Women's role in domestic decision-making in Pakistan: implications for reproductive behaviour.

Mahmood, Naushin

Women's involvement in domestic decision-making is recognised as a distinct aspect of their autonomy with implications for reproductive behaviour. Using data from the Pakistan Fertility and Family Planning Survey 1996-97, this study examines the extent of Pakistani women's participation in household decision-making relative to their husbands and other family members, and determines its effects on the demand for children and contraceptive use in both urban and rural settings. The findings reveal that women's decision-making authority is clearly related to the context in which they live, as urban women have a say in household matters, almost equal to their husbands', whereas most rural women report that their husbands and other family members have a predominant role in household decisions with regard to seeking medical treatment for a sick child or to make purchases of household items. The results also indicate that women with greater freedom to go outside home alone are also more likely to participate in domestic decisions, and the linkage is stronger for rural than for urban women. The multivariate analysis reveals that the effect of decision-making variables on measures of reproductive behaviour is strongly, conditioned by socio-economic and demographic factors, implying that measures of women's empowerment give only a partial explanation of the likelihood of women's desire to have fewer children and to increase contraceptive use. The results suggest that Pakistani women's enhanced role in household decision-making has an effect on achieving gender equality and fertility reduction outcomes--goals that are central to population and development policy.

INTRODUCTION

Women's role in household decision-making is identified as an important dimension of her status and autonomy which in turn has implications for reproductive behaviour. The theoretical and empirical research on the relationship between women's status and demographic behaviour has revealed that the more conventional measures of education, employment, marital status duration, etc., are inadequate proxies for their status and do not explain women's decision-making autonomy, their control over economic resources and the power relations dynamics of families factors that can significantly influence women's reproductive intentions and behaviour [Balk (1994); Jejeebhoy (1996); Govindasamy and Malhotra (1996); Sathar and Kazi (1997)]. Yet, few studies have measured these dimensions of women's status, and fewer have thus far used these direct measures in different socio-cultural contexts [Basu (1992); Morgan and Niraula (1995); Sathar and Kazi (2000)].

The nature and extent of women's involvement in decision-making and its linkage with reproductive behaviour is not a much researched topic in the social context of Pakistan. Most studies of gender-related aspects of demographic change in Pakistan have used such commonly available measures as women's education, economic activity, and attitudes towards family planning to explain their fertility and contraceptive use behaviour or demand for children [Syed (1978); Shah (1986); Sathar, et al. (1988); Mahmood and Ringheim (1997)]. These analyses have lacked assessment of the critical dimensions of women's status that are considered to enhance their relative position within the household in relation to demographic behaviour. This is largely because the routinely available fertility and demographic surveys do not provide adequate information on direct measures of women's status. At the same time, small-scale studies, including qualitative analysis, that have focussed on assessing various aspects of women's status and gender relations parameters have lacked the advantages offered by large-scale socio-demographic surveys. However, with the availability of the nationally representative survey of Fertility and Family Planning (1996-97)1 which incorporates several direct measures of women's position in the household, it becomes possible to address some of the questions relating to women's decision-making autonomy, gender inequality, and reproductive behaviour.

Recognising that Pakistan is a patriarchical society exhibiting high levels of gender inequality in social and economic spheres, a closer look at women's participation in domestic decision-making and its relation with reproductive choices and fertility attitudes would provide further insight into family building behaviour-a question of great relevance to achieving gender equality and further declines in fertility.

The objective of the study is to examine women's role in household decision-making and see whether it is linked to their freedom of movement and reproductive behaviour, more specifically in urban and rural areas with distinct social and cultural characteristics. The main questions addressed in the paper are:

--First, to what extent are Pakistani women involved in domestic decisionmaking relative to their husbands and other family members, and how closely are standard proxies of women's status, i.e., education, employment, marital status duration, etc., associated with domestic and reproductive decision-making authority?

--Second, do women with a greater role in decision-making and greater freedom of movement also exhibit desirable demographic outcomes--such as higher contraceptive use and lower demand for children, and how do these relationships vary between the urban and rural settings or across regions?

These questions are of special significance in Pakistan's social context because of large variation in individual and regional characteristics of surveyed women, and the complex nature of gender relations and fertility-limiting behaviour in urban and rural settings.

THEORETICAL ARGUMENTS

Deriving from both the theoretical and empirical work that identifies the relationship between women's status and demographic behaviour [Mason (1984, 1993, 1998); Dyson and Moore (1983); Malhotra, Schuler, and Boender (2002)], it is recognised that a woman's involvement in domestic decision-making is a distinct aspect of her autonomy. For example, women who have a greater say in household matters are also likely to have freedom of movement, access to resources, and equality in their relationship with the spouse.

In determining the connection between women's decision-making autonomy and reproductive attitudes and behaviour it is important to understand the social and cultural context in which they live. In relatively modern and gender-egalitarian societies, one would expect greater female autonomy and freedom of movement on account of widespread schooling, greater opportunities for work, and equality of gender relations, whereas in traditional and patriarchical settings women's actions and behaviour at the individual and community levels are influenced by social norms, division of gender roles, and the variability in gender relations.

It is argued that religious values and cultural practices in traditional settings restrict women's decision-making options and freedom of movement at the same time that they encourage and favour their reproductive role. Recognising the importance of the family as the basic social unit and the complementarily of male and female roles in such societies, it is likely that women tend to play a major role in household matters and exert substantial influence on domestic and reproductive decisions because they fall within the socially prescribed female domain. It is alternatively argued that the "outside" role of men and their control of the economic resources empower them to have more influence on household decision-making, whereas women's position and role within the household depends much more on their social and economic status, access to education, health care, job opportunities, etc. Thus, the association between women's decision-making autonomy and demographic outcome would be affected by their social and economic class and the variability and complexity of gender relations within and across societies. Research findings, however, support the view that women's status is often measured by socio economic background factors, i.e., women's education and/or employment, which appear to have an indirect and more speculative effect on fertility change [Mason (1993)], and need to be supplemented by more direct measures of women's status so as to assess the underlying process of demographic behaviour. Hence, it is of interest to understand how the constraints of gender inequality and limited decision-making power of women in less modern societies like that of Pakistan influence the reproductive attitudes and behaviour of couples.

