# Sindh’s Urban Paradox: Pakistan’s Most Urban Province Still Leaves 4 in 10 Urban Children Out of School ## A Gallup Pakistan Digital Analytics analysis spanning more than three decades finds major progress in fertility, sanitation and maternal healthcare—but also deep inequalities between Karachi and the interior, men and women, and rich and poor households. Sindh is Pakistan’s most urbanized major province. It contains the country’s largest city, its principal commercial centre and some of its most productive agricultural districts. Yet its advantages in geography, trade and urbanization have not translated evenly into better social outcomes. A new Gallup Pakistan Digital Analytics deep dive brings together data from the Pakistan Demographic and Health Surveys, Pakistan Social and Living Standards Measurement Surveys, Household Integrated Economic Surveys, Labour Force Survey, Population Census, Agricultural Census and provincial budget documents. Covering trends from 1991 to 2025 and drawing on more than 1.17 million harmonized survey records, the analysis presents Sindh as a province of extraordinary scale, genuine progress—and sharp internal contradictions. ## One Province, Two Different Realities Sindh’s population increased from approximately 47.9 million in 2017 to 55.7 million in 2023—an increase of around 16% in just six years. More than half of the province’s population is now urban. Karachi alone contains approximately 18.9 million people, accounting for roughly one-third of Sindh’s entire population. It is larger than the province’s next several cities combined. But provincial averages conceal two very different Sindhs. One is the metropolitan Karachi-Hyderabad corridor, where incomes, assets and access to private services are considerably higher. The other is the rural Indus-basin interior, where agriculture remains central and households face much greater deficits in education, sanitation and economic opportunity. The economic divide is particularly striking. According to the report’s asset-based classification, 68.8% of urban Sindh households are middle class or above, compared with only 21.4% of rural households—a gap of more than 47 percentage points. Karachi’s prosperity, in other words, does not automatically diffuse across the province. ## More Than Half of Young Women Are Neither Studying Nor Working Sindh’s gender gap becomes even more visible among young people. Nearly 31.62% of Sindh’s youth aged 15–24 are classified as NEET—not in employment, education or training. But the overall figure hides an enormous difference between men and women. The male NEET rate is 13.99%. For young women, it rises to 51.7%. This means that more than half of young Sindhi women are disconnected from all three principal pathways into adult economic life: education, employment and vocational training. The same pattern appears in the wider working-age population. Around 81.97% of men aged 15–64 are employed, compared with only 18.29% of women—a gap approaching 64 percentage points. No other economic opportunity available to Sindh is comparable in scale to the potential contribution of women who are currently excluded from paid work. Improving female employment will require more than conventional job-creation programmes. Safe transportation, childcare, digital access, home-based work opportunities, vocational training and changes in workplace practices will all be necessary. ## Women’s Education Has Improved—but More Than Half Still Have No Schooling Sindh has made real progress in women’s education over the past three decades. Among women aged 15–49, the proportion reporting no education declined from 76.82% in 1990–91 to 54.69% in 2017–18. That is a reduction of more than 22 percentage points. But the remaining deficit is still enormous: even in 2017–18, more than half of Sindhi women had never attended school. Household wealth is one of the strongest predictors of educational opportunity. The no-education rate ranges from 88.97% among women in the poorest wealth quintile to only 9.46% among those in the richest. This suggests that girls’ education in Sindh is not only a rural problem. It is also fundamentally an affordability and household-poverty problem. Digital access remains similarly restricted. In 2017–18, only 28.23% of women owned a mobile phone and just 11.69% reported having used the internet. Digital education, telehealth and mobile financial services may eventually expand women’s opportunities—but they cannot be treated as universal solutions while most women remain digitally excluded. ## Family Size Is Falling, but Social Change Is Selective Sindh’s total fertility rate fell from approximately five children per woman in 1990–91 to 3.63 in 2017–18, closely tracking Pakistan’s broader fertility transition. The decline appears to be driven more by families stopping childbearing earlier than by a dramatic postponement of marriage. The mean age at first marriage increased from approximately 16.8 years to 18.97 years over the same period—a rise, but still a relatively modest one across nearly three decades. Education is strongly associated with family size. Women with no education had an estimated completed fertility of 6.47 children, compared with 4.28 among women with higher education. Yet modernization has not affected every social institution in the same direction. The proportion of women married to a blood relative increased from 61.43% in 1990–91 to 71.39% in 2017–18. Polygamous marriage, by contrast, declined modestly from 6.04% to 4.32%. Sindh’s social transition is therefore not a simple movement from “traditional” to “modern.” Education, fertility, marriage practices and family structures