Socio-Economic Inequalities and Child Mortality in Pakistan: Evidence From the Pakistan Demographic and Health Survey 2017–18

Abstract

Introduction

Child mortality remains a critical public health challenge in Pakistan, where rates persistently exceed regional and global averages.

Methods

Using data from the Pakistan Demographic and Health Survey (PDHS) 2017–18 (n = 13 558 live births in the 5 years preceding the survey), this study examines how socioeconomic inequalities, measured through maternal education, household wealth, place of residence, and paternal occupation, shape under-five, infant, and neonatal mortality. Discrete-time event-history models and concentration indices are applied to assess both the magnitude of mortality risk and the degree of socioeconomic inequality in its distribution.

Results

Results reveal that children born to mothers with no education face more than three times the under-five mortality risk compared with children of mothers with secondary or higher education (OR = 3.42; 95% CI: 2.61–4.49). Household wealth quintile gradients are steep and consistent across all mortality indicators. Concentration indices confirm significant pro-rich inequality in child survival (C = −0.142, p = 0.001).

Conclusion

Rural children experience substantially higher mortality even after adjustment for compositional factors. These findings underscore the urgency of equity-focused health and education investments in Pakistan and carry broad implications for low- and middle-income countries facing similar structural disadvantages.