Kenya Enters the Fertility Transition

Contraceptive prevalence is rising and fertility is falling in Kenya, and the speed with which these changes are occurring suggests that Kenya has passed a turning point and entered a transition. In this paper the author explores these recent trends with data from the 1989 Kenya Demographic Health Survey and several other small-scale surveys and qualitative research studies. Underlying the changed contraceptive – fertility behaviour, there appears to have been a major shift in attitudes regarding desired family size. In the second part of the paper the earlier almost universally pessimistic predictions regarding fertility in Kenya, which now appear to have been wrong are considered. Since Kenya has emerged as a bellwether among sub-saharan African states, these earlier predictions are re-examined with a view to learning from their mistakes. It is concluded that incorrect theoretical paradigms and assumptions led to the erroneous results, rather more than incorrect data, or analysis.     

Regional variation in acceptance of Indonesia's family planning program

Indonesia's family planning program is regarded as a major success.Survey data from 1997 reveal that rates of contraceptive use vary dramatically amongIndonesia's 27 provinces, from a high of 67 percent of ever married women currently using contraceptives in the province of North Sulawesi, to a low of 19 percent current users in East Timor and28 percent in Aceh. This study uses both a quantitative analysis of the 1997 Indonesia Demographic and Health Survey, and a qualitative study carried out in July of 2000 to understand regionalvariation. The study identified a small number of factors that show a clear relation with levels of contraceptive use. Media exposure and education are the strongest and most consistent predictors of levels of contraceptive use, and appear to be the surest strategies for promoting family change. But the study also showed that the process of social change is subjectto culturally and historically specific local factors whose presence and importance is difficult to predict. Our study of regional variation in contraceptive use illustrates the range and complexityof obstacles faced by Indonesia's leaders in attempting to forge a single nation fromsuch a diverse and far-flung population. Although the creation of Indonesia in the space of just half a century is a monumental achievement, the project is clearly not yet complete.     

中国生殖健康方案的推进和已婚育龄人口避孕模式转变——ICPD 10:避孕方法的医控模式和自控模式有变化吗

避孕节育是生殖健康极为重要的内容。文章利用国家人口和计划生育委员会1988年至2001年全国生育节育抽样调查和全国计划生育/生殖健康调查数据,分析了已婚育龄人口在避孕模式上的时空变化特征,在此基础上进一步研究了在已婚育龄人口的年龄、子女数和生活的不同区域环境等方面避孕模式的时空变化。结果表明,在我国人口转变的过程中,低生育水平下的避孕模式以及推行避孕节育知情选择后已婚育龄人口的避孕模式,特别是医院控制的避孕方法与自己控制的避孕方法的构成已经发生了变化,有必要进一步改善生殖健康服务的技术服务等。     

First Politics,Then Culture: Accounting for Ethnic Differences in Demographic Behavior in Kenya

Ethnic differences in demographic behavior tend to be disguised behind analytically opaque labels like “district” or “region,” or else subjected to simplistic cultural explanations. Drawing on new political economy, sociological theory and the political science literature on sub‐Saharan Africa, this article proposes an alternative explanatory model and tests it empirically with reference to Kenya. Access to political power and, through power, access to a state's resources—including resources devoted to clinics, schools, labor opportunities, and other determinants of demographic behavior—are advanced as the key factors underlying ethnic differences. District‐level estimates of “political capital” are introduced and merged with two waves of Demographic and Health Survey data. The effects on models of contraceptive use are explored. Results confirm that measures of political capital explain residual ethnic differences in use, providing strong support for a political approach to the analysis of demographic behavior.     

The determinants of the duration of contraceptive use in China: A multilevel multinomial discrete-hazards mdeling approach

Often in demography, individuals may change state over time for a variety of reasons. Competing-risks hazards models have been developed to model such situations. This paper describes the extension of the discrete-time competing-risks hazards model to a multilevel framework that allows for data at different levels of aggregation. The model is illustrated with data from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence, which collected complete contraceptive histories. Women may stop using a method of contraception for a number of reasons; this paper describes how one can control for correlations between the outcomes of repeated spells of contraceptive use.     

