Preference for Sons Influences Contraceptive Use and Reproductive Decision Making in Pakistan

Pakistani couples’ preference for having more sons than daughters may influence fertility and contraceptive behavior in Pakistan, according to "Son Preference and Family Limitation in Pakistan: A Parity- and Contraceptive Method–Specific Analysis," by Melanie Dawn Channon of the Oxford Institute of Population Ageing, University of Oxford. The study finds that over the past two decades, son preference has become more strongly associated with the practice of continuing to bear children until couples have achieved their desired number of sons and daughters. According to the study, the persistence of son preference may undermine Pakistan’s ability to meet its development goals, including the transition to lower fertility rates.

While researchers have documented a strong preference for sons in other parts of Asia, including China, India and Nepal, few studies have explored the extent to which this preference exists in Pakistan. A range of social and economic factors tends to drive son preference. Inheritance passes through male children, the payment of dowries can prove financially burdensome and women’s limited workforce participation often prevents them from contributing to family income.

The article uses data from Pakistan Demographic and Health Surveys (PDHS) conducted in 1990–1991, 2006–2007 and 2012–2013 to analyze the relationship between son preference and reproductive decision making. Respondents were ever-married men and women aged 15–49, though no data from men were available in the 2006–2007 survey.

PDHS respondents reported their ideal number of male and female children, which the author used as one measure of son preference. The author also looked at how many sons and daughters respondents already had and whether they wanted to have more children. The desire for more children was highest among those with no sons. In 2012–2013, for example, among women with four children, 62% of those who had no sons wanted another child, compared with 24% of those who had four sons.

The study also explored the relationship between son preference and contraceptive behavior, assessing use based on four categories: none, temporary modern method (i.e., any modern method except sterilization), permanent modern method and traditional method. The author found that contraceptive use varied considerably according to the number of boys and girls respondents had, and was lowest among women who had given birth only to daughters.

For example, in the most recent survey, women who had three daughters and no sons were less likely to be using a modern contraceptive than were those who had three sons and no daughters (16% vs. 31%). This disparity grows even wider when comparing women with four daughters and no sons to those with four sons and no daughters (14% vs. 51%). Overall, the study estimates that the prevalence of modern contraceptive use among women who have given birth would have been 19% higher in 2012–2013 in the absence of son preference. These findings suggest that many families in Pakistan are increasingly making reproductive decisions based on the number of sons they have.

The author suggests that this reproductive trend affects Pakistan’s ability to make its desired transition to lower birth rates and meet other developmental targets. Pakistan can make progress toward these goals by improving access to reproductive health care services and addressing the root causes of son preference, including the inequitable gender norms that uphold the perception that sons are more valuable than daughters.

"Son Preference and Family Limitation in Pakistan: A Parity- and Contraceptive Method–Specific Analysis," by Melanie Dawn Channon, appears in International Perspectives on Sexual and Reproductive Health and is currently available online.