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especially in developing countries (5). As a reference, the World Health Organization, in its 1985 report, suggested an optimal range for C-section rates of 5-15% (6). Many studies have found that the likelihood of delivery through C-section depends on a number of institutional, demographic and socioeconomic factors. The availability of facilities, obstetricians and the place of birth, that is, private or public sector institutions, is associated with C-section rate (7,8). C-section is significantly associated with multiple conception, maternal age at birth, rise in institutional deliveries, number of previous deliveries, site of prenatal care (private or public), socioeconomic status of household and access to antenatal care (9-11). Some maternal characteristics such as education and access to antenatal care are also strongly associated with the likelihood of C-section (4,10,12). In view of the recent understanding about the factors associated with C-section, this study identified a set of socioeconomic, demographic, spatial and institutional indicators associated with C-section delivery. We used data from the Multiple Indicator Cluster Survey (MICS)

ii The Population Council confronts critical health and development issues-from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives.

While schooling outcomes for girls have improved over the period 2001–11, progress has been uneven within Pakistan. Rural girls lag far behind urban girls and progress across the provinces remains unequal. The transition to secondary school—in some ways more critical for improving employability, reproductive health, and other outcomes—shows even more disparate progress by province and income class. Questions about the preference for public versus private schools and the actual choice of schools available to girls in most rural areas need to be answered if we are serious about a rapid escalation of secondary school enrollments for girls. We use data from the Pakistan Integrated Household Survey for 2001/02 and the Pakistan Social and Living Standards Measurement Survey (PSLMS) for 2007/08 and 2010/11 to look at patterns in this transition. Access is likely to be the main driving force behind the transition to secondary-level schooling. Initial findings reflect the almost total reliance on public schools for 10–14-year-old girls. This suggests that private secondary schools are not an option for girls in rural areas. The next major intervening factor is household income level: even rich families appear to favor public schools for girls. The data also suggest that girls from poor and large families compete with their brothers and other siblings for limited resources.

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The Population Council's Population, Environmental Risk, and Climate Change (PERCC) initiative is a multidisciplinary effort to understand how environmental changes affect demographic trends and the impact they have on vulnerable populations. The Council is bringing together its experience in social and behavioral science research, diverse perspectives, data, methodologies, and tools to better understand the many facets of adaptation, resilience, and mitigation. This evidence will inform programs, policies and technologies that ensure the grave threat of climate change does not roll-back decades of progress in reducing poverty and improving lives around the world. ABOUT THIS MONOGRAPH Climate, Population, and Vulnerability in Pakistan: Exploring Evidence of Linkages for Adaption uses diverse data sources to initiate an interdisciplinary conversation on the interlinkages of climate change and demography through contributions from national experts in meteorology, migration, and agriculture. The aim is to provide a regionally nuanced perspective of the climatic changes to which the population is exposed; the key demographic and socioeconomic trends that have a bearing on vulnerability, resilience, and adaptation; internal migration; and the expected combined impact of these dynamics on the country's food and economic mainstay-agriculture.