Each year Eurostat collects demographic data at regional level from EU, EFTA and Candidate countries as part of the Population Statistics data collection. POPSTAT is Eurostat’s main annual demographic data collection and aims to gather information on demography and migration at national and regional levels by various breakdowns (for the full overview see the Eurostat dedicated section). More specifically, POPSTAT collects data at regional levels on:

• population stocks;
• vital events (live births and deaths).

Each country must send the statistics for the reference year (T) to Eurostat by 31 December of the following calendar year (T+1). Eurostat then publishes the data in March of the calendar year after that (T+2).

Demographic data at regional level include statistics on the population at the end of the calendar year and on live births and deaths during that year, according to the official classification for statistics at regional level (NUTS - nomenclature of territorial units for statistics) in force in the year. These data are broken down by NUTS 2 and 3 levels for EU countries. For more information on the NUTS classification and its versions please refer to the Eurostat dedicated pages. For EFTA and Candidate countries the data are collected according to the agreed statistical regions that have been coded in a way that resembles NUTS.

The breakdown of demographic data collected at regional level varies depending on the NUTS/statistical region level. These breakdowns are summarised below, along with the link to the corresponding online table:

NUTS 2 level

• Population by sex, age and region of residence — demo_r_d2jan
• Population on 1 January by age group, sex and region of residence — demo_r_pjangroup
• Live births by mother's age, mother's year of birth and mother's region of residence — demo_r_fagec
• Deaths by sex, age, and region of residence — demo_r_magec

NUTS 3 level

• Population on 1 January by sex, age group and region of residence — demo_r_pjangrp3
• Population on 1 January by broad age group, sex and region of residence — demo_r_pjanaggr3
• Live births (total) by region of residence — demo_r_births
• Live births by five-year age group of the mothers and region of residence — demo_r_fagec3
• Deaths (total) by region of residence — demo_r_deaths
• Deaths by five-year age group, sex and region of residence — demo_r_magec3

This more detailed breakdown (by five-year age group) of the data collected at NUTS 3 level started with the reference year 2013 and is in accordance with the European laws on demographic statistics. In addition to the regional codes set out in the NUTS classification in force, these online tables include few additional codes that are meant to cover data on persons and events that cannot be allocated to any official NUTS region. These codes are denoted as CCX/CCXX/CCXXX (Not regionalised/Unknown level 1/2/3; CC stands for country code) and are available only for France, Hungary, North Macedonia and Albania, reflecting the raw data as transmitted to Eurostat.

For the reference years from 1990 to 2012 all countries sent to Eurostat all the data on a voluntary basis, therefore the completeness of the tables and the length of time series reflect the level of data received from the responsible National Statistical Institutes’ (NSIs) data provider. As a general remark, a lower data breakdown is available at NUTS 3 level as detailed:

• population data are broken down by sex and broad age groups (0-14, 15-64 and 65 or more). The data have this disaggregation since the reference year 2007 for all countries, and even longer for some — demo_r_pjanaggr3
• vital events (live births and deaths) data are available only as totals, without any further breakdown — demo_r_births and demo_r_deaths

Demographic indicators are calculated by Eurostat based on the above raw data using a common methodology for all countries and regions. The regional demographic indicators computed by NUTS level and the corresponding online tables are summarised below:

NUTS 2 level

• Population structure indicators by region of residence (shares of various population age groups, dependency ratios and median age) — demo_r_pjanind2
• Fertility indicators by region of residence — demo_r_find2
• Fertility rates by age and region of residence — demo_r_frate2
• Life table by age, sex and region of residence — demo_r_mlife
• Life expectancy by age, sex and region of residence — demo_r_mlifexp
• Infant mortality rates by region of residence — demo_r_minfind

NUTS 3 level

• Population change - Demographic balance and crude rates at regional level — demo_r_gind3
• Population density by region — demo_r_d3dens
• Population structure indicators by region of residence (shares of various population age groups, dependency ratios and median age) — demo_r_pjanind3
• Fertility indicators by region of residence (total fertility rate, mean age of woman at childbirth and median age of woman at childbirth) — demo_r_find3

Notes:

1) All the indicators are computed for all lower NUTS regions included in the tables (e.g. data included in a table at NUTS 3 level will include also the data for NUTS 2, 1 and country levels).

2) Demographic indicators computed by NUTS 2 and 3 levels are calculated using input data that have different age breakdown. Therefore, minor differences can be noted between the values corresponding to the same indicator of the same region classified as NUTS 2, 1 or country level.

3) Since the reference year 2015, Eurostat has stopped collecting data on area; therefore, the table 'Area by NUTS 3 region (demo_r_d3area)' includes data up to the year 2015 included.

4) Starting with the reference year 2016, the population density indicator is computed using the new data on area 'Area by NUTS 3 region (reg_area3).

Eurostat’s annual data collections on demographic and migration statistics are structured as follows:

• NOWCAST: Annual data collection on provisional monthly data on live births and deaths covering at least six months of the reference year (Article 4.3 of the Commission implementing regulation (EU) No 205/2014).
• DEMOBAL (Demographic balance): Annual data collection on provisional data on population, total live births and total deaths at national level (Article 4.1 of the Commission implementing regulation (EU) No 205/2014).
• POPSTAT (Population statistics): The most in-depth annual national and regional demographic and migration data collection. The data relate to populations, births, deaths, immigrants, emigrants, marriages and divorces, and is broken down into several categories (Article 3 of Regulation (EU) No 1260/2013 and Article 3 of Regulation (EC) No 862/2007).

The aim is to collect annual mandatory and voluntary demographic data from the national statistical institutes. Mandatory data are those defined by the legislation listed under ‘6.1. Institutional mandate - legal acts and other agreements’.

The completeness of the demographic data collected on a voluntary basis depends on the availability and completeness of information provided by the national statistical institutes. For more information on mandatory/voluntary data collection, see 6.1. Institutional mandate - legal acts and other agreements’.

The following statistics on live births are collected from the National Statistical Institutes:

• Live births by month of occurrence;
• Live births by mother's age, year of birth and by:
  • region (NUTS 2) of residence
  • region (NUTS 3) of residence
  • mother's country of birth
  • mother's country of citizenship
  • live-birth order
  • sex of the new-born
  • mother's legal marital status
  • employment status of the mother
  • mother's educational attainment (ISCED 2011);
• Live births by birth weight and duration of gestation;
• Legally induced abortions by mother's age and parity;
• Late fœtal deaths by mother's age.

Statistics on fertility: based on the different breakdowns of data on live births and on legally induced abortions received, Eurostat produces the following:

• Statistics available in the online table Population change - Demographic balance and crude rates at national level (demo_gind):
  • natural change of the population, crude birth rate;
• Statistics available in the online table Fertility indicators (demo_find):
  • the proportion of live births outside marriage
  • total fertility rate
  • the mean age of women at childbirth
  • the mean age of women at the birth of first / second / third / fourth and higher child
  • the median age of women at childbirth
  • the percentage of first / second / third / fourth and higher live births Fertility rates by age (demo_frate);
• Fertility rates by age and NUTS 2 region (demo_r_frate2);
• Total fertility rate by NUTS 3 region (demo_r_frate3);
• Statistics available in the online table Abortion indicators (demo_fabortind):
  • abortion rate
  • abortion ratio

Eurostat’s annual data collections on demographic statistics are structured as follows:

NOWCAST: Annual data collection on provisional monthly data on live births and deaths covering at least six months of the reference year (Article 4.3 of the Commission implementing regulation (EU) No 205/2014).

DEMOBAL (Demographic balance): Annual data collection on provisional data on population, total live births and total deaths at national level (Article 4.1 of the Commission implementing regulation (EU) No 205/2014).

POPSTAT (Population Statistics): The most in-depth annual national and regional demographic and migration data collection. The data relate to populations, births, deaths, immigrants, emigrants, marriages and divorces, and is broken down into several categories (Article 3 of Regulation (EU) No 1260/2013 and Article 3 of Regulation (EC) No 862/2007).

The aim is to collect annual mandatory and voluntary demographic data from the national statistical institutes. Mandatory data are those defined by the legislation listed under ‘6.1. Institutional mandate - legal acts and other agreements’.

The completeness of the demographic data collected on a voluntary basis depends on the availability and completeness of information provided by the national statistical institutes. For more information on mandatory/voluntary data collection, see 6.1. Institutional mandate - legal acts and other agreements’.

The following statistics on deaths are collected from the National Statistical Institutes:

• Deaths by month of occurrence
• Deaths by age, year of birth, sex and by:
  • Region (NUTS 2) of residence;
  • Region (NUTS 3) of residence;
  • Country of birth;
  • Country of citizenship;
  • Legal marital status;
  • Educational attainment (ISCED 2011).
• Infant deaths by age and sex;
• Infant deaths by parents' level of educational attainment (ISCED);
• Late foetal deaths by mother's age.

