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3 H EALTH STATUS AND DEMOGRAPHICS
3.1 Health Status Indicators
Table 3-1 Indicators of Health status
Indicators 1990 1995 2000 2002
Life Expectancy at Birth: 59.10 60.88 62.96 65
HALE: - - 50.9 53. Infant Mortality Rate: 96 90 81 76 Probability of dying before 5P^ thP birthday/1000:
Maternal Mortality Ratio: 550 - - 340-
Percent Normal birth weight babies: 75 75 66-75 66- Prevalence of stunting/wasting: 51 (88) 23* - 61.
Source: DG report 2002- State of world’s children 1990 World health report 2003- Background country papers *National health survey of Pakistan 1990-
Table 3-2 Indicators of Health status by Gender and by urban rural
Indicators Urban Rural Male Female
Life Expectancy at Birth: - - 64 66
HALE: - - 54.2 52. Infant Mortality Rate: 65 88 84 81 Probability of dying before 5th birthday/1000:
Maternal Mortality Ratio: 55-150 200-500 - - Percent Normal birth weight babies: - - - - Prevalence of stunting/wasting: - - - -
Source: PIHS 2001- PDS 2001 WHO World Health report 2003
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Table 3-3 Top 10 causes of Mortality/Morbidity
Source: 1. Adnan A. Hyder, Applying Burden of Disease Methods in Developing Countries: A Case Study From Pakistan, American Journal of Public Health, August 2000, vol 90. N0. 80
- Top 10 Causes (by Rank Order) of Premature Mortality and Disability in Pakistan, 1990, www.worldbank.org/transport/forum2003/presentations/hyder.ppt
The current health status of the nation is characterized by a high population growth rate, high incidence of low birth-weight babies and maternal mortality. While communicable, infectious, and parasitic diseases remain a severe burden, malaria and tuberculosis (TB) continue to be potential threats. People in Pakistan have grown healthier over the past three decades: the rates of immunization of most groups of children have more than doubled over the past decade, and knowledge of family planning has increased remarkably and is almost universal. Pakistan’s per capita income is much higher than the average for low-income countries. Yet, despite these positive aspects and government- and donor-financed interventions, health indicators have been improving very slowly.
Communicable diseases such as diarrheal diseases, respiratory infections, tuberculosis, and immunizable childhood disease still account for the major portion of sickness and death in Pakistan. Maternal health problems are also widespread, complicated in part by frequent births. In fact, Pakistan lags far behind most developing countries in women’s health and gender equity: of every 38 women who give birth, 1 dies. The infant mortality rate (76 per 1,000) and the mortality rate for children under age five (101 per 1,000 births) exceed the averages for low-income countries. Although use of contraceptives has increased, fertility remains high, at 4.5 births per woman, and population growth rates are much higher than elsewhere in South Asia. The underlying problems that affect health—-poverty, illiteracy, women’s low status, inadequate water supplies and sanitation—persist. Nevertheless, Pakistan is committed to the goal of making its population healthier, as evidenced by the National Health Policy.
Although, consolidated public health expenditure rose during 1995-96 to 2000-01, it represents 0.60 percent of the GDP. Additionally, a major share of these expenditures is focused towards tertiary health care facility with the result that primary and secondary tiers especially in rural areas have been neglected. In addition, serious institutional and governance deficiencies mar the health sector. The other challenges facing the health system are access (availability and affordability), unawareness, and inadequate budgetary spending. Analysis of the burden of disease (BOD) conducted in 1996
Rank Mortality Morbidity/Disability
- Diarrhea Hypertension
- LTRI-Child Injuries
- Tuberculosis Eye diseases
- Rheumatic heart disease Malnutrition
- Chronic liver disease Birth diseases
- Congenital malformations Congenital malformations
- Birth diseases Dental diseases
- Ischemic heart disease Ischemic heart disease
- Child septicemia Anemia (in females)
- Other respiratory diseases Mental retardation
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Religions: HMuslimH 97% (HSunniH 77%, HShiiteH 20%), HBuddhistH , HChristianH, HHinduH , and other 3%
Languages: As a first language, Pakistanis speak: Punjabi 48%, Pashtu 15%, Sindhi 12%, HTUSiraikiUTH (a Punjabi variant) 10%, Urdu (official) 8%, Balochi 3%, Hindko 2%, Brahui 1%, English (official and lingua franca of Pakistani elite and most government ministries), Burushaski, and others 1%. The majority of Pakistanis can speak or understand two or more languages.TP^5 PT
The health and population characteristics of Pakistan are high fertility, low life expectancy, a young age structure, high maternal and child mortality, high incidence of infectious and communicable diseases, and wide prevalence of malnutrition among children and women. The country is going under a demographic transition, characterized by a change from high mortality and high fertility to lower mortality but still relatively high fertility.T P^6 PT
