MDGs Research Paper

TO EVALUATE GAPS IN THE TARGETS OF MOTHER
AND CHILD HEALTH RELATED MILLENNIUM

DEVELOPMENT GOALS OF PUNJAB, PAKISTAN
SUBMITTED BY:
Name Roll no.
Sheraz Ali 02
M. Zain ul Abideen 01
Amna Nadeem 16
Umair Ahmad Khan 302
Muhammad Faizan 07
Fraz Shahid 22
Maleeha Rauf 47
Abdul Wahab 21
Bilal Liaqat 12
Rizwan Ali 10
SUPERVISED BY:
DR. M. ASHRAF MAJROOH
MBBS, DCH, MPH, FCPS (Community Medicine)
HEAD OF DEPARTMENT
DEPARTMENT OF COMMUNITY MEDICINE

FAISALABAD MEDICAL UNIVERSITY, FAISALABAD
(SESSION 2017-2022)
DATE OF SUBMISSION: 15-11-2021
I
SUPERVISOR CERTIFICATE
It is certified that this report titled “To Evaluate Gaps in the Targets of Mother
and Child Health Related Millennium Development Goals of Punjab, Pakistan”
submitted by Sheraz Ali, Muhammad Zain ul Abideen, Amna Nadeem, Umair
Ahmad Khan, Muhammad Faizan, Fraz Shahid, Maleeha Rauf, Abdul Wahab,
Bilal Liaqat and Rizwan Ali under roll numbers 02, 01, 16, 302, 07, 22, 47, 21, 12
and 10 respectively, to the department of the community medicine, Faisalabad
Medical University, (PMC) Faisalabad is the original work of these students. They
carried out this research under my supervision. The contents of this report are found
satisfactory, certified further, that to the best of my knowledge, the work reported
herein does not form part of any other report.
Signature of Supervisor: _____________________
Date of Submission: ______________________
II
DEDICATION
It is with genuine gratitude and warm regard that we dedicate this research to our
honored supervisor Professor Dr. M. Ashraf Majrooh (Head of Community Medicine
Department, Faisalabad Medical University, Faisalabad). There is no doubt in our
minds that undoubtedly without their continued support & counsel we could not have
completed this process.
Our work is also committed to our beloved parents for their unending support and
encouragement, our respected teachers who guided us at each progression of
academic life.
III
ACKNOWLEDGEMENTS
Praise and glory be to Allah, the most beneficent, the merciful and whose blessings
upon us are countless. He bestowed upon us the strength, peace of mind and good
health in order to finish this work. We experienced so much during this process, not
only from the academic aspect but also from the aspect of personality
We owe a deep sense of gratitude to Dr. Muhammad Ashraf Majrooh, Head
of Department, Community Medicine, Faisalabad Medical University/Allied
Hospital Faisalabad for his keen interest at every stage of our research. His skillful
guidance, timely suggestions with kindness and dynamism has enabled us to
complete this project. Truly, he will remain in our minds as a great mentor,
conducive to the beauty of this subject.
We are much grateful for our teachers, especially Dr. Sumera Ashraf, Senior
Demonstrator, Department of Community Medicine, Faisalabad Medical University,
for their complete co-ordination, motivation, encouragement and facilitation
throughout our research work.
We would also like to thanks UNICEF and Pakistan Bureau of statistics for
providing us required data and allowing us to use it in our research work.
Lastly, we feel weak and deficient in vocabulary to find suitable words to express
our feelings for our loving parents whose prayers and ultimate support prepared us
for our future. Our entity at this stage is the result of the belief they had in us along
the tedious events of academic achievements.
IV
CONTENTS
ABSTRACT..........................................................................................................................................7
INTRODUCTION................................................................................................................................9
LITERATURE REVIEW...................................................................................................................11
OBJECTIVES:....................................................................................................................................13
METHODOLOGY:............................................................................................................................14
OPERATIONAL DEFINITIONS:.....................................................................................................15
Indicator 4.1: Under 5 Mortality Rate (Deaths per 1000 live births).................................................16
Indicator 4.2: Infant Mortality Rate (Deaths per 1000 live births)....................................................25
Indicator 4.3: Proportion of Fully-immunized Children 12-23 Months............................................34
Indicator 4.4: Proportion of under 1-year children immunized against measles..............................42
Indicator 4.5: Proportion of Children under 5 who suffered from Diarrhea in the Last 14 Days
(percent)..............................................................................................................................................50
Indicator 4.6: Lady Health Worker’s Coverage (Percent of target population)...............................58
Indicator 5.2: Proportion of births attended by Skilled Birth Attendants (Assistance during delivery
and C-section).....................................................................................................................................67
Indicator 5.3: Contraceptive Prevalence Rate (%)............................................................................75
Indicator 5.4: Total Fertility Rate......................................................................................................83
Indicator 5.5: Ante-natal Coverage At least Once..............................................................................91
DISCUSSION......................................................................................................................................99
CONCLUSION.................................................................................................................................105
REFERENCES.................................................................................................................................106
1
LIST OF TABLES
Table 1, Indicator 4.1.........................................................................................................
Table 2, Indicator 4.2.........................................................................................................
Table 3, Indicator 4.3.........................................................................................................
Table 4, Indicator 4.4.........................................................................................................
Table 5, Indicator 4.5.........................................................................................................
Table 6, Indicator 4.6.........................................................................................................
Table 7, Indicator 5.2.........................................................................................................
Table 8, Indicator 5.3.........................................................................................................
Table 9, Indicator 5.4.........................................................................................................
Table 10, Indicator 5.5 91
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LIST OF GRAPHS
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5
LIST OF ABBREVIATIONS
MDGs: Millennium Development Goals
MICS: Multiple Indicator Cluster Survey
U5MR: Under-5 Mortality Rate
IMR: Infant Mortality Rate
LHW: Lady Health Worker
MMR: Maternal Mortality Ratio
SBA: Skilled Birth Attendant
CPR: Contraceptive Prevalence Rate
TFR: Total Fertility Rate
T.T. Singh: Toba Tek Singh
D.G. Khan: Dera Ghazi Khan
R.Y. Khan: Rahim Yar Khan
M.B. Din: Mandi Bahauddin
N.K. Sahib: Nankana Sahib
6
ABSTRACT
BACKGROUND: The Millennium Developmental Goals (MDGs) were the eight

international goals established in 2000 by United Nations, with the aim to achieve
the set targets globally by 2015. The development in goal 4 & 5 (Reduce child
mortality and improve maternal health respectively) are the focus of this research.
The world has made an impressive progress in reducing child and maternal mortality,
but many countries including Pakistan, are unable to reach the targets of MDGs 4
and 5, and gaps are left.
OBJECTIVES: To trace the trends of progress in achievement of MDGs 4 & 5, and

to evaluate gaps in the targets of these goals across the 36 districts of Punjab,
Pakistan.
METHODS: A descriptive correlational meta-analysis of the surveys conducted by

Government of Pakistan in coordination with United Nations during the time period
of 2003 to 2018, with emphasis on evaluation of reduction in child mortality and
improvement in maternal health by making district wise graphs of the indicators of
MDGs 4 and 5. The trends in the graphs were analyzed to find the discrepancies in
the gaps of targets in genders, wealth index quintiles, urban and rural populations.
RESULTS: The data evaluate in this study suggests that there has been significant
improvement in provision of healthcare to mother and child across the 9 divisions of
Punjab, but still goals set has not been achieved fully yet. Currently, Punjab is off-
track from all the 11 indicators of these two MDGs with greater gaps in the lower
socioeconomic and rural population while greater achievement in higher
socioeconomic and urban population.
CONCLUSIONS AND RECOMMENDATIONS: All the districts of Punjab are

off-track from the targets of maternal and child health goals, with some having more
gaps than the others. The goals were set by the UN with same targets globally
without evaluating the ground situations of economy, health facilities, infrastructure
and literacy rate of the counties.
7
The policy maker should revisit the strategy and set the targets in accordance with
the above-mentioned conditions of the area. More attention should be given to the
under privileged areas having more gaps, so that the benefits of the program will be
enjoyed by all the population equally as much as possible.
KEY WORDS: MDGs, Maternal Health, Child Health, Mortality, Punjab
8
INTRODUCTION
Millennium Development Goals were 8 goals set by the United Nations in

September 2000. The purpose of MDGs was to improve the overall status of the
whole world. Regarding health, Goal no. 4 & 5 of MDGs deals with the child health
and maternal health respectively. There are certain indicators set to observe the
health state improvement of both goals.
Goal no. 4: Reduce Child Mortality
Indicators:
❖ Under 5 Mortality Rate (Deaths per 1000 Live Births)
❖ Infant Mortality Rate (Deaths per 1000 Live Births)
❖ Proportion of Fully Immunized Children 12-23 Months
❖ Proportion of under-1-year children immunized against measles
❖ Proportion of Children Under 5 who suffered from Diarrhea in the last 30

Days
❖ Lady Health Worker’s Coverage (percent of target population)
Goal no. 5: Improve Maternal Health
Indicators:
❖ Proportion of births attended by Skilled Birth Attendants
❖ Contraceptive Prevalence Rate
❖ Total Fertility Rate
❖ Proportion of women 15-49 who had given birth during last 3 years and
made at least one antenatal consultation
9
This research basically focuses on the two above-mentioned goals in the province of
Punjab, Pakistan. For that purpose, following surveys of MICS have been used to
collect data from, and analyze to generate graphical trends for following the
achievement of goals in all districts of various divisions of Punjab:
 MICS 2003-4 [1]

