Presentation: Understanding the Puzzle of High Fertility and High Contraceptive use in Malawi
PRESENTER: Dr. Jesman Chintsanya
The present study seeks to compare, over time, changes (if any) in the proximate determinants of fertility with a view to understanding whether transition to lower fertility has begun in Malawi where a woman’s average number of children has declined by a child, from 6.7 (1992) to 5.7 (2010) children. The slow decline in fertility does not reflect the notable improvement in use of modern contraception among married women (CPR); in fact CPR has increased from 7.4 % (1992) to 42.2 % (2010). The study uses 2000, 2004 and 2010 Malawi Demographic and Health Surveys. In addition, a qualitative study complements the quantitative study to explore the reasons for the slow fertility decline.
The rapid increase in modern contraceptive use is largely because the proportion of young women (aged 15–24) using modern contraceptives doubled between 2000 and 2010. However, the predominant method is injection, which is used for spacing and not for limiting. The key feature of use of sterilisation in Malawi is that it is parity-dependent; women start using it based on the number of children they have already had—typically five—as they have already produced the number of children they want. Even at high parity, women still rely on the injection instead of long-acting and highly effective methods such as the IUD and implants. Fieldwork identified two contexts that lead to the dual existence of high fertility and high contraceptive use. First, the use of contraceptives is intermittent; women would first start using contraceptives after proving fertility, mainly to achieve adequate spacing between pregnancies. Second, women would mull over terminating childbearing altogether because they were worried about marriage breakdown. Hence, they are leaving their reproductive options open for future partnering or in case of child death.
While community-based distribution has made it very convenient for women to access contraceptives, it has not actually changed women’s motivation towards having smaller family sizes.
The conclusion is that a strong family planning distribution programme will work to drive up CPR; but without a multi-sectoral approach to address desired family size and reduce the number of children wanted, the increased CPR will have limited effect on TFR.