Maternal and Child Health Journal

, Volume 19, Issue 9, pp 1993–2002 | Cite as

Factors Associated with Low Birth Weight of Children Among Employed Mothers in Pakistan

  • Sara Rizvi Jafree
  • Rubeena Zakar
  • Muhammad Zakria Zakar


Evidence shows that Pakistan has an increasing rate of children with low birth weight (LBW). Employed mothers in paid work (EMPW) in the country have predominantly been disadvantaged in terms of access to education and low-income employment; with negative consequences on maternal and child health. The objective of this study was to determine socio-demographic characteristics of EMPW and identify the association between maternal employment and child birth weight in Pakistan. Secondary data from the Pakistan Demographic Health Survey (PDHS) conducted for the year 2006–2007 was used. PDHS is a nationally representative household survey. Relevant data needed from the PDHS data file were coded and filtered. The sample size of EMPW with at least one child born in the last 5 years was 2,515. Data was analyzed by using SPSS. Descriptive and inferential statistics were used to see the association between EMPW characteristics and LBW. Findings confirm that the majority of EMPW in Pakistan are illiterate, poor, employed in unskilled work, and belonging to rural regions. Multivariate regression analysis revealed statistical association between EMPW and LBW among mothers who did not receive prenatal care from unskilled healthcare provider (AOR 1.92; 95 % CI 1.12–3.30), had lack of access to information such as radio (AOR 1.88; 95 % CI 1.28–2.77), during pregnancy did not receive calcium (AOR 1.19; 95 % CI 1.05–1.34), and iron (AOR 1.33; 95 % CI 1.05–1.69), had experienced headaches during pregnancy (AOR 1.41; 95 % CI 1.12–1.76), and were not paid in cash for their work (AOR 1.41; 95 % CI 1.04–1.90). EMPW in Pakistan, especially in low-income jobs and rural regions, need urgent support for healthcare awareness, free supplementation of micronutrients and frequent consultation with trained practitioner during the prenatal period. Long-term mobilization of social structure and governance is needed to encourage maternal health awareness, hospital deliveries, and formal sector employment for EMPW.


Employed mothers Birth weight Pakistan 



Low birth weight


Pakistan Demographic and Health Survey


Employed mothers in paid work



Measure DHS is acknowledged for permitting the use of the Pakistan Demographic Health Survey (2006–2007) data. Prof. Dr. Grace Clark is thanked for her overall support. Last, the reviewers and editors are acknowledged for their important guidance during the review process.