SOCIO-CULTURAL BACKGROUND

The social structure of Pakistan is based on deep-rooted cultural and traditional beliefs and values. The family system is patriarchical and patrilocal with strong gender biases perpetuated in society. Men have a dominant role as the household head, with the primary responsibility of financially supporting the family. However, women and children contribute significantly to farm and agricultural work especially in rural areas. There is generally a preference for joint family system, with a strong desire for having more sons than daughters. Men participate more in the formal outside-home affairs and decision-making in the community, while women tend to play a major role within home in terms of nurturing of children and maintenance of household. Overall, gender inequality in social and economic spheres is evident from the wide gap between male and female literacy and educational attainment (especially in rural areas), low female work participation in the formal sector, and high mortality among girl children (1-4 years) and mothers [Mahmood and Nayab (1998)]. People living in different regions/provinces speak their own local languages, especially in rural areas, and can be distinguished by their distinct ethno-linguistic groups and social customs. Despite this regional and cultural diversity, people are united by one common religion, Islam (97 percent of the population). Given that Pakistan has a large, homogeneously Muslim population, it is likely that religious beliefs and values in combination with low educational attainment levels and limited economic and social autonomy among women contribute to a lack of self-efficacy in adopting the small family size norms and fertility-limiting behaviour.

On the demographic front, fertility level has declined only recently from a high level of more than six births per woman in the early 1970s to around five births per woman in the 1990s, [NIPS (2001)], suggesting a slow-paced fertility transition in Pakistan. The modest decline in fertility has been associated with increasing levels of contraceptive use and rising age at marriage, especially of females, and the downward trend in family size desires [Sathar and Casterline (1998); Soomro (2000)]. Contraceptive prevalence rate has risen from a low level of 6 percent in the 1970s to about 28 percent in the 1990s. There is an evidence of falling fertility desires as indicated by wanted total fertility rate of less than four children. At the same time, it is reported that about 44 percent of women have expressed the desire for no more children, and 33 percent of the women surveyed have unmet need for family planning [NIPS (2001)]. Women often mention their husband's disapproval of family planning as one of the reasons for non-use of contraception and indicate that the influence of husbands in household and reproductive decisions is dominant [Mahmood (1998)].

These socio-cultural conditions, in combination with the issue of unmet contraceptive need, pose a challenging situation for policy-makers and population programme managers to effectively implement fertility reduction objectives of the programme. If the socio-cultural set up is portrayed with men as the dominant force in all aspects of family life, then the population programme needs to enhance male involvement and approval for family planning. Alternatively, if most of family planning services are provided to women only, then whether they are largely autonomous in decision-making or depend on husbands' consultation and involvement is an important aspect to be studied in the socio-cultural context of Pakistan.

DATA AND METHODS

The data set used in this study is the Pakistan Fertility and Family Planning Survey (PFFPS) of 1996-97, a nationally representative sample of 8,362 women between the ages of 15-49 years. The present analysis is limited to 7,584 currently married women in the weighted sample for whom fertility-limiting behaviour and decision-making autonomy is a relevant issue. The data includes many questions on women's say in household matters such as: 'Who makes the final decision about child treatment in case of illness?'; 'Who decides about household purchases including food, clothing etc?' The availability of this information, with a wide variety of background, household and socio-economic indicators, and detailed measures of fertility and contraceptive use, provides the basis for examining the gender inequality aspects and reproductive behaviour of women in urban and rural areas of Pakistan.

The methods employed to study the hypothesised relationships between the predictor and dependent variables include bivariate and multivariate analyses. First, variations in women's household decision-making are examined by their background socio-economic characteristics. The extent of women's participation in household matters is measured by the simple percentage responses in relation to selected characteristics in bivariate relationships. The multivariate analysis is then used to determine which characteristics of women are significant in explaining women's decision-making involvement in the household. The analysis pertains to currently married urban and rural women for whom having a say in household affairs vis-a-vis their husbands and other family members is an active issue.

These results are then examined using logistic regression models to see whether--or to what extent--the decision-making variables ultimately explain the reproductive behaviour of women. The analysis is done for urban and rural women separately to see the differential effect of selected factors on the dependent variables in the two types of settings.

Dependent Variables

The multivariate analysis undertaken to determine the effect of selected predictor variables on reproductive behaviour analysis focuses on two dependent variables: the desire for children coded as 1 if a woman wants no more children, and zero otherwise; and current use of contraceptives defined as 1 if a woman is using any method, and zero otherwise. Because of the dichotomous dependent variables, logistic regressions are used to examine the net effect of women's position variables on desired fertility and contraceptive use after controlling for background characteristics.

Independent Variables

Among several questions asked the women about the decision-making pattern within households and their freedom of moving outside home, only those questions are used in the analysis that are least speculative and are relevant to the objectives of the study.

Decision-making Autonomy

A woman's overall input in household decisions is a key indicator of her authority and importance within the family [Govindasamy and Malhotra (1996); Sathar and Kazi (2000)]. On the decision-making issue, (2) three questions (3) are used to assess women's final say in household matters: 'Who usually takes the final decision about treatment when a child is sick?'; 'Who takes final decision about what to buy for food?'; and 'Who takes the final decision to buy clothes for yourself?' The responses available to these questions are: (1) respondent; (2) husband; (3) jointly/mother-in-law/others. These responses indicate the preference for egalitarian or independent decision-making in women's everyday life matters, and their ability to influence household finances, which is considered largely a male domain in Pakistani society. The responses to the two questions on household purchases including food and clothing show similar distributions and are merged together to reflect the broader nature of domestic decisions involving financial and consumption matters.

Freedom of Movement

Restrictions on women's movement outside the house are considered to deny them opportunities to participate in schooling or employment, limit their access to resources and information, and reduce their ability to take care of themselves and their children in case of illness [Jejeebhoy (1996); Khan (1998)]. On the mobility issue, two questions are used to measure women's independence to go out of the house: 'Within the last four weeks, have you been outside this village/neighbourhood for any purpose without the company of any adult?'; and 'Could you go by yourself to a health clinic/hospital if you needed or would you have to be accompanied by someone else?' The responses to these questions indicate women's freedom to travel alone to the market, friends or relatives, or a health centre without being escorted or seeking permission from the husband or another family member--chiefly an issue for relatively younger Pakistani women.

Husband-Wife Communication

If couples can openly discuss family matters and the desire for children with each other, chances of mutual influence and agreement in desired fertility and contraceptive use are likely to be higher [Mahmood (1998)]. But communication between husband and wife may be hampered by social norms of modesty and privacy concerning sexuality, as well as by the subordinate position of women in Pakistani society. Using information on whether the woman has talked to her spouse about family planning matters in the past year, a variable on husband-wife communication is included in the analysis as a parameter reflecting gender relations within a household.