Statistics on mortality: based on the different breakdowns of data on deaths received, Eurostat produces the following:

• Statistics available in the online table Population change - Demographic balance and crude rates at national level (demo_gind):
  • Natural change of population, crude death rate.
• Statistics available in the online table Infant mortality rates (demo_find):
  • Infant mortality rate;
  • Neonatal mortality rate;
  • Early neonatal mortality rate;
  • Late foetal mortality rate;
  • Perinatal mortality rate.
• Life table (demo_mlifetable);
• Life expectancy by age and sex (demo_mlexpec);
• Life expectancy by age, sex and educational attainment (ISCED 2011) (demo_mlexpecedu).

https://ec.europa.eu/eurostat/cache/metadata/en/demo_r_gind3_esms.htm" target="_self">Information about statistics on deaths by NUTS regions.

In 2023, there were five countries, where the average woman of childbearing age can expect to have over six children throughout their lifetime. In fact, of the 20 countries in the world with the highest fertility rates, Afghanistan and Yemen are the only countries not found in Sub-Saharan Africa. High fertility rates in Africa With a fertility rate of 6.13 and 6.12 children per woman, Somalia and Chad were the countries with the highest fertility rate in the world. Population growth in Chad is among the highest in the world. Lack of healthcare access, as well as food instability, political instability, and climate change, are all exacerbating conditions that keep Chad's infant mortality rates high, which is generally the driver behind high fertility rates. This situation is common across much of the continent, and, although there has been considerable progress in recent decades, development in Sub-Saharan Africa is not moving as quickly as it did in other regions. Demographic transition While these countries have the highest fertility rates in the world, their rates are all on a generally downward trajectory due to a phenomenon known as the demographic transition. The third stage (of five) of this transition sees birth rates drop in response to decreased infant and child mortality, as families no longer feel the need to compensate for lost children. Eventually, fertility rates fall below replacement level (approximately 2.1 children per woman), which eventually leads to natural population decline once life expectancy plateaus. In some of the most developed countries today, low fertility rates are creating severe econoic and societal challenges as workforces are shrinking while aging populations are placin a greater burden on both public and personal resources.

Abstract

The 1993 Turkish Demographic and Health Survey (TDHS) is a nationally representative survey of ever-married women less than 50 years old. The survey was designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child health. The TDHS was conducted by the Hacettepe University Institute of Population Studies under a subcontract through an agreement between the General Directorate of Mother and Child Health and Family Planning, Ministry of Health and Macro International Inc. of Calverton, Maryland. Fieldwork was conducted from August to October 1993. Interviews were carried out in 8,619 households and with 6,519 women.

The Turkish Demographic and Health Survey (TDHS) is a national sample survey of ever-married women of reproductive ages, designed to collect data on fertility, marriage patterns, family planning, early age mortality, socioeconomic characteristics, breastfeeding, immunisation of children, treatment of children during episodes of illness, and nutritional status of women and children. The TDHS, as part of the international DHS project, is also the latest survey in a series of national-level population and health surveys in Turkey, which have been conducted by the Institute of Population Studies, Haeettepe University (HIPS).

More specifically, the objectives of the TDHS are to:

Collect data at the national level that will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; Analyse the direct and indirect factors that determine levels and trends in fertility and childhood mortality; Measure the level of contraceptive knowledge and practice by method, region, and urban- rural residence; Collect data on mother and child health, including immunisations, prevalence and treatment of diarrhoea, acute respiratory infections among children under five, antenatal care, assistance at delivery, and breastfeeding; Measure the nutritional status of children under five and of their mothers using anthropometric measurements.

The TDHS information is intended to assist policy makers and administrators in evaluating existing programs and in designing new strategies for improving family planning and health services in Turkey.

MAIN RESULTS

Fertility in Turkey is continuing to decline. If Turkish women maintain current fertility rates during their reproductive years, they can expect to have all average of 2.7 children by the end of their reproductive years. The highest fertility rate is observed for the age group 20-24. There are marked regional differences in fertility rates, ranging from 4.4 children per woman in the East to 2.0 children per woman in the West. Fertility also varies widely by urban-rural residence and by education level. A woman living in rural areas will have almost one child more than a woman living in an urban area. Women who have no education have almost one child more than women who have a primary-level education and 2.5 children more than women with secondary-level education.

The first requirement of success ill family planning is the knowledge of family planning methods. Knowledge of any method is almost universal among Turkish women and almost all those who know a method also know the source of the method. Eighty percent of currently married women have used a method sometime in their life. One third of currently married women report ever using the IUD. Overall, 63 percent of currently married women are currently using a method. The majority of these women are modern method users (35 percent), but a very substantial proportion use traditional methods (28 percent). the IUD is the most commonly used modern method (I 9 percent), allowed by the condom (7 percent) and the pill (5 percent). Regional differences are substantial. The level of current use is 42 percent in tile East, 72 percent in tile West and more than 60 percent in tile other three regions. "File common complaints about tile methods are side effects and health concerns; these are especially prevalent for the pill and IUD.

One of the major child health indicators is immunisation coverage. Among children age 12-23 months, the coverage rates for BCG and the first two doses of DPT and polio were about 90 percent, with most of the children receiving those vaccines before age one. The results indicate that 65 percent of the children had received all vaccinations at some time before the survey. On a regional basis, coverage is significantly lower in the Eastern region (41 percent), followed by the Northern and Central regions (61 percent and 65 percent, respectively). Acute respiratory infections (ARI) and diarrhea are the two most prevalent diseases of children under age five in Turkey. In the two weeks preceding the survey, the prevalence of ARI was 12 percent and the prevalence of diarrhea was 25 percent for children under age five. Among children with diarrhea 56 percent were given more fluids than usual.

Breastfeeding in Turkey is widespread. Almost all Turkish children (95 percent) are breastfed for some period of time. The median duration of breastfeeding is 12 months, but supplementary foods and liquids are introduced at an early age. One-third of children are being given supplementary food as early as one month of age and by the age of 2-3 months, half of the children are already being given supplementary foods or liquids.

By age five, almost one-filth of children arc stunted (short for their age), compared to an international reference population. Stunting is more prevalent in rural areas, in the East, among children of mothers with little or no education, among children who are of higher birth order, and among those born less than 24 months after a prior birth. Overall, wasting is not a problem. Two percent of children are wasted (thin for their height), and I I percent of children under five are underweight for their age. The survey results show that obesity is d problem among mothers. According to Body Mass Index (BMI) calculations, 51 percent of mothers are overweight, of which 19 percent are obese.

Geographic coverage

The Turkish Demographic and Health Survey (TDHS) is a national sample survey.

Analysis unit

• Household
• Women age 12-49
• Children under five

Universe

The population covered by the 1993 DHS is defined as the universe of all ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Kind of data

Sample survey data

Sampling procedure

The sample for the TDHS was designed to provide estimates of population and health indicators, including fertility and mortality rates for the nation as a whole, fOr urban and rural areas, and for the five major regions of the country. A weighted, multistage, stratified cluster sampling approach was used in the selection of the TDHS sample.

Sample selection was undertaken in three stages. The sampling units at the first stage were settlements that differed in population size. The frame for the selection of the primary sampling units (PSUs) was prepared using the results of the 1990 Population Census. The urban frame included provinces and district centres and settlements with populations of more than 10,000; the rural frame included subdistricts and villages with populations of less than 10,000. Adjustments were made to consider the growth in some areas right up to survey time. In addition to the rural-urban and regional stratifications, settlements were classified in seven groups according to population size.

The second stage of selection involved the list of quarters (administrative divisions of varying size) for each urban settlement, provided by the State Institute of Statistics (SIS). Every selected quarter was subdivided according tothe number of divisions(approximately 100 households)assigned to it. In rural areas, a selected village was taken as a single quarter, and wherever necessary, it was divided into subdivisions of approximately 100 households. In cases where the number of households in a selected village was less than 100 households, the nearest village was selected to complete the 100 households during the listing activity, which is described below.

After the selection of the secondary sampling units (SSUs), a household listing was obtained for each by the TDHS listing teams. The listing activity was carried out in May and June. From the household lists, a systematic random sample of households was chosen for the TDHS. All ever-married women age 12-49 who were present in the household on the night before the interview were eligible for the survey.

Mode of data collection

Face-to-face

Research instrument

Two questionnaires were used in the main fieldwork for the TDHS: the Household Questionnaire and the Individual Questionnaire for ever-married women of reproductive age. The questionnaires were based on the model survey instruments developed in the DHS program and on the questionnaires that had been employed in previous Turkish population and health surveys. The questionnaires were adapted to obtain data needed for program planning in Turkey during consultations with population and health agencies. Both questionnaires were developed in English and translated into Turkish.

a) The Household Questionnaire was used to enumerate all usual members of and visitors to the selected households and to collect information relating to the socioeconomic position of the households. In the first part of the Household Questionnaire, basic information was collected on the age, sex, educational attainment, marital status and relationship to the head of household for each person listed as a household member

Each year Eurostat collects demographic data at regional level from EU, EFTA and Candidate countries as part of the Population Statistics data collection. POPSTAT is Eurostat’s main annual demographic data collection and aims to gather information on demography and migration at national and regional levels by various breakdowns (for the full overview see the Eurostat dedicated section). More specifically, POPSTAT collects data at regional levels on:

• population stocks;
• vital events (live births and deaths).

