Pakistan Demographic And Health Surveys Research Articles

Maternal Health Services in Pakistan

Background: Women must be provided with necessary health services for a child's good health and future during pregnancy. Women's health has experienced a considerable epidemiological change during the past several decades. Maternal well-being and health affect not only the developed world but predominantly the developing nations. Differences in resource allocation between industrialized and developing countries ultimately led to notable differences in pregnancy complications and deaths. Aim: To investigate these barriers. A literature review was carried out to address this research topic. Methodology: Six online databases AMED, CINAHL PLUS, PUBMED, MEDLINE, COCHRANE LIBRARY and SCIENCE DIRECT were used for a preliminary search that yielded 6353 articles. No grey literature was discovered due to time restrictions. Seven publications were discovered to be eligible for inclusion in the literature review after carefully reading, analysing, and evaluating them with the help of critical appraisal techniques. After the initially searched articles were filtered using robust inclusion and exclusion criteria. Findings: Data were taken from different sources like the Pakistan Demographic and Health Surveys (PDHSs), WHO, and a comparison was made with the findings from different factors. The analysis concentrates on women of Pakistan having maternal health issues and maternal health services. The Critical Appraisal Skills Program (CASP) is used for the assessment and qualitative analysisof this study. Practical implications: By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan’s pregnancy outcomes. This review provides a better understanding of the risk factors determining maternal mortality in Pakistan.Public awareness is important as this paper almost covered the different platforms which are working on maternal health servicesto aware the society. To promote maternal health messages and encourage pregnant women to receive maternal healthcare services, policymakers, healthcare professionals, and health organizations can adopt a variety of campaigns. Results: This study discussed the impact of different factorswhich effect on maternal health. Different factors are associated with utilizing maternal healthcare services at antenatal care and delivery stages of pregnancy in Pakistan. This review concentrated on the economic and social vulnerability of pregnant women and emphasized the importance of parallel, more all-encompassing initiatives, like poverty reduction and women's empowerment. Poor maternal health in Pakistan has many root causes, including undernourishment of young girls, early marriage, high fertility rates, and unmet contraceptive needs. Conclusion: The key factors influencing women's hesitation and refusal to use the health facilities in Pakistan include structural hurdles, maternal knowledge and education levels, and men's dominance in decision-making, according to the themes drawn from the literature. Keywords: Pregnant women, Maternal health, Ante-natal care, Pakistan,Demographic and health surveys,

Trend analysis of multi-level determinants of maternal and newborn postnatal care utilization in Pakistan from 2006 to 2018: Evidence from Pakistan Demographic and Health Surveys

BackgroundPostnatal care (PNC) is crucial for maternal and newborn health. Healthcare-seeking practices within the postpartum period help healthcare providers in early detection of complications related to childbirth and post-delivery period. This study aims to investigate trends of PNC utilization from 2006 to 2018, and to explore the effects of multi-level determinants of both maternal and newborn PNC in Pakistan.MethodsSecondary data analysis of the last three waves of the nationally representative Pakistan Demographic and Health Surveys (PDHSs) was conducted Analysis was limited to all those women who had delivered a child during the last 5 years preceding each wave of PDHS Bivariate and multivariate logistic regression was applied to determine the association of maternal and newborn PNC utilization with multi-level determinants at individual, community, and institutional levels.ResultsIn Pakistan, an upward linear trend in maternal PNC utilization was found, with an increase from 43.5 to 63.6% from 2006 to 2018. However, a non-linear trend was observed in newborn PNC utilization, with an upsurge from 20.6 to 50.5% from 2006 to 2013, nonetheless a decrease of 30.7% in 2018. Furthermore, the results highlighted that the likelihood of maternal and newborn PNC utilization was higher amongst older age women, who completed some years of schooling, were employed, had decision-making and emotional autonomy, had caesarean sections, and delivered at health facilities by skilled birth attendants. Multivariate analysis also revealed higher odds for women of older age, who had decision-making and emotional autonomy, and had caesarean section deliveries over the period of 2006–2018 for both maternal and newborn PNC utilization. Further, higher odds for maternal PNC utilization were found with parity and size of newborn, while less for ANC attendance and available means of transportation. Furthermore, increased odds were recorded for newborn PNC utilization with the number of children, ANC attendance, gender of child and mass media exposure from 2006 to 18.ConclusionA difference in maternal and newborn PNC utilization was found in Pakistan, attributed to multiple individual (socio-demographic and obstetrics), community, and institutional level determinants. Overall, findings suggest the need to promote the benefits of PNC for early diagnosis of postpartum complications and to plan effective public health interventions to enhance women’s access to healthcare facilities and skilled birth assistance to save mothers’ and newborns’ lives.

