Making sense of Tanzania's fertility: the role of contraceptive use

Contraceptive use has been identified as one of the primary factors contributing to fertility decline; however, the link between contraception use and fertility is weaker and less understood in sub-Saharan Africa. For example, despite a large increase in the contraceptive prevalence rate (CPR) in Tanzania since the early 1990s, its total fertility rate (TFR) has remained high. There has been little research on the impact of method mix in this relationship. An understanding of the dynamics of the relationship between contraceptive use, method mix and fertility would provide an important evidence to advocate and plan for future scale-up of and investment in family planning programs. Main question/hypothesis What role has changes in contraceptive use and method mix played in determining fertility trends and differentials in Tanzania? Methodology (location, study design, data source, time frame, sample size, analysis approach) The study analyzes secondary data from the last three Demographic and Health Surveys (DHS) in Tanzania (1991/2, 1996, 2004/5) and the 199 Reproductive and Child Health Survey. The sample size of women 15-49 ranged from 4,029 to 10,329. Analysis is conducted at the national level and by urban and rural residence. Trends and differentials in TFR and CPR are assessed through calculating absolute and percent changes between surveys and testing for statistical significant changes. Bongaarts’ Proximate Determinants Model is constructed based on three indices: contraception (Cc), postpartum infecundability (Ci), and marriage/cohabitation (Cm). Due to insufficient data, abortion (Ca) is not included. In addition, relationships between variables are assessed using non-parametric Spearman’s correlations. Results/Key Findings The TFR, given CPR, was higher than expected in rural areas; however, the opposite is true in urban areas. To explain possible reasons for these patterns, 12 iterations of Bongaarts’ model were created- national, urban, and rural residence for each survey. Aside from one instance (1999 urban), there was consistency between the predicted and observed TRF, with a slight overestimation of urban TFR and underestimation of rural TFR. This is attributable, in part, to not including unmarried women or abortion. Examining trends in the indices revealed that contraception, although not the largest inhibiting factor, varied the most both overtime and between urban and rural areas, suggesting contraceptive use has played a key role in determining fertility trends and differentials. In rural areas a surprising pattern was found; the proportion of in-union women increased over time. Traditionally the opposite is found due to increases in age of first marriage. Therefore much of the fertility inhibiting gain in rural contraceptive use went to cancelling out resulting increases in Cm. Across the four surveys, urban CPR was consistently double rural CPR. In both urban and rural areas the largest average annual CPR increase happened between the first two surveys (1991/2 to 1996); 18.4% and 16.7% respectively. Between 1999 and 2004/5, the average annual increase slowed to less that 2% in both areas. Changes in method mix mirror those of CPR; a large increase in the use of long-acting methods during the between the first two surveys, followed by relatively small changes to method mix thereafter. This resulted in little change in average use effectiveness post-1996. An attempt to account for the relationship between method mix and fertility produced inconclusive results. This is likely due to how duration and consistency of use are accounted for in measures of average effectiveness. For example, in 2004/5 approximately one-third of in-union women using contraception had used their method for less than six months, while the TFR is measured over a three-year period. Bongaarts’ model was applied to hypothetical future scenarios. Results suggest meeting the existing unmet need could result in TFRs as low as 2.5 in urban areas and 4.0 in rural areas, and meeting the Government’s target of 60% CPR would bring fertility near replacement levels. 5. Knowledge contribution The study has shown that national level measures of CPR and TRF mask important, policy-relevant differential patterns. Specifically, sub-national analysis reveals large and growing differences in these two measures between urban and rural areas, suggesting the importance of focusing programmes and resources to underserved rural communities. The study has also highlight the need for additional research to better understand how consistency and duration of use area factored into measures of method effectiveness. Unmet need remains high in Tanzania (22% in 2004/5), and despite large increases in contraceptive use in the early to mid-1990s, the rate of increase has slowed considerably. The study results provide additional support for efforts to revitalize FP efforts in Tanzania; such as the Government’s National Family Planning Costed Implementation Program (NFPCIP). This is not only vital to respecting individual women’s fertility preferences, but also at a national level will result in slowed population growth and improvements in the development prospects of the country