Each country must send the statistics for the reference year (T) to Eurostat by 31 December of the following calendar year (T+1). Eurostat then publishes the data in March of the calendar year after that (T+2).

Demographic data at regional level include statistics on the population at the end of the calendar year and on live births and deaths during that year, according to the official classification for statistics at regional level (NUTS - nomenclature of territorial units for statistics) in force in the year. These data are broken down by NUTS 2 and 3 levels for EU countries. For more information on the NUTS classification and its versions please refer to the Eurostat dedicated pages. For EFTA and Candidate countries the data are collected according to the agreed statistical regions that have been coded in a way that resembles NUTS.

The breakdown of demographic data collected at regional level varies depending on the NUTS/statistical region level. These breakdowns are summarised below, along with the link to the corresponding online table:

NUTS 2 level

• Population by sex, age and region of residence — demo_r_d2jan
• Population on 1 January by age group, sex and region of residence — demo_r_pjangroup
• Live births by mother's age, mother's year of birth and mother's region of residence — demo_r_fagec
• Deaths by sex, age, and region of residence — demo_r_magec

NUTS 3 level

• Population on 1 January by sex, age group and region of residence — demo_r_pjangrp3
• Population on 1 January by broad age group, sex and region of residence — demo_r_pjanaggr3
• Live births (total) by region of residence — demo_r_births
• Live births by five-year age group of the mothers and region of residence — demo_r_fagec3
• Deaths (total) by region of residence — demo_r_deaths
• Deaths by five-year age group, sex and region of residence — demo_r_magec3

This more detailed breakdown (by five-year age group) of the data collected at NUTS 3 level started with the reference year 2013 and is in accordance with the European laws on demographic statistics. In addition to the regional codes set out in the NUTS classification in force, these online tables include few additional codes that are meant to cover data on persons and events that cannot be allocated to any official NUTS region. These codes are denoted as CCX/CCXX/CCXXX (Not regionalised/Unknown level 1/2/3; CC stands for country code) and are available only for France, Hungary, North Macedonia and Albania, reflecting the raw data as transmitted to Eurostat.

For the reference years from 1990 to 2012 all countries sent to Eurostat all the data on a voluntary basis, therefore the completeness of the tables and the length of time series reflect the level of data received from the responsible National Statistical Institutes’ (NSIs) data provider. As a general remark, a lower data breakdown is available at NUTS 3 level as detailed:

• population data are broken down by sex and broad age groups (0-14, 15-64 and 65 or more). The data have this disaggregation since the reference year 2007 for all countries, and even longer for some — demo_r_pjanaggr3
• vital events (live births and deaths) data are available only as totals, without any further breakdown — demo_r_births and demo_r_deaths

Demographic indicators are calculated by Eurostat based on the above raw data using a common methodology for all countries and regions. The regional demographic indicators computed by NUTS level and the corresponding online tables are summarised below:

NUTS 2 level

• Population structure indicators by region of residence (shares of various population age groups, dependency ratios and median age) — demo_r_pjanind2
• Fertility indicators by region of residence — demo_r_find2
• Fertility rates by age and region of residence — demo_r_frate2
• Life table by age, sex and region of residence — demo_r_mlife
• Life expectancy by age, sex and region of residence — demo_r_mlifexp
• Infant mortality rates by region of residence — demo_r_minfind

NUTS 3 level

• Population change - Demographic balance and crude rates at regional level — demo_r_gind3
• Population density by region — demo_r_d3dens
• Population structure indicators by region of residence (shares of various population age groups, dependency ratios and median age) — demo_r_pjanind3
• Fertility indicators by region of residence (total fertility rate, mean age of woman at childbirth and median age of woman at childbirth) — demo_r_find3

Notes:

1) All the indicators are computed for all lower NUTS regions included in the tables (e.g. data included in a table at NUTS 3 level will include also the data for NUTS 2, 1 and country levels).

2) Demographic indicators computed by NUTS 2 and 3 levels are calculated using input data that have different age breakdown. Therefore, minor differences can be noted between the values corresponding to the same indicator of the same region classified as NUTS 2, 1 or country level.

3) Since the reference year 2015, Eurostat has stopped collecting data on area; therefore, the table 'Area by NUTS 3 region (demo_r_d3area)' includes data up to the year 2015 included.

4) Starting with the reference year 2016, the population density indicator is computed using the new data on area 'Area by NUTS 3 region (reg_area3).

Eurostat’s annual data collections on demographic statistics are structured as follows:

NOWCAST: Annual data collection on provisional monthly data on live births and deaths covering at least six months of the reference year (Article 4.3 of the Commission implementing regulation (EU) No 205/2014).

DEMOBAL (Demographic balance): Annual data collection on provisional data on population, total live births and total deaths at national level (Article 4.1 of the Commission implementing regulation (EU) No 205/2014).

POPSTAT (Population Statistics): The most in-depth annual national and regional demographic and migration data collection. The data relate to populations, births, deaths, immigrants, emigrants, marriages and divorces, and is broken down into several categories (Article 3 of Regulation (EU) No 1260/2013 and Article 3 of Regulation (EC) No 862/2007).

The aim is to collect annual mandatory and voluntary demographic data from the national statistical institutes. Mandatory data are those defined by the legislation listed under ‘6.1. Institutional mandate - legal acts and other agreements’.

The completeness of the demographic data collected on a voluntary basis depends on the availability and completeness of information provided by the national statistical institutes. For more information on mandatory/voluntary data collection, see 6.1. Institutional mandate - legal acts and other agreements’.

The following statistics on deaths are collected from the National Statistical Institutes:

• Deaths by month of occurrence
• Deaths by age, year of birth, sex and by:
  • Region (NUTS 2) of residence;
  • Region (NUTS 3) of residence;
  • Country of birth;
  • Country of citizenship;
  • Legal marital status;
  • Educational attainment (ISCED 2011).
• Infant deaths by age and sex;
• Infant deaths by parents' level of educational attainment (ISCED);
• Late foetal deaths by mother's age.

Statistics on mortality: based on the different breakdowns of data on deaths received, Eurostat produces the following:

• Statistics available in the online table Population change - Demographic balance and crude rates at national level (demo_gind):
  • Natural change of population, crude death rate.
• Statistics available in the online table Infant mortality rates (demo_find):
  • Infant mortality rate;
  • Neonatal mortality rate;
  • Early neonatal mortality rate;
  • Late foetal mortality rate;
  • Perinatal mortality rate.
• Life table (demo_mlifetable);
• Life expectancy by age and sex (demo_mlexpec);
• Life expectancy by age, sex and educational attainment (ISCED 2011) (demo_mlexpecedu).

https://ec.europa.eu/eurostat/cache/metadata/en/demo_r_gind3_esms.htm" target="_self">Information about statistics on deaths by NUTS regions.

The statistic shows the 20 countries with the lowest fertility rates in 2024. All figures are estimates. In 2024, the fertility rate in Taiwan was estimated to be at 1.11 children per woman, making it the lowest fertility rate worldwide. Fertility rate The fertility rate is the average number of children born per woman of child-bearing age in a country. Usually, a woman aged between 15 and 45 is considered to be in her child-bearing years. The fertility rate of a country provides an insight into its economic state, as well as the level of health and education of its population. Developing countries usually have a higher fertility rate due to lack of access to birth control and contraception, and to women usually foregoing a higher education, or even any education at all, in favor of taking care of housework. Many families in poorer countries also need their children to help provide for the family by starting to work early and/or as caretakers for their parents in old age. In developed countries, fertility rates and birth rates are usually much lower, as birth control is easier to obtain and women often choose a career before becoming a mother. Additionally, if the number of women of child-bearing age declines, so does the fertility rate of a country. As can be seen above, countries like Hong Kong are a good example for women leaving the patriarchal structures and focusing on their own career instead of becoming a mother at a young age, causing a decline of the country’s fertility rate. A look at the fertility rate per woman worldwide by income group also shows that women with a low income tend to have more children than those with a high income. The United States are neither among the countries with the lowest, nor among those with the highest fertility rate, by the way. At 2.08 children per woman, the fertility rate in the US has been continuously slightly below the global average of about 2.4 children per woman over the last decade.