In addition to indicators of these specific dimensions of gender inequality and decision-making, selected background characteristics that can affect both women's position and reproductive behaviour are included in the analysis. These are education, employment status, paid work, and cultural and economic differences represented by the four regions/provinces. Because the demographic outcomes are greatly influenced by lifecycle factors, women's age, parity, and marriage duration are included as control variables in the analysis. Almost all variables used are categorical/dummies to examine which category of any selected variable is important in explaining variations in the dependent variables.

RESULTS

(a) Background Characteristics of Women

In all, about 70 percent of women are rural (5340) and 30 percent urban (2245), with about 48 percent having more than four living children. The majority of surveyed women reside in the Punjab province (58 percent) and the least minority in Balochistan region (5 percent), whereas the proportions residing in Sindh and the NWFP are 22 percent and 14 percent, respectively. A further disaggregation of the sample by urban and rural areas shows wide variations in characteristics of selected subgroups of women.

The percentage distributions of currently married urban and rural women with selected background characteristics are presented in Figure 1. Education levels of these women are very low, as about 86 percent of rural and 49 percent of urban women have never attended school or are exposed to only informal or Quranic learning. Rural women, in particular, indicate extremely low levels of educational attainment, as about 11 percent have completed primary and middle level schooling and only about 3 percent have attained secondary and above levels compared with urban women of those levels of schooling--24 percent and 27 percent, respectively. Even more alarming is the situation that the vast majority of women (85.8 percent urban and 78.8 percent rural) report as not being engaged in any employment activity. Of the remaining women who report to be working, a slightly higher percentage--10.2 percent--are engaged in self-employment in urban areas as compared to 17.3 percent in rural areas, and only about 4 percent report to be working for someone else or in cash-based economic activities (see Appendix Table 1 for detailed percentage distribution of these variables). These figures almost certainly underreport the contribution of women to their family work and reflect women's own perceptions about the economic value of their work, and the worth given to women's work in society. There is evidence from other research studies in developing countries like India and Egypt on underreporting of female work and biases in the estimation and measurement of women's participation in the labour force that arise mainly because of poorly constructed questionnaires, misperceptions of male interviews/respondents, and ambiguous definitions [Anker (1981); Anker, Khan and Gupta (1988)].

The percentage distributions of the two measures of decision-making, and women's freedom of movement along with the two dependent variables, are shown in Figure 2 for urban and rural areas. With regard to decision-making for child's treatment in case of illness, urban women appear to have an equal say in the household in comparison with their husbands (39 percent), whereas rural women are much less empowered than their husbands to make the final decision in this regard (23 percent wives vs. 55 percent husbands). The input by mother-in-law and other family members is about 21 percent in both urban and rural areas. In case of having a final decision regarding food and clothing purchases, about 36 percent of urban women report their input as almost equally matched by their husbands'--37 percent, whereas only 21 percent of rural women have the authority to make such decisions as compared with 50 percent by husbands. The involvement of other family members in decisions about household purchases is about 28 percent in both types of area. Thus, it is evident that domestic decision-making is not primarily a woman's domain in rural areas but largely involves input by the husband and other family members, while exposure to urban living enhances women's decision-making authority, making their point of view have the same weight as the husband's.

The percentage distribution for other measures of women's position within households is supportive of the view that only a small minority have the freedom to go outside the house alone for various purposes. For example, only about 15 percent of rural and 24 percent of urban women report to be autonomous in moving alone, and about 19 percent of rural and 35 percent of urban women exercise the freedom to go to a hospital/clinic independently, reflecting very limited mobility among rural women.

With regard to various aspects of reproductive behaviour, it is evident from Figure 2 that of currently married non-pregnant women, about 36 percent of urban and only 18.6 percent of rural women have reported using a contraceptive method. As for other indicators of reproductive and family planning behaviour, almost one-half (49.5 percent) of urban and 39 percent of rural women express the desire for no more children. Also, more than half of rural women (57.8 percent) and almost half of urban women (48.7 percent) have never discussed family planning with their husbands (see Appendix Table 1 for the percentage distribution of women for all variables used in the analysis, including life-course factors such as age, parity, and marriage duration).

(b) Variations in Women's Decision-making

Decision About Child Treatment

The results of bivariate relationships between selected background characteristics of women and decision-making about child treatment in case of illness are presented in Figure 3 for urban and rural women separately. Overall, about 39.3 percent of urban and 23 percent of rural women participate in final decisions about child treatment. Variations in final decision-making by levels of education appear to be large, especially in case of rural women. For example, only 22 percent of rural women with no formal education indicate their involvement in making the final decision about child treatment, as compared to 51.2 percent with secondary and above levels of education and 25 percent with primary and middle level of education. Urban women, on the other hand, indicate less variation in decision-making by levels of education, i.e., 36 percent for illiterate vs. 41 and 44 percent for below-matric and higher levels. Clearly, substantial variability exists in women's reported decision-making regarding regional affiliation. As Figure 3 indicates, women living in the Punjab have the highest participation in decision-making (40.2 percent urban and 30.7 percent rural), whereas women residing in rural parts of Sindh and Balochistan have much less say in domestic decisions--only 11.8 and 4.2 percent, respectively. Work participation and employment status do not appear to enhance women's decision-making power, especially in rural areas, where only a small proportion of women is engaged in paid employment.

Women's ability to move outside the house alone indicates their independence and freedom of movement, which are likely to enhance their autonomy in decision-making aspects of their domestic lives. As is evident from Figure 3, women's mobility measures significantly contribute to increasing their involvement in decision-making as more than half of urban women and between 38 to 48 percent of rural women who can go outside the house or to a hospital/clinic alone report their input in the final decision about child treatment. Among lifecycle factors, the results are as expected, as older women with high parity and longer marriage duration have a greater say in household matters than the relatively younger and low parity women. (See Appendix Table 2 for variations in women's reported decision-making in case of treatment of sick child for all factors used in the analysis).

