Pakistan

In Pakistan, marriage and motherhood are considered essential components of womanhood. Islam is the predominant religious tradition in Pakistan, and local religious and social traditions emphasize that marriage is both a spiritual and social obligation. Cultural pressures encourage women to marry and have children, and value women's role as the caretaker in the family. As a result, unmarried, divorced, and childless women often experience social stigmatization.

The minimum legal age of marriage for women is 16. Although there are penal sanctions for underage marriage, underage marriages are recognized and considered legally valid. Research indicates that the rate of adolescent marriage in Pakistan is declining. According to survey data, approximately 19 percent of women are married by the age of 19. By the age of 24, however, most women in Pakistan are married and already mothers.

Pakistan's national fertility rate is 3.6 children per woman; however, the fertility rate is unevenly distributed [Page 961]by socioeconomic class; rural and poorer families tend to have more children than urban and middle- and upper-class families. Considering that more than 60 percent of the population of Pakistan live in rural areas, the higher fertility rates among the rural population has significant consequences.

While the major urban areas in Pakistan are equipped with advanced health care facilities, most villages are far removed from these facilities and do not have access to adequate health care. In fact, 80 percent of childbirths occur at home, and about 80 percent of those are attended by dais or traditional birth attendants with minimal medical training.

Lack of adequate health care contributes to high infant and maternal mortality rates. The infant mortality rate is 65.14 deaths per 1,000 live births, and the maternal mortality rate is estimated at more than 533 deaths per 100,000 live births. On average, 60 women die every day due to pregnancy-related complications. The government is currently considering training programs to train midwives from the local regions since medical doctors prefer not to work in the remote areas, where there is the most need.

A health worker in Sindh, Pakistan, uses an illustrated calendar to teach some best practices in maternal/child health.

Medical experts suggest a need for social changes to promote increased age of marriage, increased access to contraception, and increased support for adolescent sexual and reproductive health education. Family planning education is particularly important because rural families may be ignorant about family planning strategies. Currently, the contraceptive prevalence rate is approximately 30 percent.

Abortion is illegal in Pakistan unless it is necessary to provide lifesaving medical treatment to the mother. Nevertheless, women in Pakistan do seek abortions; however, the extent of abortion in Pakistan is difficult to measure. Research indicates that induced abortions may be associated with 2–12 percent of all maternal deaths.