Community availability of contraceptives and family limitation

This study examines the impact of contraceptive service availability on contraceptive use in Korea, Mexico, and Bangladesh. Using World Fertility Survey Data on once-married females and their communities of residence, the mutivariate analysis finds that the community level of contraceptive availability directly affects the likelihood of current use, net of the effects of community development, education, parity, and marital duration. The results are supportive of the recent policy emphasis on maximizing the geographic availability of contraceptive services.     

Fertility in Kenya and Uganda: a comparative study of trends and determinants

Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent, from some eight births per woman to around five. During the same period, fertility in Uganda declined by less than 10 per cent. An analysis of the proximate determinants shows that the difference was due primarily to greater contraceptive use in Kenya, though in Uganda there was also a reduction in pathological sterility. The Demographic and Health Surveys show that women in Kenya wanted fewer children than those in Uganda, but that in Uganda there was also a greater unmet need for contraception. We suggest that these differences may be attributed, in part at least, first, to the divergent paths of economic development followed by the two countries after Independence; and, second, to the Kenya Government's active promotion of family planning through the health services, which the Uganda Government did not promote until 1995.     

Strength of fertility motivation and contraceptive use in Nepal

The study's purpose was to test whether new survey questions on strength of fertility motivation, included in Nepal's 1986 Fertility and Family Planning Survey, enable improved prediction of current contraceptive use. Intent to use contraception in the future was also tested, over and above the effects of socioeconomic background. While controlling selected demographic and socioeconomic background characteristics of the respondents, the authors found the effect of the strength of fertility motivation on current contraceptive use to be substantial and highly significant statistically. Nevertheless, the background factors largely captured the effect of motivational strength on current use when motivational strength was deleted from the model, inasmuch as measures of global fit declined only slightly as a consequence of the deletion. These findings indicate that respondents' demographic and socioeconomic background characteristics affect motivational strength, so that motivational strength does not have a large independent effect on use. These results raise the question of whether strength of fertility motivation can be affected by educational efforts mounted by family planning programs to increase contraceptive use. The analysis shows that strength of motivation does have some independent effect on contraceptive use, and it is quite possible that this independent effect could be enhanced by educational programs operating independently of the socioeconomic characteristics of program recipients. Because the 1986 survey lacks relevant data, we have not been able to explore this possibility empirically.     

Fertility in Kenya and Uganda: A comparative study of trends and determinants

Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent, from some eight births per woman to around five. During the same period, fertility in Uganda declined by less than 10 per cent. An analysis of the proximate determinants shows that the difference was due primarily to greater contraceptive use in Kenya, though in Uganda there was also a reduction in pathological sterility. The Demographic and Health Surveys show that women in Kenya wanted fewer children than those in Uganda, but that in Uganda there was also a greater unmet need for contraception. We suggest that these differences may be attributed, in part at least, first, to the divergent paths of economic development followed by the two countries after Independence; and, second, to the Kenya Government's active promotion of family planning through the health services, which the Uganda Government did not promote until 1995.     

Does Contraceptive Use Always Reduce Breast-feeding?

Previous studies suggest that access to modern contraceptives can reduce breast-feeding rates because women who had been using breast-feeding to avoid pregnancy substitute away from it. This article shows that contraceptive use can also have a positive effect on breast-feeding. A mother often weans a child if she becomes pregnant again, which can occur sooner than desired if she lacks access to contraceptives. Thus, by enabling longer birth spacing and preventing unwanted pregnancies, contraceptive use allows for a longer duration of breast-feeding. This positive effect should primarily affect infants who are past the first few months of life because their mothers are more fecund then, and the negative effect should affect infants who are very young because the contraceptive property of breast-feeding is strongest then. I test for these dual effects using Demographic and Health Survey data for Indonesia. I find evidence of the positive birth-spacing effect: contraceptive use increases the likelihood that children continue to be breast-fed past age 1. There is also suggestive evidence of a negative substitution effect among infants age 3 months and younger.     

