The fertility rate is projected to fall from the current 6. Government fertility reduction plans include 1 merging family planning and maternal and child health services, 2 sex education in schools, 3 population education, 4 maternity and paternity benefits, and 5 raising the legal marriage age. Abortion for contraception purposes is illegal; sterilization is legal.
Producing children is considered absolutely essential to your identity. One Ugandan in Katine helped explain it to me. He is one of seventeen children in a family in which his father had several wives. That was too many, he said, so he was going to have only five which he believed was a modest number. When I expressed some surprise, he insisted he couldn't have fewer, otherwise people would ask what on earth were he and his wife doing. Was he a real man?
Was she a real woman? Children are a vital part of your identity. This is partly what makes it so difficult when a woman does want to control her fertility. Often her husband is hostile to any form of birth control and she has to do it secretly.
Given the government's stance, access to family planning does not feature significantly in the state health service. Abortion is illegal in Uganda and it is estimated that 1, women die every year in botched illegal terminations. The odds are stacked against a woman getting the help she needs to reduce her pregnancies. It is interesting how many comments on articles about Katine have raised this issue.
Some Westerners see this as a very clearcut issue: have fewer babies and then you will be better off. But the reality is so different: very few women have a choice to take that course. Reducing fertility was achieved in the West over the course of a century of female education, national family planning services and the opening up of job opportunities for women.
These three elements were crucial and all three are inadequate in Uganda. This is why some NGOs argue that the single biggest thing you can do to effect change in the country is to educate women. The best chance of reducing fertility and spacing families is when a woman has some status, the confidence to assert herself so that she can look after her own wellbeing and that of her children. Specifically, the percentage changes in the women aged 15—19, 20—24, 25—29, 30—34, 35—39, 40—44 and 45—49 were; 1.
The percentage of women who had not attained any level of education decreased by 7. Similarly, the percentage of women living in urban areas increased by 3. Regarding wealth quintile, there was slight reduction in the proportion of women in the poorest, poorer, and middle categories and a slight increase in proportion of women in the richer and richest categories. There was a reduction of 2. The proportion of women reached by family planning messages increased by 4.
There was a notable change in contraceptive use. The proportion of women who were currently using any contraceptive increased by 4. Relatedly, there was a 3. Changes in fertility in this study are described by changes in number of children ever born CEB to the women. The results revealed that the MCEB was 4. A Poisson regression offset by the natural logarithm of the current age of women was done for each survey period to find out the factors associated with CEB.
Table 2 reveals that in both and , the women who had attained at least a secondary level of education had a lower MCEB compared with their counterparts. Relatedly, in both and , there was generally higher fertility among rural women compared to their urban counterparts.
The results also indicate that women in the richest wealth quintile had a lower fertility. Female headed households had lower MCEB compared with the male headed households and for the two surveys, currently working women had higher fertility. Women who were in polygamous marriage in both and had higher MCEB compared with their counterparts who were not.
When adjusted for age and marital status, the working status and co-wife status significantly affected number of children ever born only in After adjusting for age and marital status, women who knew any family planning methods in were found to have higher fertility compared with their counterparts who did not have any knowledge.
Furthermore, women who were currently using a contraceptive method had higher fertility compared to those who were not. However, when adjusted for age and marital status, the influence of contraceptive use was not significant for the two surveys.
In both and , the MCEB was lower among women whose age at first sex was reported to be at least 20 years. Relatedly, the results indicate that in both and , fertility was lower among women whose age at first marriage was 20 years or older.
When adjusted for age and marital status; education, place of residence, wealth quintile, sex of household head, age at first sex and family size preference remained significant while contraceptive use was not significant.
Table 2 shows both the crude and adjusted results. Table 3 shows the overall contribution of characteristics and reproductive behavior of the women on the observed variation in number of children ever born. The findings indicate that the overall change in fertility between and was attributed to changing characteristics of women.
Changing reproductive behavior did not contribute significantly to the observed change in fertility. Results of the detailed decomposition presented in Table 4 reveal that the change in fertility was due to changes in age, education level, place of residence, wealth quintile, polygyny, household headship, exposure to family planning messages, contraceptive use, age at first sex, family size preference and age at first marriage.