Decisions About Household Purchases

Variations in women's final decision-making for household purchases including food items and clothing by selected background characteristics are presented in Figure 4. In all, about 35.5 percent of urban and 21 percent of rural women have reported their involvement in final decisions about household purchases. This reveals that women's involvement in decisions about household purchases is somewhat less than that observed in the case of treatment of sick child, reflecting that women have a somewhat greater say in the household in problems related to nurturing or taking care of children--a socially prescribed female domain. However, the pattern of distribution shows that women with higher levels of education, greater mobility, paid work, and longer marriage duration report having greater participation in final decision-making about household purchases than those with no formal schooling, limited mobility, no paid work, and less marriage duration. Furthermore, women living in rural parts of the four regions have reported a much lower input in household purchase decisions than their counterparts in urban areas. For example, 29.6 percent of rural women in Punjab and only 8.7 percent of those residing in rural parts of the NWFP, 8 percent in Sindh, and 7.7 percent in Balochistan report their involvement in domestic decision-making. This reveals that a large majority of rural women, except for those living in the Punjab, have very little say in decision-making, especially in the case of making household purchase decisions. Compared with this, 34.5 percent of urban women in the Punjab, 40.8 percent in Sindh, 26 percent in the NWFP, and about 17 percent in Balochistan have reported their participation in household purchase matters. This indicates that there is substantial variability in women's input in domestic decision-making between urban and rural areas across regions. (See Appendix Table 3 for variations in final decision-making in household purchases for all factors used in the analysis).

(c) Multivariate Analysis of Domestic Decision-making

In order to examine which characteristics of women are important in determining their decision-making authority in the household, two-category dependent variables with regard to child treatment and household purchases (defined as one for wife and zero otherwise) are used for urban and rural women separately. In logistic regression models, the odds ratios of making decisions regarding child treatment and household purchases show the magnitude of increase in the dependent variable for each unit increase in the independent variable in comparison with the omitted (reference) category of the discrete variables. This analysis allows to determine the extent to which background characteristics and mobility factors predict women's domestic decision-making after controlling for lifecycle and socioeconomic variables. The regression results of the two measures of decision-making, i.e., child treatment and household purchases, are presented in Table 1 for urban and rural women.

As expected, age and marriage duration increase the likelihood of women's participation in domestic decision-making. The results indicate that relatively older women and with longer marriage duration are between 1.5 to 2.0 times more likely to make household decisions than women in younger ages and less marriage duration. It is also evident from Table 1 that after controlling for lifecycle factors and other background characteristics, the measures of women's mobility have a significant impact on enhancing women's decision-making input in the household. In fact, the autonomy to go to a hospital/clinic alone shows the strongest effect on the dependent variables. This means that woman's freedom of movement and her ability to go to a hospital or clinic independently is important to increasing her involvement in domestic decision-.making, particularly for rural women. This relationship indicates that Pakistani women's autonomy regarding domestic decision-making is linked with their mobility status within the household. Regional variations indicate that Punjabi women, especially in rural areas, have much greater involvement in decision-making than those living in other regions. This may be reflective of the Punjabi culture where women are relatively more egalitarian, make significant contribution to farm work, and are given more importance in the family than their rural counterparts in other regions. The finding that women in Punjab are relatively more empowered to participate in decisions relating to children and household responsibilities concurs with results of the study in rural Punjab that shows higher participation of women in domestic spheres than other dimensions of autonomy [Sathar and Kazi (1997)].

It also appears that women's education does not play a significant role in enhancing women's participation in decisions about child treatment except for those few rural women with secondary and above levels of education. For household purchases, only urban women's education makes a significant difference in exercising decision-making authority. With employment, the situation is even more complex. The results show that effects of paid employment are contrary to expectations as women engaged in economic activity are less likely to participate in household decision-making, except for those few urban women who are expected to be engaged in cash employment, The odds ratios of less than 1.00 for rural women in paid work suggest that their employment status tends slightly to increase chances of their husbands'/others' to make household decisions. This supports the contention that in settings such as Pakistan, where gender norms support the male provider role and large proportion of women are engaged in unpaid family help or selfemployment in rural areas, the small proportion of women engaged in paid employment tend to underreport their economic contribution to their families, and this may undermine the possibility of their gaining and exercising decision-making power within the household. This needs to be investigated further in the light of the circumstances of the small proportion of women engaged in paid employment and the type of work in which these women are involved. More interestingly, husbandwife communication has a significant effect on decisions regarding child treatment, while it is not significant for decisions regarding household purchases, for both urban and rural women.

(d) Women's Decision-making Role and Reproductive Behaviour

To determine whether women's involvement in household decision-making is important in affecting demographic outcome, two measures of reproductive behaviour are used for analysis: wanting no more children and current contraceptive use. Logistic regression models are estimated to show the relationships between selected explanatory variables and the two dependent variables.

Desire for Children

The desire for children is categorised into a dichotomous variable indicating wanting no more children equal to 1 and zero otherwise. The regression results of the predictors of women wanting no more children are shown in Table 2. An odds ratio above 1.00 indicates greater likelihood of wanting no more children, whereas the odds ratios below 1.00 indicate the opposite. The results are presented in three models. First, only measures of decision-making and mobility are considered in model 1. Then additional control variables such as age, parity, women's education and their work status are included in model 2. And, finally, controls for region are added in model 3. This approach permits to determine whether background factors, especially education, employment, and regional differentials tend to capture the effect of decision-making variables through these measures of women's position on reproductive behaviour. This analysis presents separate models for urban and rural women.

The results in Table 2 indicate that decision-making variables are significantly related to women's desire for no additional children. As model 1 shows, the odds of desiring no more children are higher for wives than their husbands or other family members with regard to child treatment and household purchases decision-making. This means that most women who participate actively in household matters are also more likely to desire fewer children. However, women's mobility and freedom of movement indices have a strong relationship with the desire for no more children for rural women only, and a mild effect in case of urban women. Also of interest is the finding that husband-wife communication is important in increasing the likelihood of wanting no more children as the variable shows the strongest effect for both urban and rural women.

In model 2, the strength of decision-making variables is substantially reduced for wives and becomes insignificant for husbands after introducing controls for socio-demographic indicators. Also notable is the finding that the effect of mobility factors observed earlier for rural women is wiped off in model 2. As expected, the lifecycle factors such as age and parity have a powerful influence on reducing desired fertility with relatively older (35 years and above) and high parity women (4 or more children), showing the strongest effect particularly in case of rural women. More interestingly, education plays no significant role in determining the desire for no more children for urban women, whereas this effect is strong for rural women. As observed from Table 2 (model 2), the odds of rural women with primary as well as secondary and above schooling are about 1.4 to 2.8 times higher than those for women with no education. The effects of paid work are somewhat confounding as the odds ratios of less than 1.00 indicate the tendency of those few working women to deviate from desiring no more children than those not working. Such an effect is mildly significant for urban women only, and insignificant for rural women.