Factors associated with female age at first marriage: An analysis using all waves of the Pakistan Demographic and Health Survey.

In conventional Muslim societies, fertility occurs within the marital union. Therefore, fertility outcomes depend on females' age at first marriage (AFM). The present study explores the pattern of AFM in Pakistan, analyses of which are scarce in the literature. We aim to identify the factors associated with the AFM among currently married women in Pakistan. Demographic factors like birth cohort, and socioeconomic and cultural factors such as province and place of residence, education level, whether or not a woman had ever worked before marriage, ethnicity, and husband's education were studied to explore the pattern of female AFM. Data were taken from the Pakistan Demographic and Health Surveys (PDHSs) of 2012-13 and 2017-18, and a comparison was made with the findings from the earlier PDHSs of 1990-91 and 2006-07. The analysis concentrates on women born between 1941 and 1992, aged between 25 and 49 years during the data collection periods. One-way analysis of variance (ANOVA) was used to assess the difference between the mean AFM for different sub-groups of the population. To identify the covariates that are associated with AFM multiple linear regression models were estimated. We observed a gradually increasing trend in female AFM over time among women born after 1950. The ANOVA results revealed that birth cohort, province, and place of residence, female education level, whether or not a woman had ever worked before marriage, ethnicity, and husband's education were significantly associated with AFM (p-values < 0.05). In a multiple regression model, we found that the birth cohort significantly affects the AFM (p-value < 0.05). Having worked before marriage is associated with a statistically significant one-year rise in the AFM. Interestingly, all other ethnic groups have lower AFM compared with women whose mother language was Punjabi. Education has a highly significant effect on the AFM: the regression results revealed that uneducated females have a mean AFM 4 to 5 years lower than highly educated women. The results also revealed that educated men marry older women as compared to uneducated men. We conclude that the education of females and even males in Pakistan could lead to a rise in the female AFM.

Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018

Background: In developing countries, pregnancy and childbirth are the leading causes of death among women. In this context, family planning and access to contraceptives are crucial for reducing pregnancy-related morbidity and mortality. Therefore, we aimed to look into the trends of contraception and determinants of contraceptive use in Pakistan.Methods: This study used data for women of reproductive age from four Pakistan Demographic and Health Surveys datasets. Contraception was the outcome variable, whereas, women’s and partner’s education, occupation, wealth quintile, region, place of residence, and exposure to family planning messages were the explanatory variables. Pooled prevalence was estimated using SUMARI and regression analysis was undertaken using SPSS to produce an adjusted prevalence ratio with 95% confidence intervals.Results: Data of 40,259 ever-married women of reproductive age (EMWRA) was analysed. Of the total EMWRA, 30% were using contraception. Of these, 26% were using traditional methods and 74% were using modern methods. The most common method of contraception was condoms (30.5%). The pooled prevalence of contraception used was 29.5% (95% CI 29.1 to 30.0). Through multivariate analysis, women's age, place of residence, region, wealth index, women’s education, their working status, and exposure to family planning messages were found to be significant determinants of contraception usage.Conclusions: There is a noticeable gap regarding awareness and uptake of contraception leading to low contraceptive use among women in Pakistan. In the light of our results, it is important to highlight the importance of girl’s education for building awareness and empowerment.

Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018.

Background: In developing countries, pregnancy and childbirth are the leading causes of death among women. In this context, family planning and access to contraceptives are crucial for reducing pregnancy-related morbidity and mortality. Therefore, we aimed to look into the trends of contraception and determinants of contraceptive use in Pakistan. Methods: This study used data for women of reproductive age from four Pakistan Demographic and Health Surveys datasets. Contraception was the outcome variable, whereas, women's and partner's education, occupation, wealth quintile, region, place of residence, and exposure to family planning messages were the explanatory variables. Pooled prevalence was estimated using SUMARI and regression analysis was undertaken using SPSS to produce an adjusted prevalence ratio with 95% confidence intervals. Results: Data of 40,259 ever-married women of reproductive age (EMWRA) was analysed. Of the total EMWRA, 30% were using contraception. Of these, 26% were using traditional methods and 74% were using modern methods. The most common method of contraception was condoms (30.5%). The pooled prevalence of contraception used was 29.5% (95% CI 29.1 to 30.0). Through multivariate analysis, women's age, place of residence, region, wealth index, women's education, their working status, and exposure to family planning messages were found to be significant determinants of contraception usage. Conclusions: There is a noticeable gap regarding awareness and uptake of contraception leading to low contraceptive use among women in Pakistan. In the light of our results, it is important to highlight the importance of girl's education for building awareness and empowerment.

