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Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary (2016)

Chapter: 3 Trends in Reproductive Behavior

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Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

3

Trends in Reproductive Behavior

Decisions about family size and contraceptive use are at the heart of fertility trends, and numerous factors influence these decisions. John Casterline of the Institute for Population Research at Ohio State University discussed the desire to have large families that has been characteristic in the sub-Saharan region. Ian Timaeus of the London School of Hygiene and Tropical Health discussed childbearing patterns and the importance of birth spacing and postponement. Véronique Hertrich of the Institut National d’Etudes Démographique (INED) provided an overview of trends in age at marriage and fertility. Parfait Eloundou-Enyegue of Cornell University discussed socioeconomic trends that influence fertility. Maggwa Baker Ndugga of the Bill & Melinda Gates Foundation gave these issues a closer look through a focus on trends and policies in Kenya and Ghana. Cheikh Mbacké of the William and Flora Hewlett Foundation offered comments on the presentations.

FERTILITY DESIRES

High demand for children is typical in sub-Saharan countries, Casterline noted. He explored trends in fertility desires there in comparison with those in other regions, and considered the implications for fertility decline in Africa. Using national demographic survey data for 84 countries, Casterline examined people’s views about the ideal number of children to have and their prospective preferences, as expressed in their current answers to the question of whether they would like to have

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

images

FIGURE 3-1 Trends in ideal number of children and total fertility rates.
SOURCE: Casterline (2015).
NOTE: Samples for each region were Eastern and Southern Africa, 18 countries, 60 surveys; Central and West Africa, 20 countries, 70 surveys; Latin America, 18 countries, 72 surveys; and Asia and North Africa, 27 countries, 89 surveys.

another child. Using linear regression analysis and other tools, he was able both to estimate a mean preferred number of children and also to establish regional and country-by-country trends.

Casterline explained that ideas about the ideal number of children have tended to change with total actual fertility rate, and he highlighted differences in both across four regions; see Figure 3-1. These data demonstrate that while fertility desires have declined in all regions, they are markedly higher in sub-Saharan African countries than in other regions, he explained, and people in the Central and West African regions desire the highest numbers of children. As this region began its fertility transition in the mid-1990s, he noted, actual fertility levels approximately matched people’s desires in terms of number of children to have. In other regions, the actual fertility levels generally exceeded people’s desires at that same point.

Looking more closely at the relationship between desires and actual numbers of children born, Casterline found that in most of the countries studied, parents’ desire to stop having additional children increases with

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

parity, or as they have additional children.1 However, although there is an overall trend in the African countries studied toward increased desires to stop having additional children, parents in the sub-Saharan region tended to be slower to reach the point of desiring to stop.

To fully understand trends, it is important to incorporate varying fertility desires and other factors into models of fertility decline, Casterline emphasized. He and his colleagues identified four factors to incorporate in calculating a hypothetical change in total fertility rate (TFR):

  • Nuptiality—adult years spent in or out of marital union;
  • Preference composition—in-union years spent not wanting another child (versus wanting a child);
  • Wanted rates—rate of childbearing among those wanting another child (conditional wanted rate); and
  • Unwanted rates—rate of childbearing among those not wanting another child (conditional unwanted rate).

The results of this analysis for four sub-regions of Africa show that nuptiality is the factor with the largest effect on TFR and that change in preference composition is not a strong factor. Given high fertility desires, especially in Central and West Africa, Casterline and his colleagues were surprised at this result and conducted further analysis to determine whether changes in both preference composition and unwanted rates together would show a greater effect. The results indicated that a joint change was far more consequential than the sum of the separate effects of these two factors. He concluded that a substantial fertility decline in the region will therefore require changes in both fertility desires and the implementation of those desires.

Casterline closed by pointing out that there is a need for much deeper understanding of fertility demand in African countries. Research on the topic has been limited, he noted. Perhaps most important, in his view, would be further examination of the intersection between the desires individuals have for additional children and the implementation of those desires.

CHILDBEARING PATTERNS

Timaeus focused on the many different factors that influence fertility and how they interact. He pointed out that demographers have tended to focus only on the use of contraceptives to limit family size, and to view

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1Parity is used in the context of childbearing to refer to the number of pregnancies carried to term.

