Sociology Ph.D. Dissertations


Reproductive Behavior in Pakistan: Incorporating Men and Couples to Understand Change Over Time

Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)



First Advisor

Karen Guzzo (Advisor)

Second Advisor

Wendy Manning (Committee Member)

Third Advisor

Kara Joyner (Committee Member)

Fourth Advisor

Kelly Balistreri (Committee Member)

Fifth Advisor

Steven Lab (Other)


Attention to gender has been largely absent from research on the fertility decline in less industrialized societies. In patriarchal societies like Pakistan, it seems likely that women power has increased, allowing them to assert their own preferences for contraceptive use and childbearing behaviors. However, given that women tend to want smaller families as their status improves, the stagnation in fertility levels implies that women are still unable to assert their preferences. Using individual- and couple-level data from the 1990-91 and 2012-13 Pakistan Demographic Health Survey (PDHS), I conducted three distinct sets of analyses to provide a better understanding of gender and couple dynamics of reproductive behavior. First, I examined the associations between women perception of their husbands fertility desires, women education, and birth intendedness. Second, I looked at the change over time in future fertility intentions as a couple-level construct and examined how congruence varies by relative education. Finally, I examined the role of gender in reproductive decision-making by analyzing couples joint prospective fertility intentions, women education, and current contraceptive use. I find women perception about their husband desired family size is generally not associated with unintended fertility, but, unexpectedly, better educated women are more likely to have an unintended birth than less educated women. Next, I find that the risk of spousal disagreement is higher among couples in which the wife is more educated than her husband. Further, when couples disagree, it is the husband who wants another child, especially if the wife has secondary education or higher. Finally, on the relationship between couple fertility preferences and contraceptive use, husbands and wives fertility preferences exert equal influence on contraceptive use. Moreover, the positive association between women own education and contraceptive use has weakened over time. Although contraceptive use is higher among educated women, uneducated women are driving the fertility decline. The findings of this dissertation demonstrate that despite marked improvement in women education in the last two decades, the stalled fertility level in Pakistan suggest that gender changes at the societal level are slow to translate into interpersonal relationships.