Human capital formation has become central In summary, the persistent inequities and gaps in
to contemporary policy discourse on inequities regarding human capital have serious implications for maternal
socioeconomic status, education, skill attainment, and and child health, fertility, and family planning. Three
health. The World Bank (2020) defines human capital as the factors – education level, demographic background (rural
“attainment of quality of life in terms of health, education, vs. urban), and socioeconomic status – play vital roles in
and skill development.” That is, human capital comprises shaping these outcomes. This paper argues that reductions
the knowledge, skills, and health individuals accumulate in maternal mortality and fertility and increases in
over their lifetime (World Bank, 2020). The Human Capital contraceptive prevalence rate (CPR), cannot be sustained
Index (HCI) is calculated based on health and education without structural reforms in education, social protection,
dimensions, including child and adult survival rates, and women empowerment. These factors are further
stunting, and expected years of schooling. The HCI ranges discussed in the following sections in relation to maternal
from 0 to 1: A child born today would score a value of 1 if health, fertility, and family planning uptake.
they fully benefit from health and education opportunities.
Meanwhile, a score of 0 represents the lowest level of 2. Status and disparities in maternal health,
human capital. fertility, and family planning
Comparing the HCI of several Asian, Middle Eastern, Historically, progress on indicators of maternal health,
and African countries reveals varying levels. Countries fertility trends, and family planning uptake in Pakistan
such as Pakistan, Afghanistan, Iraq, and Senegal score has been inconsistent, with periods of slow and rapid
between 0.4 and 0.42. In contrast, countries such as Sri advancements. However, overall progress remains
Lanka, Iran, Malaysia, Indonesia, and Saudi Arabia score disappointing, despite decades of investment by the public
between 0.54 and 0.6 (Figure 1). and private sectors and development partners. In the

Within Pakistan, a comparison between provinces, 1990s, Pakistan made notable strides in family planning
differentiated by gender and conducted by the World Bank, through key initiatives in the public and private sectors.
highlights disparities between the North and the South. These included the introduction of 100,000 lady health
The southern provinces of Sindh (ranging from 0.36 to workers at the grassroots level in the public sector and
0.35 for men and women) and Balochistan (ranging from social marketing and franchising efforts in the private
0.35 to 0.32 for men and women) show lower HCI scores sector. These interventions contributed to an increase in
than the northern provinces of Punjab (0.43 for men and CPR from 12% in 1991 to 28% within a decade in 2006 –
women) and Khyber Pakhtunkhwa (KP; from 0.45 to 0.35 2007 (NIPS, 2006). However, because these interventions
for men and women) (Figure 2). were not accompanied by sustained reforms in education,
A multivariate analysis of the literature indicates social protection, poverty reduction, or women’s
that educational attainment, socioeconomic status, and empowerment, the gains could not be maintained, despite
urban–rural characteristics correlate with maternal and some progress in these sectors. The following sections
provide an overview of trends in maternal mortality,
child health and family planning outcomes. A study fertility, and family planning.
conducted in India using data from five rounds of
national health surveys illustrates the differential impact 2.1. Maternal mortality
of maternal education on child mortality. Secondary
and higher education among mothers significantly Pakistan’s maternal mortality ratio (MMR) was reported
reduces the under-five mortality rate. Likewise, women to be 186/100,000 live births in 2019, with significant
with secondary education in urban areas have lower differences observed between provinces (NIPS, 2019;
under-five mortality rates compared with those in rural Figure 3).
areas (Moradhvaj & Samir, 2023). Furthermore, there As seen in Figure 3, variations in MMR are evident
is a correlation between increased poverty and adverse based on demographic characteristics. For instance, the
effects on child health (Arif, 2004). Therefore, education rural MMR was 199/100,000 live births, almost 21% higher
and urbanization have positive causal effects on fertility than the urban MMR (158/100,000 live births) in the year
and mortality. The evidence suggests that higher levels 2019. The rural MMR is higher due to factors such as poor
of parental education result in lowered child mortality. infrastructure, lack of human resources, limited mobility
Meanwhile, fertility rates decline once parents surpass of women accessing health care due to factors such as
the threshold of primary education. Notably, in urbanized the lacking transportation services, limited decision-

Volume 3 Issue 1 (2025) 77 https://doi.org/10.36922/ghes.2531