 MICS 2007-8 [2]
 MICS 2011 [3]
 MICS 2014 [4]
 MICS 2017-18 [5]
The purpose of this study is to analyze the lacking and shortcomings of the districts
in achieving the targets set for their development. The quantification of the gaps will
further provide the information for the analysis of the factors that played a role in the
gross discrepancies in gaps of some districts. Moreover, the gaps can also be
assessed in terms of wealth indices of districts to analyze where to allocate more of
the health resources and maintain equity among all districts with respect to their
socioeconomic strata.
10
LITERATURE REVIEW
Millennium Developmental Goals, or MDGs for short, are a set of checkpoints

designed by the United Nations in the September of 2000, under United Nations
Millennium Declaration in order to improve the general living standards for
humanity. A total of 8 goals were devised, addressing the major issues of the time,
ranging from food shortage and healthcare to socioeconomic and environmental
problems and all of the 191 UN Member States have unanimously pledged to try to
achieve by the end of next 15 years, i.e., till 2015. This research, however, focuses
on the gaps in achieving the goals no. 4 and 5 only (Reduction in Child Mortality and
Improvement of maternal health, respectively) and the probable causes behind these
gaps in the achievement of said goals, limiting the area to the nine divisions of
Punjab, Pakistan.
Goal no. 4: Reduce Child Mortality
Child mortality is a reliable indicator of provision of health facilities in any country,

and Child Mortality can be better assessed by measuring the aforementioned
indicators. Therefore, under MDG 4, Pakistan had set out to bring down the
mortality rates of children under 5 years by two thirds. The country has shown a
gradual, but slow progress on this front, as evident by the progress in each individual
indicator. Under-five morality had fallen from 117 deaths in 1990/91 to 89 deaths
per 1,000 live births in 2012/13 [6]
and the infant mortality rate in this time period
from 102 to 74 deaths per 1,000 live births. However, both are still short of the MDG
targets of 52 deaths per 1,000 live births for under-five mortality, and 40 deaths per
1,000 live births for infant mortality, set in 2000. The coverage for children fully
vaccinated increased from 75 to 80 percent and that of measles immunization from
80 to 81 percent in this period; both are still substantially short of the set target of
>90 percent coverage. Pakistan was able to achieve the MDG target (less than 10
11
percent) for reducing the proportion of children under five who had suffered from
diarrhea in the last thirty days. [7]
It fell from 26 to 8 percent. Lady health worker
coverage stood at 83 percent in 2008/09 as opposed to the target of 100 percent. We
believe that the progress on health indicators has been affected by a number of
internal and external factors and therefore, despite the progress shown, Pakistan has
fallen short in five out of six indicators and hence, is likely to fail in its objective of
attaining the MDG 4. [8]
Goal no. 5: Improve Maternal Health
As with Child mortality, maternal health is also an indicator of provision of adequate

health facilities to a given population. For improvement in standards of living for its
populace, Pakistan had set out to make reforms in healthcare provision enough to
reduce the maternal mortality rate (MMR) by three-quarters and to ensure universal
access to reproductive health. [9]
Over the past decade or so, a renewed focus on
providing timely and efficient health care options to women of child-bearing age is
apparent. Pakistan has shown a considerable progress in achieving the targets set for
2015, but still falls substantially short in achieving the targets set in 2000; MMR has
been almost halved (down to 276 per 100,000 births in 2006/07), [10]
contraceptive
usage has almost tripled (up to 35.4 percent), proportion of births attended by skilled
birth attendants (SBAs) have more than doubled (up to 52.1 percent), and antenatal
consultations have more than quadrupled (up to 68 percent) since 1990/91.The total
fertility rate at 3.8 remains considerably higher than the target of 2.1. Despite all
these gains, Pakistan is still off-track on all indicators mentioned above and is
therefore, very unlikely to achieve MDG 5. [11]
And, as with MDG 4, a variety of
external and internal factors have played a role in impeding the achievement of
MDG 5, including Economic instability, Floods (in 2010) and earthquakes (in 2005)
that led to a significant impact to infrastructure, lack of awareness stemming from
illiteracy and others.
12
OBJECTIVES:
 To quantify the gap in the achievement of MDGs (Goal no. 4 & 5) in whole
Punjab and all of its districts individually.
 To generate trends of achievement of goals in all districts according to
different surveys of MICS Punjab.
 To observe the difference in the trends of different districts.
13
METHODOLOGY:
Study Design: Descriptive, Correlational
Study Settings: Punjab, Pakistan
Study Duration: 22 weeks, starting from 1st June, 2021 till 15th November, 2021
Data Source: MICS Punjab 2003-4, 2007-8, 2011, 2014, 2017-18
14
OPERATIONAL DEFINITIONS:
MDGs: The Millennium Development Goals (MDGs) were eight international

development goals for the year 2015 that had been established following the
Millennium Summit of the United Nations in 2000, following the adoption of the
United Nations Millennium Declaration. These were based on the OECD DAC
International Development Goals agreed by Development Ministers in the "Shaping
the 21st Century Strategy". [12]
U5MR: The under-five mortality rate (U5MR) is the probability for a child born in
specified year to die before reaching the age of five years, if subject to current age
specific mortality rates. [13]
IMR: Probability (expressed as a rate per 1000 live births) of a child born in a
specific year or period dying before reaching the age of one, if subject to age-specific
mortality rates of that period. [14]
MMR: The number of registered maternal deaths due to birth- or pregnancy-related
complications per 100,000 registered live births. [15]
CPR: The percent of women of reproductive age who are using (or whose partner is
using) a contraceptive method at a particular point in time, almost always reported
for women married or in sexual union [16]
TFR: The average number of children a hypothetical cohort of women would have at
the end of their reproductive period if they were subject during their whole lives to
the fertility rates of a given period and if they were not subject to mortality. It is
expressed as children per woman. [17]
Skilled Birth Attendants: A skilled birth attendant (SBA) is a midwife, physician,
obstetrician, nurse or other health care professional who provides essential and
emergency health care services to women and their newborns during pregnancy,
childbirth and the postpartum period. [18]
15
Indicator 4.1: Under 5 Mortality Rate (Deaths per 1000 live births)
Target: 52 deaths/1000 live births
Table 1,
2003-4 2007-8 2011 2014 2017-18
Indicator 4.1
Male 118 117 111 104 69
Gender
Female 105 106 97 82 68
Rural 119 126 115 105 76
Residence
Urban 107 76 73 69 55
Poorest N/A 156 142 137 95
Second N/A 135 126 112 84
Wealth Index
Middle N/A 112 102 91 68
Quantiles
Fourth N/A 86 82 75 55
Highest N/A 52 51 53 30
Target Value 52 52 52 52 52
Value in Punjab 112 111 104 93 69
Gap in Target 60 59 52 41 17
Division District
Bahawalpur 142 170 130 119 72
Bahawalpur Bahawalnagar 138 123 124 122 71
R. Y. Khan 137 148 127 100 66
D. G. Khan 147 113 124 116 63
Layyah 136 103 92 97 61
D. G. Khan
Muzaffargarh 150 128 124 113 86
Rajanpur 153 170 104 109 62
Faisalabad 106 108 103 86 72
Chiniot N/A N/A 126 92 94
Faisalabad
Jhang 134 130 109 98 90
T. T. Singh 112 90 107 123 74
16
Division District 2003-4 2007-8 2011 2014 2017-18
Gujranwala 93 95 85 82 52
Gujrat 92 100 68 61 58
Hafizabad 131 94 154 122 109
Gujranwala
M.B. Din 111 113 69 123 66
Narowal 114 120 66 78 53
Sialkot 84 70 90 82 60
Lahore 82 72 62 64 44
Kasur 139 112 123 143 80
Lahore
N. Sahib N/A 117 115 108 86
Sheikhupura 124 116 97 102 64
Multan 130 73 100 88 70
Khanewal 134 138 104 113 93
Multan
Lodhran 147 167 97 114 105
Vehari 140 119 125 90 84
Rawalpindi 82 52 60 64 41
Attock 127 60 88 73 48
Rawalpindi
Chakwal 100 82 74 48 43
Jhelum 89 69 72 77 61
Sahiwal 120 132 119 96 76
Sahiwal
Okara 135 167 173 125 83
Pakpattan 143 121 141 126 72
Sargodha 120 101 121 83 78
Bhakkar 153 119 117 100 78
Sargodha
Khushab 135 108 100 88 86
Mianwali 129 113 77 63 79
17
Under 5 Mortality Rate in Punjab, Target=52
120 112 111
Number of infant deaths per 1000 104
100 93
80 69
60 59
60 52
41
40
17
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1a
Value in Punjab Gap in Target
Graph 1
Bahawalpur Division
180
160
Number of infant death per 1000
140
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1b
Bahawalpur Bahawalnagar R. Y. Khan
Graph 2
18
D.G Khan Division
180
160
140
No. of infant deaths per 1000
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab,4.1c
D. G. Khan Layyah Muzaffargarh Rajanpur
Graph 3
Faisalabad Division
160
140
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1d
Faisalabad Chiniot Jhang T. T. Singh
Graph 4
19
Gujranwala Division
180
160
140
120
100
80
60
40
20
0
Gujranwala Gujrat Hafizabad M.B. Din Narowal Sialkot
MICS Punjab, 4.1e
Gujranwala Gujrat Hafizabad M.B. Din Narowal
Graph 5
Lahore Division
160
140
no. of infant deaths per 1000
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1f
Lahore Kasur N. Sahib Sheikhupura
Graph 6
20
Multan Division
180
160
140
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1g
Multan Khanewal Lodhran Vehari
Graph 7
Rawalpindi Division
140
120
No.of infant deaths per 1000
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1h
Rawalpindi Attock Chakwal Jhelum
Graph 8
21
Sahiwal Division
200
180
160
140
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1i
Sahiwal Okara Pakpattan
Graph 9
Sargodha Division
180
160
140
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.1j
Sargodha Bhakkar Khushab Mianwali
Graph 10
22
The target for U5MR was to reduce this by two third from the year 1990 to 2015,
i.e., 52 deaths per 1000 live births. U5MR shows a gradual decline from 112 deaths
per 1000 live births in the year 2003-4 to 69 deaths per 1000 live births in year 2017-
18, according to the data provided by MICS Punjab, and still, it is short of the set
target.
Considering the U5MR according to genders, male children show a greater mortality
rate as compared to females.
Considering the residence, mortality rates are higher in rural areas as compared to
urban areas and comparatively lower in the major developed urban cities.
Considering the wealth quantiles, the mortality rates show a decline as we move
from poorest to highest with a value of 95 deaths in poorest in 2017-18, 30 deaths in
the highest in the same year.
According to MICS Punjab 2003-4, the districts Bahawalpur, D.G. Khan, Lodhran,
Vehari, Pakpattan, show U5MR greater than 140 deaths per 1000 live births, while
Bhakkar, Rajanpur, Muzaffargarh show U5MR greater than 150 deaths per 1000 live
births. On the contrary, districts Lahore, Sialkot, Rawalpindi, Jhelum, Gujrat and
Gujranwala show a U5MR less than 100 deaths per 1000 live births.
According to MICS Punjab 2007-8, the districts Bahawalpur, R.Y. Khan, Rajanpur,
Jhang, Khanewal, Lodhran, Sahiwal, Okara show mortality rates greater than 130
while Lahore, Sialkot, Rawalpindi, Attock, Jhelum, and Multan show a mortality rate
less than 70 deaths per 1000 live births.
According to MICS Punjab 2011, Vehari, Kasur, Hafizabad, Chakwal, D.G. Khan,
R.Y. Khan, Bahawalpur and Bahawalnagar, Okara, Pakpattan show U5MR greater
than 120 while Jhelum, Lahore, Rawalpindi, Gujrat show mortality rates less than 70
deaths per 1000 live births.
23
According to MICS Punjab 2014, Pakpattan, Lodhran, Khanewal, Kasur, T.T. Singh,
Hafizabad, Muzaffargarh, D.G. Khan, Bahawalpur show U5MR greater than 110
deaths per 1000 live births while in Lahore, Gujrat, Chakwal, Mianwali, Rawalpindi,
it is less than 65.
According to MICS Punjab 2017-18, Lodhran, Hafizabad show mortality rates

