Recent trends in fertility and contraceptive prevalence indicate that the fertility transition in Pakistan has begun in the 1990s. Before that decade, the total fertility rate had exceeded six births per woman for at least three decades, and fewer than 10 percent of married women practiced contraception. The most recent survey data, collected in 1996–97, show a total fertility rate of 5.3 births per woman and a contraceptive prevalence rate of 24 percent. Underlying this development are macroeconomic trends that have led to widespread economic distress at the household level, and social changes that have diluted the influence of extended kin and resulted in greater husband-wife convergence in reproductive decisionmaking. The direct causes of declining fertility are a crystallization of existing desires for smaller families, along with a decline in family size desires and a reduction in the social, cultural, and psychic costs of contraception. Improvements in family planning services have contributed little to the onset of fertility decline but could be decisive in sustaining the decline over the next decade.