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What do we know about women with an intent to limit? Lynn Bakamjian, EngenderHealth Consultant Patricia MacDonald, USAID Photo by E. Uphoff / EngenderHealth For Those Who’ve Had Enough: Acknowledgements Funding from USAID under RESPOND Project Melanie Yahner – EngenderHealth Lynn Van Lith – Johns Hopkins Bloomberg School of Public Health Center for Communication Programs Emily Sonneveldt – Futures Institute What does the literature say? The proportion of women who want no more children is a strong predictor of CPR and TFR (Westoff & Bankole, 2000) Fertility intention (for both spacing and limiting) is an important predictor of reproductive behavior (Islam et al, 2003; Roy et al, 2003) Increasing contraceptive use among limiters reduces high-parity births and maternal mortality (Stover & Ross, 2009) Secondary DHS Analysis Country Survey Year Benin 2006 Cameroon 2004 Ghana 2009 Kenya 2003 Lesotho 2004 Madagascar 2009 Malawi 2004 Namibia 2007 Rwanda 2005 & 2007/8 Senegal 2006 Swaziland 2007 Tanzania 2005 Uganda 2006 Zambia 2007 Zimbabwe 2006 15 African countries with DHS surveys after 2000 Part of larger global secondary analysis of 37 countries Countries excluded if LA or PM method use was >25 All women 15-49 included— analysis done using STATA & SPSS Married women of reproductive age with unmet need 0% Unmet need to space Unmet need to limit Zimbabwe 2005/06 Zambia 2007 Uganda 2006 Tanzania 2004/05 Swaziland 2006/07 Senegal 2005 Rwanda 2005 Namibia 2006/07 Malawi 2004 Madagascar 2008/09 Lesotho 2004 Kenya 2003 Ghana 2008 Cameroon 2004 Benin 2006 Unmet need for limiting versus spacing 100% 80% 60% 40% 20% 0 Unmet need to limit Zimbabwe Zambia Uganda Tanzania Swaziland Senegal Rwanda Namibia Malawi Madagascar Lesotho Kenya Ghana Cameroon Benin Unmet need for limiting among postpartum women 20 15 10 5 Demand for Limiting Many assume Africa has low demand for limiting—data suggest otherwise – 20.4% women in Anglophone Africa wanted no more children at last birth – Despite generally high fertility desires, data suggest many women do indeed have need to limit Photo by W. Betemariam / EngenderHealth Demand for limiting has remained strong or increased in nearly all analysis countries over past 20 years Increasing Trends in Demand for Limiting Desire to limit births 60 50 30 20 10 0 19 86 19 87 19 88 19 89 19 90 19 91 19 92 19 93 19 94 19 95 19 96 19 97 19 98 19 99 20 00 20 01 20 02 20 03 20 04 20 05 20 06 20 07 20 08 20 09 MWRA 40 Benin Cameroon Ghana Kenya Madagascar Malawi Rwanda Senegal Tanzania Uganda Zambia Zimbabwe Namibia Younger African Women Want to Limit As age increases, demand to limit begins to exceed demand to space Demand to limit “crossover” begins at: – 31.3 years in AA – 34.3 in FA Demand for limiting often associated with older women, however, demand to limit exists among younger women Namibia: 31.7% of MWRA 15-29 have a demand for limiting Lesotho: 26.37% Kenya: 14.43% Malawi: 12.77% Pattern not limited Southern Africa Counters claim that only older high-parity MWRA have demand for limiting Photo by N. Rajani / EngenderHealth – – – – – “Crossover Age” decreases as CPR increases Age at which demand for limiting meets or exceeds demand for spacing 50 Age 40 30 20 10 0 0 10 20 30 Modern CPR 40 50 60 Limiters using traditional and short-acting methods Family planning use and non-use among women with a demand to limit births 60% 50% 30% 20% 10% Permanent Long-acting Short-acting Traditional a Zi m ba bw e Le so th o N am ib ia Sw az ila nd en y K ar as c ag da ga n M ad U aw i M al na G ha m bi a Za w an da n R en i B er oo n Ta nz an ia C am ne g al 0% Se MWRA 40% Unmet need for limiting African Women Exceeding Desired Parity Mean and ideal parity among permanent method users 8 7 6 5 4 3 2 1 Mean ideal parity Mean parity bw e Zi m ba m bi a Za da ga n U ni a nz a Ta ila nd al Sw az ne g Se da w an R N am ib ia aw i M al ar as c ag M ad so th o Le a en y K na G ha er oo n am C B en i n 0 Conclusions: Profile of Limiters in Africa Unmet need for limiting exists in Africa Younger cohorts desire to limit future childbearing Large # exceed desired fertility Remember….spacers eventually become limiters Photo by C. Svingen / EngenderHealth Demand for limiting exists in Africa How will FP programs respond to their needs?