greater than 100, while Lahore, Rawalpindi, Attock, Chakwal have U5MR less than
50 deaths per 1000 live births.
24
Indicator 4.2: Infant Mortality Rate (Deaths per 1000 live births)
Target: 40 deaths/1000 live births
Table 2,
2003-4 2007-8 2011 2014 2017-18
Indicator 4.2
Male 81 81 89 84 61
Gender
Female 73 73 75 65 59
Rural 82 86 90 83 66
Residence
Urban 55 55 61 57 49
Poorest N/A 102 109 105 83
Second N/A 91 97 88 74
Wealth Index
Middle N/A 77 81 73 60
Quantiles
Fourth N/A 62 67 61 49
Highest N/A 40 44 45 27
Value in Punjab 77 77 82 75 60
Gap in Target 37 37 42 35 20
Division District
Bahawalpur 90 110 100 92 61
Bahawalnaga
Bahawalpur 88 84 96 94 62
r
R. Y. Khan 87 98 98 79 56
D. G. Khan 93 78 96 91 53
Layyah 87 72 74 77 54
D. G. Khan
Muzaffargarh 95 86 97 88 77
Rajanpur 97 110 82 86 54
Faisalabad Faisalabad 69 75 82 69 63
Jhang 86 88 86 77 81
25
T. T. Singh 73 64 85 95 61
26
Gujranwala 61 67 69 67 41
Gujrat 61 70 57 51 52
Hafizabad 84 67 117 95 97
Gujranwala
M.B. Din 72 78 58 95 62
Narowal 74 82 56 63 50
Sialkot 57 52 73 66 55
Lahore 55 53 52 53 38
Kasur 89 77 95 109 73
Lahore
N. Sahib N/A 81 90 84 76
Sheikhupura 80 79 77 81 56
Multan 83 54 80 71 59
Khanewal 86 92 82 88 81
Multan
Lodhran 93 108 78 89 88
Vehari 89 82 97 72 75
Rawalpindi 55 40 51 53 35
Attock 81 45 71 60 40
Rawalpindi
Chakwal 66 60 61 41 38
Jhelum 59 51 60 63 56
Sahiwal 78 89 93 76 66
Sahiwal Okara 86 83 108 97 72
Pakpattan 91 109 130 97 61
Sargodha 76 71 94 67 72
Bhakkar 97 82 91 79 74
Sargodha
Khushab 86 75 79 70 72
Mianwali 83 78 63 53 66
27
Infant Mortality Rate, Target=40
90 82
77 77 75
80
70
No. of Infant Deaths per 1000
60
60
50 42
37 37 35
40
30
20
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2a
Graph 11
Bahawalpur Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2b
Graph 12
28
D. G. Khan Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2c
Graph 13
Faisalabad Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2d
Graph 14
29
Gujranwala Division
140
120
No. of Infant Deaths per 1000 100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2e
Graph 15
Lahore Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2f
Graph 16
30
Multan Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2g
Graph 17
Rawalpindi Division
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2h
Graph 18
31
Sahiwal Division
140
120
No. of Infant Deaths per 1000 100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2i
Graph 19
Sargodha Division
120
100
80
60
40
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.2j
Graph 20
32
The target for IMR was to reduce this by two third from the year 1990 to 2015, i.e.,
40 deaths per 1000 live births. IMR shows a gradual decline from 77 deaths per 1000
live births in the year 2003-4 to 60 deaths per 1000 live births in the year 21017-18,
according to the data provided by MICS Punjab, and still, it is short of the set target.
Considering the IMR, according to genders, male children show a greater mortality
rate as compared to females.
Considering the residence, mortality rates are higher in rural areas as compared to
urban areas and comparatively lower in the major developed urban cities.
Considering the wealth quantiles, the mortality rates show a decline as we move
from poorest to highest with a value of 83 deaths in poorest in 2017-18, 27 deaths in
the highest in the same year.
According to MICS Punjab 2003-4, the districts Bahawalpur, D.G. Khan, Lodhran,
Vehari, Pakpattan, show IMR greater than 90 deaths per 1000 live births, while
Bhakkar, Rajanpur, Muzaffargarh show IMR greater than 95 deaths per 1000 live
births. On the contrary, Lahore, Sialkot, Rawalpindi, Jhelum, Gujrat and Gujranwala
show IMR less than 60 deaths per 1000 live births.
According to MICS Punjab 2007-8, the districts Bahawalpur, Rajanpur, Jhang,

Khanewal, Lodhran, Pakpattan show mortality rates greater than 105 while Lahore,
Sialkot, Rawalpindi, Attock, Jhelum Multan shows a mortality rate less than 55
According to MICS Punjab 2011, Vehari, Kasur, Hafizabad, Chakwal, D.G. Khan,
R.Y. Khan, Bahawalpur and Bahawalnagar, Okara, Pakpattan show IMR greater than
95 while Jhelum, Lahore, Rawalpindi, and Gujrat show mortality rates less than 60
33
According to MICS Punjab 2014 Pakpattan, Lodhran, Khanewal, Kasur, T.T. Singh,
Hafizabad, Muzaffargarh, D.G. Khan and Bahawalpur show IMR greater than 90
deaths per 1000 live births while in Lahore, Gujrat, Chakwal, Mianwali, Rawalpindi,
it is less than 55.
According to MICS Punjab 2017-18, Lodhran, Hafizabad show mortality rates

greater than 90, while Lahore, Rawalpindi, Attock and Chakwal have IMR less than
40 deaths per 1000 live births. Hence, it is achieved in these districts.
34
Indicator 4.3: Proportion of Fully-immunized Children 12-23 Months
Target: >90%
Table 3,
2003-4 2007-8 2011 2014 2017-18
Indicator 4.3
Male N/A N/A 46.7 63.7 63.8
Gender
Female N/A N/A 47.0 60.7 64.4
Rural 86 N/A 44.8 59.8 65.7
Residence
Urban 79 N/A 51.9 68.0 61.1
Poorest N/A N/A 32.9 42.2 56.9
Second N/A N/A 41.3 58.8 66.1
Wealth Index
Middle N/A N/A 49.5 67.8 67.8
Quantiles
Fourth N/A N/A 53.6 70.5 67.7
Highest N/A N/A 57.8 74.1 62.0
Target Value >90 N/A N/A >90 >90
Value in Punjab 81 N/A N/A 58.7 64.1
Gap in Target 9 N/A N/A 31.3 25.9
Division District
Bahawalpur 83 N/A 46.2 48.2 60.0
Bahawalpur Bahawalnagar 81 N/A 36.9 67.3 61.2
R. Y. Khan 80 N/A 52.9 55.8 62.2
D. G. Khan 69 N/A 9.1 21.5 44.1
Layyah 76 N/A 43.5 57.3 72.9
D. G. Khan
Muzaffargarh 64 N/A 32.0 33.7 65.1
Rajanpur 64 N/A 23.7 30.1 47.0
Faisalabad 79 N/A 50.7 71.3 59.8
Chiniot 86 N/A 26.2 82.6 63.0
Faisalabad
Jhang 82 N/A 47.0 55.8 61.8
T. T. Singh 80 N/A 52.7 74.7 67.2
35
Gujranwala 84 N/A 65.5 65.6 62.5
Gujrat 87 N/A 80.1 91.6 85.1
Hafizabad 94 N/A 57.2 53.1 72.6
Gujranwala
M.B. Din 75 N/A 69.8 46.4 62.6
Narowal 89 N/A 43.2 86.9 82.8
Sialkot 88 N/A 59.3 78.2 77.7
Lahore 87 N/A 44.1 62.3 51.4
Kasur 79 N/A 37.4 45.6 51.7
Lahore
N. Sahib 88 N/A 59.0 49.6 84.1
Sheikhupura 88 N/A 44.7 48.0 56.6
Multan 81 N/A 64.2 53.5 76.4
Khanewal 72 N/A 55.1 50.8 67.6
Multan
Lodhran 82 N/A 11.6 71.6 73.8
Vehari 76 N/A 38.2 84.7 68.8
Rawalpindi 94 N/A 49.9 56.7 56.7
Attock 81 N/A 52.4 74.2 70.5
Rawalpindi
Chakwal 84 N/A 57.2 87.2 60.5
Jhelum 95 N/A 33.1 88.1 78.5
Sahiwal 83 N/A 45.8 59.8 81.8
Sahiwal
Okara 73 N/A 32.6 39.4 68.3
Pakpattan 77 N/A 51.2 56.5 73.4
Sargodha 85 N/A 44.6 61.2 67.0
Bhakkar 81 N/A 27.3 27.3 47.2
Sargodha
Khushab 92 N/A 39.1 50.2 69.3
Mianwali 78 N/A 33.9 45.3 77.4
36
Proportion of Fully-immunized Children 12-23 months of age
in Punjab, Target=>90%
90
81
80
70 64.1
58.7
No. of children fully immunized
60
50 46.8
43.2
40
31.3
30 25.9
20
9
10
0
2003-4 2011 2014 2017-18
MICS Punjab, 4.3a
Graph 21
Bahawalpur Division
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-4 2011 2014 2017-18
MICS Punjab, 4.3b
Graph 22
37
D. G. Khan Division
80.00
70.00
No. of children fully immunized 60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-4 2011 2014 2017-18
MICS Punjab, 4.3c
Graph 23
Faisalabad Division
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-4 2011 2014 2017-18
MICS Punjab, 4.3d
Graph 24
38
Gujranwala Division
100.00
90.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-4 2011 2014 2017-18
MICS Punjab, 4.3e
Graph 25
Lahore Division
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-4 2011 2014 2017-18
MICS Punjab, 4.3f
Graph 26
39
Multan Division
90.00
80.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-04 2011 2013-14 2017-18
MICS Punjab, 4.3g
Graph 27
Rawalpindi Division
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-04 2011 2013-14 2017-18
MICS Punjab, 4.3h
Graph 28
40
Sahiwal Division
90.00
80.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-04 2011 2013-14 2017-18
MICS Punjab, 4.3i
Graph 29
Sargodha Division
100.00
90.00
80.00
70.00
60.00
50.00
40.00
30.00
20.00
10.00
0.00
2003-04 2011 2013-14 2017-18
MICS Punjab, 4.3j
Graph 30
41
According to World Health Organization, Children who have received BCG vaccine,
3 doses of DTP, Measles and OPV each, are considered fully vaccinated. The MDGs
target was to achieve the immunization coverage greater than 90% in 12–23-month-
old children up to the year 2015.
According to data provided by MICS Punjab 2003, 81% children are vaccinated,
considering BCG scar mark as a criterion of vaccination and the data provided by
MICS Punjab 2017-18 shows 64.1% children are fully vaccinated considering the
presence of vaccination card as a criterion. The target is still not achieved with a gap
of for the year 2017-18.
Considering the genders, the vaccination coverage is comparatively greater in girls

as compared to boys.
Considering the residence, vaccination coverage is less in rural areas as compared to

urban areas
Considering the wealth quantiles, the vaccination coverage gradually increases as we

