2011 International Conference on Family Planning
29 November–2 December 2011
Francophone countries in West Africa have the highest fertility rates and among the poorest maternal health indicators in the world. Among the many determinants of these high levels are early marriage and childbearing, coupled with large family norms and poor access to critical health services. The majority of the populations in these countries live in rural areas, often subsisting at or below the poverty line; those that do migrate usually move to informal settlements in urban areas that are characterized by extreme poverty and poor health care. They also tend to be the youth, seeking better economic possibilities.
How urbanization, sustained traditional norms and behaviors—including high fertility, polygamy and gender inequities—and poor access to reproductive and maternal health services are affecting fertility preferences, family planning, birth spacing, fertility and maternal health among the youth in these countries is, however, not well understood. In particular, trends in marriage patterns, childbearing and fertility behaviors and family planning use among youth living in urban areas of Francophone West Africa have not been adequately documented; consequently, policy and programmatic responses to address the needs of the youth experiencing urbanization in this region have little evidence for guidance.
Methodology and results
This paper addresses these knowledge gaps by presenting findings from two sources: a secondary analysis of Demographic and Health Surveys (DHS) from six countries in Francophone West Africa (Benin, Burkina Faso, Cameroon, Guinea, Mali and Senegal); and a review of the relevant literature from the region over the past ten years. The analysis, which is currently on-going, will first present descriptions of key fertility events in the lives of youth, and particularly age at first intercourse, age at first union, age at first birth, the duration between current and previous births, and age-specific fertility rates for adolescents (15–19 years) and young adults (20–24 years). Trends over time and between generations will be assessed through comparing these indicators for younger and older age groups of respondents. Urban-rural comparisons are made to identify whether and how programming to meet the reproductive and maternal health needs of the youth should vary by residence. Preliminary analyses suggest that some distinct differences are emerging between urban and rural youth and between countries for many of these indicators; for example, age at first birth has increased over time in urban Senegal, whereas it has become significantly younger in rural Guinea. Our analyses are also disaggregating youth by wealth status and level of education to determine the extent to which these well-known determinants of fertility preference and achievement of fertility intentions are influencing time trends and urban-rural differences. Importantly, differences and time trends in these fertility-related behaviors among married and unmarried youth will be identified, especially among those populations where age at marriage is increasing.
Secondly, we will analyze and compare demand for and use of family planning services, exposure to family planning messages, and the wantedness of the last pregnancy, among married and unmarried adolescents and young adults, again disaggregating by residence, wealth and education. Given the social pressures on newly married women, it is unsurprising that contraceptive use is low among this population, but it is somewhat surprising to find that contraceptive use is much higher and unmet need much lower, among sexually active unmarried youth. Reasons for non-use will be analyzed to determine the role that improving family planning services could play in increasing use and reducing unmet need among the youth. Sources of family planning services appear to vary considerably country by country; although the private sector appears to dominate, and increasingly so, in most countries, in some (e.g. Senegal) the public sector remains the main source of supply. Thirdly, we will consider the role played in this region by two key fertility determinants among youth that are extremely poorly understood—abortion and polygamy. The literature review found very few papers on either topic, both generally and specific to youth, and so this paper will present what limited data exist and will comment on priority areas for further research.
The rapidly increasing numbers of young people under the age of 24 years highlights the importance of addressing fertility norms and behaviors, including family planning, among youth in developing countries; indeed, the adolescent birth rate is one indicator for MDG 5B. Urbanization is a real phenomenon in most African countries, including those in Francophone West Africa, bringing with it often rapidly changing social norms and changing health-related behaviors. The confluence of these trends and their implications for policy and programming around reproductive and maternal health services is not well understood; this paper provides evidence and policy and programmatic recommendation that can guide governments, the private sector and development partners in responding to the growing and diversifying needs of the young people living in urban areas.
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