The Interaction Effect of Birth Spacing and Maternal Healthcare Services on Child Mortality in Pakistan.

There is widespread agreement that improved health should be regarded as a means and an end in the context of the development process. The health of the populace and the equitable provision of healthcare are two indicators of a society's level of development. A variety of factors influences child mortality. This study investigated the causes of child death and the interaction effect of birth spacing (B.S.) and maternal health care services (MHCS) on child mortality. Using SPSS version 20, we used the Pakistan Demographic and Health Survey (PDHS) 2017-2018 data set to investigate the associated factors of child mortality and the moderating influence of birth spacing using binary logistic regression. The outcome variable is categorical with two categories. The findings indicated that the risk of infant death decreased with adequate B.S. between two pregnancies and access to maternal health care services. Birth spacing was found to moderate the link between access to maternal health care services (MHCS) and child mortality. Our research leads us to conclude that the amount of time between children's births significantly reduces infant mortality. When the birth spacing is at least 33 months, the relationship between maternal health care services and child mortality becomes more evident and negative.

The Moderating Role of Maternal Education and Employment on Child Health in Pakistan.

BACKGROUND: Pakistan has challenges in fulfilling its universal responsibilities of providing better health facilities to everyone. The Sustainable Development Goals (SDGs) aim to reduce maternal and infant mortality rates. Despite declines in mother and child death, the total mortality ratio has marginally increased. However, neonatal death has not decreased significantly. Family planning is important for controlling population growth and improving child as well as maternal health. Pakistan's government has unceasingly tried to enhance the provision of contraceptive facilities, but still, an unmet need for family planning (UMNFP) exists in our country. Women are said to have UMNFP if they want to limit or space childbearing, but they are not using contraception methods for any reason. The study aimed to explore the effect of the UMNFP and to investigate the moderating role of a mother's education and employment status on a child's health. METHODS: We analyzed the data of 2,244 women in this study. To investigate the study objectives, we utilized the secondary dataset of the Pakistan Demographic and Health Survey (PDHS) 2017-18 (publicly available on the website of the National Institute of Population Studies) and applied binary logistic regression using SPSS 24. RESULTS: Results suggest a positive effect of a woman's age (25 to 39 years), maternal education (higher), father's education (higher), family's wealth status (richest), mass media exposure, and adequate birth spacing (at least for 33 months) on a child's health. On the other hand, there is an indirect association between maternal employment, unmet need for family planning, and a child's health. The moderating role of maternal education and employment on the relationship between household wealth status and a child's health is positive. CONCLUSIONS: We conclude that the strong predictors of child health are UMNFP, maternal education, and employment. The link between the met need for family planning and the child's health is positive. The moderating effect of maternal education and household wealth status on a child's health is progressive. Similarly, the interaction effect of a mother's employment and household wealth status on a child's health is positive. Finally, we concluded that the link between the health of the child and household wealth status is much more diverse and positive when the mother is highly educated and currently employed.

Predictors of Child's Health in Pakistan and the Moderating Role of Birth Spacing.

There is a consensus that better health should be viewed both as a means and an end to achieve development. The level of development should be judged by the health status of the population and the fair distribution of health services across the people. Many determinants affect a child's health. This study aimed to explore a child's health predictors and the moderating role of birth spacing on the association between mother's health care services utilization (MHCSU) and a child's health. In this study, we used the dataset of Pakistan Demographic and Health Survey 2017-18 to explore the predictors of child health and the moderating role of birth spacing through binary logistic regression, using SPSS version 20. The results showed an association of mother's age (35 to 49 years), her education (at least secondary), health care services (more accessible), father's education (at least secondary), their wealth status (high), and exposure to mass media to improved child health. However, the effect of a mother's employment status (employed) on her child's health is significant and negative. The coefficient of moderation term indicated that the moderating role of birth spacing on the association between MHCSU and a child's health is positive. We conclude that birth spacing is a strong predictor for improving a child's health. The association between MHCSU and child's health is more distinct and positive when the birth spacing is at least 33 months.

Socio-economic determinants of child mortality in Pakistan and the moderating role of household's wealth index.