move from poorer to higher quantiles.
According to MICS Punjab 2011, D.G. Khan and Lodhran show a vaccination
coverage up to 12%, Gujranwala, M.B. Din and Multan up to 65%, while Gujrat up
to 80%.
According to MICS Punjab 2014, D.G. Khan, Rajanpur and Bhakkar show a
vaccination coverage less than 30%, Chiniot, Narowal, Vehari and Chakwal have
coverage up to 80%. Gujrat up to 91% thus achieving the set target in this district.
According to MICS Punjab 2017-18, D.G. Khan, Rajanpur and Bhakkar show a
vaccination coverage less than 50% while Gujrat has coverage greater than 85%.
42
Indicator 4.4: Proportion of under 1-year children immunized against measles
Target: >90%
Table 4,
2003-4 2007-8 2011 2014 2017-18
Indicator 4.4
Male N/A N/A 64.2 N/A N/A
Gender
Female N/A N/A 64.7 N/A N/A
Rural N/A N/A 62.8 76.7 82.6
Residence
Urban N/A N/A 68.7 80.3 83.1
Poorest N/A N/A 52.6 59.2 71.7
Second N/A N/A 60.6 76.4 83.3
Wealth Index
Middle N/A N/A 65.6 82.6 86.3
Quantiles
Fourth N/A N/A 69.4 84.6 86.6
Highest N/A N/A 74.7 88.3 86.9
Target Value N/A N/A N/A >90 >90
Value in Punjab N/A N/A N/A 77.8 82.7
Gap in Target N/A N/A N/A 12.2 7.3
Division District
Bahawalpur N/A N/A 51.6 76.2 76.3
Bahawalpur Bahawalnagar N/A N/A 51.9 65 73.4
R. Y. Khan N/A N/A 65.6 55.9 78.5
D. G. Khan N/A N/A 22.6 46.6 59.4
Layyah N/A N/A 57.1 77.2 79.4
D. G. Khan
Muzaffargarh N/A N/A 55.7 62.6 88.4
Rajanpur N/A N/A 40.8 41 65.9
Faisalabad N/A N/A 65.3 82.2 83.3
Chiniot N/A N/A 58.7 82.9 83.2
Faisalabad
Jhang N/A N/A 64.5 63.2 80.2
T. T. Singh N/A N/A 63.7 80.7 86.4
43
Gujranwala N/A N/A 75.7 80.7 78.8
Gujrat N/A N/A 90.0 98.1 95.8
Hafizabad N/A N/A 74.9 94.2 87
Gujranwala
M.B. Din N/A N/A 78.7 87.9 84.1
Narowal N/A N/A 74.3 92.1 93.1
Sialkot N/A N/A 73.3 95.3 90.8
Lahore N/A N/A 63.2 75.5 75.6
Kasur N/A N/A 55.7 65.9 64.2
Lahore
N. Sahib N/A N/A 78.7 92.5 96.3
Sheikhupura N/A N/A 68.0 77.9 83.2
Multan N/A N/A 72.4 76.8 92.3
Khanewal N/A N/A 67.8 78.2 79.5

Multan
Lodhran N/A N/A 62.4 71.4 89.5
Vehari N/A N/A 64.3 85.4 85.1
Rawalpindi N/A N/A 75.2 84.9 84.9

Attock N/A N/A 62.6 84.9 91.8
Rawalpindi
Chakwal N/A N/A 68.2 91.8 87.1
Jhelum N/A N/A 52.7 91.4 95.6
Sahiwal N/A N/A 76.4 87.0 93.9
Sahiwal
Okara N/A N/A 60.4 90.1 85.5
Pakpattan N/A N/A 74.0 79.8 90.9
Sargodha N/A N/A 60.9 87.7 92.1
Bhakkar N/A N/A 50.4 76.9 80.9
Sargodha
Khushab N/A N/A 55.2 87.3 86.7
Mianwali N/A N/A 57.4 83.0 92.7
44
Proportion of under 1 year children immunized against
measles, Target=>90%
90 82.7
No. of children immunized against measles

77.8
80
70 64.5
60
50
40
30 25.5
20 12.2
7.3
10
0
2011 2014 2017-18
MICS Punjab, 4.4a
Graph 31
Bahawalpur Division
90
No. of children immunized against measles
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4b
Graph 32
45
D. G. Khan Division
100
no. of children immunized against meassles

90
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4c
Graph 33
Faisalabad Division
100
no. of children immunized against measles
90
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4d
Graph 34
46
Gujranwala Division
120
100
80
60
40
20
0
2011 2014 2017-18
MICS Punjab, 4.4e
Graph 35
Lahore Division
120
100
80
60
40
20
0
2011 2014 2017-18
MICS Punjab, 4.4f
Graph 36
47
Mutan Division
100

90
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4g
Graph 37
Rawalpindi Division
120
100
80
60
40
20
0
2011 2014 2017-18
MICS Punjab, 4.4h
Graph 38
48
Sahiwal Division
100

90
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4i
Graph 39
Sargodha Division
100
90
80
70
60
50
40
30
20
10
0
2011 2014 2017-18
MICS Punjab, 4.4j
Graph 40
49
The target for the indicator, Proportion of Under 1-Year Children Immunized against
measles was to achieve greater than 90% coverage by the year 2015, but still there
exists a gap of 7.3% according to MICS Punjab 2017-18.
Considering the genders, the vaccination coverage is comparatively greater in girls

as compared to boys.
Considering the residence, vaccination coverage is less in rural areas as compared to

urban areas
Considering the wealth quantiles, the vaccination coverage gradually increases as we

move from poorer to highest quantile.
According to MICS Punjab 2011, D.G. Khan shows a marked less coverage of only
30%, on the contrary Gujranwala, Hafizabad, Narowal, Sialkot, Sahiwal, Multan,
Rawalpindi and Pakpattan have up to 70% coverage.
According to MICS Punjab 2014, the vaccination against measles coverage shows a
gap of 7.3%, in Kasur it is less than 65%, M.B. Din, Vehari, Rawalpindi, Sahiwal
and Khushab have up to 85%, Gujrat, Hafizabad, Narowal. Nankana Sahib, Chakwal
and Jhelum have coverage greater than 90% thus achieving the target.
According to MICS Punjab 2017-18 the gap in the target is 12.2%. Kasur, D.G.
Khan and Nankana Sahib have unexpectedly low value of less than 65% coverage
while Gujrat, Sialkot, Multan, Jhelum and Sargodha show a coverage great than 90%
thus achieving the target.
50
Indicator 4.5: Proportion of Children under 5 who suffered from Diarrhea in
the Last 14 Days (percent)
Target: <10%
Table 5, Indicator
2003-4 2007-8 2011 2014 2017-18
4.5
Male N/A 8.1 16.2 17.9 14.3

Gender
Female N/A 7.4 16.0 16.9 13.1
Rural 24 7.2 17.0 17.4 14.3
Residence
Urban 38 9.3 13.9 17.5 12.6
Poorest N/A 8.3 21.6 18.7 18.1
Second N/A 8.2 17.9 18.7 14.4
Wealth Index
Middle N/A 7.1 14.9 17.4 12.8
Quantiles
Fourth N/A 7.1 13.2 16.1 11.6
Highest N/A 8.0 11.5 16.7 10.6
Target Value <10 <10 <10 <10 <10
Value in Punjab 22 7.8 16.1 17.4 13.7
Gap in Target 12 Achieved 6.1 7.4 3.7
Division District
Bahawalpur 21 12.3 28.0 15.1 11.5
Bahawalpur Bahawalnagar 27 8.6 33.3 11.5 16.4
R. Y. Khan 21 10.9 12.0 11.4 8.8
D. G. Khan 52 10.5 20.2 20.4 22.1
Layyah 35 4.5 23.0 13.6 17.9
D. G. Khan
Muzaffargarh 41 13.8 26.0 18.8 29.4
Rajanpur 34 7.6 22.7 22.8 28.0
Faisalabad Faisalabad 18 6.9 10.6 15.9 10.9
Chiniot N/A N/A 14.9 15.5 10.7
Jhang 18 5.6 25.0 12.9 19.9
51
T. T. Singh 18 10.1 12.1 15.8 13.5

Gujranwala 17 6.4 10.2 22.3 6.6
Gujrat 21 6.0 13.8 15.0 12.0
Hafizabad 17 2.1 26.3 23.5 11.6
Gujranwala
M.B. Din 20 2.6 4.2 11.5 6.1
Narowal 23 3.9 4.4 16.1 6.0
Sialkot 14 3.1 11.6 21.0 12.6
Lahore 14 13.9 14.0 18.6 9.9
Kasur 10 6.8 13.0 20.5 12.6
Lahore
N. Sahib N/A 7.4 7.4 18.0 10.3
Sheikhupura 23 9.0 12.9 22.7 13.0
Multan 29 4.9 23.9 20.4 17.0
Khanewal 30 4.5 7.5 16.3 13.8
Multan
Lodhran 33 8.9 10.8 15.3 16.0
Vehari 30 4.6 17.9 16.8 13.1
Rawalpindi 17 2.7 12.6 15.9 17.0
Attock 25 5.0 17.4 10.5 11.6
Rawalpindi
Chakwal 11 3.5 9.9 7.5 9.8
Jhelum 13 4.3 11.1 11.7 12.9
Sahiwal 29 8.9 14.8 19.4 7.1
Sahiwal Okara 19 7.4 10.3 21.9 12.7
Pakpattan 17 6.8 20.4 19.4 11.9
Sargodha 18 12.2 19.2 20.3 15.0
Bhakkar 17 2.4 26.5 17.2 16.0
Sargodha
Khushab 20 1.2 13.8 11.9 9.4
Mianwali 22 5.8 10.3 18.6 16.0
52
Proportion of Children Under 5 who suffered from Diarrhea
during last 2 Weeks in Punjab (Percent), Target= <10%
25.00 22.00
20.00
proportion of children under 5, suffered from
17.40
16.10
15.00 13.70
12.00
Dirrhea in last 2 weeks (%)
10.00 7.80 7.40

6.10
5.00 3.70
0.00 -2.20
2003-4 2007-8 2011 2014 2017-18
-5.00
MICS Punjab, 4.5a
Graph 41
Bahawalpur Division
35.00
Proportion of children under 5, suffered from
30.00
Diarrhea in the last 2 weeks (%)
25.00
20.00
15.00
10.00
5.00
0.00
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5b
Graph 42
53
D.G. Khan Division
60.00
Proportion of children under 5,suffered from

50.00
diarrhea in the last 2 weeks (%)

40.00
30.00
20.00
10.00
0.00
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5c
Graph 43
Faisalabad Division
30.00
25.00
20.00
15.00
10.00
5.00
0.00
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5d
Graph 44
54
Gujranwala Division
30.00

25.00

20.00
15.00
10.00
5.00
0.00
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5e
Graph 45
Lahore Division
25
20
15
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5f
Lahore Kasur N.Sahab Sheikhupura
Graph 46
55
Multan Division

35
30

25
20
15
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5g
Graph 47
Rawalpindi Division
30
25
20
15
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5h
Rawalpindi Attock Chakwal Jehlum
Graph 48
56
Sahiwal Division
35

