Limits...
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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Expected fertility rate under scenarios of contraceptive prevalence and breastfeeding. Both figures show the relationship between contraceptive prevalence, average length of breastfeeding, and fertility. The left figure show these relationships in terms of fertility indices; the right figure shows these relationships in terms of prevalence. Values in the color bands correspond with different levels of TFR. Currently, Idjwi is positioned in the bottom left corner with 8.3 TFR, an estimated 1% contraceptive prevalence (Cu=0.991), and average length of total breastfeeding 10.4 months (Ci=0.812). If an interim goal is to reduce TFR to 6 births per woman, this figure outlines a range of scenarios to achieve that goal including increasing contraceptive prevalence to 30% (Cu=0.715), extending average length of breastfeeding to 21 months (Ci=0.608), or some combination of both such as extending average length of breastfeeding to 15 months (Ci=0.718) and providing contraception to 20% (Cu=0.810) of the Island’s sexually active fecund women.
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Figure 5: Expected fertility rate under scenarios of contraceptive prevalence and breastfeeding. Both figures show the relationship between contraceptive prevalence, average length of breastfeeding, and fertility. The left figure show these relationships in terms of fertility indices; the right figure shows these relationships in terms of prevalence. Values in the color bands correspond with different levels of TFR. Currently, Idjwi is positioned in the bottom left corner with 8.3 TFR, an estimated 1% contraceptive prevalence (Cu=0.991), and average length of total breastfeeding 10.4 months (Ci=0.812). If an interim goal is to reduce TFR to 6 births per woman, this figure outlines a range of scenarios to achieve that goal including increasing contraceptive prevalence to 30% (Cu=0.715), extending average length of breastfeeding to 21 months (Ci=0.608), or some combination of both such as extending average length of breastfeeding to 15 months (Ci=0.718) and providing contraception to 20% (Cu=0.810) of the Island’s sexually active fecund women.

Mentions: Using the proximate determinants framework, we modeled Idjwi’s TFR to be 9.86, which is greater than TFR measured by our survey (8.3). This is likely due to under-estimation of TFR in our sample, as well as some imprecision in our estimates of proximate determinants. Despite these challenges, the model adequately captures the relative impact of each proximate determinant on fertility, which we report (Figure 5). Of the five proximate determinants, fertility is most influenced by the proportion of sexually active women who are unable to become pregnant (Cx=0.668), length of breastfeeding (Ci=0.812), and the proportion of women who are sexually active (Cf=0.874). Induced abortion (Ca=1) and contraceptive prevalence (Cu=0.991) currently play little role in determining fertility. These figures coincide with settings where there are no limits on fertility and contraceptive use is virtually zero [38].


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)

Expected fertility rate under scenarios of contraceptive prevalence and breastfeeding. Both figures show the relationship between contraceptive prevalence, average length of breastfeeding, and fertility. The left figure show these relationships in terms of fertility indices; the right figure shows these relationships in terms of prevalence. Values in the color bands correspond with different levels of TFR. Currently, Idjwi is positioned in the bottom left corner with 8.3 TFR, an estimated 1% contraceptive prevalence (Cu=0.991), and average length of total breastfeeding 10.4 months (Ci=0.812). If an interim goal is to reduce TFR to 6 births per woman, this figure outlines a range of scenarios to achieve that goal including increasing contraceptive prevalence to 30% (Cu=0.715), extending average length of breastfeeding to 21 months (Ci=0.608), or some combination of both such as extending average length of breastfeeding to 15 months (Ci=0.718) and providing contraception to 20% (Cu=0.810) of the Island’s sexually active fecund women.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Expected fertility rate under scenarios of contraceptive prevalence and breastfeeding. Both figures show the relationship between contraceptive prevalence, average length of breastfeeding, and fertility. The left figure show these relationships in terms of fertility indices; the right figure shows these relationships in terms of prevalence. Values in the color bands correspond with different levels of TFR. Currently, Idjwi is positioned in the bottom left corner with 8.3 TFR, an estimated 1% contraceptive prevalence (Cu=0.991), and average length of total breastfeeding 10.4 months (Ci=0.812). If an interim goal is to reduce TFR to 6 births per woman, this figure outlines a range of scenarios to achieve that goal including increasing contraceptive prevalence to 30% (Cu=0.715), extending average length of breastfeeding to 21 months (Ci=0.608), or some combination of both such as extending average length of breastfeeding to 15 months (Ci=0.718) and providing contraception to 20% (Cu=0.810) of the Island’s sexually active fecund women.
Mentions: Using the proximate determinants framework, we modeled Idjwi’s TFR to be 9.86, which is greater than TFR measured by our survey (8.3). This is likely due to under-estimation of TFR in our sample, as well as some imprecision in our estimates of proximate determinants. Despite these challenges, the model adequately captures the relative impact of each proximate determinant on fertility, which we report (Figure 5). Of the five proximate determinants, fertility is most influenced by the proportion of sexually active women who are unable to become pregnant (Cx=0.668), length of breastfeeding (Ci=0.812), and the proportion of women who are sexually active (Cf=0.874). Induced abortion (Ca=1) and contraceptive prevalence (Cu=0.991) currently play little role in determining fertility. These figures coincide with settings where there are no limits on fertility and contraceptive use is virtually zero [38].

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