Post on 15-Jan-2016
Factors Behind Recent Fertility Plateauing in Jordan
&Challenges to Maintaining Future Fertility
Decline
byIssa Almasarweh
Professor – Jordan University
Presentation Outlines
1) Jordan Fertility Trends
2) Jordan Fertility Goals
3) Factors Affecting Fertility Rates
4) Challenges to Sustained Decline in Jordan Fertility
Current TFR in the Region
3.8
3.3 3.2
2.11.9
2.9
2.2 2.1
3.0
0
1
2
3
4
Jordan Oman Syria Israel Turkey Iran Egypt Morocco Tunisia
Bir
ths
per
wom
an
Source: 2011 PRB WPDSSource: 2011 PRB WPDS
Jordan Fertility Level is Plateauing
5.96.6
6.1
3.83.73.6
0
1
2
3
4
5
6
7
2002 2007 2009
Birt
hs p
er W
oman
Completed
TFR
DHSDHS
Wanted Fertility Increased
3.0
2.6 2.8
0
1
2
3
4
2002 2007 2009
Birt
hs p
er W
oman WTFR
DHSDHS
Early progression to first child
0%
20%
40%
60%
80%
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Months Since Marriage
Hav
e T
hei
r 1s
t C
hil
d
2009 DHS
Fertility – a key component in Jordan future PG
226,000
190,000
140,000
160,000
180,000
200,000
220,000
240,000
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Birth
s
3 million born in the last 20 years
2.3 are expected in the next 10 years
RECENT09 ConstantRECENT09 Constant
Reducing Fertility is a National Priority Goal for Jordan
3.83.5
3.0
2.5
2.1
0
1
2
3
4
2009 2012 2017 2025 2030
Births per couple
RHAP2RHAP2
Direct Factors Affecting Fertility Rate
1) % of women 15-49 married
2) Contraceptive use
3) Postpartum insusceptibility
4) Induced abortion 5) Infertility
Fertility
(1 )Marriage - % of Women 15-49 Ever-married
59
54
57
40
45
50
55
60
2002 2007 2009
DHSDHS
% Ever-married below the age of 30 years
0
15
30
45
60
75
15-19 20-24 25-29
2002 2009
2002 & 2009 DHS
High Growth in Number of First Time Brides )4.3% annually(
10000
20000
30000
40000
50000
60000
2002 2009
http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf
Early Marriages<18= 14% of total 1st time brides
15-19= 30% of total 1st time brides
0
3000
6000
9000
12000
15000
18000
2002 2003 2008 2009
< 18 15- 19
http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf
Age Specific Fertility Rates
0
50
100
150
200
250
15-19 20-24 25-29 30-34 35-39 40-44 45-49
2002 2009
2002 & 2009 DHS
Age Specific Fertility Rates - Urban
0
50
100
150
200
250
15-19 20-24 25-29 30-34 35-39 40-44 45-49
2002 2009
2002 & 2009 DHS
(2 )Contraceptive use has leveled off
10
20
30
40
50
60
2002 2007 2009
%
All Methods
Modern
DHSDHS
Modern CPR by Sector -JCLS
0
5
10
15
20
25
%
GOV. NGOs Total
2002 2010
Based on JCLS
Infertility increased = % of women 45-49 who are childless
0
3
6
9
12
15
%
2002 2009
Ever- married Currently married
Based on JCLS
40
5.6
0
10
20
30
40
50
60
70
1990 1997 2002 2007 2009 2017
0.0
1.5
3.0
4.5
6.0
7.5
Con
trac
epti
ve P
reva
lenc
e R
ate
Total F
ertility Rate
65 %65 %
3.03.0
Contraceptive Use needs to increase!
FertilityFertility PlateauingPlateauing
FamPlan: File RECENT09FamPlan: File RECENT09
Summary – Indexes of direct factors affecting fertility
0.0
0.2
0.4
0.6
0.8
1.0
Contraceptive Use Marriage PPI Infertility
2002 2009
Challenges to raise contraceptive use and reduce fertility
1) Shrinking FP Choices / Access
2) Missed / Lost Opportunities
3) Churning – Discontinuation
4) Others
1( Shrinking Choices / Access
Limited access to permanent & long-acting methods : Female Sterilization, Injectables, Implanon
Dominance of one and provider-based method )IUD(
Unmet preference for female providers )87%(
Disappearance of low-price OCs in the commercial sector
Uncertain role of major FP providers )JAFPP, RMS, Universities Hospitals(
2( Missed Opportunities
At premarital exam At time of signing marriage contract At delivery and postnatal period
• low postnatal return• low postnatal counseling• no immediate IUDs insertion after delivery )providers
fear of expulsion or lack training( At child health care visits At Schools and Colleges At youth centers, clubs, camps At Mosques At Workplace At pharmacies
2( Missing Opportunities
Low demand on available services at SDPs
High downtime at SDPs due to lack of appointment system
Exclusion of FP in private health insurance
Exclusion of important groups: men, newly married, unmarried youth
Unfriendly breastfeeding environment at private hospitals
3( Churning – Discontinuation
High FP discontinuation and failure rates
– Quality of services - informed choice )poor treatment of side effects; inadequate and poor FP counseling(
– High use of traditional methods
– Unsatisfied users )20% want another method(
– Son Preference
– Family pressure )63% - 2007 DHS(
1st Year Discontinuation Rate )%(
4245
0
10
20
30
40
50
2002 2009
Reasons for Discontinuation
Method Failure 10 %
To Become Pregnant 9 %
Switched to Modern 10 %
Switched to Traditional 5 %
Stopped Using 8%
42 %42 %
Source: Contraceptive Dynamics Study
Unmet need for FP use
Using59%
Not Using30%
Not using but want no more
children or delay next child
11%
Source : 2009 DHS
TFR and Unmet Need and Discontinuation
3.10
3.80
3.39
0
1
2
3
4
Current 50% Reduction in UnmetNeed
50% Reduction in UnmetNeed and Failure Rate
Birt
hs p
er W
oman
HPC, 2011, Reducing Discontinuation of Contraceptive Use and Unmet Need for FP, policy BriefsHPC, 2011, Reducing Discontinuation of Contraceptive Use and Unmet Need for FP, policy Briefs
4( Other Challenges
Population Momentum – more than one million girl child exists now
• Number of women 15-49 years will increase from 1.6 to 2.0 million by 2020
• The impact of this is shown in the next slide
Projected Contraceptive Users )all methods(
250,000
500,000
750,000
2010 2020
MWRA Growth NPS
Current Users
19 %
FamPlan: Files RECENT09 & RECENT09 ConstantFamPlan: Files RECENT09 & RECENT09 Constant
42 %
4( Other Challenges
Divided civil society- politicalization of issues
Distortion of market forces through subsidies may delay the rationalization of childbearing decision by parents
Abuse of maternity leave by public sector servants