30

25
20
15
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5i
Graph 49
Sarghodha Division
30
25
20
15
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.5j
Sarghodha Bhakkar Khushab Mianwali
Graph 50
57
Pakistan was able to achieve the target of reducing the proportion of children who
suffered from diarrhea in the last thirty days to less than 10 percent in the year 2007-
8. It fell from 22% (2003-4) to 13.7% in the year 20017-18 with a gap of 3.7%
percent.
Considering the genders, the prevalence of diarrhea is greater in boys as compared to

girls, under 5 years of age.
Considering the residence, the prevalence of diarrhea was surprisingly greater in the
urban Punjab as compared to rural Punjab
Considering the wealth quantiles, the prevalence of diarrhea is greater in poor as

compared to rich.
According to MICS Punjab 2003-4, D.G. Khan has an alarming prevalence of

diarrhea i.e., 52%. In Layyah, Muzaffargarh, Rajanpur, Khanewal the prevalence is
greater than 30% while in Sialkot, Lahore, Kasur, Chakwal, it is less than 15%.
According to MICS Punjab 2007-8, the target is achieved in all the districts of
Punjab except Bahawalpur Muzaffargarh, Lahore, Sargodha, R.Y. Khan, and D.G.
Khan.
Considering the data provided by MICS Punjab 2011, the target is achieved in M.B.
Din, Narowal, Nankana Sahib, Khanewal, Chakwal while Bahawalpur,
Bahawalnagar, Muzaffargarh, Hafizabad Bhakkar are farthest away from the target
with prevalence of diarrhea greater than 25%.
According to MICS Punjab 2014, the target is achieved only in Chakwal, while D.G.
Khan, Rajanpur, Gujranwala, Hafizabad, Sialkot, Sheikhupura and Okara show the
greatest gaps.
58
According to MICS Punjab 2017-18, the target is achieved in R.Y. Khan,
Gujranwala, M.B. Din, Narowal, Lahore, Chakwal, Khushab, while D.G. Khan,
Muzaffargarh, Rajanpur, the maximum gap.
59
Indicator 4.6: Lady Health Worker’s Coverage (Percent of target population)
Target: 100%
Table 6,
2003-4 2007-8 2011 2014 2017-18
Indicator 4.6
Male N/A N/A N/A N/A N/A
Gender
Female N/A N/A N/A N/A N/A
Rural 38 56.2 52.4 42.6 58.8
Residence
Urban 18 37.6 36.6 26.4 46
Poorest N/A 45.8 47 37.8 49.8
Second N/A 55.8 51.6 42.3 59.9
Wealth Index
Middle N/A 58.5 53.2 39.6 62.6
Quantiles
Fourth N/A 56.1 50.4 37.7 53.4
Highest N/A 36.4 43.1 29.7 46.3
Target Value 100 100 100 100 100
Value in Punjab 35 50.4 48.1 37.6 54.5
Gap in Target 65 49.6 51.9 62.4 45.5
Division District
Bahawalpur 38 59.6 38.5 46.9 68.3
Bahawalnaga
Bahawalpur 35 60.5 61.7 42.3 63.5
r
R. Y. Khan 28 42.1 67.7 42.7 56.5
D. G. Khan 29 69 53.1 51.5 32.8
Layyah 38 77.1 75.7 48.4 53.7
D. G. Khan
Muzaffargarh 23 65.3 79.8 53.1 31.5
Rajanpur 8 37.7 27.5 47.9 49.5
Faisalabad Faisalabad 14 22 24 28.9 42.4
Jhang 23 33.5 34.9 24.7 54.9
60
T. T. Singh 53 67 58.7 39.3 46.4

Gujranwala 23 38.2 67.7 36.1 11.9
Gujrat 22 75.4 62.4 51.7 76.6
Hafizabad 89 63.9 51.4 37.8 54.3
Gujranwala
M.B. Din 50 68.2 79.6 44.7 66.6
Narowal 34 80 50.3 54 76.1
Sialkot 41 69.9 65.6 51.2 65.3
Lahore 18 22.2 23.7 13.5 33.4
Kasur 25 31 30.2 22 64.4
Lahore
N. Sahib N/A 31 65.5 29.1 66.5
Sheikhupura 11 18.3 43.4 25.4 31
Multan 74 66.2 42.8 33.8 77.5
Khanewal 54 70.7 66.5 44.7 64.4
Multan
Lodhran 28 59.5 80.6 43.6 73.9
Vehari 56 66.3 46.1 39.5 71.1
Rawalpindi 36 44 27.9 34.1 55.7
Attock 22 57 26.9 32.9 41.2
Rawalpindi
Chakwal 56 81.8 72 49.4 79.7
Jhelum 73 74.1 51.3 56.8 77.4
Sahiwal 58 83.1 49.3 49.5 81.6
Sahiwal
Okara 41 58.7 36.4 37.2 89.5
Pakpattan 40 73.3 46 49.5 79.2
Sargodha 27 41.8 37.9 31.6 39.5
Bhakkar 60 62.7 37.7 31.8 51.2
Sargodha
Khushab 55 55.2 42.5 35.3 65
Mianwali 49 57 67.2 62.8 90.1
61
LHW's Coverage in Punjab, Target=100%
70 65
62.4
60 54.5
51.9
% of Target Population Covered
50.4
49.6 48.1
50 45.5
37.6
40 35
30
20
10
0
1 2 3 4 5
MICS Punjab, 4.6a
Graph 51
Bahawalpur Division
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6b
Graph 52
62
D. G. Khan Division
90
80

70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6c
Graph 53
Faisalabad Division
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.h6d
Graph 54
63
Gujranwala Division
100
90

80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6e
Graph 55
Lahore Division
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6f
Graph 56
64
Multan Division
90
80

70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6g
Graph 57
Rawalpindi Division
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6h
Graph 58
65
Sahiwal Division
100
90

80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6i
Graph 59
Sargodha Division
100
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 4.6j
Graph 60
66
The MDG for Lady Health Worker coverage in the targeted population was 100%. It
was 35% in 2003-4, gradually increased to 54.5% in 2017-18 with a gap of 45.5%.
Hence, the target is not achieved in Punjab yet. The D.G. Khan, Gujranwala, Multan,
Sahiwal and Sargodha divisions have a comparatively better coverage as compared
to Lahore, Faisalabad and Rawalpindi divisions.
Considering the residence, rural Punjab shows a proportionately higher LHWs

coverage as compared to urban Punjab.
Considering the wealth quantiles, the coverage is better in the poorest, second and
middle class as compared to highest class.
According to MICS Punjab 2003-4, Hafizabad, Multan, Khanewal, Vehari, Chakwal,

Jhelum, Sahiwal, Bhakkar, Khushab, T.T. Singh show a LHW coverage greater than
50% while Rajanpur has the lowest coverage i.e., 8%.
According to MICS Punjab 2007-8, Layyah, Gujrat, Chakwal, Narowal and Sahiwal
have the maximum coverage i.e., greater than 75% while Faisalabad, Lahore,
Sheikhupura have the lowest coverage i.e., less than 25%.
According to MICS Punjab 2011, the highest coverage is in Layyah, Muzaffargarh,

M.B. Din, Lodhran, i.e., greater than 75% while Attock, Rawalpindi, Faisalabad,
Chiniot and Rajanpur have the lowest coverage i.e., less than 30%.
According to MICS Punjab 2014, the coverage in overall all the districts remain less
than 50%, while in Lahore and Kasur it remains less than 20%. Mianwali has the
maximum coverage of 62%.
67
According to MICS Punjab 2017-18, the target is still not achieved. Okara and
Mianwali are closest to the target with coverage greater than 85%, while Gujranwala
has the lowest coverage i.e., 11.9%.
68
Indicator 5.2: Proportion of births attended by Skilled Birth Attendants
(Assistance during delivery and C-section)
Target: >90%
Table 7, Indicator
2003-4 2007-8 2011 2014 2017-18
5.2

Gender
Female 33 42.6 58.5 64.7 76.4
Rural 26 34.7 52.3 57.7 72.2
Residence
Urban 44 63.0 75.2 80.4 84.7
Poorest N/A 15.3 32.8 36.3 52.6
Second N/A 28.7 46.2 52.5 69.4
Wealth Index
Middle N/A 41.7 58.7 68.3 81.5
Quantiles
Fourth N/A 57.6 71.4 79.9 88.0
Highest N/A 80.2 89.0 92.1 94.6
Value in Punjab 33 42.6 58.5 64.7 76.4
Gap in Target 57 47.4 31.5 25.3 13.6
Division District
Bahawalpur 20 27.3 37.3 41.2 60.6
R. Y. Khan 21 28.1 43.6 42.9 65.5
D. G. Khan 26 21.9 25.9 39.6 43.8
Layyah 23 25.6 48.6 46.7 68.1
D. G. Khan
Muzaffargarh 16 19.9 36.2 44.5 52.8
Rajanpur 7 11.7 16.8 29.6 40.3
Chiniot N/A N/A 57.9 73.9 80.1
Jhang 21 34.7 51.6 65.9 73.2
69
T. T. Singh 38 44.4 58.4 63.0 80.1

Gujranwala 45 59.1 73.2 82.5 85.2
Gujrat 47 67.7 73.1 85.0 93.0
Hafizabad 32 41.5 69.6 72.3 82.2
Gujranwala
M.B. Din 22 34.8 51.5 50.9 78.7
Narowal 39 44.8 54.5 61.5 90.0
Sialkot 43 58.7 72.2 78.9 88.9
Lahore 60 66.1 81.7 81.1 86.8
Kasur 23 28.9 52.6 52.8 67.9
Lahore
N. Sahib N/A 44.4 59.9 73.8 87.5
Sheikhupura 32 53.4 65.1 71.8 85.7
Multan 34 38.8 64.5 66.8 80.1
Khanewal 22 36.1 48.7 59.7 72.3
Multan
Lodhran 14 30.5 43.2 45.6 72.7
Vehari 30 32.9 49.8 59.7 77.0
Rawalpindi 65 67.5 79.4 85.3 88.1
Attock 28 46.7 60.5 68.1 77.5
Rawalpindi
Chakwal 44 57.9 74.9 77.9 86.9
Jhelum 46 62.0 79.7 83.5 93.9
Sahiwal 37 49.8 68.3 68.5 84.4
Sahiwal Okara 26 27.4 56.5 63.1 74.6
Pakpattan 22 34.6 51.0 64.2 71.8
Sargodha 38 44.8 60.9 70.0 83.3
Bhakkar 16 33.7 49.8 52.7 72.6
Sargodha
Khushab 34 42.1 60.6 68.7 76.3
Mianwali 41 31.2 65.2 68.5 82.6
70
Proportion of births attended by Skilled Birth Attendants,
Target= >90%
90
Proportion of births attended by SBAs

80 76.4
70 64.7
57 58.5
60
47.4
50 42.6
40 33 31.5
30 25.3
20 13.6
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2a
Graph 61
Bahawalpur Division
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2b
Graph 62
71
D. G. Khan Division
80
70
Proportion of births attended by SBAs 60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2c
Graph 63
Faisalabad Division
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2d
Graph 64
72
Gujranwala Division
100
90