Conflict of interest



  1. 1.
    UNICEF. (2011). Gender influences on child survival, health and nutrition: A narrative review. UNICEF and Liverpool School of Tropical Medicine.Google Scholar
  2. 2.
    Wardlaw T. M. (2004). Low birthweight: Country, regional and global estimates: UNICEF.Google Scholar
  3. 3.
    Demographic, P. (2007). Health Survey 2006–2007 [Preliminary report] (p. 25). National Institute of Population Studies, Islamabad, Pakistan Columbia MA: IRD/Macro International.Google Scholar
  4. 4.
    Mason, J. B. (2001). UNICEF. Improving child nutrition in Asia: Asian Development Bank.Google Scholar
  5. 5.
    Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., De Onis, M., Ezzati, M., et al. (2008). Maternal and child undernutrition: Global and regional exposures and health consequences. The Lancet, 371(9608), 243–260.CrossRefGoogle Scholar
  6. 6.
    Wilcox, A. J. (2001). On the importance—And the unimportance—Of birthweight. International Journal of Epidemiology, 30(6), 1233–1241.PubMedCrossRefGoogle Scholar
  7. 7.
    Hack, M., Flannery, D. J., Schluchter, M., Cartar, L., Borawski, E., & Klein, N. (2002). Outcomes in young adulthood for very-low-birth-weight infants. New England Journal of Medicine, 346(3), 149–157.PubMedCrossRefGoogle Scholar
  8. 8.
    Cunningham, S. A., Elo, I. T., Herbst, K., & Hosegood, V. (2010). Prenatal development in rural South Africa: Relationship between birth weight and access to fathers and grandparents. Population Studies, 64(3), 229–246.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Siza, J. (2008). Risk factors associated with low birth weight of neonates among pregnant women attending a referral hospital in northern Tanzania. Tanzania Journal of Health Research, 10(1), 1–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Awoyemi, T. T., Odozi, J. C., & Ogunniyi, A. (2012). Environmental and socioeconomic correlates of child malnutrition in Iseyin area of Oyo state Nigeria. Food and Public Health, 2(4), 92–98.CrossRefGoogle Scholar
  11. 11.
    Dooley, D., & Prause, J. (2005). Birth weight and mothers’ adverse employment change. Journal of Health and Social Behavior, 46(2), 141–155.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith, L. C., Ruel, M. T., & Ndiaye, A. (2005). Why is child malnutrition lower in urban than in rural areas? Evidence from 36 developing countries. World Development, 33(8), 1285–1305.CrossRefGoogle Scholar
  13. 13.
    Attanasio, O., & Vera-Hernández, M. (2004). Medium-and long run effects of nutrition and child care: Evaluation of a community nursery programme in rural Colombia (pp. 1–97). London: Centre for the Evaluation of Development Policies, The Institute for Fiscal Studies. Retrieved from Accessed 30 Jan 2015.
  14. 14.
    Khan, A. (2007). Women and paid work in Pakistan. Karachi: South Asian Research Program.Google Scholar
  15. 15.
    Hussain, I. (2008). Problems of working women in Karachi. Pakistan: Cambridge Scholars Publishing.Google Scholar
  16. 16.
    Werbner, P. (2004). Women: Ethnicity, economy, and gender relations. In P. Bhachu & S. Westwood (Eds.), Enterprising women: Ethnicity, economy and gender relations. Taylor and Francis.Google Scholar
  17. 17.
    Khan, R. E. A., & Khan, T. (2009). Labor force participation of married women in Punjab (Pakistan). Journal of Economic and Social Research, 11(2), 77–106. Retrieved from Accessed 30 Jan 2015.
  18. 18.
    Winkvist, A., & Akhtar, H. Z. (2000). God should give daughters to rich families only: Attitudes towards childbearing among low-income women in Punjab, Pakistan. Social Science and Medicine, 51(1), 73–81.PubMedCrossRefGoogle Scholar
  19. 19.
    Baig-Ansari, N., Badruddin, S. H., Karmaliani, R., Harris, H., Jehan, I., Pasha, O., et al. (2008). Anemia prevalence and risk factors in pregnant women in an urban area of Pakistan. Food and Nutrition Bulletin, 29(2), 132–139.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Mumtaz, Z., Shahab, S., Butt, N., Rab, M. A., & DeMuynck, A. (2000). Daily iron supplementation is more effective than twice weekly iron supplementation in pregnant women in Pakistan in a randomized double-blind clinical trial. The Journal of Nutrition, 130(11), 2697–2702.PubMedGoogle Scholar