are changing at different speeds—and sometimes in different directions. ## A Maternal Health Transformation Led Mainly by the Private Sector One of Sindh’s clearest success stories is the movement away from home births. In 1990–91, approximately 72.55% of births took place at home or outside a health facility. By 2017–18, this had fallen to 24.93%. This represents a major improvement in access to skilled and facility-based maternity care. However, most of the transition was captured by private providers rather than government facilities. By 2017–18, 54.3% of deliveries took place in private facilities, compared with only 20.1% in government facilities. Private facilities therefore handled approximately 2.7 times as many deliveries as the public sector. The numbers raise an important policy question: is the private sector expanding because it offers greater trust and convenience, or because public facilities lack sufficient capacity and quality? Sanitation has also improved. The share of households without a toilet facility declined from 31.05% in 1990–91 to 18.36% in 2017–18. But Sindh remained behind the national rate, indicating that progress has been slower than in some other parts of Pakistan. ## Karachi’s Wealth Cannot Conceal Province-Wide Economic Vulnerability Despite containing Pakistan’s largest economic centre, Sindh’s province-wide middle class remains smaller than its urban image might suggest. The report estimates that 39.5% of Sindh households were middle class or above in 2024–25. Meanwhile, 45.4% remained in the poorest asset tier. The middle-class share was estimated at 49% in 2019–20, suggesting that the economic disruption, inflation and declining purchasing power of recent years may have pushed some households backwards. The rural-urban divide remains central. More than two-thirds of urban households are classified as middle class or above, compared with little more than one-fifth of rural households. Sindh is therefore not simply a wealthy province with pockets of deprivation. It is a highly unequal province in which metropolitan prosperity exists alongside widespread rural and peri-urban vulnerability. ## Sindh Is Urban—but Agriculture Still Supports More Than One-Third of Its Population Karachi often dominates perceptions of Sindh, but agriculture remains the backbone of the rural economy. The Agricultural Census 2024 records approximately 1.8 million farms and 8.2 million cultivated acres in Sindh. Agriculture is estimated to support around 37% of the province’s population. Farm fragmentation is accelerating. The number of farms increased from approximately 1.12 million in 2010 to 1.8 million in 2024, while average farm size declined from 8.8 acres to around five acres. This creates challenges for mechanization, profitability and the long-term viability of smallholdings. At the same time, livestock has become an increasingly important rural asset. Sindh’s livestock population expanded from approximately 32 million in 2006 to 50 million in 2024, led by goats, buffaloes and cattle. Sindh is also nationally dominant in several important crops. It produces more than 80% of Pakistan’s red chillies, around 70% of its bananas and approximately 40% of its dates. It also accounts for substantial shares of national rice, cotton and sugarcane cultivation. But 71% of irrigated land remains dependent on canal water alone, leaving the rural economy highly exposed to Indus water availability, upstream allocation decisions and climate-related disruptions. ## Provincial Averages Hide Enormous District Differences Perhaps the report’s most important contribution is demonstrating how much provincial averages can conceal. Estimated fertility ranges from 6.96 children per woman in Kashmore and 5.97 in Jacobabad to 2.31 in Karachi Malir and 2.16 in Larkana. This is a more than threefold difference within a single province. Northern rural districts such as Kashmore and Jacobabad repeatedly appear among the most disadvantaged areas, particularly on fertility, education and access to services. Karachi’s districts, meanwhile, also differ substantially from one another. Policies designed around a single “Sindh average” will therefore miss much of the province’s real diversity. District-level targeting is essential. ## Sindh’s Challenge Is Not a Lack of Progress—but Unequal Progress Sindh has changed enormously since the early 1990s. Fertility has declined. Home births have fallen dramatically. Sanitation has improved. Women’s education has expanded. Livestock and agricultural mechanization have grown. But progress has been unevenly distributed. Urbanization has outpaced public education capacity. Private healthcare has expanded faster than government provision. Karachi’s wealth has not spread evenly across the province. More than half of young women remain outside employment, education and training. Rural northern districts remain far behind metropolitan areas. Sindh’s central development challenge is therefore not simply how to generate more growth. It is how to convert the province’s economic scale, urban concentration and fiscal resources into broader public capability. The evidence points towards five immediate priorities: expanding affordable schooling in Karachi, protecting education and health development budgets, creating pathways into employment for women, strengthening public healthcare, and directing greater resources towards high-need northern districts. Sindh is not standing still. But unless its progress becomes more inclusive—across gender, income, geography and districts—the province’s extraordinary economic and demographic weight will continue to coexist with equally extraordinary inequality.