80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2e
Graph 65
Lahore Division
100
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2f
Graph 66
73
Multan Division
90
80
Proportion of births attended by SBAs 70

60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2g
Graph 67
Rawalpindi Division
100
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2h
Graph 68
74
Sahiwal Division
90
80

70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2i
Graph 69
Sargodha Division
90
80
70
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.2j
Graph 70
75
The MDG target is to achieve the skilled birth attendant coverage greater than 90%.
The proportion increases from 33% (2003-4) to 76.4% (2017-18) with a gap of
13.6% hence the target is not yet achieved in Punjab.
The coverage is better in urban Punjab as compared to rural Punjab.
According to MICS Punjab 2003-4, the target is not achieved in a single district,
Rajanpur, Lodhran, Bhakkar show the maximum gap while Lahore and Rawalpindi
are closest to target.
According to MICS Punjab 2007-8, the target is not achieved even in a single
district, Muzaffargarh and Rajanpur have the maximum gap i.e., 70% while Gujrat,
Lahore, Rawalpindi, Jhelum have the minimum gap i.e., almost 20%.
According to MICS Punjab 2011, the trends for the districts in Punjab are same as in
the year 2007-8.
According to MICS Punjab 2014, the target is not achieved, Gujranwala, Gujrat,
Lahore, Rawalpindi, Jhelum are closest to target with a gap less than 10% while
Rajanpur shows a max gap i.e., greater than 60%.
According to MICS Punjab 2017-18, the target is achieved in Gujrat, Jhelum,

Narowal while D.G. Khan and Rajanpur show the maximum gap.
76
Indicator 5.3: Contraceptive Prevalence Rate (%)
Target: 55%
Table 8,
2003-4 2007-8 2011 2014 2017-18
Indicator 5.3
Gender
Rural N/A 28.1 32.0 35.4 32.5
Residence
Urban N/A 41.3 42.9 45.1 37.6
Lowest N/A 19 27.9 28.1 29.7
Second N/A 27.2 32.8 36.3 34.1
Wealth Index
Middle N/A 33.4 34.7 41.3 35.4
Quantiles
Fourth N/A 36.9 37.4 41.5 35.2
Highest N/A 43.5 42.9 45.4 36.9
Value in Punjab 36 32.2 35.2 38.7 34.4
Gap in Target 19 22.8 19.8 16.3 20.6
Division District
Bahawalpur 24 27.0 34.3 25.7 37.8
Bahawalnaga
Bahawalpur 16 22.8 25.9 35.2 43.8
r
R. Y. Khan 29 15.4 28.7 27.9 36.1
D. G. Khan 22 17.9 22.1 22.1 20.6
Layyah 12 26.7 26.3 30.6 40.0
D. G. Khan
Muzaffargarh 26 23.2 26.9 27.1 24.7
Rajanpur 11 13.0 25.2 21.8 20.3
Chiniot N/A N/A 41.4 28.3 25.8
Jhang 20 20.9 33.3 31.7 25.1
77
T. T. Singh 27 36.5 33.6 40.0 43.4

Gujranwala 32 39.5 47.3 46.9 16.7
Gujrat 22 37.1 26.0 46.1 31.0
Hafizabad 33 31.0 23.8 50.3 27.5
Gujranwala
M.B. Din 27 41.3 34.5 40.6 19.9
Narowal 20 26.0 25.0 51.0 32.8
Sialkot 39 49.9 37.3 47.6 36.3
Lahore 34 44.6 41.2 47.3 40.0
Kasur 27 38.4 29.0 42.3 41.3
Lahore
N. Sahib N/A 33.1 38.6 45.7 39.2
Sheikhupura 20 34.8 44.7 43.4 27.7
Multan 42 24.4 42.7 39.0 49.6
Khanewal 17 24.2 40.4 39.5 39.8
Multan
Lodhran 37 23.1 45.9 39.2 31.0
Vehari 28 32.7 41.7 40.4 37.0
Rawalpindi 34 41.2 40.3 43.2 33.9
Attock 24 37.0 36.5 48.2 25.9
Rawalpindi
Chakwal 30 28.5 25.6 44.9 31.1
Jhelum 28 38.1 34.8 42.7 30.2
Sahiwal 25 36.1 36.8 37.6 39.9
Sahiwal
Okara 23 23.2 32.3 37.4 28.4
Pakpattan 19 19.3 32.0 38.6 37.5
Sargodha 27 39.9 32.6 34.6 34.3
Bhakkar 11 20.0 21.8 31.9 33.5

Sargodha
Khushab 14 19.3 27.4 32.2 28.5
Mianwali 17 20.5 32.3 32. 9 24.8
78
Contraceptive Prevalence Rate in Punjab, Target=55
45
38.7
40 36
% of Population Using Contraceptive

35.2 34.4
35 32.2
30
25 22.8
19.8 20.6
19
20 16.3
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3a
Graph 71
Bahawalpur Division
50
45
40
35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3b
Graph 72
79
D. G. Khan Division
45
40

35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3c
Graph 73
Faisalabad Division
50
45
40
35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3d
Graph 74
80
Gujranwala Division
60

50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3e
Graph 75
Lahore Division
50
45
40
35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3f
Graph 76
81
Multan Division
60

50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3g
Graph 77
Rawalpindi Division
60
50
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3h
Graph 78
82
Sahiwal Division
45
40

35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3i
Graph 79
Sargodha Division
45
40
35
30
25
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.3j
Sargodha Bhakkar Khushab
Graph 80
83
The MDG target was to achieve a contraceptive prevalence rate of 55% by the year
2015. The target is not yet achieved. The contraceptive prevalence rate shows an
irregular trend, in the year 2003-4 the gap was 19 while in 2017-18, it increases and
attains a value of 20.6.
The contraceptive prevalence rate is higher in the urban Punjab as compared to rural
Punjab, same goes for the wealth quantiles.
According to MICS Punjab 2003-4, not even a single district was able to achieve the
set target. Faisalabad (36%), Sialkot (39%) and Multan (42%) are closet to the set
target while Bahawalpur (16%), Layyah (12%), Rajanpur (11%), Khanewal (17%),
Pakpattan (19%), Bhakkar (11%), Khushab (14%) show the maximum gap.
set target. Faisalabad (44%), Sialkot (49.9%), Lahore (44%) are closest to target
while R.Y. Khan (15.4%), D.G. Khan (17.9%), Rajanpur (13%), Pakpattan (19%)
show the maximum gap.
According to MICS Punjab 2011, not even a single district was able to achieve the
set target. Faisalabad (40.8%), Chiniot (41.4%), Gujranwala (47%), Lahore (41.2%),
Sheikhupura (44.7%), Multan (42.7%) show the minimum gap while D.G. Khan
(22.1%), Hafizabad (23.8%), Bhakkar (21.8%) show the maximum gap.
set target. Hafizabad (50.3%), Narowal (51%), are closest to the target of 55% while
Bahawalpur (25.7%), D.G. Khan (22.1%) are farthest away from the set target.
According to MICS Punjab 2017-18, not even a single district was able to achieve
the set target of 55%. Multan (49.6%) is closest to target while Gujranwala (16.7%)
shows the maximum gap.
84
Indicator 5.4: Total Fertility Rate
Target: 2.1%
Table 9,
2003-4 2007-8 2011 2014 2017-18
Indicator 5.4
Gender
Rural N/A 4.2 3.82 3.7 4
Residence
Urban N/A 3.6 3.06 3 3.2
Poorest N/A 5.3 4.79 4.5 5
Second N/A 4.2 3.71 3.8 4
Wealth Index
Middle N/A 3.9 3.54 3.4 3.6
Quantiles
Fourth N/A 3.3 3.31 3 3.3
Highest N/A 3.1 2.8 2.7 2.9
Target Value 2.1 2.1 2.1 2.1 2.1
Value in Punjab 4.7 4.3 3.58 3.5 3.7
Gap in Target 2.6 2.2 1.48 1.4 1.6
Division District
Bahawalpur 6.9 N/A 3.53 3.8 3.9
Bahawalpur Bahawalnagar 5.8 N/A 4.32 3.4 3.7
R. Y. Khan 5.9 N/A 4.25 3.3 4.6
D. G. Khan 8.9 N/A 4.87 4.9 5.4
Layyah 7.7 N/A 3.97 3.5 4
D. G. Khan
Muzaffargarh 6.4 N/A 4.65 4.6 4.7
Rajanpur 6.7 N/A 4.84 6.2 5.9
Faisalabad 5.8 N/A 3.19 3.4 3.3
Chiniot 5 N/A 3.81 3.2 3.8
Faisalabad
Jhang 5.3 N/A 4.01 3.7 4.3
T. T. Singh 6.3 N/A 3.43 3.3 3.5
85
Gujranwala 5.9 N/A 3.49 3.3 3.4
Gujrat 5.5 N/A 3.25 2.9 3.1
Hafizabad 5.5 N/A 4.1 3.3 3.7
Gujranwala
M.B. Din 6.1 N/A 3.2 3.1 3.4
Narowal 6.3 N/A 3.59 4.3 4
Sialkot 5.8 N/A 3.32 3.1 3.5
Lahore 5.4 N/A 3.21 3.1 3.1
Kasur 6.7 N/A 4.38 4.5 4.3
Lahore
N. Sahib 6.8 N/A 3.45 3.5 3.7
Sheikhupura 6.8 N/A 3.45 3.5 3.7
Multan 5.9 N/A 3.55 3.6 3.6
Khanewal 6.1 N/A 3.01 3.4 4
Multan
Lodhran 7.1 N/A 3.26 3.9 3.8
Vehari 5.8 N/A 3.74 2.8 3.8
Rawalpindi 5 N/A 3.05 3.1 3.2
Attock 4 N/A 2.8 3 3.4
Rawalpindi
Chakwal 5 N/A 2.51 2.7 3
Jhelum 5.8 N/A 3.45 2.3 3.1
Sahiwal 8.9 N/A 3.35 3.9 3.6
Sahiwal Okara 6.2 N/A 3.78 3.7 4.3
Pakpattan 6.1 N/A 4.28 3.8 3.6
Sargodha 5.5 N/A 3.71 2.6 3.6
Bhakkar 7.5 N/A 3.56 3.9 4.2
Sargodha
Khushab 4.8 N/A 2.91 3.3 3.3
Mianwali 5.2 N/A 2.87 3.3 3.7
86
Total Fertility Rate, Target=2.1%
120 112 111
104
100 93
Total Fertility Rate, %