Polygyny and family planning programs in sub-Saharan Africa: representation and reality

1. Significance/background Polygyny is rarely, if ever, included in family planning (FP) messaging in Sub-Saharan Africa, even though the region has the world’s highest rates of polygyny. In West Africa a majority of women will spend some portion of their married life in a polygynous union as a co-wife. Research on polygyny has tended to focus on the influence of polygyny on outcomes such as fertility preferences and rates and contraceptive use, and there is little consensus as to the direction of these relationships. The role played by polygyny in the design and consumption of FP programs has been ignored. For example, the study of spousal communication about FP has been limited to monogamous couples and there is no model for spousal communication within polygynous marriages. This paper will focus on the ways in which – if at all – polygyny is represented by, or addressed in, family planning programs in sub-Saharan Africa. It assesses the presence (or absence) of polygyny in FP messaging and research and argues that polygynous unions are sufficiently different from monogamous unions to warrant audience segmentation in FP programs in areas with high levels of polygyny. 2. Main question/hypothesis This paper aims to assess the place of polygyny in FP messaging in sub-Saharan Africa, and whether a case should be made for segmentation by marriage type (polygynous/monogamous) in FP communication. It sets out three research questions in order to address this aim: i. Do the FP experiences of men and women differ significantly between monogamous and polygynous marriages? ii. How is polygyny represented in FP messaging? iii. What might be the consequences of excluding polygyny from FP program design and implementation? 3. Methodology This paper uses mixed methods including: i. Systematic mapping of the research relating to polygyny and FP in sub-Saharan Africa ii. Review FP visual communication materials (e.g.: JHU Bloomberg School of Public Health Center for Communication Programs Media/Materials Clearinghouse) for evidence pertaining to polygyny in family planning messaging iii. Secondary quantitative analyses of DHS data Our mapping of current literature reveals little consensus on the relationship between polygyny and fertility. While many studies conclude that individual fertility is lower for polygynous than for monogamous women (although polygyny increases fertility at the aggregate level because fewer women remain unmarried) others report that polygynous women have higher fertility than their monogamous counterparts. Polygyny increases individual male fertility. Our analyses of polygyny and its effects on fertility intentions and behaviors, contraceptive use, and husband-wife communication regarding FP consider whether men and women in polygynous unions face situations different from their monogamous counterparts. By comparing results on FP perceptions, intentions and behaviors of polygynous men and women this those in monogamous marriages, we demonstrate how using conventional models of couples’ analysis (i.e. studying monogamous couples) is inappropriate for researching polygynous unions, which should therefore be specifically segmented and targeted in FP messaging. 4. Results/key findings Polygyny is rarely, if ever, included in FP messaging in Sub-Saharan Africa, even in areas with high rates of polygyny. Polygynous marriages differ from monogamous marriages in a number of crucial ways (greater age difference between polygynous spouses, decreased decision-making power for wives, higher fertility preferences for men, competition for a husband’s resources, and lower spousal communication about FP) that have major implications for FP programs. Polygynous marriages may result in higher fertility preferences for women, longer periods of breast-feeding and post-partum abstinence, and decreased likelihood of contraceptive use and increased likelihood that, if used, it would be clandestinely. While formally recognized polygyny is declining, it is often replaced by unofficial forms of polygynous unions (“private polygyny”). Polygyny may be increasingly replaced by private polygyny because polygyny is now often considered less acceptable or is illegal. Many seemingly monogamous marriages are actually adapted forms of polygyny, with unofficial outside wives. Lastly, polygyny seems to have a strong effect on men’s desired number of children, which are considerably greater than those of both polygynous women and monogamous men or women. Desired high fertility is often given as a reason for marrying polygynously. The implication for this kind of marriage decision on family size and for FP programs is significant. 5. Knowledge Using conventional models of couples’ analysis (i.e. studying monogamous couples) may be inappropriate for researching polygynous unions. Polygyny is often disregarded or misrepresented in research, even when studies are carried out in areas with high rates of polygyny. Men and women in polygynous unions have markedly different experiences than do their monogamous counterparts. Ignoring the reality of polygyny in FP communication has implications for the effectiveness of family planning campaigns in parts of Africa with high rates of official and/or unofficial polygyny. We conclude with suggestions of ways that polygyny might be included in FP messaging in Sub-Saharan Africa

