Child Mortality, Fertility and Poverty: A Counterfactual Analysis

Larger sizes of households tighten the resources of families particularly those in lower wealth quintiles. Households in poorer quintiles are trapped into high child mortality. The risk of child survival leads to high fertility and little investment in children. The conditions to pull these households from this malicious trap are already absent. For instance, the indicators like, women’s low rates of education, early marriages and early pregnancies, and too little birth intervals are very discouraging in Pakistan. Unfortunately, households in poorer quintiles are the least beneficiaries from national revenues and policies in developing countries, in general, are designed for general public and benefit from those policies rarely reach to most needy households. The objectives of this paper are: (i) to emphasize the changing dynamics of fertility behavior and incidence of child mortality across the wealth distribution through an empirical investigation of five wealth quantiles, (ii) to explore the causal relationship between under 5 child mortality and fertility, and finally to examine the counter effect of a few policy instruments. For this purpose, the paper exploits the latest Pakistan Demographic Health Survey to examine few important policy variables to break the nexus between poverty, child mortality and high fertility. The counterfactual analysis suggests marginal improvement in a few variables; like female education, delay in first conception and incremental increase in birth intervals if in targeted households, will significantly change the child mortality and fertility rates. The analysis will be helpful for designing interventions. This analysis can also provide guidelines for women centered institutions like Banazir Income Support Programme, federal and provincial mother and child health departments and family planning offices.