In 2024, the average number of children born per 1,000 people in China ranged at ****. The birth rate has dropped considerably since 2016, and the number of births fell below the number of deaths in 2022 for the first time in decades, leading to a negative population growth rate. Recent development of the birth rate Similar to most East-Asian countries and territories, demographics in China today are characterized by a very low fertility rate. As low fertility in the long-term limits economic growth and leads to heavy strains on the pension and health systems, the Chinese government decided to support childbirth by gradually relaxing strict birth control measures, that had been in place for three decades. However, the effect of this policy change was considerably smaller than expected. The birth rate increased from **** births per 1,000 inhabitants in 2010 to ***** births in 2012 and remained on a higher level for a couple of years, but then dropped again to a new low in 2018. This illustrates that other factors constrain the number of births today. These factors are most probably similar to those experienced in other developed countries as well: women preferring career opportunities over maternity, high costs for bringing up children, and changed social norms, to name only the most important ones. Future demographic prospects Between 2020 and 2023, the birth rate in China dropped to formerly unknown lows, most probably influenced by the coronavirus pandemic. As all COVID-19 restrictions were lifted by the end of 2022, births figures showed a catch-up effect in 2024. However, the scope of the rebound might be limited. A population breakdown by five-year age groups indicates that the drop in the number of births is also related to a shrinking number of people with child-bearing age. The age groups between 15 and 29 years today are considerably smaller than those between 30 and 44, leaving less space for the birth rate to increase. This effect is exacerbated by a considerable gender gap within younger age groups in China, with the number of females being much lower than that of males.

This statistic shows the 20 countries * with the lowest infant mortality rate in 2024. An estimated 1.5 out of 1,000 live births died in the first year of life in Slovenia and Singapore in 2024. Infant mortality Infant mortality rates are often used as an indicator of the health and well-being of a nation. Monaco, Iceland, and Japan are among the top three countries with the lowest infant mortality rates with around 2 infant deaths per 1,000 infants within their first year of life. Generally, the countries with the lowest infant mortality also have some of the highest average life expectancy figures. Additionally, the countries with the highest density of physicians and doctors also generally report low infant mortality. Yet, many different factors contribute to differing rates, including the overall income of a country, health spending per capita, a mother’s level of education, environmental conditions, and medical infrastructure, to name a few. This creates a lot of variation concerning the level of childbirth and infant care around the world. The countries with the highest rates of infant mortality include Afghanistan, Mali, and Somalia. These countries experience around 100 infant deaths per 1,000 infants in their first year of life. While the reasons for high rates of infant mortality are numerous, the leading causes of death for children under the year five around the world are Pneumonia, Diarrhea, and Prematurity.

Rural population change is a critical element of the strategy for rural revitalization in China. Many studies emphasize large-scale macro-population trends, but a noticeable gap exists in micro-level simulations and predictions regarding rural population size and structure. This study employs an agent-based model(ABM), defining a population agent and its behavioral rules. By modeling individual-level birth, death, and migration behaviors, it generates agent-based outputs that aggregate to capture population dynamics and forecast rural demographic trends over the next 11 years. Using two representative villages as study areas, the results were validated by comparing them with actual population data and predictions made by the Leslie model. The findings demonstrate the following: 1) the agent-based modeling effectively captures the dynamics of births, deaths, and migrations at the micro level, elucidating the underlying determinants of rural population retention. 2) In economically disadvantaged villages, the total population, labor force, and proportion of adolescents have significantly declined. Notably, emigration is pronounced in villages without industrial advantages, regardless of substantial per capita arable land; the youth labor force constitutes less than 30%, while the aging population is as high as 45%. 3) Migration and birth rates are key factors influencing rural population trends. To mitigate future rural population aging, enhancing birth rates and fostering rural industrial development is essential to curb migration. These findings support evidence-based policies to stimulate birth rates, attract and retain younger populations, and enhance economic opportunities in rural areas. The micro-level analysis enables the design of more effective and context-specific rural revitalization programs, bridging the gap between micro-level behaviors and macro-level demographic patterns.

This dataset provides a global gridded (5 arc-min resolution) detailed annual net-migration dataset for 2000-2019. We also provide global annual birth and death rate datasets – that were used to estimate the net-migration – for same years. The dataset is presented in details, with some further analyses, in the following publication. Please cite this paper when using data.

Niva et al. 2023. World's human migration patterns in 2000-2019 unveiled by high-resolution data. Nature Human Behaviour 7: 2023–2037. Doi: https://doi.org/10.1038/s41562-023-01689-4

You can explore the data in our online net-migration explorer: https://wdrg.aalto.fi/global-net-migration-explorer/

Short introduction to the data

For the dataset, we collected, gap-filled, and harmonised:

a comprehensive national level birth and death rate datasets for altogether 216 countries or sovereign states; and

sub-national data for births (data covering 163 countries, divided altogether into 2555 admin units) and deaths (123 countries, 2067 admin units).

These birth and death rates were downscaled with selected socio-economic indicators to 5 arc-min grid for each year 2000-2019. These allowed us to calculate the 'natural' population change and when this was compared with the reported changes in population, we were able to estimate the annual net-migration. See more about the methods and calculations at Niva et al (2023).

We recommend using the data either over multiple years (we provide 3, 5 and 20 year net-migration sums at gridded level) or then aggregated over larger area (we provide adm0, adm1 and adm2 level geospatial polygon files). This is due to some noise in the gridded annual data.

Due to copy-right issues we are not able to release all the original data collected, but those can be requested from the authors.

List of datasets

Birth and death rates:

raster_birth_rate_2000_2019.tif: Gridded birth rate for 2000-2019 (5 arc-min; multiband tif)

raster_death_rate_2000_2019.tif: Gridded death rate for 2000-2019 (5 arc-min; multiband tif)

tabulated_adm1adm0_birth_rate.csv: Tabulated sub-national birth rate for 2000-2019 at the division to which data was collected (subnational data when available, otherwise national)

tabulated_ adm1adm0_death_rate.csv: Tabulated sub-national death rate for 2000-2019 at the division to which data was collected (subnational data when available, otherwise national)

Net-migration:

raster_netMgr_2000_2019_annual.tif: Gridded annual net-migration 2000-2019 (5 arc-min; multiband tif)

raster_netMgr_2000_2019_3yrSum.tif: Gridded 3-yr sum net-migration 2000-2019 (5 arc-min; multiband tif)

raster_netMgr_2000_2019_5yrSum.tif: Gridded 5-yr sum net-migration 2000-2019 (5 arc-min; multiband tif)

raster_netMgr_2000_2019_20yrSum.tif: Gridded 20-yr sum net-migration 2000-2019 (5 arc-min)

polyg_adm0_dataNetMgr.gpkg: National (adm 0 level) net-migration geospatial file (gpkg)

polyg_adm1_dataNetMgr.gpkg: Provincial (adm 1 level) net-migration geospatial file (gpkg) (if not adm 1 level division, adm 0 used)

polyg_adm2_dataNetMgr.gpkg: Communal (adm 2 level) net-migration geospatial file (gpkg) (if not adm 2 level division, adm 1 used; and if not adm 1 level division either, adm 0 used)

Files to run online net migration explorer

masterData.rds and admGeoms.rds are related to our online ‘Net-migration explorer’ tool (https://wdrg.aalto.fi/global-net-migration-explorer/). The source code of this application is available in https://github.com/vvirkki/net-migration-explorer. Running the application locally requires these two .rds files from this repository.

Metadata

Grids:

Resolution: 5 arc-min (0.083333333 degrees)

Spatial extent: Lon: -180, 180; -90, 90 (xmin, xmax, ymin, ymax)

Coordinate ref system: EPSG:4326 - WGS 84

Format: Multiband geotiff; each band for each year over 2000-2019

Units:

Birth and death rates: births/deaths per 1000 people per year

Net-migration: persons per 1000 people per time period (year, 3yr, 5yr, 20yr, depending on the dataset)

Geospatial polygon (gpkg) files:

Spatial extent: -180, 180; -90, 83.67 (xmin, xmax, ymin, ymax)

Temporal extent: annual over 2000-2019

Coordinate ref system: EPSG:4326 - WGS 84

Format: gkpk

Units:

Net-migration: persons per 1000 people per year

Abstract

Moldova's first Demographic and Health Survey (2005 MDHS) is a nationally representative sample survey of 7,440 women age 15-49 and 2,508 men age 15-59 selected from 400 sample points (clusters) throughout Moldova (excluding the Transnistria region). It is designed to provide data to monitor the population and health situation in Moldova; it includes several indicators which follow up on those from the 1997 Moldova Reproductive Health Survey (1997 MRHS) and the 2000 Multiple Indicator Cluster Survey (2000 MICS). The 2005 MDHS used a two-stage sample based on the 2004 Population and Housing Census and was designed to produce separate estimates for key indicators for each of the major regions in Moldova, including the North, Center, and South regions and Chisinau Municipality. Unlike the 1997 MRHS and the 2000 MICS surveys, the 2005 MDHS did not cover the region of Transnistria. Data collection took place over a two-month period, from June 13 to August 18, 2005.

