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Modelling strategic interventions in a population with a total fertility rate of 8.3: a cross-sectional study of Idjwi Island, DRC.

Thomson DR, Hadley MB, Greenough PG, Castro MC - BMC Public Health (2012)

Bottom Line: Over half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired.We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children.Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Harvard Medical School, Boston, MA 02115, USA. dana_thomson@hms.harvard.edu

ABSTRACT

Background: Idjwi, an island of approximately 220,000 people, is located in eastern DRC and functions semi-autonomously under the governance of two kings (mwamis). At more than 8 live births per woman, Idjwi has one of the highest total fertility rates (TFRs) in the world. Rapid population growth has led to widespread environmental degradation and food insecurity. Meanwhile family planning services are largely unavailable.

Methods: At the invitation of local leaders, we conducted a representative survey of 2,078 households in accordance with MEASURE DHS protocols, and performed ethnographic interviews and focus groups with key informants and vulnerable subpopulations. Modelling proximate determinates of fertility, we evaluated how the introduction of contraceptives and/or extended periods of breastfeeding could reduce the TFR.

Results: Over half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired. We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children. Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.

Conclusions: To meet women's need and desire for fertility control, we recommend adding family planning services at health centers with NGO support, pursuing a community health worker program, promoting extended breastfeeding, and implementing programs to end sexual- and gender-based violence toward women.

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Historical population trend, Idjwi, DRC.
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Figure 2: Historical population trend, Idjwi, DRC.

Mentions: Limited demographic data show alarming population trends for Idjwi over the last century. Consistently high fertility and immigration, combined with the island’s fertile soil and regular rainfall (55 ± 8 inches annually) [5] supported annual population growth rates ranging from 2.9% to 3.3% between 1929 and 1994 (Figure 2) [5,13]. In the 1950s, TFR in South Kivu province was 8.5, and it has remained high since [14]. During the 1994 Rwandan Genocide, Idjwi’s population increased 41% when 46,000 Rwandan refugees, mostly women and children, fled to the island [13]. Since the mid-1990’s, many Congolese have also moved to Idjwi fleeing the conflict in mainland DRC. In 2001, LandScan population estimates put Idjwi’s population just under 180,000 [15]. Based on these trends and an annual growth rate of 2.2% since 1994, we estimated Idjwi’s population to be approximately 220,000 in 2010. Satellite imagery from 2009 [16] and field observations in 2010–2012 revealed extensive deforestation.


Modelling strategic interventions in a population with a total fertility rate of 8.3: a cross-sectional study of Idjwi Island, DRC.

Thomson DR, Hadley MB, Greenough PG, Castro MC - BMC Public Health (2012)

Historical population trend, Idjwi, DRC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3526584&req=5

Figure 2: Historical population trend, Idjwi, DRC.
Mentions: Limited demographic data show alarming population trends for Idjwi over the last century. Consistently high fertility and immigration, combined with the island’s fertile soil and regular rainfall (55 ± 8 inches annually) [5] supported annual population growth rates ranging from 2.9% to 3.3% between 1929 and 1994 (Figure 2) [5,13]. In the 1950s, TFR in South Kivu province was 8.5, and it has remained high since [14]. During the 1994 Rwandan Genocide, Idjwi’s population increased 41% when 46,000 Rwandan refugees, mostly women and children, fled to the island [13]. Since the mid-1990’s, many Congolese have also moved to Idjwi fleeing the conflict in mainland DRC. In 2001, LandScan population estimates put Idjwi’s population just under 180,000 [15]. Based on these trends and an annual growth rate of 2.2% since 1994, we estimated Idjwi’s population to be approximately 220,000 in 2010. Satellite imagery from 2009 [16] and field observations in 2010–2012 revealed extensive deforestation.

Bottom Line: Over half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired.We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children.Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Harvard Medical School, Boston, MA 02115, USA. dana_thomson@hms.harvard.edu

ABSTRACT

Background: Idjwi, an island of approximately 220,000 people, is located in eastern DRC and functions semi-autonomously under the governance of two kings (mwamis). At more than 8 live births per woman, Idjwi has one of the highest total fertility rates (TFRs) in the world. Rapid population growth has led to widespread environmental degradation and food insecurity. Meanwhile family planning services are largely unavailable.

Methods: At the invitation of local leaders, we conducted a representative survey of 2,078 households in accordance with MEASURE DHS protocols, and performed ethnographic interviews and focus groups with key informants and vulnerable subpopulations. Modelling proximate determinates of fertility, we evaluated how the introduction of contraceptives and/or extended periods of breastfeeding could reduce the TFR.

Results: Over half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired. We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children. Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.

Conclusions: To meet women's need and desire for fertility control, we recommend adding family planning services at health centers with NGO support, pursuing a community health worker program, promoting extended breastfeeding, and implementing programs to end sexual- and gender-based violence toward women.

Show MeSH
Related in: MedlinePlus