Contraceptive Initiation Patterns in Thailand

Data from the Thailand Demographic and Health Survey permit a detailed examination of the pattern of contraceptive initiation in terms both of first post-marital contraceptive use and initiation of use following childbirth. A clear trend towards beginning contraception earlier in the family-building process over the course of the fertility transition is evident. During the earliest stage, contraception was first used mainly after a couple had already achieved their desired family size, but later on couples increasingly began use in order to space births, and most recently it has become common to begin use to delay the start of childbearing. There are two distinctive patterns of contraceptive initiation following childbirth. For women who chose sterilization, initiation occurs during the immediate post partum period, while for those who used other methods, use most commonly began shortly after the return of menses. As a result, few Thai women are at present unprotected against unplanned pregnancies for any substantial period of risk following childbirth. Beginning to use contraception early in the family-building process and rapid adoption of contraception following childbirth are now found in most segments of Thai society, testifying to the maturing of Tailand's fertility transition.     

Recent trends in Tanzanian fertility

This paper provides an assessment of the nature and magnitude of Tanzania's recent fertility decline, using robust methods for the identification of fertility trends. A decline in Tanzanian fertility began some time in the late 1970s or early 1980s. The pattern of decline exhibits similarities to patterns identified some years ago in Zimbabwe and Kenya. The decline has been especially marked in urban areas. It has been accompanied by a rapid rise in contraceptive prevalence from the very low levels before 1990 to just under 20 per cent of currently married women of reproductive age. Although falling marital fertility associated with a rise in contraceptive use is the main contributor to the decline in fertility, a rise in the average age at marriage has also made a (smaller) contribution, as has the AIDS epidemic. The fact that fertility is declining in Tanzania raises questions about the social and economic requirements for fertility transitions to begin in sub-Saharan Africa.     

Sex preference and fertility: what is the link?

It is argued that investment in programs for changing attitudes toward sex preference may not have the greatest impact on reducing fertility or increasing fertility control. Arnold's new method of analysis of determining sex preference was applied to data from a 1977 Egyptian survey of 36,000 rural households in Menoufia Governorate. Findings indicated that couples increased their use of modern contraceptives in direct proportion to an increase in the number of sons. Arnold determined that a large majority of all couples would have at least one boy early in their childbearing years. Thus sex preference would not have a large effect on fertility. Arnold's analysis among 27 countries found that without any sex preference, contraceptive usage would increase by an average of less than 3.7 percentage points. Arnold found that sex preference was strongest in Asia, particularly in South Korea and Taiwan that already have reduced fertility levels. In Africa, where fertility is high, the total elimination of sex preference would have only a 2.9 percentage point difference in contraceptive use. Sex preference had small effects on the percent of women who practice contraception, the percent who desire no more children, and the average number of additional children wanted. For example, in Bangladesh having no sex preference would show a percentage difference of 1.6 percentage points for contraceptive use, 4.7 percentage points difference for women desiring no more children, and -0.1 percentage point difference for the average number of additional children wanted. The effect of having no sex preference was strongest in India compared with Bangladesh, Indonesia, Nepal, the Philippines, Thailand, Ghana, Kenya, Costa Rica, Haiti, Paraguay, and Peru. The effect of no sex preference in India would have the respective percentage point effect of 3.7, 8.9, and -0.2. Public policy should be directed to information, education, and communication with other social goals.     

Individual and community effects of women's education and autonomy on contraceptive use in India

This study makes use of the National Family Health Survey of 1998-99 to investigate whether differences in women's autonomy can explain much of the relationship between education and contraceptive use among married Indian women with at least one child. The analyses show that a woman's education does not influence her contraceptive use through a strengthening of her position in relation to that of men, but that the inclusion of a simple indicator of her general knowledge reduces education effects appreciably. Further, the average educational level of other women in the census-enumeration area has an effect on a woman's contraceptive use above and beyond that of her own education. This effect cannot be explained by the specific indicators of autonomy, but can to some extent be explained by the son preference of the community. The latter is a more general autonomy indicator that may also pick up other contextual factors.     

