Peer-reviewed article

Maternal Education, Reproductive Behavior, and Fertility Outcomes in Pakistan: Evidence From the Pakistan Demographic and Health Survey 2017-2018.

Xiaofen Qiu, Mukhtiar Hussain Ibupoto · 1 Jun 2026

Abstract

INTRODUCTION: This study examines the association between maternal education, human reproductive behavior, and fertility adaptation in Pakistan, using nationally representative data from the Pakistan Demographic and Health Survey (PDHS) 2017-2018. It aims to assess how different levels of maternal education influence fertility outcomes, particularly children ever born, while controlling for key demographic, socioeconomic, and reproductive factors. METHODS: The study utilizes cross-sectional data from ever-married women aged 15-49 years (N = 14 500). Fertility behavior is measured using children ever born (CEB) as a count variable. Maternal education is categorized into four levels: no education, primary, secondary, and higher education. Descriptive and bivariate analyses are conducted to examine fertility differentials, followed by multivariate regression models, including Poisson and Negative Binomial regression, to estimate adjusted incidence rate ratios (IRRs). Logistic regression is additionally employed to assess high fertility (CEB ≥ 4). All analyses account for the complex survey design using sampling weights. RESULTS: The findings reveal a strong and statistically significant inverse relationship between maternal education and fertility behavior. Women with higher education have substantially lower fertility compared to those with no education. Specifically, higher education is associated with nearly a 49% reduction in children ever born (IRR = 0.51, p < 0.001), while secondary education reduces fertility by approximately 28%. The results indicate a clear dose-response relationship, with stronger effects observed at higher levels of education. Additionally, age at marriage, urban residence, wealth status, and modern contraceptive use are significantly associated with reduced fertility. These findings remain robust across multiple model specifications. CONCLUSIONS: Maternal education emerges as a critical determinant of fertility behavior in Pakistan, operating through multiple pathways, including delayed marriage, increased contraceptive use, and enhanced reproductive autonomy. The findings highlight the importance of expanding access to secondary and higher education for women as a key strategy for lower fertility intensity and improved reproductive outcomes. The findings contribute to understanding how maternal education shapes reproductive behavior and fertility outcomes within the broader sociocultural and ecological context of a high-fertility population.