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

fertility transitions as arising primarily from increasing availability of contraception. However, he noted, the reality is more complicated. Women may use contraceptives to control the intervals between births, but they may also wish to avoid getting pregnant for reasons that are unrelated to their childbearing history, including poor health, marital instability or infidelity, inadequate housing, or a need to save money for existing children’s education. Women may also delay childbearing because they are not sure whether they want a child.

This is important, Timaeus explained, because postponing childbearing and spacing out births are different decisions that researchers often lump together. Postponement refers to a strong motivation to avoid having a child in the present that is accompanied by the idea that having a child in the future might be desirable, he explained. Spacing is a plan to have a child at a suitable time, for example to coincide with favorable expected life changes.

In broad terms, Timaeus explained, the fertility transition that occurs in response to economic development is a response to several factors that affect fertility desires:

  • declines in child mortality, which allow couples to plan on having fewer children, typically half as many as before the decline;
  • more productive occupations opening up for women, increasing the opportunity cost of childbearing, and also increasing the benefits of educating children;
  • possibility of insurance and other supports for old age reducing the pressure to have children who will bear this responsibility;
  • improvements in birth control technology and access to it; and
  • people increasingly viewing childbearing as a choice, rather than “something that happens to you.”

Women’s thinking about childbearing is also affected by institutional factors, modeled in Figure 3-2, and it may be these issues that often cause them to postpone childbearing, Timaeus suggested. Timaeus quoted another expert on the importance of these factors: “Everyday life in contemporary Africa is deeply uncertain, due to economic reversals, political instability, and substantial cultural change over the past decades” (Johnson-Hanks, 2004, p. 351). Cultural traditions still recognized in many African countries, such as bride wealth customs or mutual support within extended families, may conceal significant changes in family structure and dynamics that have occurred. These include frequent premarital childbearing, high incidence of divorce and remarriage, increasing numbers of female-headed households, and the geographic dispersal of extended families.

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

images

FIGURE 3-2 Institutional factors that may influence childbearing decisions.
SOURCE: Moultrie and Timaeus (2015), used with permission.

Women with children often cannot rely on their partners, families, or communities, or on public services for support in raising their children, or “are unsure whether they can,” Timaeus explained. “This insecurity exacerbates the impacts of poverty and an uncertain environment,” he added.

Timaeus closed with several points. First, he noted that demographers should consider the full range of concerns that affect women’s decisions about childbearing and should recognize the significant differences among decisions to postpone the next birth, to plan particular spacing of children’s births, or to limit the total number of children desired.

The impact of birth spacing on fertility is inherently limited, he observed, but birth postponement can result in substantial fertility declines and appears to be having this effect in Southern and Eastern African countries. Both birth postponement and the slow decline in African fertility, he suggested, are mediated by institutional factors that cause people to feel economically insecure. Timaeus suggested that demographers have too often viewed the decisions of women in African countries “through a

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

Eurasian lens” and that greater understanding of the institutional contexts in which women make decisions about childbearing is needed.

TRENDS IN AGE AT MARRIAGE AND FERTILITY

Hertrich examined nuptiality—the tendency of a population to get married. Declines in nuptiality often occur in response to economic development, she noted. Nuptiality is a proximate (or direct) determinant of fertility, and its decline is often the first step in a country’s fertility transition, she explained. The connection between nuptiality and fertility, she added, reflects social and family structures. Marriage is a structure “where gender differences are organized,” she noted, and where individual and conjugal autonomy are defined. Thus, “women’s agency and gender issues are important factors” in reproductive behavior.

Hertrich noted several differences in African nuptiality patterns as compared with international averages. First, sub-Saharan African women’s median age at first union, 21.1 years, is the lowest in the world; the median age is 22.6 in Asia and 26.4 in Latin America. The median age difference between spouses is also the greatest in the sub-Saharan region, with men 5.3 years older than their wives, as compared with 3.2 and 2.9 years older in Asia and Latin America, respectively. More broadly, the sub-Saharan region could be described as pro-natalist, she explained. Features such as universal marriage for both sexes, early marriage for girls, prompt remarriage for widowed and divorced women, and polygamy tend to mean that women spend most of their reproductive life in a union, with their social status focused on their role as mother and wife.