BACKGROUND: Child mortality is an important social indicator that describes the health conditions of a country as well as determines the country's overall socio-economic development. The Government of Pakistan has been struggling to reduce child mortality (67.2 per thousand live births in 2019). Pakistan could not achieve the target set for Millennium Development Goals to reduce child mortality and still working to meet the target set by the Sustainable Development Goals. This study has investigated the socio-economic determinants of child mortality in Pakistan by using household-level data. Socio-economic characteristics related to women (mothers) and households have been considered as possible determinants of child mortality. The moderating role of a household's wealth index on the association between woman's education and child mortality has also been investigated. METHODS: The comprehensive dataset of the Pakistan Demographic and Health Survey 2017-18 has been used to explore the determinants of child mortality by using multivariable logistic regression. The interaction term of women's education and household wealth index has been used to investigate the moderating role of the household's wealth index. RESULTS: The results indicate that the likelihood of child mortality decreases with an increase in women's education, their empowerment, their husband's education, the wealth status of their households, access to clean drinking water, access to toilet facilities, and exposure to mass media. Whereas, an increase in unmet need for family planning increases the likelihood of child mortality. The study also identified the moderating role of a household's wealth index on the association between woman's education and child mortality. CONCLUSIONS: Household wealth status moderates the association between women's education and child mortality. The absolute slope of the curve showing the association of women's education and child mortality is higher (more negative) for richer households than poorer households. It implies that a household's wealth status strengthens the relationship between women's education and child mortality. With the increase in the household's wealth status, the effect of a mother's education on child mortality becomes more pronounced.

Role of husband's attitude towards the usage of contraceptives for unmet need of family planning among married women of reproductive age in Pakistan.

BACKGROUND: Family planning services deliver a wide range of benefits to the well-being of females and the community. It can curtail the risk of maternal and neonatal mortality through the reduction in abortions and pregnancies. The government of Pakistan has been struggling to convince people about the usefulness of family planning programs. However, different factors related to social norms, values, and culture are important to determine the success of these programs. One such factor is the patriarchal structure of Pakistani society where most of the household decisions are made by men. The objective of this research is to examine the role of the husband's attitude towards the usage of contraceptives for the unmet need of family planning (UMNFP) among married women of reproductive age (MWRA) in Pakistan. METHOD: The dataset of Pakistan Demographic and Health Survey 2017-18 is utilized to examine the role of the husband's attitude towards the usage of contraceptives in UMNFP among MWRA in Pakistan. RESULTS: The UMNFP was considerably lower among MWRA between 40 years and above compared to women 15-19 years. The odds of UMNFP were higher among women and men who were educated up to the primary level compared to those with no education. Odds of UMNFP were higher among women from the poor wealth quintile compared to the poorest wealth quintile; similarly, it was significantly lower among women who were from the richer and the richest wealth quintile compared to the poorest wealth quintile. The odds of UMNFP were lower among women who were employed compared to those who were not employed. Lastly, the odds of UMNFP were higher among women whose husbands opposed to using contraceptives, who perceived that there was a religious prohibition for such use and when a decision on the contraception use was solely made by the husband. CONCLUSIONS: Husband's attitude towards the usage of contraceptives is an important predictor of UMNFP. Liaising with the community and religious leaders to persuade people particularly men about the usefulness of family planning programs and encouraging men to understand their women's say in using contraceptives should be encouraged.

Socio-demographic determinants of unmet need for family planning among married women in Pakistan.

BACKGROUND: Family planning is considered as an effective tool to control population and to bring improvement in maternal and child health. The Government of Pakistan has been continuously struggling to improve the availability of family planning services. However, like many other developing countries of the world, unmet need for family planning still exists in the country. According to Pakistan Demographic and Health Survey 2012-13, the prevalence of unmet need for family planning is 21% in the country. The objective of this study is to investigate the determinants of unmet need for family planning among married women in Pakistan. METHODS: Secondary data of Pakistan Demographic and Health Survey 2012-13 has been used to analyze the determinants of unmet need for family planning through Binary and Multinomial Logistic regressions. RESULTS: Outcomes of the study show that the likelihood of unmet need for family planning among married women in Pakistan goes on to decrease with an increase in their age and education. The likelihood of unmet need for family planning decreases with the increase in wealth status of women's household, number of living children and husband's education. Similarly, the women residing in rural areas are more likely to have unmet need for family planning as compared with women living in urban areas. The women who lack mass media exposure, who are not employed and who have fear of side effects for using contraceptives are more likely to have unmet need for family planning. CONCLUSIONS: Fear of side effects for using contraceptives has been identified as the major cause of unmet need for family planning in Pakistan. The Government of Pakistan has been putting a lot of efforts to convince people about the usefulness of population control programs. A huge media campaign has been launched to persuade people about the benefits of birth control. But the efforts of the government do not seem to be very much effective to clear the perception of people about side effects of contraceptive use. Hence, fear of side effects still remains one of the most important reason behind unmet need for family planning.