Adolescent Reproductive Health: The Role of Agency and Autonomy

The world is experiencing the largest cohort of adolescents in its history, and there are about 1 billion youngsters in this age group, most of whom belong to the developing countries. Worldwide, the adolescent age group is gaining prominence for researchers, policy-makers and donors. This issue is more important for Pakistan where about one-third of 150 million Pakistanis are in the age range of 10–24 years [Pakistan Census Organisation (2001)]. In Pakistan, the fertility transition has just begun [Sathar and Casterline (1998)], and we will have the largest cohort of young people in next five years. With a TFR of 4.1 which represents a significant decline in fertility in the past two decades for about two children [Pakistan (2003)], still we have a large population base. Nearly 33 percent of the population is aged 10–24, and ready to enter marriage and childbearing. Adolescents represents as a “bulge” in the population pyramid of Pakistan that will have serious implications at a variety of levels. Literature available on population and demographics, suggests that productive and reproductive actions of younger people will shape the size, health, and prosperity of the world’s future population. Despite rising trend in contraceptive use, rising age at marriage etc. the population will keep on increasing in absolute numbers, just due to the sheer pressure of the population momentum. Also the population moment our adolescent carry will offset the decline in population growth rates. The paper explores the linkages of such reproductive health outcomes as early marriage and contraceptive intention, desegregated by age, gender, socio-economic status, locality and province, and aims to provide essential information on predicting early marriage in Pakistan. Moreover the role of autonomy, agency and mobility will also be analysed to see if there if these factors play any role in determining the most important transition of a young person, that is marriage. It will also highlight the future demand for fertility control by analysing future intentions of Pakistani youth to use family planning. Results of this paper depict the socioeconomic and regional diversity in adolescents reproductive health across Pakistan and can be used to form youth policy and programmes in Pakistan.

Coming of Age in Contemporary Pakistan: Influences of Gender and Poverty

Economic development is strongly connected to the longevity, growth and structure of country’s population [Bloom and Canning (2003)]. Pakistan currently has the largest cohort of young people in its history (25 million aged 15–24, Census 1998) that has serious implications for the provision of schooling, health services and adequate jobs. Therefore the well being of these valuable young cohorts is profoundly important for the social and economic development and prosperity of Pakistan [Population Council (2003)]. This demographic lift can promote economic lift-off [Bloom and Canning (2003)]. In fact, Pakistan will face dire consequences if this resource is not capitalised and young people remain uneducated and unskilled [Faizunnisa and Ikram (2003)]. Work is one of the key transitions in the lives of young people. It is an important marker of adulthood, with strong implications for a country’s social and economic development. Work depending on its nature and remuneration can be the most important factor shaping adult lives. Youth employment has many implications for the labour market, poorer households and for the youth themselves. There has been relatively little or no opportunity to study the transition to adulthood in developing countries due to the lack of longitudinal data on youth. Most development research and programmes on adolescents and youth have focused on sexual and reproductive behaviour [Mensch and Greene (1998)]. However the participation of young people aged 15–24 in the labour force is emerging as an important development issue. Most of the studies, carried out on economic activities are primarily restricted to the empirical efforts to estimate the level of labour force participation. This is the area least explored in Pakistan and little is known regarding various dimensions of youth’s involvement in labour force including the determinants pushing them towards work. Increased attention has been directed at understanding the factors that encourage and/or discourage their involvement in work. Durrant (2000), analysed the Pakistan Integrated Household Surveys 1991 and PIHS 1995-96, that highlighted various opportunities and constraints towards

Adolescent Reproductive Health: The Role of Agency and Autonomy

The world is experiencing the largest cohort of adolescents in its history, and there are about 1 billion youngsters in this age group, most of whom belong to the developing countries. Worldwide, the adolescent age group is gaining prominence for researchers, policy-makers and donors. This issue is more important for Pakistan where about one-third of 150 million Pakistanis are in the age range of 10-24 years [Pakistan Census Organisation (2001)]. In Pakistan, the fertility transition has just begun [Sathar and Casterline (1998)], and we will have the largest cohort of young people in next five years. With a TFR of 4.1 which represents a significant decline in fertility in the past two decades for about two children [Pakistan (2003)], still we have a large population base. Nearly 33 percent of the population is aged 10-24, and ready to enter marriage and childbearing. Adolescents represents as a “bulge” in the population pyramid of Pakistan that will have serious implications at a variety of levels

Coming of Age in Contemporary Pakistan: Influences of Gender and Poverty

Economic development is strongly connected to the longevity, growth and structure of country’s population [Bloom and Canning (2003)]. Pakistan currently has the largest cohort of young people in its history (25 million aged 15-24, Census 1998) that has serious implications for the provision of schooling, health services and adequate jobs. Therefore the well being of these valuable young cohorts is profoundly important for the social and economic development and prosperity of Pakistan [Population Council (2003)]. This demographic lift can promote economic lift-off [Bloom and Canning (2003)]. In fact, Pakistan will face dire consequences if this resource is not capitalised and young people remain uneducated and unskilled [Faizunnisa and Ikram (2003)]. Work is one of the key transitions in the lives of young people. It is an important marker of adulthood, with strong implications for a country’s social and economic development. Work depending on its nature and remuneration can be the most important factor shaping adult lives. Youth employment has many implications for the labour market, poorer households and for the youth themselves

Discrimination starts at home: A brief on parents\u27 aspirations for adolescents and youth in Pakistan