The survey obtained detailed information on fertility levels, abortion levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, adult health, and awareness and behavior regarding HIV infection and other sexually transmitted diseases. Hemoglobin testing was conducted on women and children to detect the presence of anemia. Additional features of the 2005 MDHS include the collection of information on international emigration, language preference for reading printed media, and domestic violence. The 2005 MDHS was carried out by the National Scientific and Applied Center for Preventive Medicine, hereafter called the National Center for Preventive Medicine (NCPM), of the Ministry of Health and Social Protection. ORC Macro provided technical assistance for the MDHS through the USAID-funded MEASURE DHS project. Local costs of the survey were also supported by USAID, with additional funds from the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and in-kind contributions from the NCPM.

MAIN RESULTS

CHARACTERISTICS OF RESPONDENTS

Ethnicity and Religion. Most women and men in Moldova are of Moldovan ethnicity (77 percent and 76 percent, respectively), followed by Ukrainian (8-9 percent of women and men), Russian (6 percent of women and men), and Gagauzan (4-5 percent of women and men). Romanian and Bulgarian ethnicities account for 2 to 3 percent of women and men. The overwhelming majority of Moldovans, about 95 percent, report Orthodox Christianity as their religion.

Residence and Age. The majority of respondents, about 58 percent, live in rural areas. For both sexes, there are proportionally more respondents in age groups 15-19 and 45-49 (and also 45-54 for men), whereas the proportion of respondents in age groups 25-44 is relatively lower. This U-shaped age distribution reflects the aging baby boom cohort following World War II (the youngest of the baby boomers are now in their mid-40s), and their children who are now mostly in their teens and 20s. The smaller proportion of men and women in the middle age groups reflects the smaller cohorts following the baby boom generation and those preceding the generation of baby boomers' children. To some degree, it also reflects the disproportionately higher emigration of the working-age population.

Education. Women and men in Moldova are universally well educated, with virtually 100 percent having at least some secondary or higher education; 79 percent of women and 83 percent of men have only a secondary or secondary special education, and the remainder pursues a higher education. More women (21 percent) than men (16 percent) pursue higher education.

Language Preference. Among women, preferences for language of reading material are about equal for Moldovan (37 percent) and Russian (35 percent) languages. Among men, preference for Russian (39 percent) is higher than for Moldovan (25 percent). A substantial percentage of women and men prefer Moldovan and Russian equally (27 percent of women and 32 percent of men).

Living Conditions. Access to electricity is almost universal for households in Moldova. Ninety percent of the population has access to safe drinking water, with 86 percent in rural areas and 96 percent in urban areas. Seventy-seven percent of households in Moldova have adequate means of sanitary disposal, with 91 percent of households in urban areas and only 67 percent in rural areas.

Children's Living Arrangements. Compared with other countries in the region, Moldova has the highest proportion of children who do not live with their mother and/or father. Only about two-thirds (69 percent) of children under age 15 live with both parents. Fifteen percent live with just their mother although their father is alive, 5 percent live with just their father although their mother is alive, and 7 percent live with neither parent although they are both alive. Compared with living arrangements of children in 2000, the situation appears to have worsened.

FERTILITY

Fertility Levels and Trends. The total fertility rate (TFR) in Moldova is 1.7 births. This means that, on average, a woman in Moldova will give birth to 1.7 children by the end of her reproductive period. Overall, fertility rates have declined since independence in 1991. However, data indicate that fertility rates may have increased in recent years. For example, women of childbearing age have given birth to, on average, 1.4 children at the end of their childbearing years. This is slightly less than the total fertility rate (1.7), with the difference indicating that fertility in the past three years is slightly higher than the accumulation of births over the past 30 years.

Fertility Differentials. The TFR for rural areas (1.8 births) is higher than that for urban areas (1.5 births). Results show that this urban-rural difference in childbearing rates can be attributed almost exclusively to younger age groups.

CONTRACEPTION

Knowledge of Contraception. Knowledge of family planning is nearly universal, with 99 percent of all women age 15-49 knowing at least one modern method of family planning. Among all women, the male condom, IUD, pills, and withdrawal are the most widely known methods of family planning, with over 80 percent of all women saying they have heard of these methods. Female sterilization is known by two-thirds of women, while periodic abstinence (rhythm method) is recognized by almost six in ten women. Just over half of women have heard of the lactational amenorrhea method (LAM), while 40-50 percent of all women have heard of injectables, male sterilization, and foam/jelly. The least widely known methods are emergency contraception, diaphragm, and implants.

Use of Contraception. Sixty-eight percent of currently married women are using a family planning method to delay or stop childbearing. Most are using a modern method (44 percent of married women), while 24 percent use a traditional method of contraception. The IUD is the most widely used of the modern methods, being used by 25 percent of married women. The next most widely used method is withdrawal, used by 20 percent of married women. Male condoms are used by about 7 percent of women, especially younger women. Five percent of married women have been sterilized and 4 percent each are using the pill and periodic abstinence (rhythm method). The results show that Moldovan women are adopting family planning at lower parities (i.e., when they have fewer children) than in the past. Among younger women (age 20-24), almost half (49 percent) used contraception before having any children, compared with only 12 percent of women age 45-49.

MATERNAL HEALTH

Antenatal Care and Delivery Care. Among women with a birth in the five years preceding the survey, almost all reported seeing a health professional at least once for antenatal care during their last pregnancy; nine in ten reported 4 or more antenatal care visits. Seven in ten women had their first antenatal care visit in the first trimester. In addition, virtually all births were delivered by a health professional, in a health facility. Results also show that the vast majority of women have timely checkups after delivering; 89 percent of all women received a medical checkup within two days of the birth, and another 6 percent within six weeks.

CHILD HEALTH

Childhood Mortality. The infant mortality rate for the 5-year period preceding the survey is 13 deaths per 1,000 live births, meaning that about 1 in 76 infants dies before the first birthday. The under-five mortality rate is almost the same with 14 deaths per 1,000 births. The near parity of these rates indicates that most all early childhood deaths take place during the first year of life. Comparison with official estimates of IMRs suggests that this rate has been improving over the past decade.

NUTRITION

Breastfeeding Practices. Breastfeeding is nearly universal in Moldova: 97 percent of children are breastfed. However the duration of breast-feeding is not long, exclusive breastfeeding is not widely practiced, and bottle-feeding is not uncommon. In terms of the duration of breastfeeding, data show that by age 12-15 months, well over half of children (59 percent) are no longer being breastfed. By age 20-23 months, almost all children have been weaned.

Exclusive breastfeeding is not widely practiced and supplementary feeding begins early: 57 percent of breastfed children less than 4 months are exclusively breastfed, and 46 percent under six months are exclusively breastfeed. The remaining breastfed children also consume plain water, water-based liquids or juice, other milk in addition to breast milk, and complimentary foods. Bottle-feeding is fairly widespread in Moldova;

In 2025, India overtook China as the world's most populous country and now has almost 1.46 billion people. China now has the second-largest population in the world, still with just over 1.4 billion inhabitants, however, its population went into decline in 2023. Global population As of 2025, the world's population stands at almost 8.2 billion people and is expected to reach around 10.3 billion people in the 2080s, when it will then go into decline. Due to improved healthcare, sanitation, and general living conditions, the global population continues to increase; mortality rates (particularly among infants and children) are decreasing and the median age of the world population has steadily increased for decades. As for the average life expectancy in industrial and developing countries, the gap has narrowed significantly since the mid-20th century. Asia is the most populous continent on Earth; 11 of the 20 largest countries are located there. It leads the ranking of the global population by continent by far, reporting four times as many inhabitants as Africa. The Demographic Transition The population explosion over the past two centuries is part of a phenomenon known as the demographic transition. Simply put, this transition results from a drastic reduction in mortality, which then leads to a reduction in fertility, and increase in life expectancy; this interim period where death rates are low and birth rates are high is where this population explosion occurs, and population growth can remain high as the population ages. In today's most-developed countries, the transition generally began with industrialization in the 1800s, and growth has now stabilized as birth and mortality rates have re-balanced. Across less-developed countries, the stage of this transition varies; for example, China is at a later stage than India, which accounts for the change in which country is more populous - understanding the demographic transition can help understand the reason why China's population is now going into decline. The least-developed region is Sub-Saharan Africa, where fertility rates remain close to pre-industrial levels in some countries. As these countries transition, they will undergo significant rates of population growth.