80 69
60 59
60 52
41
40
17
20
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.4a
Punjab Gap in Target
Graph 81
Bahawalpur Division
8
6
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4b
Graph 82
87
D. G. Khan Division
10
9
8
Total Fertility Rate, % 7
6
5
4
3
2
1
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4c
Graph 83
Faisalabad Division
7
5
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4d
Graph 84
88
Gujranwala Division
7
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4e
Graph 85
Lahore Division
8
6
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4f
Graph 86
89
Multan Division
8
6
5
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4g
Graph 87
Rawalpindi Division
7
5
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4h
Graph 88
90
Sahiwal Division
10
9
8
6
5
4
3
2
1
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4i
Graph 89
Sargodha Division
8
6
0
2003-4 2011 2014 2017-18
MICS Punjab, 5.4j
Graph 90
91
The MDG target was to achieve a total fertility rate to a value as low as 2.1% by
2015. The set target is not yet achieved even in a single district of Punjab
considering the data up to MICS 2017-18. The lowest fertility rate (3.5%) was
achieved in year 2014.
Considering the residence, rural Punjab has a greater fertility rate as compared to
urban Punjab.
Considering the wealth quantiles, total fertility rates are higher in poor as compared
to the rich.
set target. Attock (4%) and Khushab (4.8%) have the lowest fertility rates while D.G
Khan (8.9%), Layyah (7.7%), Sahiwal (8.9%) have the maximum fertility rates.
set target. Chakwal (2.5%), Attock (2.8%), Khushab (2.9%), Mianwali (2.8%) are
closest to the set target of 2.1% while D.G Khan (4.9%) and Rajanpur (4.84%) are
farthest away.
set target. Vehari (2.8%), Gujrat (2.9%), Jhelum (2.3%), Sargodha (2.6%) are closest
to the target of 2.1%. while D.G Khan (4.9%), Muzaffargarh (4.6%), Rajanpur
(6.2%) are farthest away from target.
the set target. All the districts show total fertility rates greater than 3%.
92
Indicator 5.5: Ante-natal Coverage At least Once
Target: 100%
Table 10,
2003-4 2007-8 2011 2014 2017-18
Indicator 5.5
Gender
Rural N/A N/A 10.1 9.0 41
Residence
Urban N/A N/A 3.7 4.3 23.7
Poorest N/A N/A 13.9 13.6 52
Second N/A N/A 11.8 9.9 48.7
Wealth Index
Middle N/A N/A 8.8 7.7 35.5
Quantiles
Fourth N/A N/A 4.2 3.5 23.8
Highest N/A N/A 2.0 1.8 12.0
Target Value 100 100 100 100 100
Value in Punjab 44 52.7 8.4 7.5 35.2
Gap in Target 56 47.3 91.6 92.5 64.8
Division District
Bahawalpur 25 43.3 18.1 14.5 34.6
R. Y. Khan 27 40.4 14.6 12.4 35.5
D. G. Khan 47 43.5 8.7 12.0 48.9
Layyah 37 37.6 14.9 21.8 46.7
D. G. Khan
Muzaffargarh 33 44.4 11.9 11.9 53.5
Rajanpur 29 37.1 13.9 7.7 53.4
Faisalabad 54 61.4 6.6 3.9 28.9
Chiniot N/A N/A 3.1 6.7 43.5
Faisalabad
Jhang N/A 39.6 9.0 4.0 45.2
T. T. Singh 49 56.9 7.5 5.4 43.1
93
Gujranwala 53 69.2 4.1 5.3 26.0
Gujrat 62 85 5.5 1.0 25.1
Hafizabad 33 55.9 9.2 2.5 39.8
Gujranwala
M.B. Din 45 59.3 4.2 4.4 26.7
Narowal 52 64.3 11.2 10.0 36.7
Sialkot 62 67.9 2.4 5.2 26.7
Lahore 67 73.4 2.8 1.8 17.2
Kasur 30 36.4 6.6 11.9 39.4
Lahore
N. Sahib N/A 50.4 7.5 5.0 29.5
Sheikhupura 43 63.5 4.4 6.5 28.5
Multan 39 43.6 5.9 6.8 38.6
Khanewal 34 44.3 16.1 10.1 42.1
Multan
Lodhran 24 45.7 5.2 9.9 50.5
Vehari 39 39.3 9.3 10.5 48.1
Rawalpindi 73 74.6 2.1 0.2 14.9
Attock 45 57.9 5.9 4.4 30.0
Rawalpindi
Chakwal 59 62.9 7.0 2.8 20.4
Jhelum 72 75.5 4.7 4.2 16.6
Sahiwal 45 52.5 6.2 7.3 36.0
Sahiwal
Okara 31 34.2 9.8 9.8 44.1
Pakpattan 32 36.1 16.2 6.8 43.3
Sargodha 43 54 11.2 12.3 34.8
Bhakkar 28 38.6 12.6 13.5 55.6
Sargodha
Khushab 48 49.9 11.8 9.7 46.2
Mianwali 55 43.6 9.9 11.2 39.2
94
Ante-natal Coverage at least once in Punjab, Target=100%
100 91.6 92.5

No. of woman visiting health care providers atleast 90
80
70 64.8
60 56
52.7
47.3
50 44
40 35.2
once
30
20
8.4 7.5
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5a
Graph 91
Bahawalpur Division
50
No. of woman visiting health care providers atleast
45
40
35
30
25
once
20
15
10
5
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5b
Graph 92
95
D. G. Khan Division
60
No. of woman visiting health care providers at

50
least once 40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5c
Graph 93
Faisalabad Division
70
No. of woman visiting health care provider atleast
60
50
40
once
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
`MICS Punjab, 5.5d
Graph 94
96
Gujranwala Division

90
80
70
60
50
once
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5e
Graph 95
Lahore Division
80
70
60
50
40
once
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5f
Graph 96
97
Multan Division

60
50
40
30
once
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab 5.5g
Graph 97
Rawalpindi Division
80
No. of woman visiting health care providers
70
60
50
atleast once
40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5h
Graph 98
98
Sahiwal Division
60
no. of woman visiting health care providers at

50
least once 40
30
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5i
Graph 99
Sargodha Division
60
50
40
30
once
20
10
0
2003-4 2007-8 2011 2014 2017-18
MICS Punjab, 5.5j
Sargodha bhakkar khushab mianwali
Graph 100
99
The MDG target was to achieve 100% antenatal coverage (at least once) by the year
2015. The target is not yet achieved in a single district of Punjab. the maximum
coverage 92.5% was seen in year 2014.
Considering the residence, the antenatal coverage is greater in rural Punjab as