Population Projection of Pakistan: What is there in 2028?

Pakistan has been facing a massive population upheaval for the past three decades which needs to be tackled through a comprehensive, effective, and resourceful plan. This study aimed to build a methodology for population projection as an imperative step to address the population concerns for an inclusive socioeconomic development planning. The projections made in this study are based on three data sets of Pakistan Demographic and Health Surveys (PDHS) and Pakistan Census Reports (PCR). Cohort Component Method is employed for projecting total population and population aggregates of young, working, and old aged people, women (in childbearing age)and sex ratio, crude birth and crude death rates, and population growth for the period 1998 to 2028. The empirical results exhibited that due to continuous drop-in total fertility rate, proportion of young and old aged group would likely to reduce, whereas working age population appeared to be increased. The percentage of reproductive women is projected to be increased, whereas sex ratio, crude birth and death rates are predicted to be decreased over time. A carefully drawn population policy must be focused on awareness about family planning programs to control an immense population growth in Pakistan.

Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys

Background: Information on determinants of postnatal care is essential for maternal health services, and this information is scarce in Pakistan. This study aimed to determine the factors of newborn postnatal care utilization from the Pakistan Demographic and Health Surveys (PDHS) conducted from 2006–2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative PDHS 2006–07, 2012–13, and 2017–18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postnatal care within two months. Results: This study included 5724 women from the 2006–07 PDHS, 7461 from the 2012–13 survey, and 8287 from the 2017–18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006–07 to 43% in 2012–13 but dropped to 27% in 2017–18. Respondent’s occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006–2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women’s economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

Trends in socioeconomic inequalities in childhood BCG immunization coverage in Pakistan

Abstract Background Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage. Methods Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged &amp;lt; 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII). Results Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased. Conclusions Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan. Key messages The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.

Determinants of newborn care utilization in Pakistan: Findings from the Demographic and Health Surveys.

Background: Information on determinants of postpartum care is essential for public health action, yet this information is scarce in Pakistan. Hence, the current study aimed to determine the factors of newborn postpartum care utilization from the Pakistan Demographic and Health Surveys conducted from 2006-2018. Methods: We analyzed data from three rounds of cross-sectional, nationally representative Pakistan Demographic and Health Surveys (PDHS) 2006-07, 2012-13, and 2017-18. Multivariable logistic regression models were applied to explore factors associated with utilization of newborn postpartum care within two months. Results: This study included 5724 women from the 2006-07 PDHS, 7461 from the 2012-13 survey, and 8287 from the 2017-18 survey. The proportion of women receiving newborn postnatal care within the first two months of delivery increased from 13% in 2006-07 to 43% in 2012-13 but dropped to 27% in 2017-18. Respondent's occupation and prenatal care utilization of maternal health services were common factors that significantly influenced newborn postnatal care utilization within two months. The utilization of postnatal care was greater among women having educated husbands and where the first child was a male in PDHS 2007 round. Higher wealth index and educated respondent had higher postnatal care utilization odds in DHS 2012 and DHS 2018. However, the odds of using postnatal care decreased with the number of household members and total number of children ever born in DHS 2012 and 2018 rounds. Conclusions: There was a general increase in the proportion of women who utilized postnatal care for their newborns during 2006-2013 but a decrease in 2018. The decreased utilization in 2018 warrants further investigation. Improving women's economic status, education, employment, and antenatal care attendance and reducing parity may increase newborn postnatal care utilization.

Identifying the factors associated with cesarean section modeled with categorical correlation coefficients in partial least squares.