The 1998 Philippines National Demographic and Health Survey (NDHS). is a nationally-representative survey of 13,983 women age 15-49. The NDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. It was implemented by the National Statistics Office in collaboration with the Department of Health (DOH). Macro International Inc. of Calverton, Maryland provided technical assistance to the project, while financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. Fieldwork for the NDHS took place from early March to early May 1998. The primary objective of the NDHS is to Provide up-to-date information on fertility levels; determinants of fertility; fertility preferences; infant and childhood mortality levels; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health and family planning services in the country. MAIN RESULTS Survey data generally confirm patterns observed in the 1993 National Demographic Survey (NDS), showing increasing contraceptive use and declining fertility. FERTILITY Fertility Decline. The NDHS data indicate that fertility continues to decline gradually but steadily. At current levels, women will give birth an average of 3.7 children per woman during their reproductive years, a decline from the level of 4.1 recorded in the 1993 NDS. A total fertility rate of 3.7, however, is still considerably higher than the rates prevailing in neighboring Southeast Asian countries. Fertility Differentials. Survey data show that the large differential between urban and rural fertility levels is widening even further. While the total fertility rate in urban areas declined by about 15 percent over the last five years (from 3.5 to 3.0), the rate among rural women barely declined at all (from 4.8 to 4.7). Consequently, rural women give birth to almost two children more than urban women. Significant differences in fertility levels by region still exist. For example, fertility is more than twice as high in Eastern Visayas and Bicol Regions (with total fertility rates well over 5 births per woman) than in Metro Manila (with a rate of 2.5 births per woman). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 5.0 children in their lifetime, compared to 2.9 for women with at least some college education. Women with either elementary or high school education have intermediate fertility rates. Family Size Norms. One reason that fertility has not fallen more rapidly is that women in the Philippines still want moderately large families. Only one-third of women say they would ideally like to have one or two children, while another third state a desire for three children. The remaining third say they would choose four or more children. Overall, the mean ideal family size among all women is 3.2 children, identical to the mean found in 1993. Unplanned Fertility. Another reason for the relatively high fertility level is that unplanned pregnancies are still common in the Philippines. Overall, 45 percent of births in the five years prior to the survey were reported to be unplanned; 27 percent were mistimed (wanted later) and 18 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in the Philippines would be 2.7 births per woman instead of the actual level of 3.7. Age at First Birth. Fertility rates would be even higher if Filipino women did not have a pattem of late childbearing. The median age at first birth is 23 years in the Philippines, considerably higher than in most other countries. Another factor that holds down the overall level of fertility is the fact that about 9 or 10 percent of women never give birth, higher than the level of 3-4 percent found in most developing countries. FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in the Philippines has been the gradual but fairly steady increase in contraceptive use over the last three decades. The contraceptive prevalence rate has tripled since 1968, from 15 to 47 percent of married women. Although contraceptive use has increased since the 1993 NDS (from 40 to 47 percent of married women), comparison with the series of nationally representative Family Planning Surveys indicates that there has been a levelling-off in family planning use in recent years. Method Mix. Use of traditional methods of family planning has always accounted for a relatively high proportion of overall use in the Philippines, and data from the 1998 NDHS show the proportion holding steady at about 40 percent. The dominant changes in the "method mix" since 1993 have been an increase in use of injectables and traditional methods such as calendar rhythm and withdrawal and a decline in the proportions using female sterilization. Despite the decline in the latter, female sterilization still is the most widely used method, followed by the pill. Differentials in Family Planning Use. Differentials in current use of family planning in the 16 administrative regions of the country are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao and Central Luzon. Contraceptive use varies considerably by education of women. Only 15 percent of married women with no formal education are using a method, compared to half of those with some secondary school. The urban-rural gap in contraceptive use is moderate (51 vs. 42 percent, respectively). Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in the Philippines for some time and the NDHS results indicate that 99 percent of currently married women age 15-49 have heard of at least one method of family planning. More than 9 in 10 married women know the pill, IUD, condom, and female sterilization, while about 8 in 10 have heard of injectables, male sterilization, rhythm, and withdrawal. Knowledge of injectables has increased far more than any other method, from 54 percent of married women in 1993 to 89 percent in 1998. Unmet Need for Family Planning. Unmet need for family planning services has declined since I993. Data from the 1993 NDS show that 26 percent of currently married women were in need of services, compared with 20 percent in the 1998 NDHS. A little under half of the unmet need is comprised of women who want to space their next birth, while just over half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 47 percent to 70 percent of married women. Currently, about three-quarters of this "total demand" for family planning is being met. Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. NDHS data indicate that about 40 percent of contraceptive users in the Philippines stop using within 12 months of starting, almost one-third of whom stop because of an unwanted pregnancy (i.e., contraceptive failure). Discontinuation rates vary by method. Not surprisingly, the rates for the condom (60 percent), withdrawal (46 percent), and the pill (44 percent) are considerably higher than for the 1UD (14 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifty-two percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. MATERNAL AND CHILD HEALTH Childhood Mortality. Survey results show that although the infant mortality rate remains unchanged, overall mortality of children under five has declined somewhat in recent years. Under-five mortality declined from 54 deaths per 1,000 births in 1988-92 to 48 for the period 1993-97. The infant mortality rate remained stable at about 35 per 1,000 births. Childhood Vaccination Coverage. The 1998 NDHS results show that 73 percent of children 12- 23 months are fully vaccinated by the date of the interview, almost identical to the level of 72 percent recorded in the 1993 NDS. When the data are restricted to vaccines received before the child's first birthday, however, only 65 percent of children age 12-23 months can be considered to be fully vaccinated. Childhood Health. The NDHS provides some data on childhood illness and treatment. Approximately one in four children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, 58 percent were taken to a health facility for treatment. Seven percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that four-fifths of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Breastfeeding Practices. Almost all Filipino babies (88 percent) are breastfed for some time, with a median duration of breastfeeding of 13 months. Although breastfeeding has beneficial effects on both the child and the mother, NDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in the Philippines. For example, among newborns less than two months of age, 19 percent were already receiving supplemental foods or liquids other than water. Maternal Health Care. NDHS data point to several areas regarding maternal health care in which improvements could be made. Although most Filipino mothers (86 percent) receive prenatal care from a doctor, nurse, or midwife, tetanus toxoid coverage is far from universal and

The American black bear (Ursus americanus) has one of the broadest geographic distributions of any mammalian carnivore in North America. Populations occur from high to low elevations and from mesic to arid environments, and their demographic traits have been documented in a wide variety of environments. However, the demography of American black bears in semiarid environments, which comprise a significant portion of the geographic range, is poorly documented. To fill this gap in understanding, we used data from a long-term mark-recapture study of black bears in the semiarid environment of eastern Utah, USA. Cub and yearling survival were low and adult survival was high relative to other populations. Adult life stages had the highest reproductive value, comprised the largest proportion of the population, and exhibited the highest elasticity contribution to the population growth rate (i.e., λ). Vital rates of black bears in this semiarid environment are skewed toward higher survival of adults, and lower survival of cubs compared to other populations. Methods Mark-Recapture study We estimated survival rates from long-term mark-recapture data gathered as part of a 27-year study on American black bears of the East Tavaputs Plateau. During the first 12 years of the study (June to August 1991-2003) female bears were captured and radio-collared, and all bears were tagged in the ear, except for cubs and yearlings. For the entire study (1992 – 2019), collared females were visited in their dens annually during their winter hibernation to count newborn cubs and surviving yearlings. Age of individual bears was determined by 2 methods: (1) direct observation of cubs or yearlings (i.e., year of birth was known) or (2) cementum annuli analysis of a cross-section of the root of an extracted premolar (Palochak, 2004; Willey, 1974). The data we used to derive survival and fecundity rates consisted of the ID_number, cohort (cub, yearling, subadult, prime-aged adult, and old adult), age in years, sex (female, male, unknown), number of cubs, number of yearlings, first observation of individual, last observation of individual, days from last observation, and survival status. We did not include subadult and adult male bears in the analysis. Survival rates To determine the average survival rates for each life stage, we used a Cox proportional hazards model in program R (Team, 2022). This model accommodates staggered entries, where individuals enter the study at different times, and censoring, where the event of interest (e.g., mortality) is not observed for all individuals due to the inability to follow-up or the study ending before the event occurs. These features allow for a more accurate representation of survival over time, even with incomplete data (Cox, 1972). The Cox model is a semi-parametric approach that examines how covariates, such as age and environmental factors, influence the risk of death at any given point in time. Unlike fully parametric models, which require defining the baseline hazard function (the risk of death when all covariates are at baseline levels), the Cox model does not require this step, making it highly flexible and suitable for diverse data and applications (Zhang, 2016). The hazard function in this context refers to the rate or likelihood of an event (e.g., death) occurring at a specific moment, given that the individual has survived up to that time. The Cox model is expressed as follows: h(t|X) = h0(t) exp(β1X1 + β2X2 +...+ βpXp) where h(t|X) is the hazard function at time t given covariates X, h0(t) is the baseline hazard function β1, β2, …, βp are the coefficients for the predictor variables X1, X2, …, Xp. The model assumes proportional hazards, meaning the relative risk of death (the hazard ratio) between two groups remains constant over time (Zhang, 2016). The advantage of the Cox model is its ability to handle censored data, common in survival analysis. Censoring occurs when some individuals have not experienced mortality by the end of the study, so we only know that they survived up to that point. Moreover, the Cox model can incorporate time-dependent covariates, enabling a dynamic analysis of how risk factors influence survival over time (Therneau & Grambsch, 2000). For our analysis, we formulated four Cox proportional hazards models as follows: 1) constant survival, 2) a model with the effect of maternal age, 3) a model with the effect of cohort, and 4) a model with the combined effect of age and cohort. We compared these models using Akaike’s Information Criterion (AIC) to identify the best fit and then evaluate the effect sizes of covariates based on the β coefficients from the top-performing model (Burnham et al., 2011; Symonds & Moussalli, 2011). When there was uncertainty in model selection, we used model averaging to estimate effect sizes and β coefficients. Each model was also checked for uninformative parameters (Arnold, 2010). We reviewed the model summaries to assess the estimated effects of covariates (constant survival, maternal age, cohort, and the combination of age and cohort) on survival outcomes. Fecundity rates To determine fecundity rates, we used females monitored through the use of radio-collars. All females that were ≥ four years old were counted in the breeding pool. We removed any female ≥ 25 years of age from the breeding pool (Noyce, 2010). We classified old adults as ≥ 15 years old and prime-aged adults as 4-14 years of age. We visited dens of females to observe whether they were alone or accompanied by cubs or yearlings as well as the sexes of their offspring. At the height of the study, we had 15 prime-aged adult females, along with a few old-adult females. There was variation in the number of adult females and old-adult females throughout the study period and we had at least two old-adult females in each year for 12 years during the study. Matrix Transition Model and Analysis We developed a transition matrix model based on adult females and their offspring to estimate population growth and additional demographic parameters. In the model, we assumed every cub was born on January 1st and survived through the full year if they were alive through the 15th of October. We assumed density of males does not affect breeding success (Lewis et al., 2014). We divided the population into five age-based stages: cub (0–1 year-old); yearling (1–2 years old), subadult (2–4 years old), prime-aged adult (4–14 years old), and old adult (15+). We used the term sm to indicate the probability of surviving and transitioning to a new stage (matrix sub diagonal), and the term ss indicated the probability of surviving and staying in the same stage (matrix diagonal). We used f to indicate fecundity or reproduction (matrix upper right corner; Fig. 1A, 1B). We used the software Unified Life Models (ULM; (Legendre & Clobert, 1995) to evaluate the matrix model and to calculate population growth rate, stable age distribution, reproductive value, and sensitivity and elasticity matrices. We summed elasticity values across all stages for the three demographic processes: fecundity (f), growth (sm, transition from one age stage to another), and stasis (ss, survival without transitioning). Our matrix transition model differed from the matrix transition model generated by Beston (2011), which used nine life stages. To ensure an accurate comparison between the two models, we combined the nine life stages from the matrix transition model in the meta-analysis (Beston, 2011) into five broader stages: cub, yearling, subadult, adult, and old adult. We selected five life stages due to the assumption that age might influence reproductive output, a pattern supported by research on other mammals (Hilderbrand et al., 2019; Nussey et al., 2008; Promislow & Harvey, 1990).

