The effect of family planning exposure on fertility choices and reproductive health care in rural Pakistan

This paper investigates whether family planning exposure mainly through the Lady Health Worker Program has had any effect on women's fertility choices and use of reproductive health care service in rural Pakistan, using the 2013 Pakistan Demographic and Health Survey (PDHS). Exploiting variations in the program intensity across regions, we conduct instrumental variables (IV) estimation on the impact of family planning exposure on women's fertility preferences and reproductive behaviors. Our analysis shows that even in the presence of strong son preferences in Pakistan, increasing family planning exposure reduces women's incentive to have additional children. Moreover, family planning exposure is associated with more antenatal care visits, more deliveries performed by skilled professionals, and a greater chance of delivery at the health center. Finally, we examine the heterogeneity in the effect on fertility preference by age group and education level, and find that the effect is mainly significant for the educated and young women.