The inclusion of region in model 3 does not change the picture much. As we can see from Table 2, region of residence itself has no strong effect on desired fertility of urban women, while it shows significant variations among rural women. This means that the regional variations as observed in the bivariate analysis reflected mainly the socio-economic and decision-making differences among respondents in those regions so that region ceases to be significant once these are controlled for at least for urban women in the sample. For rural women, on the other hand, region remains significant in determining the desire for no more children after controlling for all other variables in the analysis. The results reveal that women living in rural Punjab show the greatest likelihood to want no more children, closely followed by women in the NWFP and Sindh, in comparison with those living in Balochistan.

Current Contraceptive Use

Taking current contraceptive use as another indicator of reproductive behaviour, the variable is defined as 1 for those who reported using any method at the time of survey and zero otherwise. The logistic regression results are shown in Table 3 as a function of decision-making and background characteristics of urban and rural women separately. The odds ratios above 1.0 indicate greater likelihood of using a contraceptive method for each unit increase in specific category of discrete variables in comparison with the omitted (reference) category and are presented in three models.

The results in Table 3 indicate that the effects of decision-making and mobility variables on contraceptive use are strong and significant for urban women across all models, but give a somewhat mixed picture for rural women. For urban women in model 3, where controls for socio-demographic factors and region of residence are included, all variables except those for paid employment and region, show a significant positive impact on contraceptive use. The odds ratios of using contraceptives are the highest for women with higher ages, high parity, primary as well as secondary and above schooling, and those reporting husband-wife communication. However, the effects of wife's decision-making on use also remain positive and significant. For rural women, on the other hand, the findings indicate that except for participation in decisions with regard to household purchases and freedom to go outside home alone, all other variables are important in increasing the likelihood of the woman's using a contraceptive method. This means that most of the effect of decision-making and mobility factors for rural women is channelled through her demographic and educational background. As Table 3 (model 3) shows, the odds ratios of rural women are the highest for primary as well as secondary and above levels of education, high parity, and communication with husbands about family planning.

Also interesting to note is the finding that paid work tends slightly to lower women's use of contraception in comparison with those not working. It appears that paid employment for those few rural women does not empower them to make family planning choices, and these women may be especially conscious of accepting family planning as normative behaviour. Moreover, women's paid employment is most often based on need rather than choice, and as such may not be a motivating factor to adopt fertility control behaviour.

Overall, these results suggest that much of the effect of decision-making variables on reproductive behaviour is captured by socio-demographic indicators; notable are age, parity, and level of education. Age and parity can always be expected to account for much of the variation in desired fertility and contraceptive use, but the fact that the inclusion of other socio-demographic indicators has weakened the strength of the decision-making and mobility variables supports the argument that a woman's autonomy is substantially conditioned by her socioeconomic background and the type of setting in which she lives. Hence, women's decision-making involvement gives only a partial explanation of their demographic behaviour once these background factors are controlled for. Despite this, however, it is worth noting that husband-wife communication is critical in determining reproductive behaviour of Pakistani women as its effects remain strong and positive across all models for both urban and rural samples of women.

CONCLUSIONS

The results of the study provide important insights into the relationship between women's decision-making power and reproductive behaviour in two distinct urban and rural settings of Pakistan. Although the relationship is complex and mediated by many socio-demographic and cultural factors, the analysis reveals broad patterns and variations in women's domestic decision-making and the limited explanatory power it has in predicting demographic behaviour.

The findings reveal that women's decision-making authority is strongly related to the context in which they live, with urban women having an almost equal say as their husbands in domestic decisions, whereas rural women report that most household matters are predominantly decided by their husbands and other family members. There is a clear regional diversity in women's involvement in decision-making, indicating to some extent the variability in power relations and gender inequality across regions, especially in rural areas. The results also indicate that women who enjoy freedom to go either to a neighbouring village or to hospital/clinic alone are also more likely to participate in domestic decisions, and the linkage is stronger for the rural than urban women. This means that efforts to improve women's status indicators in terms of mobility and access to health services and other resources can have important repercussions for enhancing women's position in the household and thus influencing demographic outcome.

The ways in which women's decision-making position influences reproductive behaviour are rather more complex and give a somewhat mixed picture for urban and rural women. However, it appears that decision-making autonomy as such is not irrelevant or negative in shaping and influencing fertility intentions and contraceptive use. Rather, it has an important independent effect and only a partial implication for women's demographic behaviour. However, the strong and positive relationship between husband-wife communication and contraceptive use or desire for future birth is evident for both urban and rural women across all models. It can be inferred from this that policy-makers and programme managers should increasingly consider men's involvement in family planning programme objectives, while focusing on women's special needs and constraints in accessing the availability of services. The results also suggest that the impact of decision-making autonomy on measures of reproductive behaviour is strongly conditioned by socioeconomic and demographic factors. In this regard, the results confirm the importance of women's education and lifecycle factors in determining reproductive behaviour, especially in case of rural women. However, the case for the use of paid employment as a proxy of women's position and decision-making authority, especially in its relationship to fertility behaviour, is discredited by these results. The contrary effect to that expected of paid work on measures of decision-making and reproductive behaviour as well as the small number of women reported as engaged in paid employment raise some questions about exploring this relationship further.