compared to urban Punjab. The coverage is greater in those of lower socioeconomic
status as compared to higher class.
set target. Gujrat (62%), Sialkot (62%), Lahore (67%), Rawalpindi (73%), Jhelum
(72%), show the maximum coverage in all districts while Bahawalpur (25%), R.Y.
Khan (27%), Rajanpur (29%) have the minimum coverage.
set target. Lahore (73%), Rawalpindi (74.5%), Jhelum (75.5%), Gujrat (85%) show
the maximum coverage in all districts while Bahawalpur (43%), R.Y. Khan (40%),
Rajanpur (37%) have the minimum coverage.
set target.
the set target.
100
DISCUSSION
This research was carried out to trace the trend in attempted achievement of the
health-related MDGs, i.e., MDG-4 and MDG-5, and to evaluate the gaps in their
achievement, across the 36 districts of Punjab, Pakistan. For this purpose, the data
from the MICS Punjab for the years 2003-04, 2007-08, 2011, 2013-14 and 2017-18
was used. The data gathered in this research since 2003 up until 2017-18 shows that
there has been significant improvement in provision of healthcare to Mothers and
their children across the nine divisions of Punjab, but still the goals set have not yet
been fully achieved. Across the 11 indicators (six for MDG-4 and five for MDG-5),
only indicator 4.5, “The proportion of children Under 5 who suffered from diarrhea
in the last 30 days” has met its target, the value in 2017-18 MICS being 13.7% .
However, the same cannot be said about the rest of the indicators.
The Under-5 Mortality Rate (Indicator 4.1), or U5MR for short, has gone from 112
deaths/ 1000 live births in 2003-04 to 69 deaths/ 1000 live births in 2017-18, shying
away by mere 17 from reaching its target value of under 52 deaths/ 1000 live births.
Over the years, there has been a steady decline in the U5MR, as evidenced by the
trend lines previously discussed. According to the data gathered, Rural areas had a
higher U5MR consistently and so did the families falling in the lower quantiles of
the wealth index. The male gender also showed a greater U5MR as compared to the
female gender. All the 36 districts showed almost similar pattern, with the exception
of a few under-developed districts showing a higher-than-expected U5MR,
especially during 2007-08, indicating the presence of another factor, perhaps disease
outbreak or as an after effect of the 2005 earthquakes, a substantial stress being put
on the healthcare system of Pakistan.
The Infant Mortality Rate (Indicator 4.2) or IMR, has gone from 77 deaths/1000 live
births in 2003-04 to 60 deaths/1000 live births in 2017-18, the target value being
101
less-than 40 deaths/1000 live births. The decrease has been gradual, all the 36
districts of
Punjab showing a roughly similar trend in decrease of the IMR. The Rural areas and
the families from lower Wealth-Index quantiles fared worse than major Urban areas
and the higher wealth-index families, respectively. The IMR for male children was
higher consistently over the years as compared to the feminine gender. It should be
noted that the year 2011 showed an unexpectedly higher IMR, defying the previous
trend. This can be, in part, attributed to the 2010 floods that swept across Punjab and
Sindh, causing massive destruction of facilities in their wake. The under-developed
districts took a heavier blow, as evidenced by the trend-lines discussed previously
whilst the major Urban districts did fairly well.
The proportion of children 12-23 months of age, fully-vaccinated under the EPI-
program (Indicator 4.3) showed an erratic trend, the values being substantially higher
in the years 2003-04 (81%) and then declining abruptly till 2011 (46.8%), then again
rising gradually to 64.1% in 2017-18 that was still lower than the one in 2003-04.
This discrepancy was due to a change in the criterion used to identify the fully-
vaccinated children and there being a gap in data for the year 2007-08. In the MICS
2003-04, the criterion for a vaccinated child was set so that only the presence of scar
from BCG vaccine was taken as confirmation of complete vaccination and no data
for this indicator was found in the MICS surveys carried out in 2007-08. In the
subsequent MICS, however, the criterion for considering a child fully-vaccinated has
been set as “having received BCG vaccine, 3 doses each of DTP, measles and OPV”
AND having the vaccination card to prove it. As with the previously discussed
indicators, the vaccination coverage in Urban areas, families with a greater wealth-
index and the female gender are greater than Rural areas, families with lower wealth-
index and the male gender, respectively.
102
The indicator 4.4, proportion of under-1 children immunized against measles shows
a gradual increase from 64.5% in 2011 to 82.7% in 2017-18, the target being >90%
and there being no data for the said indicator for the years 2003-04 and 2007-08.
This indicator came close to being realized in 2017-18 with a minor gap of only 7.3
remaining. All the districts have shown a similar trend of gradual increase and the
vaccination coverage in Urban areas, families with a greater wealth-index and the
female gender are found to be greater than Rural areas, families with lower wealth-
index and the male gender, respectively.
The indicator 4.5, proportion of children who suffered from diarrhea in the last 30
days, is by far the only indicator whose target value (<10%) has been considered to
be achieved, the value in 2017-18 being 13.7%, the gap remaining was only a
negligible 3.7%. The goal was achieved in 2007-08 (7.8%), but subsequent surveys
showed an increased proportion of children suffering from diarrhea which rose until
2014 (17.4%), but then fell again, reaching the aforementioned value in 2017-18.
The cause behind this trend could be the poor hygienic conditions due to the flood or
the data itself being erroneous. The collected data has shown lower proportion of
diarrhea-affected children in families with a higher wealth index. The reason behind
possibly lies in the improved sanitation and hygiene, accessibility to clean drinking
water, etc. The female gender fared better, but the Rural areas surprisingly showed a
better outlook for this indicator, with the proportion of children affected by diarrhea
being lower than in Urban areas.
The lady health worker (LHW) coverage is the indicator 4.6 and as with others,
Pakistan is currently off-track from achieving the target of 100%, with a massive gap
of 45.5%. It should be noted that the trend of a gradual increase was noted with
respect to LHW coverage, with the value in 2003-04 being 35% and gradually
increasing to 54.5% in 2017-18. The rural and poor populace showed a greater LHW
consistently than Urban and Posh families. A major factor here could be that the
103
LHW program itself was primarily directed towards the underprivileged and rural
population of Pakistan.
Moving onto the MDG-5, concerning improvement of maternal health care, the first
indicator, 5.1 is the maternal mortality ratio, for which no documented authentic data
was available and therefore, no comments can be made regarding the gaps in
achievement of this indicator.
The indicator 5.2, skilled birth attendant (SBA) coverage was supposed to have been
increased beyond 90% by 2015, however, despite the efforts, this value is currently
76.4%, seeing a gradual increase since its value of 33% in 2003-04. SBA coverage is
better in urban and posh areas than in rural, underdeveloped ones, as evidenced in
2017, the SBA coverage in Lahore was 86.8% whereas the value in Pakpattan was
only 71.8%. This correlates to the better educational facilities and employment
perspectives that more developed areas provide, as well as a stronger purchasing
power of the wealthy families.
The contraceptive prevalence rate is the indicator 5.3 and quite a controversial topic.
The target to achieve was set at 55%, which has as of yet, not been achieved and the
trend has been irregular over the years, the gap being 19 in 2003-04 which fluctuated
over the years and was 20.6 in 2017-18. A major reason for the failure to achieve is
the concerns of the clergy whose dogma is that “God provides for every living
person, so no matter how much the population arises, it is of no concern.” As it is an
issue of sexual nature and such concerns being an unspoken taboo in South-East
Asian societies, open advertisements, etcetera are generally discouraged and the low
purchasing power means further lower CPR. Secondly, the reason for CPR being
lower in poor population is also because children are also considered breadwinners
and due to poverty, such households have a greater number of children than a
wealthy family.
104
The total fertility rate (indicator 5.4) was supposed to be reduced below 2.4% by
2015, but as with the rest of the goals, Pakistan was off-track. No single district has
achieved this target and the closest Punjab has been to achieving it was in 2013-14,
where a value of 3.5% was observed. As in 2017-18, all the districts showed a TFR
more than 3%, with the value being higher in Rural, poor are and vice versa, most
probably due to the factors discussed above in the discussion for CPR.
The indicator 5.5, the antenatal coverage was supposed to reach 100% by 2015, but
the closest Punjab has come to achieving that was in 2013-14, when a value of
92.5% was observed, but as shown by the relevant graphs, the trend has been very
irregular, the values being high in 2011-2014 period, but then declining to 64.8% in
2017-18. Similar trends were seen for all the districts of Punjab and the coverage
remained high for rural and underprivileged masses because the LHW program was
directed primarily towards this portion of population.
As seen from the discussion above, it can be rightly assumed that efforts have been
made to realize the goals set by the UN by the Federal and the provincial
governments of Pakistan and Punjab, respectively, however, these efforts have still
fallen short of the gigantic task laid in front of them. It should be duly noted that the
goals were set by UN indiscriminate of the situation of economy, political stability
and initial status of healthcare of the signatory countries. Some of the nations with a
stronger starting economy and with relatively peaceful environment might have been
able expend their resources into improving the healthcare system to such a degree
that these unrealistic goals were achieved, but for a country like Pakistan, which has
been described as a Third-World Country or a Developing country, which in addition
to poverty, has faced the full brunt of terrorism over the past decades, these goals
could not have possibly been achieved, even if there was no set-backs in the form of
natural disasters like 2005 earthquakes or the 2010 floods.
105
Similarly, as indicated by the data collected, setting the same criterion for developed
and under-developed districts, for the poor and the wealthy gives an unfair advantage
to the latter in each category, and therefore, the results vary, despite there being a
significant effort by the government over time in trying to make healthcare facilities
accessible to the under-privileged masses.
This research has found the possible factors that the policy-makers and the stake-
holders need to consider while setting such goals so as to eliminate any unfair
advantage that some areas might get over the others. The gender, the wealth-index,
natural disasters, status of national/ provincial economy and the developmental
status, the presence of an already-established healthcare delivery system should be
kept in consideration and goals should be set differently for different areas, so that
sufficient attention can be given to the development of under-developed regions in
an attempt to minimize the discrepancies between them and more-developed regions.
The purpose of this research was to streamline the relevant data for all the districts of
Punjab as to facilitate the decision-makers and the relevant stake-holders in setting
more realistic goals in future, keeping in mind the present situation in every district
so that a more comprehensive and efficient plan can be formulated to achieve said
goals.
106
CONCLUSION
The purpose of Millennium Development Goals 4 & 5 was to improve the health
status of the world and various indicators were used and targets were set to observe
the improvements. By following the data provided by the surveys of MICS Punjab, it
was observed that the districts of Punjab remained short of the targets set for each
indicator, with some districts showing greater gaps in the achievement of targets.
The major reason for such gross lacking is the application of a single target on all of
the districts irrespective of their wealth indices and economic strata. This research
can help assess those gaps clearly and compare the results of all districts, so that the
major differences can be observed and the health resources be divided according to
the socioeconomic status of the districts and individual local targets can be set to
observe the improvement in a more realistic way.
107
REFERENCES
1. Multiple Indicator Cluster Survey, Punjab 2003-4

3. Multiple Indicator Cluster Survey, Punjab 2011
4. Multiple Indicator Cluster Survey, Punjab 2014
6. Ahmed S. Millennium Development Goal-4 for Reducing Child Mortality-are we on
the Right Track. Journal of Bahria University Medical and Dental College. 2014 Jun
2;4(1):36-
7. Rizvi A, Bhatti Z, Das JK, Bhutta ZA. Pakistan and the Millennium Development
Goals for Maternal and Child Health: progress and the way forward. Paediatrics and
international child health. 2015 Oct 2;35(4):287-97.
8. UniversityK, Ahmed V. Legislative Gaps in Implementation of Health-related
Millennium Development Goals: a case study from Pakistan. Journal of the Pakistan
Medical Association. 2016 Jun 1;66(6).
9. World Health Organization. Trends in maternal mortality: 1990 to 2008.
10. Khan YP, Bhutta SZ, Munim S, Bhutta ZA. Maternal health and survival in Pakistan:
issues and options. Journal of obstetrics and gynaecology canada. 2009 Oct
1;31(10):920-9.
11. Pakistan Millennium Development Goals Report 2013 by UNDP
12. Wikimedia Foundation. (2021, September 25). Millennium development goals.
Wikipedia. Retrieved September 26, 2021, from
https://en.m.wikipedia.org/wiki/Millennium_Development_Goals.
13. 4.1 under-five mortality rate - screwturn wiki. (n.d.). Retrieved September 26, 2021,
from http://mdgs.un.org/unsd/mi/wiki/4-1-Under-five-mortality-rate.ashx?
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14. Indicator metadata registry details [Internet]. World Health Organization. World
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TO EVALUATE GAPS IN THE TARGETS OF MOTHER

AND CHILD HEALTH RELATED MILLENNIUM

DEPARTMENT OF COMMUNITY MEDICINE

Signature of Supervisor: _____________________

Date of Submission: ______________________

Table 1, Indicator 4.1.........................................................................................................

Table 2, Indicator 4.2.........................................................................................................

Table 3, Indicator 4.3.........................................................................................................

Table 4, Indicator 4.4.........................................................................................................

Table 5, Indicator 4.5.........................................................................................................

Table 6, Indicator 4.6.........................................................................................................

Table 7, Indicator 5.2.........................................................................................................

Table 8, Indicator 5.3.........................................................................................................

Table 9, Indicator 5.4.........................................................................................................

Table 10, Indicator 5.5 91

MDGs: Millennium Development Goals

MICS: Multiple Indicator Cluster Survey

U5MR: Under-5 Mortality Rate

IMR: Infant Mortality Rate

LHW: Lady Health Worker

MMR: Maternal Mortality Ratio

SBA: Skilled Birth Attendant

CPR: Contraceptive Prevalence Rate

TFR: Total Fertility Rate

T.T. Singh: Toba Tek Singh

D.G. Khan: Dera Ghazi Khan

R.Y. Khan: Rahim Yar Khan

M.B. Din: Mandi Bahauddin

N.K. Sahib: Nankana Sahib

BACKGROUND: The Millennium Developmental Goals (MDGs) were the eight

OBJECTIVES: To trace the trends of progress in achievement of MDGs 4 & 5, and

METHODS: A descriptive correlational meta-analysis of the surveys conducted by

CONCLUSIONS AND RECOMMENDATIONS: All the districts of Punjab are

KEY WORDS: MDGs, Maternal Health, Child Health, Mortality, Punjab

Millennium Development Goals were 8 goals set by the United Nations in

Goal no. 4: Reduce Child Mortality

❖ Under 5 Mortality Rate (Deaths per 1000 Live Births)

❖ Infant Mortality Rate (Deaths per 1000 Live Births)

❖ Proportion of Fully Immunized Children 12-23 Months

❖ Proportion of under-1-year children immunized against measles

❖ Proportion of Children Under 5 who suffered from Diarrhea in the last 30

❖ Lady Health Worker’s Coverage (percent of target population)

Goal no. 5: Improve Maternal Health

❖ Proportion of births attended by Skilled Birth Attendants

❖ Contraceptive Prevalence Rate

❖ Total Fertility Rate

 MICS 2003-4 [1]

Millennium Developmental Goals, or MDGs for short, are a set of checkpoints

Goal no. 4: Reduce Child Mortality

Child mortality is a reliable indicator of provision of health facilities in any country,

Goal no. 5: Improve Maternal Health

As with Child mortality, maternal health is also an indicator of provision of adequate

Study Design: Descriptive, Correlational

Study Settings: Punjab, Pakistan

Data Source: MICS Punjab 2003-4, 2007-8, 2011, 2014, 2017-18

MDGs: The Millennium Development Goals (MDGs) were eight international

Value in Punjab 112 111 104 93 69

Value in Punjab Gap in Target

Bahawalpur Bahawalnagar R. Y. Khan

D. G. Khan Layyah Muzaffargarh Rajanpur

Faisalabad Chiniot Jhang T. T. Singh

Gujranwala Gujrat Hafizabad M.B. Din Narowal

Lahore Kasur N. Sahib Sheikhupura