Title: Pattern and trends of the total and age-specific fertility rates during 1990-2018 in Pakistan
Version: 2 Date: 12 Dec 2022
Reviewer:  Marion Burkimsher
Reviewer's report:
This is an interesting article on TFR and ASFR trends in Pakistan from 1990-2018 using the
data collected in the Pakistan Demographic and Health Surveys. The material is worthy of
publication. However, in my opinion, the content would be better published in a demographic
journal rather than the BMC Women’s Health. I would suggest the journals Demographic
Research (perhaps as a shorter ‘descriptive finding’) or Population Studies might be more
appropriate than the BMC Women’s Health whose stated remit is to publish articles on “women's
public health issues, health behaviours, breast cancer, gynecological diseases, mental health and
health promotion”.
If the article does move forward to publication, in this journal or another, then the following are
the issues that should be dealt with.
I am unsure of what the author’s definition is of ‘direct estimates of fertility’. Is this calculated
using only registered births by population estimates by age of women (as it would be in
developed countries), i.e. a calculation of the TFR as the sum of age-specific fertility rates?
Instead of calling it ‘direct estimates of fertility’ then perhaps it would be better referred to as
‘estimates derived from birth registrations’.
In the description of the data used then the sample sizes of each DHS should be included. Because
of the increase in women’s education over time I would tend to assume that the accuracy of the
responses might increase over time: would you agree and might this be worth mentioning – and
could it impact the results?
I wonder whether the census could also be used to estimate either or both TFR and cohort fertility
rates? Could co-habiting children, say under the age of 15, be associated with the (probable)
mother in the household? This assumes that the age of each household member is recorded in
the census.
There is a discussion of the weakness of Brass P/F ratio method early in paper (because of its
assumption of constant fertility over time which is clearly false). Therefore, I would suggest
further discussion and calculation of the Brass P/F ratio is not required and the paper should
only concentrate on the relational Gompertz model, RGM.
In Table 1 one of the headings is MCEB, but that is not written out in full and I am not sure
what measure it is.
I think that the clarity of the graphs could be improved, eg. not a grey background, larger font,
put the legend above or below the graphs.
I was interested to see a drop in ASFRs at every age (Fig 3), but no change in the modal age
of childbearing: this is a different evolution from that of developed countries where the fertility
curve has changed from being skewed left (as in Pakistan) to skewed right.
There is no mention of trends in childlessness nor proportion of women who remain single. Do
such data exist for Pakistan?
The results presented in Tables 2 and 3 and in the opposite chronological order to the results in
Tables 4 and 5. They should be the same and in standard chronological order, i.e the lines in
Tables 4 and 5 should be reversed.
The paper focuses solely on Pakistan, but it would be interesting if there was at least a
passing mention to one or two countries at a similar level of development. A comparison with
India would be particularly interesting, especially as the official TFR of India is now below
replacement level.
I discovered a more detailed article on the same topic by
2 of the same authors: https://www.researchgate.net/profile/Muhammad-Suhail-6/
publication/353070981_Comparison_of_Ridge_M-
Estimators_for_Linear_Regression_Models_Violating_the_Usual_Assumptions/
links/60e69a7230e8e50c01eb9270/Comparison-of-Ridge-M-Estimators-for-Linear-
Regression-Models-Violating-the-Usual-Assumptions.pdf#page=312
If the authors submit the paper to another journal, then the additional information included in that
article may be of interest, as it includes comparisons of the rural/urban differentials in fertility
and the regional variations.