["American Journal of Human Biology, Volume 38, Issue 4, April 2026. ", "\nABSTRACT\n\nObjective\nFertility trends and population dynamics in Pakistan significantly influence the nation's socioeconomic progress. Elevated fertility rates drive rapid population expansion, creating major challenges for the healthcare system, education sector, and overall resource management. This study aims to identify key determinants influencing household fertility decisions among women aged 15–49 years in Punjab, Pakistan.\n\n\nMethods\nThe number of children ever born to a woman is used as a proxy for household fertility. The analysis is based on data from the latest round of the Punjab Multiple Indicator Cluster Survey (MICS) 2017–2018. A Poisson regression model was employed to account for the count nature of the dependent variable. Both Poisson regression and logistic regression analyses were conducted to explore the most significant predictors of fertility variation across the province.\n\n\nResults\nBoth the Poisson and logistic regression analyses identified a similar set of significant factors influencing fertility, including age, education, household wealth, fertility intentions, and delivery method. In both models, fertility increased progressively with advancing age, whereas higher educational attainment and better economic status were associated with reduced fertility and lower odds of having more than two children. Women who reported no desire for additional children exhibited higher fertility and a greater likelihood of higher parity in each model, while casarean delivery consistently showed a negative association with fertility outcomes.\n\n\nConclusion\nFertility differentials across Punjab appear to be shaped by a combination of biological, socioeconomic, and maternal factors. The study highlights the influence of women's age, household wealth, desire for a child, educational attainment, and previous delivery methods on reproductive behavior. These findings carry important implications for fertility regulation strategies in high‐fertility settings and suggest targeted interventions for promoting planned parenthood in similar socioeconomic contexts.\n\n"]