Fertility Transition: Unlike its neighbors- Sri Lanka, India, and Bangladesh- Pakistan has confounded demographers by maintaining a high rate of fertility. However, the transition to lower fertility in Pakistan, which had been expected as early as the 1960s, has begun in the 1990s, according to Population Council researchers. The decline, though moderate, is definitive. Several studies confirm that between the 1960s and the 1980s, the total fertility rate (TFR) in Pakistan remained above six births per woman. “Pakistan has been a puzzle, a stalwart resister to fertility transition,” comments Casterline. Beginning in the 1990s, however, the fertility rate dipped below six births per woman for the first time. Among other surveys, the Pakistan Fertility and Family Planning Survey (1996–97) found a TFR of 5.3 for the period 1992–96. The researchers note that all the demographic analyses they examined point to a fertility decline in the 1990s. Some of the most persuasive evidence for a fertility decline comes from trends in contraceptive use. During the 1980s, fewer than 10 percent of married women in Pakistan practiced contraception. By 1991 that figure had risen to 12 percent, and by 1995 to 18 percent. As of the most recent survey, conducted in 1996 and 1997, about 24 percent of married women were using contraception. Women in urban areas were about twice as likely as women in rural areas to use contraception. Demographic trends throughout the world show that when mortality declines and social and economic conditions improve, fertility decline follows, often with only a short lag. This has not been true in Pakistan, where improvements in these conditions first appeared in the 1950s. Several other factors conspired to thwart any reduction in fertility. Women's status remains unusually low in Pakistan, and men make many of the decisions about reproduction. A strong economy in the 1960s through the 1980s gave families little motivation to restrict fertility. Until the end of the 1980s, people viewed the social, psychological, and cultural costs of contraceptive use as higher than the cost of additional births.
Pakistan’s economy has turned sharply downward in the 1990s, while the spread of mass media has helped to raise the aspirations of parents for the lives of their children. Together these trends have led to a growing conviction that children are costly. At the same time, there has been a cultural shift during the 1990s from the bonds of extended family to the autonomy of the couple. In the past, kin had a voice in fertility decisions. But many couples have migrated from rural to urban areas, weakening these family ties. Reflecting these societal changes, the ideal family size has shrunk during the 1990s, from 4.1 children in 1991 to 3.6 children in 1995.
“The most important reason that the transition is happening now rather than earlier is a sense of economic stress that did not exist before. Sathar and Casterline believe that
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public and private family planning services have not played a large role in stimulating the fertility changes in the 1990s. Family planning services in Pakistan remain seriously deficient, with one study finding that only 10 percent of the population had easy access to the services. To sustain the fertility transition in Pakistan, family planning services— especially those in rural areas—should be expanded and improved as rapidly as possible. Unmet need for contraception remains relatively high, and many couples desire appropriately designed services. “The potential payoff of investing in and improving family planning services is greater now than ever before,” stresses Sathar. “Without expanded and improved services, we do not believe the transition will go far or proceed rapidly.” Over the long run, however, the demand for children must fall further for population growth to wane significantly in Pakistan. Ideal family size, while lower than in past decades, remains well above replacement levels. TP^7 PT
Table 3-4 Demographic indicators
Indicators 1990 1995 2000 2002
Birth Rate per 1,000 Population: (^41 37 34) 27.
Death Rate per 1,000 Population: (^13 10 8) 7.
Population Growth Rate: (^) 2.54 2.46 2.2 2.
Dependency Ratio %: 0.85 0.87 0.82 0.
% Population <15 years 41.99 42.62 41.70 40.
Total Fertility Rate: 5.84 5.20 4.68 4.
Source: Pakistan demographic survey 2001, Federal Bureau of Statistics Stat-Pocket-Book 2003, Federal Bureau of Statistics NIPS
Table 3-5 Demographic indicators by Gender and Urban rural
Indicators Urban Rural Male Female
Crude Birth Rate: - - - -
Crude Death Rate: 6.3 7.6 7.4 6.
Population Growth Rate: - - - -
Dependency Ratio: - - 31.84 30.
% Population <15 years - - 29.2 27.
Total Fertility Rate: - - - -
Source: Pakistan Demographic Survey 2001 World health report 2003
