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POPULATION WELFARE

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5 Population Welfare

Introduction
Population welfare plays a vital role in enhancing the health, well -being, and socio - economic progress of a nation. It focuses on empowering individuals and couples to make informed decisions about family size, reproductive health, and responsible parenthood through access to education, healthcare, and family planning services. In 2025, Pakistan’s federal go vernment updated its National Action Plan on Population (2025–30), which serves as the current national framework for family planning and reproductive health. The plan aims to reduce the population growth rate to 1.1%, lower the total fertility rate
to 2.2, and raise the contraceptive prevalence rate to 60% by 2030. It emphasizes informed family planning choices, improved service delivery, and integration of population goals into socio - economic development. Implemented under the Ministry of National Health Services, Regulations & Coordination (MoNHSR&C) in collaboration with provincial departments and partners such as UNFPA and FP2030, the plan focuses on strengthening supply chains, mobilizing resources, and enhancing coordination between federal and provincial levels. While there is no standalone “National Family Planning Programme,” these initiatives collectively represent Pakistan’s renewed national commitment to family planning and population management. Despite these continued efforts, high fertility ra tes and low contraceptive prevalence
remain significant challenges. Cultural barriers, gender disparities, and misconceptions about family planning continue to limit progress. The Government of Pakistan, with the support of

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development partners, is focusin g on integrated population and health strategies to accelerate progress toward population stabilization.
In alignment with the Sustainable Development Goals (SDG 3.7 and SDG 5.6), Pakistan remains committed to ensuring universal access to reproductive health and family planning services by 2030. Strengthened provincial capacity, improved service delivery, and sustained advocacy are key to achieving the national objective of balanced population growth and sustainable development. This chapter presents analysis on major indicators of population welfare, including Total Fertility Rate (TFR), Contraceptive Prevalence Rate (CPR), Marital patterns, Family planning patterns currently used and the number of children ever born to women. These indicators provide valuable insights into reproductive behaviour, family planning trends, and the overall demographic transition in the country. Marriage Patterns & Fertility

Marriage patterns are an important indicator of demographic behaviour and have direct implications for fertility, family formation, and population growth. Table 1 & Figure 5.1
presents the percentage of women aged 15–49 years who have ever been married, by province, age category, and place of residence, comparing the results of 2024–25 with those of 2018–19. At the national level, 67 percent of women aged 15 –49 years have ever been married in 2024 –25, showing the same percentage as reported in 2018 –19. The rural proportion (68%) remains higher than the urban (6 4%), reflecting earlier

10 48 80 93 96 97 98 12 53 82 94 96 98 98 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 2024-25 2018-19 Figure 5.1 Percentage of Women Age 15-49 Years Ever Married

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marriage patterns and traditional social norms in rural areas. Figure 5.1 indicates that marriage patterns among younger women (15–19 years) remains relatively low, with 10 percent ever married in 2024 –25 compared to 12 percent in 2018 –19, indicating a gradual rise in age at marriage. The proportion increases sharply among women aged 20–24 years (48%) and reaches 80 percent by the 25 –29 years age group. Nearly all women are married by age 35 and above, consistent with past trends. Figure 5.2 presents the percentage of ever -married women aged 15 –49 years across provinces and region. Sindh records the highest overall level (69%), driven by a much higher rural figure (73%) compa red with urban (66%). KP & Balochistan both show overall patterns (67%)
and (66%) respectively , the pattern remains consistent, with rural areas (68%) reporting higher levels than urban areas (63%). Punjab has the lowest overall proportion (65%) and the sm allest rural–urban gap (66% rural vs. 64% urban), indicating more similar marriage patterns
across regions.
Figure 5.2 Percentage of Women Age 15-49 Years Ever Married by Province 5.2.1 Mean Number of Children Ever Born to All Women & Ever-Married Women Table 2 presents the mean number of children ever born to all women aged 15 –49 years, as well as to ever -married women, by province, age group, and place of residence for the year 2024–25.
At the National level, the average number of children ever born to all women aged 15–49 years is 1.9, rural women report a higher mean (2.0) compared to urban women (1.7), highlighting 64 66 63 63 66 73 68 68 65 69 67 66 Punjab Sindh Kp Balochistan Overall Rural Urban

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the continued urban–rural fertility differential. A mong ever-married women the average number of children stands at 2.9. Rural women report a higher average (3.0) compared to urban women (2.7). The mean number of children born to ever -married women increases steadily with age. Among women aged 15–19 years, the average number of children is negligible (0.4), rising to 1.2 among those aged 20–24 years , and reaching 2.0 in the 25–29 years age group. The number increases to 2.8 among ever married women aged 30–34 years, and further to 3.5, 4.0 and 4.3 for the 35 -39, 40–44 and 45–49 age groups respectively, reflecting the cumulative nature of childbearing over a women’s reproductive span (Figure 5.3).
Across provinces, Balochistan reports the highest average number of children ever born to all women (2.2), while Punjab records the lowest (1.8). A similar pattern is observed among ever-married women, where Balochistan again shows the highest average (3.3), and Sindh reports the lowest (2.7). Rural women consistently report more children than urban women in all provinces, reflecting persistent urban rural fertility differences. When compared with 2018 -19, significant decline in average from 4 to 3.4 for age group 35-39, 4.7 to 3.9 for age group 40 -44 and 5.0 to 4.0 for age group 45-49, is indicating the preference for smaller family size.

