title: The context and limitations of female sterilization services in Pakistan.
abstract: BACKGROUND
  Female sterilization has long been the most popular method of family planning (FP) in Pakistan, and yet most public health experts feel it contributes little to controlling family size or to population welfare. We used Pakistan Demographic Health Survey (PDHS) data to understand the role female sterilization plays in the overall context of FP in Pakistan.
  
  
  METHODS
  We performed a secondary analysis of data from the PDHS 1990-1 and 2006-7 to study factors that lead to sterilization and trends in the use of the procedure. In addition, census data were multiplied by proportions from PDHS data to estimate the number of women availing sterilization services.
  
  
  RESULTS
  Around 1.9 million women in Pakistan are currently sterilized--up from 0.55 million in 1990-1, and around 173,867 undergo the procedure, annually. Women usually receive sterilization after 30 years of age (mean = 39) and after six children. The probability of sterilization increases with age, family size, and urban residence, and is unaffected by poverty, province of residence, or the woman or her husband's education. Most sterilizationis conducted in public sector facilities.
  
  
  CONCLUSIONS
  Sterilization in Pakistan may be common, but occurs too late to have any significant effect on family size or benefit public health. Future avenues to make this option more useful to women and society would be to improve the repertoire and access and quality of FP services that are available, and to address governance issues that limit the performance and utility of government facilities.
authors.affiliation: Research and Development Solutions, Islamabad. adnan@resdev.org
authors.forename: Adnan Ahmad
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Ayesha
authors.initials: A
authors.lastname: Khan
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Khadija
authors.initials: K
authors.lastname: Abbas
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Syed Farhan Ali
authors.initials: SF
authors.lastname: Tirmizi
authors.affiliation: Research and Development Solutions, Islamabad.
authors.forename: Zia
authors.initials: Z
authors.lastname: ul Islam
mesh_terms: D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D010154:Pakistan; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013245:Sterilization, Reproductive / Q000706:statistics & numerical data*