Hertrich explored the connections between long-term trends in nuptiality and the timing of fertility in sub-Saharan Africa by asking three questions:

  1. To what extent is fertility decline preceded by changes in nuptiality patterns?
  2. Is there a threshold in age at marriage to be reached before fertility starts to decrease?
  3. Are there regional differences in the link between nuptiality and fertility changes?

She and her colleagues used national surveys and censuses to examine long-term (starting in the 1960s) trends for 55 countries. They created a database to bring together statistical data on marital status, focusing on the median age at first marriage for women, calculated from the percentage of women who had never been married by various ages. For fertility data, they used the fertility series from the 2012 revision of World Popu-

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

lation Prospects, a set of global demographic estimates and projections produced by the United Nations.2

The data in Figure 3-3 show the trends from 1965 to 2010 for African countries, which include a widespread increase in women’s age at first marriage. The darker colors in the top row of maps indicate areas with higher ages at first marriage. The maps in the bottom row show changes in fertility across the same time span; the darker areas show areas with lower TFRs. A comparison of these two sets of maps shows the time lag between changes in nuptiality and changes in fertility.

Hertrich and her colleagues estimated the median age at first marriage at the beginning of a fertility decline and at earlier years for each country in their sample, and they determined that fertility transition is not likely to begin in a country where the median age at first marriage for women has not reached at least 18 years. If the increase in age at marriage was a direct factor in fertility decline, she went on, then one would expect that age at marriage and TFR would change together. This occurs in some countries, she explained, but is not the most common pattern. There were three distinct patterns: one in which the two developments occur in separate stages, one in which they occur together, and one in which there is no clear connection.

Hertrich concluded that these data demonstrate that a fertility decline is not possible where the age at first marriage is below 18—and she noted that in most cases fertility begins to decline after the median age reaches 19 years.

THE IMPACT OF SOCIOECONOMIC TRENDS

Eloundou-Enyegue’s focus was on ways to understand how individual processes add up to trends that can be discerned at the national level. He suggested that relying exclusively on either micro- or macro-level analyses is insufficient. A method that aggregates the individual processes and synthesizes those results with macro-level data, he explained, yields more sophisticated understanding of socioeconomic factors that influence fertility, such as education, urbanization, and socioeconomic status. He focused particularly on the effects of education on different patterns of change in fertility levels.

There is a rich literature in micro-level analyses, Eloundou-Enyegue noted, that rest on solid theoretical grounds. This type of analysis provides high-quality information about individual fertility determinants, but it fails to shed light on macro-level historical processes. Macro-level analysis, in his view, rests on a weaker theoretical platform, and sam-

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2See http://esa.un.org/wpp/ [July 2015].

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

images

FIGURE 3-3 Long-term trends in age at marriage and total fertility rates.
SOURCE: Hertrich (2015).

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

images

FIGURE 3-4 Cross-sectional relationship between education and fertility.
SOURCE: Eloundou-Enyegue (2015).

ple sizes are frequently small, he noted. They are often also limited by endogeneity—the confounding effect of variables that affect the outcome but are not measured.

One is that these approaches tend to be based on an assumption that processes remain constant across the fertility transition. However, he explained, a determinant such as education may have a differing influence at different points in the course of a fertility transition—both in terms of the magnitude of its effect and in terms of the mechanisms. The scatter plot in Figure 3-4 shows how a simple regression line might not reveal two distinct groups with different slopes, he noted, which represent the differences across time. The effect of socioeconomic factors does not necessarily remain static over the course of the transition. Another issue is that there can be enormous differences within countries—such as between the changes among less and more educated women—that would not be captured by macro-level analysis.

Eloundou-Enyegue proposed a theoretical approach for integrating the two types of analysis that is based on the idea of aggregating three types of processes that can happen at the same time, or at different times:

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
  • compositional effects—the effect of the characteristics of a group, such as an increase in the numbers of people who are educated, on individual outcomes;
  • behavioral effects—the effects of a policy or change, such as an increase in educational opportunity, on individual behavior; and
  • spillover effects—the effects of seemingly unrelated events, such as the influence of people who are educated on other people’s behavior.