.4 1.3 2.1 2.8 3.4 3.9 4.0 0.4 1.2 2.2 3.1 4.0 4.7 5.0 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Categories 2024-25 2018-19 Figure 5.3 Mean Number of children born to ever married women aged 15-49

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5.2.2 Total Fertility Rate Table-3 presents the Age-Specific Fertility Rates (ASFR) and Total Fertility Rate (TFR) for women aged 15– 49 years by region and residence. The fertility pattern shows that childbearing is highest among women aged 25–29 years, with rates of 181 (urban) & 218 (rural) births per 1,000 women. Fertility gradually declines after age 30, dropping to 39 births among women aged 40–44 and 18 among those aged 45–49. The Total fertility rate (TFR) for period of (2021-2023) is estimated at 3.6 children per woman , with a notable rural urban gap 4.1 in rural areas compared to 3.0 in urban . This pattern is consistent with previous HIES rounds (2018–19) for period of (2015–2017), though a slight overall decline is observed, reflecting gradual progress in fertility reduction, particularly in urban regions.

Awareness and Use of Family Planning Practicing family planning plays a crucial role in improving maternal and child health, empowering couples to make informed reproductive decisions, and contributing to sustainable 3 4.1 3.6 3.1 4.2 3.7 URBAN RURAL TOTAL 2024-25 2018-19 Figure 5.4 Total Fertility Rate

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population growth. This survey examines the extent of awareness and utilization of contraceptive methods among currently married women, highlighting patterns of use , preferences, and influencing factors such as education, socio -economic conditions, cultural attitudes, and
availability of health services. The findings aim to support evidence-based policy interventions for strengthening family planning initiatives and promoting overall reproductive well-being. 5.3.1 Knowledge about Family Planning Methods Overall awareness among currently married women aged 15 –49 years remains stagnant, with 99% of women reporting knowledge of family planning methods 2024–25 compared to provincial Round 2018–19 (Table 4). Awareness continues to be higher in urban areas (100%) than in rural areas (99%). Provincial analysis shows that awareness is highest in Sindh (100%) followed by Khyber Pakhtunkhwa (99%) & Punjab (99%), while Balochistan (96%) lags significantly behind, marking an increase from 94% in 2018–19. 5.3.2 Ever Used
The proportion of women who have ever used any family planning method has slightly increased at the national level from 43% in 2018–19 to 45% in 2024–25 as per (Table 4 & F igure 5.5 ). Urban women (51%) are more likely to have ever used a method than rural women (41%). Among provinces, Khyber Pakhtunkhwa shows the highest rate (49%), followed by Punjab (48%), Sindh (38%) , and Balochistan (30%). Notably, Balochistan reflects the

48 38 49 30 47 36 47 17 Punjab Sindh KP Balochistan 2024-25 2018-19 Figure 5.5 Ever use of Family Planning Method

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most significant improvement from 17% in 2018–19 to 30% in 2024–25.
5.3.3 Currently Using Family Planning - Contraceptive Prevalence Rate (CPR)

The current use of family planning methods at national level has increased from 34% in 2018–19 to 38% in 2024–25, reflecting a rise of 4 percentage points (Table 4).

The urban–rural gap persists, with 44% of urban and 34% of rural women currently using contraceptives. Among provinces, Punjab has the highest current use rate (43%), followed by Khyber Pakhtunkhwa (36%) , Sindh (31%) , and Balochistan (22%) . All provinces show improvements over 2018 –19 levels, particularly Khyber Pakhtunkhwa & Balochistan, indicating enhanced progress in contraceptive adoption.

100 99 99 51 41 4544 34 38 0 20 40 60 80 100 120 Urban Rural Total Know About Ever Used Currently Used Figure 5.6: Current use of Family Planning Method Figure 5.7:Awareness about Family Planning Method 43 31 36 22 39 30 31 14 Punjab Sindh KP Balochistan 2024-25 2018-19

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5.3.4 Profile of Women Currently using Contraception:

Use of contraceptives is needed for long birth intervals and fewer births to older and very young mothers to reduce the maternal mortality and improve reproductive health of women. Table 6 shows that the current use of family planning methods increases steadily with age, reaching its highest level among women aged 35 –44 years. The lowest use is observed among women aged 15–19 years (6%) , as these age groups generally include newly married women who are more likely to desire pregnancy soon after marriage and may therefore be less inclined to use family planning methods.

However, it is encouraging to note that the current use of contraceptives has increased among women in all age groups except aged 40–44 in 2024–25 compared to 2018–19. Overall, contraceptive use tends to rise with age, as older women are more likely to have achieved their desired family size and thus adopt family planning methods to limit or space further births.

6 18 30 40 48 48 44 5 14 27 38 47 49 38 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 2024-25 2018-19 Figure 5.8:Use of CPR- By Age Category