  21. 21.
    Corsi, D. J., Neuman, M., Finlay, J. E., & Subramanian, S. (2012). Demographic and health surveys: A profile. International Journal of Epidemiology, 41(6), 1602–1613.PubMedCrossRefGoogle Scholar
  22. 22.
    Mbuagbaw, L., & Gofin, R. (2010). Can recall of birth size be used as a measure of birthweight in Cameroon? Paediatric and Perinatal Epidemiology, 24(4), 383–389.PubMedCrossRefGoogle Scholar
  23. 23.
    Taren, D. (2012). Historical and practical uses of assessing night blindness as an indicator for vitamin A deficiency. World Health Organization report: Priorities in the assessment of vitamin A and iron status in populations; Panama City, Panama, 15–17 September 2010.Google Scholar
  24. 24.
    Mannion, C. A., Gray-Donald, K., & Koski, K. G. (2006). Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. Canadian Medical Association Journal, 174(9), 1273–1277.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Daysal, N. M., Trandafir, M., Van Ewijk, R. Saving lives at birth: The impact of home births on infant outcomes: Discussion paper series, Forschungsinstitut zur Zukunft der Arbeit2012.Google Scholar
  26. 26.
    Bonzini, M., Coggon, D., Palmer, K. T. (2006). Risk of prematurity, low birth weight, and pre-eclampsia in relation to working hours and physical activities: A systematic review. Occupational and Environmental Medicine.Google Scholar
  27. 27.
    Dičkutė, J., Padaiga, Ž., Grabauskas, V., Nadišauskienė, R. J., Basys, V., & Gaižaukienė, A. (2004). Maternal socio-economic factors and the risk of low birth weight in Lithuania. Medicina (Kaunas), 40(5), 475–482.Google Scholar
  28. 28.
    Lu, M. C., Tache, V., Alexander, G., Kotelchuck, M., & Halfon, N. (2003). Preventing low birth weight: Is prenatal care the answer? Journal of Maternal-Fetal and Neonatal Medicine, 13(6), 362–380.PubMedCrossRefGoogle Scholar
  29. 29.
    Badshah, S., Mason, L., McKelvie, K., Payne, R., & Lisboa, P. J. (2008). Risk factors for low birthweight in the public-hospitals at Peshawar, NWFP-Pakistan. BMC Public Health, 8(1), 197.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Sachdev, H. P. S. (2001). Low birth weight in South Asia. International Journal of Diabetes in Developing Countries, 21(1), 13–33.Google Scholar
  31. 31.
    Hawkins, S. S., Cole, T. J., & Law, C. (2008). Maternal employment and early childhood overweight: Findings from the UK Millennium Cohort Study. International Journal of Obesity, 32(1), 30–38.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Pappas, G., Akhtar, T., Gergen, P. J., Hadden, W. C., & Khan, A. Q. (2001). Health status of the Pakistani population: A health profile and comparison with the United States. American Journal of Public Health, 91(1), 93.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Agha, S. (2000). The determinants of infant mortality in Pakistan. Social Science and Medicine, 51(2), 199–208.PubMedCrossRefGoogle Scholar
  34. 34.
    Jabeen, N., & Iqbal, M. Z. (2010). Gender and local governance in Pakistan: Promoting participation through capacity building. South Asian Studies (1026-678X), 25(2), 255.Google Scholar
  35. 35.
    Weiss, A. M. (2003). Interpreting Islam and women’s rights implementing CEDAW in Pakistan. International Sociology, 18(3), 581–601.CrossRefGoogle Scholar
  36. 36.
    Lewenhak, S. (2013). The revaluation of women’s work. London: Routledge.Google Scholar
  37. 37.
    Glick, P. (2002). Women’s employment and its relation to children’s health and schooling in developing countries: Conceptual links, empirical evidence, and policies: Cornell University.Google Scholar
  38. 38.
    Rahman, A., Patel, V., Maselko, J., & Kirkwood, B. (2008). The neglected ‘m’in MCH programmes–Why mental health of mothers is important for child nutrition. Tropical Medicine and International Health, 13(4), 579–583.PubMedCrossRefGoogle Scholar
  39. 39.
    McMichael, C., Waters, E., & Volmink, J. (2005). Evidence-based public health: what does it offer developing countries? Journal of Public Health, 27(2), 215–221.PubMedCrossRefGoogle Scholar