The two graphs in Figure 3-5 illustrate two hypotheses about how a fertility transition might progress. The top graph shows a scenario in which more-educated women experience the decline much more rapidly than less-educated women do, which means that there is considerable inequality between the two groups during the middle phase of the transi-

images

FIGURE 3-5 Two hypotheses about the pattern of fertility transition.
SOURCE: Eloundou-Enyegue (2015).

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

tion. The bottom graph shows that the three types of effects may each be most influential at different phases of the transition.

To test the hypothesis that the three types of effects actually occur in sequence, Eloundou-Enyegue used a mix of demographic and regression decompositions. Using cross-sectional data from 22 sub-Saharan African countries at different stages of the fertility transition, he produced preliminary results that seem to confirm his prediction that the compositional effect would be greatest at the early stages of a transition.

Eloundou-Enyegue explained that this “middle-ground” approach to incorporating sub-national processes into the analysis of national trends can help to clarify the mechanisms by which different factors influence fertility, which, in turn, can shed light on the pace of fertility declines and their effects.

FOCUS ON KENYA AND GHANA

Ndugga offered four reasons why a focus on Kenya and Ghana would be useful. These two countries, which reflect different social and economic contexts, were the first in the sub-Saharan region to develop and launch population policies, which they both did in the 1960s, he noted. Both have developed and implemented a wide range of policies and programs aimed at making family planning options more readily available. Both have also experienced significant changes in TFR and contraceptive prevalence rate since 1970. Ndugga and his colleagues drew on numerous sources of data for these two countries, including Demographic and Health Survey datasets, Performance Monitoring and Accountability Survey results,3 and review of national documents and other materials, as well as their own experience and discussions with country program managers and implementation partners.

They reviewed three primary factors that influence fertility: the reproductive behavior of individual women or couples, as indicated by changes in their fertility preferences or contraceptive behaviors; socioeconomic and demographic characteristics of sub-populations; and institutional factors such as shifts in policy or service delivery environments. Kenya and Ghana experienced similar patterns of fertility decline starting in 1970: a rapid decline followed by a stall and a plateau. Rates of desired fertility and desired family size have also plateaued in both countries. Rates of unwanted fertility have plateaued as well, though they are significantly lower in Ghana. Looking at sub-populations, Ndugga noted that in both

___________________

3See http://dhsprogram.com/What-We-Do/Survey-Types/DHS.cfm [August 2015] and http://www.pma2020.org/about-pma2020 [August 2015].

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

countries, the poorest and least educated segments of the population have the highest TFRs.

In Ghana, there has recently been an uptick in fertility in both rural and urban areas; in Kenya, there has been just a slight uptick in urban areas. Focusing on 15- to 19-year-olds, Ndugga noted that in both countries differences between urban and rural populations increased, and that there are large differences among groups with different levels of education.

For example, contraceptive use among married women, which is noticeably higher in Kenya than in Ghana, increased between 1988 and 2014, but this change is not reflected in trends for unwanted fertility. A look at data for married women in Kenya illustrates the discrepancies within the group that may explain this result; see Figure 3-6. Use of mod-

images

FIGURE 3-6 Contraceptive use among Kenyan married women by education level and wealth.
NOTE: Y axis indicates percentage using modern contraceptives.
SOURCE: Ndugga (2015).

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

ern contraceptive methods has increased more among rural than among urban women in both countries, Ndugga added, and has stalled among educated and wealthy women in Ghana.4

These data about the two countries highlight a few broad points about behavioral, socioeconomic and demographic, and policy factors that influence fertility, Ndugga concluded. In terms of behaviors, both countries have experienced similar total fertility trends, despite differences in contraceptive use and levels and patterns. While ages at first sexual experience and at marriage have increased, married and unmarried women still have long periods of nonuse of contraceptives. Ghana has lower rates of both wanted and unwanted fertility.

