New Survey Findings: The Reproductive Revolution Continues

Since 1990, 120 surveys of women (many also including men) have taken place in 71 countries as part of the Demographic and Health Surveys (DHS) and the Reproductive Health Surveys (RHS) programs. These surveys report on contraceptive use, child survival, and other key reproductive health topics. The INFO Project's complete report on its survey findings are available in the latest issue of Population Reports, "New Survey Findings: The Reproductive Revolution Continues," which is available online (http://www.infoforhealth.org/pr/m17/index.shtml) and in pdf format
(http://www.infoforhealth.org/pr/m17/m17.pdf). Summary findings from this issue of Population Reports are presented here.

Fertility fell in almost all developing countries surveyed since 1990, as use of modern contraception rose. These trends continue a long-term change in attitudes and behavior. Findings from more than 100 surveys conducted since 1990 suggest that, as family planning programs have become widespread, more and more people want smaller families, and more succeed in having the size of family that they want.

Contraceptive use and fertility rates vary substantially among developing countries. In a few countries of Asia and Latin America, at least 75% of married women use a contraceptive method—levels equal to those in developed countries. In contrast, in some sub-Saharan African countries, less than 10% of married women use contraception. Fertility rates range from just 2.3 children per woman in Vietnam to 7.2 in Niger (1).

Although fertility is higher and contraceptive use less common in sub-Saharan Africa than elsewhere, surveys suggest that parts of Africa have started down the path already taken in other regions. Fertility fell by more than 1% per year in 9 of 16 sub-Saharan countries with more than one survey since 1990.

Use of contraception: Around the world, more than 600 million married women are using contraception—nearly 500 million in developing countries. Among married women, contraceptive use rose in all but two developing countries
surveyed more than once since 1990 (2). Among unmarried sexually active women, contraceptive use rose in 21 of 25 countries. Four modern contraceptive methods—female sterilization, oral contraceptives, injectables, and IUDs—are the most widely used methods among married women in developing countries. Together they account for almost 75% of all
contraceptive use. Male condoms rank just behind IUDs. Since 1990, use of injectables has increased substantially, and they have become the third most commonly used method in developing countries surveyed.

Reproductive intentions: A growing share of married women do not want any more children. Outside sub-Saharan Africa, nearly 60% of married women surveyed since 1990 want to end childbearing. As new reproductive attitudes spread, the family sizes that women consider ideal are falling (3).

Unmet need: An estimated 105 million married women, about 1 in every 5, have an unmet need for family planning—that is, they are sexually active and want to avoid pregnancy, but are not using contraception. The percentage of women with unmet need fell since 1990, but the number changed little because populations grew (4).

Unmarried youth: In many countries a growing share of unmarried women ages 15 to 24 are sexually active before marriage. These young women increasingly use contraception, and in particular, condoms. Still, many unmarried young women have unintended pregnancies, and many are at risk for HIV/AIDS and other sexually transmitted infections (5).

Child survival and health: Infant and child survival rates improved by nearly 30% in surveyed developing countries as a whole since 1990. But infant and child mortality increased in some sub-Saharan countries, particularly in those hardest hit by the HIV/AIDS epidemic. Few surveyed countries have met the goal set by WHO and UNICEF of immunizing at least 80% of children against the common childhood diseases by 2000 (6).

Maternal health care: In general, the percentage of married women who gave birth in a medical facility increased somewhat since 1990. Nevertheless, in much of North Africa and Asia and in some parts of sub-Saharan Africa,
women are still much more likely to deliver at home than in a medical facility. One-fourth of women surveyed in developing countries received no antenatal care from a skilled attendant during their most recent pregnancy (7).

References:

1. Zlidar, V.M., Gardner, R.. Rutstein, S.O, Morris, L, Goldberg, H.; and Johnson, K. New Survey Findings: The Reproductive Revolution Continues. Population Reports, Series M, No. 17. Baltimore, The Johns Hopkins Bloomberg School of Public Health, The INFO Project, Spring 2003. Available at: http://www.infoforhealth.org/pr/m17/m17chap2_2.shtml. Accessed October 22, 2003.

2. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap2.shtml. Accessed October 22, 2003.

3. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap2_4.shtml. Accessed October 22, 2003.

4. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap6_3.shtml. Accessed October 22, 2003.

5. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap7.shtml. Accessed October 22, 2003.

6. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap8.shtml. Accessed October 22, 2003.

7. Ibid. Available at: http://www.infoforhealth.org/pr/m17/m17chap9.shtml. Accessed October 22, 2003.