Estimating unmet need for contraception by district within Ghana: an application of small-area estimation techniques

The importance of meeting the unmet need for contraception is nowhere more urgent than in the countries of sub-Saharan Africa, where the fertility decline is stalling and total unmet need exceeds 30 per cent among married women. In Ghana, where fertility levels vary considerably, demographic information at sub-national level is essential for building effective family planning programmes. We used small-area estimation techniques, linking data from the 2003 Ghana Demographic and Health Survey to the 2000 Ghana Population and Housing Census, to derive district-level estimates of contraceptive use and unmet need for contraception. The results show considerable variation between districts in contraceptive use and unmet need. The prevalence of contraceptive use varies from 4.1 to 41.7 per cent, while that of the use of modern methods varies from 4.0 to 34.8 per cent. The findings identify districts where family planning programmes need to be strengthened.     

Is breast-feeding a substitute for contraception in family planning?

Using data from the Cebu Longitudinal Health and Nutrition Survey, I disentangle the complex interrelationship between breast-feeding, postpartum amenorrhea, and choice of contraceptive method. I find evidence that women substitute breast-feeding for contraception. Further, endogeneity bias, if not controlled, would cause the relationship to be slightly overstated. In addition, the results suggest that although increased education and income result in decreased breast-feeding, any effect on fertility will be offset by changes in contraceptive use.     

Adolescent Contraceptive Method Choices

This article analyzes determinants of contraceptive method choices among adolescent women in the United States. By using data from the 1982 National Survey of Family Growth, we examined factors that differentiate users of various methods early in the sexual careers of teenaged women. We find that patterns of method choice not only vary by race and region within the United States but also change over the teenager's life course. In addition, among teenagers who did not use a method at first sex, the likelihood of adopting a method soon thereafter was low for both whites and blacks and was unaffected by social structural characteristics.     

Reducing unsafe abortion in Kenya

In Kenya, where abortion is permitted only to save a woman's life, unsafe abortion accounts for over one-third of maternal deaths and hospital emergency rooms are overcrowded with women suffering complications of induced and spontaneous abortions. Postabortion care, a service linking emergency treatment of abortion complications with family planning counseling and comprehensive reproductive health care, is under review by the Population Council as a method of reducing maternal mortality and morbidity as well as the incidence of repeat unsafe abortion. An operations research study conducted by the Kenyan Ministry of Health identified several obstacles to such care: lack of information on abortion management, limited service provider skills, inconsistent supplies, and a lack of empathy for women presenting with incomplete abortion. Although 86% of abortion patients from 6 Kenyan hospitals expressed an interest in contraceptive counseling, only 5% reported actually receiving such information. As part of the operations research, these 6 hospitals introduced postabortion care, including, in 3 hospitals, use of manual vacuum aspiration. All 6 hospitals provided contraceptive counseling and psychosocial support. Based on the success of this experience, the Ministry of Health is considering introducing postabortion care to all hospitals in Kenya.     

Individual and community effects of women's education and autonomy on contraceptive use in India

This study makes use of the National Family Health Survey of 1998‐99 to investigate whether differences in women's autonomy can explain much of the relationship between education and contraceptive use among married Indian women with at least one child. The analyses show that a woman's education does not influence her contraceptive use through a strengthening of her position in relation to that of men, but that the inclusion of a simple indicator of her general knowledge reduces education effects appreciably. Further, the average educational level of other women in the census‐enumeration area has an effect on a woman's contraceptive use above and beyond that of her own education. This effect cannot be explained by the specific indicators of autonomy, but can to some extent be explained by the son preference of the community. The latter is a more general autonomy indicator that may also pick up other contextual factors.     

A multilevel model of family planning availability and contraceptive use in rural Thailand

This paper assesses the ways in which the availability of family planning program outlets influences the likelihood of contraceptive use in rural Thailand. It focuses on a village-level measure of actual availability of sources rather than respondent perceptions of availability. Individuallevel and village-level data collected as part of the second Thailand Contraceptive Prevalence Survey are used to test three hypotheses about the effects of actual availability: that (a) availability of family planning outlets increases the likelihood of contraceptive use; (b) it enhances the effect of a desire for no more children on the likelihood of use; and (c) it weakens the positive relationship between education and the likelihood of use.