Parents play a critical role in socializing their children and passing on essential information and life skills. The attitudes of parents help determine what young boys and girls do in life, and how they utilize opportunities and develop the skills necessary to make a comfortable transition into adulthood. This brief is based on interviews with Pakistani parents and describes their aspirations, which are likely to influence the lives of young people. More young people aged 15–24 live in Pakistan now than at any other time in its history—an estimated 36 million in 2004. Recognizing the dearth of information on the situation of this large group of young people, the Population Council undertook a nationally representative survey from October 2001 to March 2002. The analysis presented here comes from Adolescents and Youth in Pakistan 2001–02: A Nationally Representative Survey. The survey sought information from youth aged 15–24, responsible adults in the household, and other community members in 254 communities. A total of 6,585 households were visited and 8,074 young people were interviewed

Obstacles to contraceptive use in Pakistan: A study in Punjab

The principal aim of this study is to assess the strength in Pakistan of a set of hypothesized obstacles to practicing contraception. Our concern is those factors that prevent women from translating a desire to avoid becoming pregnant into contraceptive practice, a common predicament in Pakistan in recent decades. We analyze survey data collected in Punjab province in 1996 that contain unusually detailed measurement of various perceived costs of practicing contraception, as well as focused measurement of fertility motivation. The framework guiding the research specifies six major obstacles to contraceptive use: the strength of motivation to avoid pregnancy, awareness and knowledge of contraception, the social and cultural acceptability of contraception, perceptions of the husband’s preferences and attitudes, health concerns, and perceived access to services. For each of these, the survey data provide a block of measured indicators. Net effects of each obstacle are estimated through structural equation modeling of the intention to practice contraception in the near future (the two years subsequent to the survey) in which the six obstacles are treated as latent variables. The estimates indicate that the two principal obstacles to using a contraceptive are the woman’s perception that such behavior would conflict with her husband’s views (that is, his fertility preferences and his attitudes toward family planning) and her perception of the social or cultural unacceptability of contraception. Of lesser importance but also significant is the woman’s awareness and knowledge of contraception. The other three obstacles do not show statistically significant effects. The results confirm the value of taking contraceptive costs seriously, and, in particular, of attempting to measure these costs in empirical research on family planning. Punjabi women confront many obstacles to adopting and continuing to practice contraception, and policies and programs that overcome these obstacles should be developed

Bringing About a Behavioural Change in Providers to Meet the Reproductive Health Needs of Clients

The international conference on population and development held in Cairo in 1994 has became a historical turning point in the way population policies and programmes are perceived and sexual and reproductive health services are conceptualised and delivered. Inherent in the ICPD plan of action is the concept of care that recommends providing a range of reproductive health services to both men and women, that are safe and effective, and that satisfy clients, needs and wants. Clients are far more likely to use services that are of high quality. Achieving quality care requires complying with high technical and ethical standards (such as freedom of choice, informed consent, and freedom from coercion and abuse) and providing services at costs that are affordable to both clients and health care system. The most common barriers to quality are negative provider attitudes or behaviours, poor interactions between clients and providers, a lack of essential drugs and supplies in facilities, and delays in referrals to other necessary services

The power of girls\u27 schooling for young women\u27s empowerment and reproductive health

This report comprises evidence that increases our understanding of girls\u27 schooling in Pakistan. It is useful for policymakers, donors, civil society, program/intervention designers, evaluators, and researchers alike. The findings of this report should be used to guide points of influence and policies on girls\u27 education in Pakistan

Schooling opportunities for girls as a stimulus for fertility change in rural Pakistan

This paper tests Caldwell’s mass schooling hypothesis in the context of rural Pakistan. His hypothesis was that the onset of the fertility transition is closely linked to the achievement of “mass formal schooling” of boys and girls. Punjab and Northwest Frontier Province (NWFP) were selected for this study because they appear to be on the leading edge of the demographic transition-a transition that has only recently begun-as suggested by rapid recent increases in contraceptive practice. The study covered a range of rural villages or communities with very different socioeconomic and schooling conditions in order to examine the effects of both school access and quality on family-building behavior in Pakistan. The study concludes that gender equity in the schooling environment, as measured by the number of public primary schools for girls in the community or by the ratio of the number of girls’ schools to boys’ schools, has a statistically significant effect on the probability that a woman will express a desire to stop childbearing and, by extension, on the probability that she will operationalize those desires by practicing contraception. Indeed, the achievement of gender equity in primary school access in rural Punjab and NWFP could lead to a 14-15 percentage point rise in contraceptive use in villages where no girls’ public primary school currently exists and an 8 percentage point rise in villages with one primary school for girls. This is entirely supportive of the Caldwell argument that mass schooling is an important determinant of fertility change, particularly when girls are included. It would appear that fertility change will be much more difficult and will come much more slowly when girls are left behind

Effect of dai training on maternal and neonatal care: An operations research study

This study examines the use of training traditional birth attendants, or dais as they are known in Pakistan, to reduce maternal mortality. By training dais to adopt safer routine delivery, newborn care practices, and recognize and refer in case of emergencies, dais can improve maternal and neonatal health. While one group of women met with specially trained dais who received Safe Motherhood Applied Research Training (SMART), a control group met with dais who offered health services only. The objectives of this evaluation were to determine whether dais substantially improved their performance after attending the SMART dai training course, to determine their knowledge, attitude and behavior regarding maternal and neonatal health, to assess the skills regarding maternal and neonatal health, and to determine the perceptions of clients regarding practices and behavior of dais who served them. Findings from this study concluded that SMART dai training was sufficiently effective to result in changes and knowledge and behavior in many aspects of maternal and neonatal care, but the testing of the SMART dai approach is needed in other settings