These results suggest that greater gender inequality and limited decision-making power of women in a given social context clearly affect reproductive behaviour. The fact that decision-making measures of empowerment have a mitigated effect on women's decision-making (once the conditioning effect of socioeconomic and regional factors is taken into consideration) means that these measures of empowerment give only a partial explanation of women's fertility-related behaviour. This study, however, reinforces the point that while efforts at improving Pakistani women's status in terms of their enhanced role in domestic decision-making is not just an appropriate goal and a positive end in itself, but that the benefits extend to achieving gender equality and fertility reduction outcomes--goals that should be central to a population and development policy. Appendices Appendix Table 1 Percentage Distribution of Currently Married Urban and Rural Women:, by Socio-economic and Demographic Characteristics, Pakistan, 1996-97 Urban Women Rural Women Characteristics % Number % Number All Women 100.0 (2245) 100.0 (5340) Women Age 15-24 19.2 (431) 26.7 (1426) 25-34 42.6 (957) 41.2 (2205) 35+ 38.2 (857) 32.0 (1709) Marriage Duration <10 Years 36.1 (788) 40.8 (2118) 10-19 Years 36.8 (802) 38.7 (1907) 20+ Years 10.9 (591) 22.5 (1167) Parity Less than 4 Living Children 51.0 (1144) 52.4 (2795) 4 or More 49.0 (1101) 47.6 (2545) Women's Education None/Informal 49.3 (11.06) 85.7 (4578) Below Matric (1-9) 23.8 (535) 11.5 (615) Matric and Above (10+) 26.9 (604) 2.8 (147) Region NWFP 8.7 (195) 17.0 (907) Punjab 52.4 (1176) 60.9 (3253) Sindh 36.3 (814) 16.2 (866) Balochistan 2.6 (59) 4.1 (313) Paid Work Yes 14.5 (325) 21.2 (1133) No 85.5 (1920) 78.8 (4207) Employment Status Not Working 85.5 (1920) 78.8 (4207) Works for Someone Else 4.2 (95) 3.8 (206) Self-employed 10.2 (230) 7.9 (926) Mobility Gone Outside Home Alone 24.4 (848) 15.0 (803) No 75.6 (1697) 85.0 (6234) Can Go to Hospital Alone 35.5 (796) 19.1 (1019) Accompanied/Depends 64.5 (1149) 80.9 (4320) Decision about Child Treatment Wife 39.4 (791) 23.1 (1066) Husband 39.4 (791) 55.2 (2545) Jointly/Others 21.3 (428) 21.7 (998) Decision about HH Purchases Wife 35.6 (793) 21.2 (1134) Husband 36.8 (82G) 50.4 (2689) Others 27.6 (620) 28.4 (1516) Husband-Wife Communication Never 48.7 (1042) 57.8 (3087) Once or More 51.3 (1152) 42.2 (2252) Contraceptive Use Yes 36.5 (819) 18.6 (994) No 63.5 (1425) 81.4 (4345) Desire for Additional Children No More Children 49.5 (1111) 39.2 (2094) Want More Children 50.5 (1134) 60.8 (3245) Appendix Table 2 Percentage of Currently Married Urban and Rural Women Reporting Final Decision-making about Child Treatment, Pakistan: 1996-97 Urban Women % Number [chi square] Characteristics Values All Women 39.3 (2011) Women Age 15-24 24.3 (300) 51.5 25-34 38.6 (876) P<.001 35+ 45.5 (835) Marriage Duration <10 32.3 (657) 38.3 10/19/2009 40.5 (776) P<.001 20+ 46 (576) Parity <4 33.4 (910) 38.8 4+ 44.2 (1101) P<.001 Women Education No Formal Education 36.0 (1004) 18.5 Below Matric 41.1 (470) P<.001 Manic and Above 44.3 (537) Region NWFP 19.3 (176) Punjab 40.2 (1073) 60.1 Sindh 44.8 (708) P<.001 Balochistan 18.9 (54) Paid Work Yes 54.0 (291) 35.2 Not Working 36.9 (1720) P<.001 Employment Status Works for Someone Else 50.0 (80) 35.9 Self-employed/Family 55.5 (211) P<.001 Not Working 36.9 (1720) Mobility Moved Alone 55.4 (505) 74.7 No 34.0 (1505) P<.001 Can Go to Hospital Alone 56.5 (744) 144.5 Accompanied 29.3 (1266) P<.001 Husband-Wife Communication Never 37.4 (927) 12.1 Once or More 41.1 (1083) P<.001 Rural Women % Number [chi square] Characteristics Values All Women 23.1 (4609) Women Age 15-24 15.1 (910) 94.1 25-34 23.5 (2065) P<.001 35+ 27.2 (1634) Marriage Duration <10 16.5 (1640) 10/19/2009 26.3 (1829) 136.2 20+ 27.6 (1139) P<.001 Parity <4 19.8 (2065) 84.9 4+ 25.8 (2544) P<.001 Women Education No Formal Education 22.0 (3966) 121.9 Below Matric 25.0 (516) P<.001 Manic and Above 51.2 (127) Region NWFP 12.9 (790) Punjab 30.7 (2819) 279.0 Sindh 11.8 (735) P<.001 Balochistan 4.2 (264) Paid Work Yes 20.7 (987) 4.9 Not Working 23.8 (3621) P<.10 Employment Status Works for Someone Else 31.6 (187) 210.6 Self-employed/Family 18.1 (800) P<.001 Not Working 23.8 (3623) Mobility Moved Alone 38.7 (764) 128.9 No 20.0 (3854) P<.001 Can Go to Hospital Alone 48.8 (971) 457.7 Accompanied 16.3 (3638) P<.001 Husband-Wife Communication Never 21.1 (2517) 13.5 Once or More 25.6 (2092) P<.001 Appendix Table 3 Percentage of Currently Married Urban and Rural Women Reporting Final Decision-making about Household Purchases, Pakistan, 1996-97 Urban Women % Number [chi square] Characteristics Values All Women 35.5 (2245) Women Age 15-24 18.3 (431) 164.8 25-34 33.8 (957) P<.001 35+ 46.2 (857) Marriage Duration <10 Years 23.6 (788) 10-19 Years 41.8 (803) 142.4 20+ Years 45.0 (591) P<.001 Parity <4 Living Children 30.9 (1144) 80.9 4+ Living Children 40.3 (1101) P<.001 Women Education No Formal Education 30.7 (1106) Below Matric 37.5 (539) 74.1 Matric and Above 42.9 (609) P<.001 Region NWFP 26.0 (196) Punjab 34.5 (1176) 46.0 Sindh 40.8 (814) P<.001 Balochistan 16.7 (60) Paid Work Yes 42.0 (324) 10.9 Not Working 34.5 (1921) P<.001 Employment Status Works for Someone Else 45.3 (95) Self-employed/Family 40.6 (229) 11.6 Not Working 34.5 (1921) P<.05 Mobility Gone Outside Home Alone 48.4 (548) 51.9 No 31.4 (1697) P<.001 Can Go to Hospital Alone 53.5 (795) 173.0 Accompanied/Depends 25.7 (1449) P<.001 Husband-Wife Communication Never 33.2 (1092) 7.3 Once or More 37.8 (1152) P<.15 Rural Women % Number [chi square] Characteristics Values All Women 21.2 (5340) Women Age 15-24 10.0 (1426) 420.3 25-34 22.0 (2205) P<.001 35+ 29.0 (1709) Marriage Duration <10 Years 13.3 (2118) 593.5 10-19 Years 25.1 (1907) P<.001 20+ Years 30.8 (1167) Parity <4 Living Children 16.3 (2795) 429.9 4+ Living Children 26.7 (2545) P<.001 Women Education No Formal Education 20.6 (4577) Below Matric 23.6 (615) 84.3 Matric and Above 30.8 (146) P<.001 Region NWFP 8.6 (807) Punjab 29.6 (3253) 415.3 Sindh 8.0 (866) P<.001 Balochistan 7.7 (314) Paid Work Yes 15.4 (1132) 44.8 Not Working 22.9 (4207) P<.001 Employment Status Works for Someone Else 19.0 (205) Self-employed/Family 14.3 (920) 40.6 Not Working 22.9 (4209) P<.001 Mobility Gone Outside Home Alone 39.2 (803) 184.0 No 18.1 (4536) P<.001 Can Go to Hospital Alone 47.8 (1019) 531.7 Accompanied/Depends 15.0 (4321) P<.001 Husband-Wife Communication Never 19.0 (3088) 38.6 Once or More 24.2 (2252) P<.001

Author's Note: The author wishes to thank the anonymous referee for useful suggestions to improve an earlier draft of the paper.