Cesarean section (CS) is associated with maternal morbidity and mortality in developing countries. This study is conducted to assess factors associated with CS in Pakistan using partial least squares (PLS) algorithm, where categorical factors are modeled. Nationally representative maternal data from Pakistan Demographic and Health Surveys (PDHS) conducted during 2012-2013 is used in this study. Among correlation coefficient based PLS regression proposed algorithms for categorical factors, Pearson’s Contingency Coefficient (CC) PLS coupled with loading weight (LW) appeared to be the most efficient method in terms of model performance and influential factor selection. Region of residence, type of place of residence, mother’s and her partner’s level of education, wealth index, year of birth, previous terminated pregnancy, use of contraception, prenatal care provided by a doctor and nurse/midwife/LHV (lady health visitor), assistance provided by a nurse/midwife/LHV,number of antenatal visits, size of child, antenatal care provided by government hospital, transport facility for medical care, baby birth status, mother’s age at first birth, preceding birth interval and vaccination of hepatitis B-1 and B2 are found to be significantly affecting the CS delivery method. Correlation coefficient based PLS regression algorithms may serve more efficiently as a multivariate technique to treat high-dimensional categorical data.

Risk factors and causes of stillbirths among pregnant women in Pakistan.

Globally 3 million stillbirths occur per year, and Pakistan is ranked 3rd among the countries having the highest burden. Despite being a major public health problem, efforts to reduce this figure are insufficient. The aim of the study was to identify and measure the inequalities in stillbirth associated risk factors, causes and fertility risk behaviors. Data were derived from the Pakistan Demographic and Health Surveys (PDHS) 1990-2013. Inequalities on determinants were evaluated using rate differences and rate ratios; time trends computed with annualized reduction rate (ARR). Overall ARR determined for stillbirth was -12.52 percent per annum. The high ARR were recorded for mothers age <20, urban areas, educated mothers and for highest wealth quintile. The relative inequalities were most pronounced for wealth quintiles, education and age of mothers. Stillbirth causes were unexplained antepartum (33%), unexplained intrapartum (21%), intrapartum asphyxia (21%) and antepartum maternal disorders (19%). The high fertility risk behavior was found in mothers with age >34 and birth order >3. The study concluded that to achieve gain in child survival, there is need to promote antenatal care, birth spacing, and family planning programs in developing countries.

Rising trends and inequalities in cesarean section rates in Pakistan: Evidence from Pakistan Demographic and Health Surveys, 1990-2013

Despite global efforts to improve maternal health, many developing countries including Pakistan have failed to achieve the target of a 75% reduction in maternal deaths by 2015. Addressing socioeconomic inequalities in access to emergency obstetric care is crucial for reducing the maternal mortality rate. This study was done to examine the time trends and socioeconomic inequalities in the utilization of cesarean section (C-section) in Pakistan during 1990–2013. We used data from the Pakistan Demographic and Health Surveys (PDHS) conducted during 1990 to 2013. All these surveys are nationally representative surveys of ever-married women aged 15–49 years with a sample size of 6611, 10,023, and 13,558 women in 1990–1991, 2006–2007, and 2012–2013, respectively, with an overall response rate of over 90%. The unit of analysis for this study was women with their most recent live birth in the five years preceding the surveys. Bivariate analyses and multivariable logistic regression models were employed to investigate the prevalence of cesarean sections according to selected sociodemographic characteristics of women. C-section rates were found to have increased during this period, with an especially significant rise from 2.7% in 1990–1991 to 15.8% in 2012–2013 with lower utilization among the non-educated women (7.5%), compared with the women with higher education (40.3%). C-section rates ranged from 5.5% in the poorest women to 35.3% in the richest women. Only 11.5% of the rural women had a C-section compared to 25.6% of the urban women. A greater likelihood of having a cesarean section was observed in the richest, highly educated, and urban-living women while there was no significant difference observed in cesarean section rates between the private and public sectors in all three surveys. To improve maternal health, routine monitoring and evaluation of the provision of emergency obstetric services are needed to address the underuse of C-section in poor and rural areas and overuse in rich and urban areas.