Zambia urged to tackle the stigma of abortion and unwanted pregnancies

Around 43 million abortions are carried out globally each year, 22 million of which are unsafe and mostly confined to developing countries. The latter cause 47,000 unnecessary deaths as well as serious health issues for another five million women. LSE researchers are bringing this to the world’s attention with a major fieldwork project in Zambia

The commodity chain of the household: from survey design to policy and practice

Data collection and analysis and policy formulation all require a social unit to be defined, generally called the household. Multidisciplinary evidence shows that households as defined by survey practitioners often bear little resemblance to lived socio-economic units. This study examines how a shared language, the 'household', can generate misunderstandings because different groups with distinctive understandings of the term 'household' are often unaware that others may be using ‘household’ differently. Results from 4 interlinked and iterative methods are presented: review of household survey documentation (1950s-present); ethnographic ground-truthing fieldwork; in-depth key informant interviews; and modelling. Results show that whereas data collectors have a clear idea of what a `household` is, data users are often unaware of the nuances of the constraints imposed by data collection. This has implications for policy planning and practice. What interviewees consider when they think of their household can differ systematically from data collectors' definitions

Mapping intergenerational care across households in the UK: analysing proximity, propinquity and resources in the "tacit intergenerational contract"

Intergenerational exchanges of care form the backbone of informal care arrangements in the UK. Against a background of cuts in public spending and an increasingly ageing population, the centrality of familial or kinship care, in the provision of everyday or practical intergenerational care (including providing housing, personal care, doing the shopping, providing childcare etc) is an ever more pressing question for policy-makers and ageing professionals. At present, flows of intergenerational care are difficult to capture precisely in surveys enumerated at the household level. In 2011 in the UK, the household was defined as‘one person living alone or a group of people (not necessarily related) living at the same address, who share cooking facilities and share a living room or a sitting room or a dining area’. Within this definition of the household, recognition of transfers of care which transcend the household are lacking. This has implications for recognising the financial, residential and temporal (amongst others) obligations which might tie households together and impact in a very real way on the day-to-day well-being of people at a societal level. Drawing on data gathered from interviews with policy makers and ageing specialists as well as from 36 purposively-sampled household interviews, this paper examines how proximity – the spatial closeness between people – and propinquity – the emotional closeness between people – and access to financial resources - intersect to influence normative familial expectations (e.g.children will contribute to their elderly parents’ care, grandparents can be relied upon to look after grandchildren) intertwine to create a network of intergenerational care that transcends both familial kinship ties and the household itself. Diagrammatically reproducing these relationships with genographs, we outline the heterogeneity of these relationships and suggest how the complexity of day-to-day household arrangements of intergenerational care can better be accounted for at policy level

Gender-based violence and reproductive health in five Indian states

Gender-based violence is a multi-faceted public health problem with numerous consequences for an individual’s physical and mental health and wellbeing. This collection develops a comprehensive public health approach for working with gender-based violence, paying specific attention to international budgets, policies and practice and drawing on a wide selection of empirical studies

Disciplining anthropological demography

This study furthers the epistemological development of anthropological demography, and its role in understanding the demography of Europe. Firstly we situate anthropological demography against the context of an evolving world of research in which boundaries between academic disciplines have become much more permeable. This is achieved via an overview of recent theoretical debates about the role and nature of disciplinarity, including interdisciplinarity, multidisciplinarity and transdisciplinarity. Secondly, in order to understand the current state of the art, we sketch out the evolution of anthropological demography, paying particular attention to the different knowledge claims of anthropology and demography. Finally, we flesh out some of the epistemological and theoretical debates about anthropological demography by sketching out the formative research process of our own work on low fertility in the UK.anthropological demography, anthropology, demography, disciplinarity, epistemology, Europe, interdisciplinarity, low fertility, multidisciplinarity, reproductive decisions