In terms of demographic factors, poor, uneducated, and rural Kenyan women have high TFRs, low contraceptive use, and high unmet need for contraceptives, in comparison with other groups in both countries. TFRs and modern contraceptive use have stalled among urban educated and wealthier women in Ghana, while they have increased among rural women there.

Both countries have established multiple policies and programs designed to reduce fertility, Ndugga noted, but implementation has not been effective enough to allow the programs to achieve desired results. Both countries rely on donor funding to implement their strategies, and major funding gaps have hampered thorough implementation. The mix of methods is likely not sufficient to meet women’s needs in either country, Ndugga concluded—in particular those of poor rural women in Kenya and wealthy urban women in Ghana.

DISCUSSION

Discussion of these presentations covered a range of issues and questions, many relating to what can be inferred from survey results. In response to points raised in the discussion, several presenters suggested that more detailed research to explore the meaning of survey data on fertility desires and other issues would be useful. One person suggested that it is not clear from the DHS data exactly what women mean when they say they do not want any more children. On the other hand, it was observed that over the years such data points have proven to have a lot of validity and reliability—and that African respondents have consistently shown very high demand for children, in comparison with respondents in other regions.

___________________

4Modern contraceptive methods include birth control pills, patches, injections, and implants; intrauterine devices; and sterilization. Traditional methods include the calendar or rhythm method and withdrawal. See Chapter 4.

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×

Another participant suggested that survey data may disguise variation in views across the sub-Saharan region and that if this variation were better understood, then the idea that African countries as a group are “exceptional” would be undermined. A related point was that Latin American countries have seen significant fertility declines even though age at first marriage and even age at first birth in those countries have not declined nearly as much—a point that highlights the importance of understanding the context and meaning of survey responses.

Another participant suggested that women may not always choose to be candid in response to questions about their contraceptive use and that researchers need to find additional means to understand their views. For example, this participant noted that Ghana appears to have achieved significant declines in fertility rates even though women there appear to be quite resistant to modern contraceptive methods. Others noted that donors are heavily focused on modern methods, but that heavy use of traditional methods, emergency contraceptives, and abortion in some places indicate that other approaches may need greater attention.

Mbacké provided comments on the presentations. With respect to the discussion of fertility desires, he agreed that the meaning of changes in people’s responses to surveys could be better understood. He noted that the framing of survey questions has changed over time and may not fully capture people’s actual thinking. As recently as 1990, for example, very high percentages of survey respondents indicated that family size is “up to God,” but that option is no longer included in surveys, and that few are asked about “unwanted births.” “We are sometimes asking questions and interpreting answers in our own way,” he said, adding the questions are sometimes answered by persons who do not fully understand the context. Fertility desires are “very fluid,” he added, so basing models on them may be problematic.

Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 21
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 22
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 23
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 24
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 25
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 26
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 27
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 28
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 29
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 30
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 31
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 32
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 33
Suggested Citation:"3 Trends in Reproductive Behavior." National Academies of Sciences, Engineering, and Medicine. 2016. Recent Fertility Trends in Sub-Saharan Africa: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21857.
×
Page 34
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Fertility rates and population growth influence economic development. The marked declines in fertility seen in some developing nations have been accompanied by slowing population growth, which in turn provided a window of opportunity for rapid economic growth. For many sub-Saharan African nations, this window has not yet opened because fertility rates have not declined as rapidly there as elsewhere.

Fertility rates in many sub-Saharan African countries are high: the total rate for the region is estimated to be 5.1 births per woman, and rates that had begun to decline in many countries in the region have stalled. High rates of fertility in these countries are likely to contribute to continued rapid population growth: the United Nations projects that the region's population will increase by 1.2 billion by 2050, the highest growth among the regions for which there are projections.

In June 2015, the Committee on Population organized a workshop to explore fertility trends and the factors that have influenced them. The workshop committee was asked to explore history and trends related to fertility, proximate determinants and other influences, the status and impact of family planning programs, and prospects for further reducing fertility rates. This study will help donors, researchers, and policy makers better understand the factors that may explain the slow pace of fertility decline in this region, and develop methods to improve family planning in sub-Saharan Africa.

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