  40. 40.
    Bradley, R. H., & Corwyn, R. F. (2002). Socioeconomic status and child development. Annual Review of Psychology, 53(1), 371–399.PubMedCrossRefGoogle Scholar
  41. 41.
    Rugolo, L. M. (2005). Birth weight: A cause for concern over both the short and long terms. Jornal de Pediatria, 81(5), 359–360. Retrieved from Accessed 30 Jan 2015.
  42. 42.
    Bhutta, Z. A., Soofi, S., Cousens, S., Mohammad, S., Memon, Z. A., Ali, I., et al. (2011). Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: A cluster-randomised effectiveness trial. The Lancet, 377(9763), 403–412.CrossRefGoogle Scholar
  43. 43.
    Omer, K., Mhatre, S., Ansari, N., Laucirica, J., & Andersson, N. (2008). Evidence-based training of frontline health workers for door-to-door health promotion: A pilot randomized controlled cluster trial with lady health workers in sindh province, Pakistan. Patient Education and Counseling, 72(2), 178–185.PubMedCrossRefGoogle Scholar
  44. 44.
    Jokhio, A. H., Winter, H. R., & Cheng, K. K. (2005). An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. New England Journal of Medicine, 352(20), 2091–2099.PubMedCrossRefGoogle Scholar
  45. 45.
    Latham, M. (2010). The great vitamin A fiasco. World Nutrition, 1(1), 12–45.Google Scholar
  46. 46.
    Facchinetti, F., Allais, G., Nappi, R., D’amico, R., Marozio, L., Bertozzi, L., et al. (2009). Migraine is a risk factor for hypertensive disorders in pregnancy: A prospective cohort study. Cephalalgia, 29(3), 286–292.PubMedCrossRefGoogle Scholar
  47. 47.
    Chatterjee, M., & Lambert, J. (2007). Women and nutrition: Reflections from India and Pakistan. Planning, 27(25.5), 23.Google Scholar
  48. 48.
    Hamid, A., & Ahmed, A. M. (2011). An analysis of multi-dimensional gender inequality in Pakistan. Asian Journal of Business Management, 3(3), 166–177.Google Scholar
  49. 49.
    Bugvi, A. S., Rahat, R., Zakar, R., Zakar, M. Z., Fischer, F., Nasrullah, M., et al. (2014). Factors associated with non-utilization of child immunization in Pakistan: Evidence from the Demographic and Health Survey 2006–2007. BMC Public Health, 14(1), 232.PubMedCentralPubMedCrossRefGoogle Scholar
  50. 50.
    Jafarey, S., Kamal, I., Qureshi, A. F., & Fikree, F. (2008). Safe motherhood in Pakistan. International Journal of Gynecology and Obstetrics, 102(2), 179–185.PubMedCrossRefGoogle Scholar
  51. 51.
    Anwar, M., Green, J., & Norris, P. (2012). Health-seeking behaviour in Pakistan: A narrative review of the existing literature. Public Health, 126(6), 507–517.PubMedCrossRefGoogle Scholar
  52. 52.
    Upvall, M. J., Sochael, S., & Gonsalves, A. (2002). Behind the mud walls: The role and practice of lady health visitors in Pakistan. Health Care for Women International, 23(5), 432–441.PubMedCrossRefGoogle Scholar
  53. 53.
    Bhutta, Z. A., Rizvi, A., Raza, F., Hotwani, S., Zaidi, S., Hossain, S. M., et al. (2009). A comparative evaluation of multiple micronutrient and iron–folic acid supplementation during pregnancy in Pakistan: Impact on pregnancy outcomes. Food and Nutrition Bulletin, 30(Suppl. 4), 496–505.Google Scholar
  54. 54.
    Feng, X. L., Xu, L., Guo, Y., & Ronsmans, C. (2011). Socioeconomic inequalities in hospital births in China between 1988 and 2008. Bulletin of the World Health Organization, 89(6), 432–441.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    McNab, C. (2009). What social media offers to health professionals and citizens. Bulletin of the World Health Organization, 87(8), 566.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Siegmann, K. A. (2009). The gender digital divide in rural Pakistan: How wide is it and how to bridge it?.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sara Rizvi Jafree
    • 1
    • 2
  • Rubeena Zakar
    • 1
  • Muhammad Zakria Zakar
    • 3
  1. 1.Institute of Social and Cultural StudiesUniversity of the PunjabLahorePakistan
  2. 2.Forman Christian College UniversityLahorePakistan
  3. 3.Faculty of Behavioral and Social Sciences, Institute of Social and Cultural StudiesUniversity of the PunjabLahorePakistan

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