Abstract

The 1995 Uganda Demographic and Health Survey (UDHS-II) is a nationally-representative survey of 7,070 women age 15-49 and 1,996 men age 15-54. The UDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. Fieldwork for the UDHS took place from late-March to mid-August 1995. The survey was similar in scope and design to the 1988-89 UDHS. Survey data show that fertility levels may be declining, contraceptive use is increasing, and childhood mortality is declining; however, data also point to several remaining areas of challenge.

The 1995 UDHS was a follow-up to a similar survey conducted in 1988-89. In addition to including most of the same questions included in the 1988-89 UDHS, the 1995 UDHS added more detailed questions on AIDS and maternal mortality, as well as incorporating a survey of men. The general objectives of the 1995 UDHS are to: - provide national level data which will allow the calculation of demographic rates, particularly fertility and childhood mortality rates; - analyse the direct and indirect factors which determine the level and trends of fertility; - measure the level of contraceptive knowledge and practice (of both women and men) by method, by urban-rural residence, and by region; - collect reliable data on maternal and child health indicators; immunisation, prevalence, and treatment of diarrhoea and other diseases among children under age four; antenatal visits; assistance at delivery; and breastfeeding; - assess the nutritional status of children under age four and their mothers by means of anthropometric measurements (weight and height), and also child feeding practices; and - assess among women and men the prevailing level of specific knowledge and attitudes regarding AIDS and to evaluate patterns of recent behaviour regarding condom use.

MAIN RESULTS

• Fertility:

Fertility Trends. UDHS data indicate that fertility in Uganda may be starting to decline. The total fertility rate has declined from the level of 7.1 births per woman that prevailed over the last 2 decades to 6.9 births for the period 1992-94. The crude birth rate for the period 1992-94 was 48 live births per I000 population, slightly lower than the level of 52 observed from the 1991 Population and Housing Census. For the roughly 80 percent of the country that was covered in the 1988-89 UDHS, fertility has declined from 7.3 to 6.8 births per woman, a drop of 7 percent over a six and a half year period.

Birth Intervals. The majority of Ugandan children (72 percent) are born after a "safe" birth interval (24 or more months apart), with 30 percent born at least 36 months after a prior birth. Nevertheless, 28 percent of non-first births occur less than 24 months after the preceding birth, with 10 percent occurring less than 18 months since the previous birth. The overall median birth interval is 29 months. Fertility Preferences. Survey data indicate that there is a strong desire for children and a preference for large families in Ugandan society. Among those with six or more children, 18 percent of married women want to have more children compared to 48 percent of married men. Both men and women desire large families.

• Family planning:

Knowledge of Contraceptive Methods. Knowledge of contraceptive methods is nearly universal with 92 percent of all women age 15-49 and 96 percent of all men age 15-54 knowing at least one method of family planning. Increasing Use of Contraception. The contraceptive prevalence rate in Uganda has tripled over a six-year period, rising from about 5 percent in approximately 80 percent of the country surveyed in 1988-89 to 15 percent in 1995.

Source of Contraception. Half of current users (47 percent) obtain their methods from public sources, while 42 percent use non-governmental medical sources, and other private sources account for the remaining 11 percent.

• Maternal and child health:

High Childhood Mortality. Although childhood mortality in Uganda is still quite high in absolute terms, there is evidence of a significant decline in recent years. Currently, the direct estimate of the infant mortality rate is 81 deaths per 1,000 births and under five mortality is 147 per 1,000 births, a considerable decline from the rates of 101 and 180, respectively, that were derived for the roughly 80 percent of the country that was covered by the 1988-89 UDHS.

Childhood Vaccination Coverage. One possible reason for the declining mortality is improvement in childhood vaccination coverage. The UDHS results show that 47 percent of children age 12-23 months are fully vaccinated, and only 14 percent have not received any vaccinations.

Childhood Nutritional Status. Overall, 38 percent of Ugandan children under age four are classified as stunted (low height-for-age) and 15 percent as severely stunted. About 5 percent of children under four in Uganda are wasted (low weight-for-height); 1 percent are severely wasted. Comparison with other data sources shows little change in these measures over time.

• AIDS:

Virtually all women and men in Uganda are aware of AIDS. About 60 percent of respondents say that limiting the number of sexual partners or having only one partner can prevent the spread of disease. However, knowledge of ways to avoid AIDS is related to respondents' education. Safe patterns of sexual behaviour are less commonly reported by respondents who have little or no education than those with more education. Results show that 65 percent of women and 84 percent of men believe that they have little or no chance of being infected.

Availability of Health Services. Roughly half of women in Uganda live within 5 km of a facility providing antenatal care, delivery care, and immunisation services. However, the data show that children whose mothers receive both antenatal and delivery care are more likely to live within 5 km of a facility providing maternal and child health (MCH) services (70 percent) than either those whose mothers received only one of these services (46 percent) or those whose mothers received neither antenatal nor delivery care (39 percent).

Geographic coverage

The 1995 Uganda Demographic and Health Survey (UDHS-II) is a nationally-representative survey. For the purpose of the 1995 UDHS, the following domains were utilised: Uganda as a whole; urban and rural areas separately; each of the four regions: Central, Eastern, Northern, and Western; areas in the USAID-funded DISH project to permit calculation of contraceptive prevalence rates.

Analysis unit

• Household
• Women age 15-49
• Men age 15-54
• Children under four

Universe

The population covered by the 1995 UDHS is defined as the universe of all women age 15-49 in Uganda. But because of insecurity, eight EAs could not be surveyed (six in Kitgum District, one in Apac District, and one in Moyo District). An additional two EAs (one in Arua and one in Moroto) could not be surveyed, but substitute EAs were selected in their place.

Kind of data

Sample survey data

Sampling procedure

A sample of 303 primary sampling units (PSU) consisting of enumeration areas (EAs) was selected from a sampling frame of the 1991 Population and Housing Census. For the purpose of the 1995 UDHS, the following domains were utilised: Uganda as a whole; urban and rural areas separately; each of the four regions: Central, Eastern, Northern, and Western; areas in the USAID-funded DISH project to permit calculation of contraceptive prevalence rates.

Districts in the DISH project area were grouped by proximity into the following five reporting domains: - Kasese and Mbarara Districts - Masaka and Rakai Districts - Luwero and Masindi Districts - Jinja and Kamuli Districts - Kampala District

The sample for the 1995 UDHS was selected in two stages. In the first stage, 303 EAs were selected with probability proportional to size. Then, within each selected EA, a complete household listing and mapping exercise was conducted in December 1994 forming the basis for the second-stage sampling. For the listing exercise, 11 listers from the Statistics Department were trained. Institutional populations (army barracks, hospitals, police camps, etc.) were not listed.

