DEMOGRAPHIC DETERMINANTS OF INFANT AND UNDER-FIVE MORTALITY IN PAKISTAN: AN INTERPROVINCIAL COMPARATIVE ANALYSIS USING MULTIPLE INDICATOR CLUSTER SURVEY (MICS) DATA

Abstract

Two of the most important indicators for child survival - Infant mortality rate (IMR) and Under 5 mortality rate (UFMR) - show the combined effect of biological, demographic, maternal and health system related factors. Despite efforts to improve indicators of child mortality, large variations exist between and within provinces and population groups in Pakistan. This study is based on Multiple Indicator Cluster Surveys (MICS6) data that is available from the MICS6 recent surveys conducted in Punjab, Sindh, Khyber Pakhtunkhwa (KP), Balochistan, Azad Jammu and Kashmir (AJ&K) and in Gilgit-Baltistan (GB). The analysis of mortality differentials was done using a comparative and descriptive approach, which was based on child sex, maternal age at birth, birth order, and previous birth interval. The results show that the levels of infant and child deaths are significantly different across different groups. The overall mortality burden in Punjab is the highest with IMR 60 and UFMR 69, followed by AJ&K (IMR 51 and UFMR 59), Balochistan (IMR 48 and UFMR 53), GB (IMR 43 and UFMR 50), Sindh (IMR 39 and UFMR 46) and KP (IMR 35 and UFMR 39). The analysis showed that children born from mothers who were less than twenty years experienced of having higher mortality risk. The greatest mortality rates are seen in Punjab, AJ&K and GB. Also, there is a consistent association where higher birth order, particularly seventh or later births and short birth intervals less than two years, are associated with high IMR and UFMR in most regions. The results indicate that the demographic factors are still significant factors in child survival in Pakistan. The study concludes that the reproductive health services need to be strengthened, optimum birth spacing should be encouraged, early childbearing should be delayed, fertility rate should be curtailed, and maternal and newborn health care interventions in high risk areas should be improved