Socio-Economic Disparities in Use of Family Planning Methods among Pakistani Women: Findings from Pakistan Demographic and Health Surveys

BackgroundSeveral developing countries like Pakistan step into Sustainable Development Goals period with crucial maternal and child health needs that need to be addressed for improving health outcomes among people. We aim to explore existent socio-economic disparities in use of family planning methods (FPM) among Pakistani women, and compare any such inequalities between the years 2006 and 2013.SettingPakistan Demographic and Health Surveys (PDHS) 2006–7 (n = 9177) and the most recent 2012–13(n = 13558) data were used to conduct secondary analysis. Participants were ever married women aged between 15 and 49 years. Socio-economic status was assessed by the education level and wealth index. Inequalities were measured through Odds Ratio (OR), Relative Index of inequality (RII), and Slope index of inequality (SII) on non-use of FPM.ResultsAlthough the prevalence of FPM use has increased over time (28% in 2006 versus 54% in 2013), the socio-economic inequalities persistently exist. Comparing results of PDHS 2006 with PDHS 2013, education related absolute inequalities among urban dwellers increased from -0.41 (95% CI -0.67, -0.13, p-value < 0.01) to -0.83 (95% CI -1.02, -0.63, p-value < 0.01); and increased from -0.93 (95% CI -1.21, -0.64, p-value < 0.01) to -0.98 (95% CI -1.20, -0.76, p-value < 0.01) among rural dwellers. Similarly wealth related absolute inequalities are also existent.ConclusionsAlthough the FPM use has increased over time, but it is important to note that socio-economic gap in use of FPM persists. Such differences have disadvantaged the poor and the illiterate. Family planning programs may target the disadvantaged subgroups for ensuring well-being of women and children in Pakistan.

Earlier initiation and use of a greater number of iron-folic acid supplements during pregnancy prevents early neonatal deaths in Nepal and Pakistan.

IntroductionEarly neonatal deaths account for 75% of neonatal deaths globally. Antenatal iron-folic acid (IFA) supplementation has significantly reduced the risk of early neonatal deaths in China and Indonesia. We investigated the impact of antenatal IFA supplements on the risk of early neonatal deaths in Nepal and Pakistan during the last decade.MethodsData from the most recent singleton live-births of 8,186 from two Nepal Demographic and Health Surveys (DHS) and 13,034 from two Pakistan DHS were selected for the current study. The primary outcome was early neonatal deaths and the main study variable was antenatal IFA supplementation. Analyses used multivariate Cox proportional regression, adjusted for the cluster sampling design and for 18 potential confounders.FindingsThe adjusted risk of early neonatal deaths was significantly reduced by 51% (aHR = 0.49, 95% CI = 0.32–0.75) in Nepal and 23% (aHR = 0.77, 95% CI = 0.59–0.99) in Pakistan with any use of IFA compared to none. When IFA supplementation started at or before the 5th month of pregnancy, the adjusted risk of early neonatal mortality was significantly reduced by 53% in Nepal, and 28% in Pakistan, compared to no IFA. When >90 IFA supplements were used and started at or before 5th months, the adjusted risk of early neonatal deaths was significantly reduced by 57% in Nepal, and 45% in Pakistan. In Nepal 4,600 and in Pakistan 75,000 early neonatal deaths could be prevented annually if all pregnant women used >90 IFA supplements and started at or before the 5th month of pregnancy.ConclusionsAny use of IFA supplements was significantly associated with reduced risk of early neonatal deaths in Nepal and Pakistan. The greatest mortality sparing effect of IFA on early neonatal deaths in both countries was with early initiation and use of a greater number of supplements.

Changes in contraceptive use and method mix in Pakistan: 1990-91 to 2006-07

To determine (a) whether the influence of the determinants of family planning use in Pakistan changed between 1990-91 and 2006-07, and (b) if these changes were associated with changes in the method mix. Data from the Pakistan Demographic and Health Surveys (PDHS) of 1990-91 and 2006-07 were used in the analyses. Data on 5184 married, non-pregnant, fecund women in 1990-91 and 8041 married, non-pregnant, fecund women in 2006-07 were used. Logistic regression analysis was used to identify factors associated with the use of any contraceptive method and whether the influence of these factors changed between the survey years. Changes in the method mix were examined. The effects of urban/rural residence, wealth and education on contraceptive use changed between 1990-91 and 2006-07. Differentials in contraceptive use by residence, wealth and education declined and were accompanied by changes in the method mix. In rural areas and among less-educated women, the contribution of traditional methods to the method mix increased. Among the poorest women, the method mix shifted towards traditional methods and condoms. Less-educated, rural, Pakistani women increased the use of family planning at a faster rate than more-educated, urban, women by adopting the use of traditional family planning methods. Poor women also increased family planning use more quickly than non-poor women, by adopting condoms and traditional methods. The more rapid increase in the demand for family planning among poorer, less-educated, rural women is a positive trend. In order to convert this demand into the use of longer-term modern methods, however, access to high quality services must be improved in rural and low-income urban areas.