From these household lists, households to be included in the UDHS were selected with probability inversely proportional to size based on the household listing results. All women age 15-49 years in these households were eligible to be interviewed in the UDHS. In one-third of these selected households, all men age 15-54 years were eligible for individual interview as well. The overall target sample was 6,000 women and 2,000 men. Because of insecurity, eight EAs could not be surveyed (six in Kitgum District, one in Apac District, and one in Moyo District). An additional two EAs (one in Arua and one in Moroto) could not be surveyed, but substitute EAs were selected in their place.

Since one objective of the survey was to produce estimates of specific demographic and health indicators for the areas included in the DISH project, the sample design allowed for oversampling of households in these districts relative to their actual proportion in the population. Thus, the 1995 UDHS sample is not self-weighting at the national level; weights are required to estimate national-level indicators. Due to the weighting factor and rounding of estimates, figures may not add to totals. In addition, the percent total may not add to 100.0 due to rounding.

Mode of data collection

Face-to-face

Research instrument

Four questionnaires were used in the 1995 UDHS.

a) A Household Schedule was used to list the names and certain

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited coughing with sputum. WOMEN'S STATUS Women's Status and Employment.

The Pakistan Demographic and Health Survey (PDHS) was fielded on a national basis between the months of December 1990 and May 1991. The survey was carried out by the National Institute of Population Studies with the objective of assisting the Ministry of Population Welfare to evaluate the Population Welfare Programme and maternal and child health services. The PDHS is the latest in a series of surveys, making it possible to evaluate changes in the demographic status of the population and in health conditions nationwide. Earlier surveys include the Pakistan Contraceptive Prevalence Survey of 1984-85 and the Pakistan Fertility Survey of 1975.

The primary objective of the Pakistan Demographic and Health Survey (PDHS) was to provide national- and provincial-level data on population and health in Pakistan. The primary emphasis was on the following topics: fertility, nuptiality, family size preferences, knowledge and use of family planning, the potential demand for contraception, the level of unwanted fertility, infant and child mortality, breastfeeding and food supplementation practices, maternal care, child nutrition and health, immunisations and child morbidity. This information is intended to assist policy makers, administrators and researchers in assessing and evaluating population and health programmes and strategies. The PDHS is further intended to serve as a source of demographic data for comparison with earlier surveys, particularly the 1975 Pakistan Fertility Survey (PFS) and the 1984-85 Pakistan Contraceptive Prevalence Survey (PCPS).

MAIN RESULTS

Until recently, fertility rates had remained high with little evidence of any sustained fertility decline. In recent years, however, fertility has begun to decline due to a rapid increase in the age at marriage and to a modest rise in the prevalence of contraceptive use. The lotal fertility rate is estimated to have fallen from a level of approximately 6.4 children in the early 1980s to 6.0 children in the mid-1980s, to 5.4 children in the late 1980s. The exact magnitude of the change is in dispute and will be the subject of further research. Important differentials of fertility include the degree ofurbanisation and the level of women's education. The total fertility rate is estimated to be nearly one child lower in major cities (4.7) than in rural areas (5.6). Women with at least some secondary schooling have a rate of 3.6, compared to a rate of 5.7 children for women with no formal education.

There is a wide disparity between women's knowledge and use of contraceptives in Pakistan. While 78 percent of currently married women report knowing at least one method of contraception, only 21 percent have ever used a method, and only 12 percent are currently doing so. Three-fourths of current users are using a modem method and one-fourth a traditional method. The two most commonly used methods are female sterilisation (4 percent) and the condom (3 percent). Despite the relatively low level of contraceptive use, the gain over time has been significant. Among married non-pregnant women, contraceptive use has almost tripled in 15 years, from 5 percent in 1975 to 14 percent in 1990-91. The contraceptive prevalence among women with secondary education is 38 percent, and among women with no schooling it is only 8 percent. Nearly one-third of women in major cities arc current users of contraception, but contraceptive use is still rare in rural areas (6 percent).

The Government of Pakistan plays a major role in providing family planning services. Eighty-five percent of sterilised women and 81 percent of IUD users obtained services from the public sector. Condoms, however, were supplied primarily through the social marketing programme.

The use of contraceptives depends on many factors, including the degree of acceptability of the concept of family planning. Among currently married women who know of a contraceptive method, 62 percent approve of family planning. There appears to be a considerable amount of consensus between husbands and wives about family planning use: one-third of female respondents reported that both they and their husbands approve of family planning, while slightly more than one-fifth said they both disapprove. The latter couples constitute a group for which family planning acceptance will require concerted motivational efforts.

The educational levels attained by Pakistani women remain low: 79 percent of women have had no formal education, 14 percent have studied at the primary or middle school level, and only 7 percent have attended at least some secondary schooling. The traditional social structure of Pakistan supports a natural fertility pattern in which the majority of women do not use any means of fertility regulation. In such populations, the proximate determinants of fertility (other than contraception) are crucial in determining fertility levels. These include age at marriage, breastfeeding, and the duration of postpartum amenorrhoea and abstinence.

The mean age at marriage has risen sharply over the past few decades, from under 17 years in the 1950s to 21.7 years in 1991. Despite this rise, marriage remains virtually universal: among women over the age of 35, only 2 percent have never married. Marriage patterns in Pakistan are characterised by an unusually high degree of consangninity. Half of all women are married to their first cousin and an additional 11 percent are married to their second cousin.

Breasffeeding is important because of the natural immune protection it provides to babies, and the protection against pregnancy it gives to mothers. Women in Pakistan breastfeed their children for an average of20months. Themeandurationofpostpartumamenorrhoeais slightly more than 9 months. After tbebirth of a child, women abstain from sexual relations for an average of 5 months. As a result, the mean duration of postpartum insusceptibility (the period immediately following a birth during which the mother is protected from the risk of pregnancy) is 11 months, and the median is 8 months. Because of differentials in the duration of breastfeeding and abstinence, the median duration of insusceptibility varies widely: from 4 months for women with at least some secondary education to 9 months for women with no schooling; and from 5 months for women residing in major cities to 9 months for women in rural areas.

In the PDHS, women were asked about their desire for additional sons and daughters. Overall, 40 percent of currently married women do not want to have any more children. This figure increases rapidly depending on the number of children a woman has: from 17 percent for women with two living children, to 52 percent for women with four children, to 71 percent for women with six children. The desire to stop childbearing varies widely across cultural groupings. For example, among women with four living children, the percentage who want no more varies from 47 percent for women with no education to 84 percent for those with at least some secondary education.

Gender preference continues to be widespread in Pakistan. Among currently married non-pregnant women who want another child, 49 percent would prefer to have a boy and only 5 percent would prefer a girl, while 46 percent say it would make no difference.

The need for family planning services, as measured in the PDHS, takes into account women's statements concerning recent and future intended childbearing and their use of contraceptives. It is estimated that 25 percent of currently married women have a need for family planning to stop childbearing and an additional 12 percent are in need of family planning for spacing children. Thus, the total need for family planning equals 37 percent, while only 12 percent of women are currently using contraception. The result is an unmet need for family planning services consisting of 25 percent of currently married women. This gap presents both an opportunity and a challenge to the Population Welfare Programme.

Nearly one-tenth of children in Pakistan die before reaching their first birthday. The infant mortality rate during the six years preceding the survey is estimaled to be 91 per thousand live births; the under-five mortality rate is 117 per thousand. The under-five mortality rates vary from 92 per thousand for major cities to 132 for rural areas; and from 50 per thousand for women with at least some secondary education to 128 for those with no education.

The level of infant mortality is influenced by biological factors such as mother's age at birth, birth order and, most importantly, the length of the preceding birth interval. Children born less than two years after their next oldest sibling are subject to an infant mortality rate of 133 per thousand, compared to 65 for those spaced two to three years apart, and 30 for those born at least four years after their older brother or sister.

One of the priorities of the Government of Pakistan is to provide medical care during pregnancy and at the time of delivery, both of which are essential for infant and child survival and safe motherhood. Looking at children born in the five years preceding the survey, antenatal care was received during pregnancy for only 30 percent of these births. In rural areas, only 17 percent of births benefited from antenatal care, compared to 71 percent in major cities. Educational differentials in antenatal care are also striking: 22 percent of births of mothers with no education received antenatal care, compared to 85 percent of births of mothers with at least some secondary education.

Tetanus, a major cause of neonatal death in Pakistan, can be prevented by immunisation of the mother during pregnancy. For 30 percent of all births in the five years prior to the survey, the mother received a tetanus toxoid vaccination. The differentials are about the same as those for

For each region, attained-age- and birth-cohort-specific annual changes in the incidence of stage 2–4 breast cancer in the 8-year period 2000–2007.