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(1) The survey was conducted by the National Institute of Population Studies (NIPS), Islamabad, in collaboration with the London School of Hygiene and Tropical Medicine (LSHTM). For details of the sample size, design, and preliminary findings of the survey, see NIPS and LSHTM (1998).

(2) Domestic decision-making in Pakistan's social context usually involves the opinion and input of all family members including mother-in-law or elders in the family, especially in a joint or extended family set-up. However, the questions chosen to examine women's involvement in decision-making pertain to only those which indicate women's reporting about making final decisions vis-a-vis their husbands and other family members in household matters.

(3) A separate question on reproductive decision-making was also asked the women who reported the first use of method: 'Who decided to use this particular method?' 'Was it mainly the wife's decision, her husband's or someone else's?' This question pertains to ever users only which reduces the sample to less than half, and hence is not included as a decision-making variable in the analysis. However, the survey report shows that the wife's decision to use a particular method has almost the same weight as the husband's for both urban and rural women [NIPS and LSHTM (1998), p. 139].

Naushin Mahmood is Chief of Research at the Pakistan Institute of Development Economics, Islamabad. Table 1 Odds Ratios of Final Decision-making Regarding Child Treatment and Household Purchases as n Function of Women's Mobility and Background Characteristics, Pakistan, 1996-97 Decision Regarding Decision Regarding Child Treatment Household Purchases Urban Rural Urban Rural Women Women Women Women (n=2011) (n=4609) (n=2245) (n=5340) Variables Odds Ratios Odds Ratios Women's Age 15-24 (r) -- -- -- -- 25-34 2.20 *** 1.42 1.53 ** 1.29 ** 35+ 2.19 *** 1.11 1.97 ** 1.10 Marriage Duration <10 (r) 10-19 1.22 * 1.88 *** 1.86 *** 1.70 *** 20+ 1.46 2.30 *** 1.76 *** 2.57 *** Women's Education None/Informal (r) -- -- -- -- Primary and Middle 1.19 0.96 1.48 *** 0.95 Secondary and Above 1.07 3.17 *** 1.63 *** 1.36 Paid Work Not Working (r) -- -- -- -- Yes 1.37 ** 0.86 * 0.96 0.55 *** Region Balochistan (r) -- -- -- -- NWFP 0.85 2.30 ** 1.60 0.78 Punjab 2.2 ** 5.91 *** 1.91 * 3.64 *** Sindh 2.51 ** 2.84 *** 2.57 ** 1.12 Mobility No (r) -- -- -- -- Yes 2.36 *** 1.13 2.53 *** 2.99 *** Go to Hospital Alone Accompanied/ Depends (r) -- -- -- -- Yes 1.5 *** 3.48 *** 2.53 *** 2.99 *** Husband-Wife Communication No (r) -- -- -- -- Yes 1.32 ** 1.20 *** 1.10 1.13 Significant at * P [less than or equal to] .05; ** P [less than or equal to] .01 and *** P [less than or equal to] .001. (r) = reference category. Table 2 Odds Ratios of Desire for No More Children as a Function of Decision-making and Socio-demographic Variables among Currently Married Urban and Rural Women, Pakistan, 1996-97 Urban Women Model Model Model 1 2 3 Variables Odds Ratios A. Decision-making Variables Decision for Child Treatment Mother-in-law/Other (r) -- -- -- Wife 2.27 *** 1.48 ** 1.48 ** Husband 1.74 *** 1.20 1.21 Decision HH Purchases Mother-in-law (r) -- -- -- Wife 1.66 *** 1.26 * 1.29 * Husband 1.43 *** 1.15 1.16 Mobility No (r) -- -- -- Yes 1.23 * 1.09 1.13 Can Go to Hospital Alone? Accompanied/Depends (r) -- -- -- Alone 1.06 0.96 0.94 Husband-Wife Communication No (r) -- -- -- Yes 2.58 *** 2.56 *** 2.41 *** B. Socio-demographic Indicators Women's Age 15-24 (r) -- -- -- 25-34 2.65 *** 2.58 *** 35+ 4.19 *** 4.06 *** Parity <4 Children (r) -- -- -- 4+ Children 3.23 *** 3.26 *** Women's Education None/Informal (r) -- -- -- Primary and Middle 1.01 0.99 Secondary and Above 1.11 1.16 Paid Work No (r) -- -- -- Yes 0.72 * 0.73 * C. Region of Residence Balochistan (r) -- -- -- NWFP 1.18 Punjab 1.44 Sindh 1.11 -2 log Likelihood 2918.6 2576.2 2568.1 (N) (2245) Rural Women Model Model Model 1 2 3 Variables Odds Ratios A. Decision-making Variables Decision for Child Treatment Mother-in-law/Other (r) -- -- -- Wife 1.76 *** 1.04 1.01 Husband 2.04 *** 1.25 * 1.27 * Decision HH Purchases Mother-in-law (r) -- -- -- Wife 2.38 *** 1.58 *** 1.51 *** Husband 1.76 *** 1.15 1.19 Mobility No (r) -- -- -- Yes 1.39 *** 1.11 1.09 Can Go to Hospital Alone? Accompanied/Depends (r) -- -- -- Alone 1.70 *** 1.18 1.09 Husband-Wife Communication No (r) -- -- -- Yes 2.26 ** 2.37 *** 2.29 ** B. Socio-demographic Indicators Women's Age 15-24 (r) -- -- -- 25-34 3.24 *** 3.19 *** 35+ 7.81 *** 7.64 *** Parity <4 Children (r) -- -- -- 4+ Children 5.21 *** 5.49 *** Women's Education None/Informal (r) -- -- -- Primary and Middle 1.61 *** 1.48 *** Secondary and Above 2.81 *** 2.62 *** Paid Work No (r) -- -- -- Yes 1.00 0.95 C. Region of Residence Balochistan (r) -- -- -- NWFP 1.58 ** Punjab 2.11 *** Sindh 1.46 ** -2 log Likelihood 6460.1 5065.8 5035.3 (N) (5340) Significant at * P [less than or equal to] .05; ** P [less than or equal to] .01 and *** P [less than or equal to] .001. (r) = reference category. Table 3 Odds Ratios of Current Contraceptive Use as a Function of Decision-making and Socio-demographic Variables among Currently Married Urban and Rural Women, Pakistan, 1996-97 Urban Women Model Model Model Variables 1 2 3 A. Decision-making Variables Decision for Child Treatment Mother-in-law/Other (r) -- -- -- Wife 2.28 *** 1.62 *** 1.61 *** Husband 2.24 1.77 *** 1.78 *** Decision HH Purchases Mother-in-law/Other (r) -- -- -- Wife 2.23 *** 1.88 *** 1.90 *** Husband 1.64 *** 1.39 *** 1.60 *** Mobility No (r) -- -- -- Yes 1.37 ** 1.22 * 1.24 * Can Go to Hospital Alone Accompanied/Depends (r) -- -- -- Alone 1.35 ** 1.23 * 1.22 * Husband-Wife Communication No (r) -- -- -- Yes 3.24 *** 3.64 *** 3.58 *** B. Socio-demographic Indicators Women's Age 15-24 (r) -- -- -- 25-34 2.81 *** 2.77 *** 35+ 4.01 *** 3.94 *** Parity <4 Children (r) -- -- -- 4 and More 2.61 *** 2.63 *** Women's Education None/Informal (r) -- -- -- Primary and Middle 2.51 *** 2.49 *** Secondary and Above 2.35 *** 2.38 *** Paid Work No (r) -- -- -- Yes 0.97 0.97 Region Balochistan (r) -- -- -- NWFP 1.24 Punjab 1.43 Sindh 1.27 -2 log Likelihood 2365.3 2363.3 (N) (2245) Rural Women Model Model Model Variables 1 2 3 A. Decision-making Variables Decision for Child Treatment Mother-in-law/Other (r) -- -- -- Wife 1.73 *** 1.45 ** 1.39 ** Husband 1.53 *** 1.35 ** 1.38 ** Decision HH Purchases Mother-in-law/Other (r) -- -- -- Wife 1.38 1.11 1.03 Husband 0.99 * 0.80 * 0.83 * Mobility No (r) -- -- -- Yes 1.20 * 1.03 1.04 Can Go to Hospital Alone Accompanied/Depends (r) -- -- -- Alone 1.73 *** 1.48 *** 1.39 ** Husband-Wife Communication No (r) -- -- -- Yes 5.67 *** 5.23 *** 5.35 *** B. Socio-demographic Indicators Women's Age 15-24 (r) -- -- -- 25-34 1.56 ** 1.49 ** 35+ 1.79 *** 1.70 *** Parity <4 Children (r) -- -- -- 4 and More 3.90 *** 3.09 *** Women's Education None/Informal (r) -- -- -- Primary and Middle 2.97 *** 2.71 *** Secondary and Above 4.39 *** 4.09 *** Paid Work No (r) -- -- -- Yes 0.90 ** 0.79 ** Region Balochistan (r) -- -- -- NWFP 1.79 ** Punjab 3.36 *** Sindh 3.18 *** -2 log Likelihood 4403.7 4413.8 4067.4 (N) (5340) Significant at * P [greater than or equal to] .05; ** P [greater than or equal to] .01 and *** P [greater than or equal to] .001. (r) = reference category. Fig. 1. Percentage Distribution of Currently Married Urban and Rural Women, by Background Characteristics, Pakistan, 1996-97. Characteristics * Urban Women Rural Women Age 19.2 42.6 49.3 26.7 41.2 32 Education 49.3 23.8 26.9 85.7 11.5 2.8 Region 8.7 52.4 36.3 17 60.9 16.2 Paid Work 14.5 85.5 21.2 78.7 * Various categories of measures of decision-making and mobility are: Age = 15-25, 25-34, 35+; Education = none/informal; below matric and above; Region = NWFP, Punjab, Sindh, Balochistan; paid Work = yes, no. Note: Table made from bar graph. Fig. 2. Percentage Distribution of Currently Married Urban and Rural Women, by Measures of Decision-making, Mobility, and Contraceptive Use, Pakistan, 1996-97. Measures of Decision-making Urban Women Rural Women and Mobility * Mobility 24.4 75.6 15 85 Can go to Hospital 35.5 64.5 19.1 80.9 Decision on Child 39.4 39.4 21.3 23.1 55.2 21.7 Decision HH Purchases 35.6 36.8 27.6 21.2 50.4 28.4 Contraceptive Use 36.5 63.5 18.6 81.4 * Various categories of measures of decision-making and mobility are: Mobility = gone outside home alone, no; Can go to hospital alone = yes, accompanied/depends; Decision on child treatment = wife, husband, jointly/others; Decision HH purchases = wife, husband, others; Contraceptive use = yes, no. Note: Table made from bar graph. Fig. 3. Percentage of Currently Married Urban and Rural Women who Report Taking the Final Decision about Treatment of a Sick Child in the Household, Pakistan, 1996-97. Variables * Urban Women Rural Women Age 24.3 38.6 45.5 15.1 23.5 27.2 Education 36 41.1 44.3 22 25 51.2 Paid Work 54 36.9 20.7 23.8 Region 19.3 40.2 44.8 18.9 12.9 30.8 11.8 4.2 Mobility 55.4 34 38.7 20 Can Go to Hospital 56.5 29.3 48.8 16.3 * Same as described in Figures 1 and 2. Note: Table made from bar graph. Fig. 4. Percentage of Currently Married Urban and Rural Women who Report Taking Final Decision about Household Purchases, i.e., Food and Clothing, Pakistan, 1996-97. Variables * Urban Women Rural Women Age 18.3 33.8 46.2 15.1 23.5 27.2 Education 30.7 37.5 42.9 22 25 51.2 Paid Work 42 34.5 20.7 23.8 Region 26 34.5 40.8 16.7 12.9 30.8 11.8 4.2 Mobility 48.4 31.4 38.7 20 Can Go to Hospital 53.5 25.7 48.8 16.3 * Same as described in Figures 1 and 2. Note: Table made from bar graph.