One in every 14 Pakistani children dies before reaching the age of one and one in every 11 does not survive his or her fifth birthday. With infant and under five mortality rates at 74 and 89 deaths respectively per 1000 live births in the five -year period before the latest 2012-2013 Pakistan Demographic and Health Survey(PDHS), the country’s chances of meeting the Millenium Development Goals (MDGs) looks very dim.

Tanvir Kiyani, director (research and survey), National Institute of Population Studies (NIPS) which carried out the survey, said the MDGs had set IMR at 40 per 1000 live births and Pakistan was a long way off. For the first time, questions on domestic violence were included in the survey, she pointed out.

One-third of married women or 32 per cent have experienced physical violence since the age of 15 and one in five women experienced physical violence in the last 12 months. Women in poorest households are more vulnerable — 25 per cent — and violence in most cases — 79 per cent — is perpetrated by the husband. Eleven per cent women also experienced violence during pregnancy. Almost 40 per cent of women have suffered abuse from their husbands at some point in their life and one-third of them reported some form of physical or emotional violence by their husbands in the last 12 months.

There was huge resistance to including questions on sexual violence, which was dropped, and even the domestic violence questionnaire was inserted with great difficulty, Ms. Kiyani said. Women do not have the power to make decisions and more than one-third of them have no say on health care, or visits to family or relatives or on major household purchases. About 43 per cent women and one-third of the men agree that a husband is justified in beating his wife if she argues with him, neglects the children or in-laws, refuses to have sex, goes out without telling the husband, or burns food. About 34 per cent women agree that if they argue with their husbands, it is justified if they are beaten.

Key findings of the survey presented at a recent meeting at the Sustainable Development Policy Institute indicated that Pakistan was lagging behind in various health indicators and there is urgency for planners to take stock of the situation and implement policies. The PDHS survey reported that 45 per cent children under five are stunted or too short for their age, indicating chronic malnutrition and 30 per cent are wasted or too thin for their age. Only 14 per cent women are thin while 40 per cent are overweight or obese.

Abdul Basit Khan, executive director of NIPS, said lack of education, financial constraints, wars and religious extremism had contributed to the situation and instead of fighting with India, Pakistan should learn from it on the health front.

Children in rural areas are more likely to die young, with under five mortality at 106 per 1000 live births, while in urban areas it is 74/1000 live births, the survey said.

Neonatal mortality at 55 deaths per 1000 live births has remained unchanged for the last 20 years. Ms. Kiyani said a national representative sample of 13,558 married women between 25 to 49 and 3134 men in one-third of the selected households were interviewed.

Pakistani households consist of an average of 6.8 persons and about 39 per cent of the population is under 15. Only 11 per cent of households are headed by women, the survey says.

Fertility has decreased from 5.4 births per woman to 3.8 in the last 23 years. Women who have a higher education have a fertility rate of 2.5 while for illiterate women it is 4.4. Thirty-five per cent of women were married at 18 and more than half — 54 per cent — by the age of 20.

Knowledge of family planning methods is universal with 99 per cent women and 95 per cent men knowing at least one modern method of family planning.

Injectable contraceptives are the most popular along with the pill and sterilisation among women. The use of modern family planning methods has increased from 9 per cent in 1990-91 to 26 per cent in 2012-2013. While half the births occur in health facilities, home births are common in rural areas -60 per cent -while in urban areas it is 32 per cent. For women there are problems in accessing health care and only 54 per cent of children aged 12 to 23 months have received all recommended vaccines, the survey said.