The significant variables in the model age, education level, place of residence, wealth index, sex of household head, polygyny, exposure to family planning messages, contraceptive use, age at first sex, family size preferences and age at first marriage were tested for confounding. Age was found to be a confounder in the model. The findings indicated that when age was dropped from the model, education was the biggest contributor with Our analysis reveals that of characteristics and reproductive behavior, only changing characteristics of women significantly contributed to the observed change in number of CEB born between and With an increase in the proportion of women who have attained at least a secondary level of education, this study highlights significant declines in fertility.
The nationwide implementation of the Universal Secondary Education Policy in increased the proportion of women who attained at least secondary level of education in The increased attainment of higher level of education could have delayed entry into marriage and also increased the likelihood of using contraceptive methods. This confirms the notion that improvements in education of women is instrumental in fertility decline.
However, this finding partly disagrees with Cai [ 18 ] who in a study conducted in China found that improvement in education had no effect on fertility change. This may partly be due to socioeconomic context differences between Uganda and China as well as the different policies that exist in the two countries.
In China, the strong government intervention in birth control policy could have suppressed variation in fertility. Our findings also point to the need for mechanisms to increase the age at which women marry. The results are in line with other studies that contended that an increase in age at first marriage reduces fertility [ 5 , 19 , 20 ].
This finding also concurs with Beatty [ 1 ] who contended that fertility transition is not likely to begin in a country where age at first marriage for women is still low. An increase in the proportion of women that were exposed to family planning messages between and was found to have contributed to the variation in fertility during the period. The finding suggests that if the population experienced increased exposure to family planning messages, a fertility transition can be facilitated.
Exposure to family planning messages may lead to changes in attitudes towards large families and use of contraceptive methods which in turn lead to adoption of small family norms such as contraceptive use. Appropriate mass media campaigns on family planning should target high fertility areas rural areas. The importance of exposure to mass media has been reported to be a determinant of the number of children desired and increased use of modern contraceptives [ 8 , 10 , 21 ].
Although contraceptive use among women in Uganda was still low, our findings indicated that contraceptive use contributed significantly to the change in number of children ever born. This finding points to the need for continued and increased government and international support for quality family planning if sustainable fertility reduction is to be achieved.
This finding confirms what numerous studies have asserted about contraceptive use significantly driving fertility transition [ 9 , 12 , 17 , 19 , 20 , 23 ]. This may be because the study by Kabagenyi et al. The contribution of family size preference to the observed change in fertility can be linked to the reduction in the proportion of women desiring large family size at least five children. There is need to continue reaching the population especially in rural areas with information about the benefits of smaller families.
The importance of shift in desired family size in fertility decline was confirmed in various studies [ 8 , 10 , 12 , 22 , 23 ]. In fact an earlier study asserted that fertility desires and not contraceptive access matter in fertility change [ 19 ]. This study also found that increase in the proportion of women who delayed their sexual intercourse to at least 20 years influenced the observed variation in children ever born. Delayed sexual intercourse implies delayed exposure to pregnancy and childbearing.
Government and other stakeholders such as parents, local leaders, and religious leaders should keep encouraging young people to delay entry into sex. Most of the sexual abstinence messages in Uganda have focused on the prevention of sexually transmitted infections and especially the Human Immune-deficiency Virus HIV , it is thus important that such messages incorporate pregnancy and childbearing.
The increases in the proportion of women residing in urban areas significantly influenced the — observed change in fertility. This may be due to improved access to family planning services and information, education and existence of smaller family size norms that usually characterize urban areas. This finding resonates with other studies that have found faster change in fertility among women residing in urban areas compared to rural counterparts [ 5 , 10 , 12 , 17 , 20 ].
Relatedly, the findings have indicated that if household wealth improved, fertility decline. Dribe, Hacker and Scalone [ 24 ] support this as they contended that middle classes and the rich class experience faster fertility transition compared to the poor.
Although the time period for this analysis is very short for detailed explanation of demographic transitions which are known to take longer periods, the two survey years chosen, and represented a period in which visible change in fertility was reported.
The and Uganda Demographic and Health Survey reports indicated that the fertility rate in Uganda reduced from 6. Earlier surveys had indicated that fertility had persisted just over 6. The study intended to identify the factors that contributed to the observed change in fertility between and In our analysis, we only included women who had ever had sex.
Most studies on fertility focus on married and ever married women or all women of reproductive age. By focusing on ever married and married women, such analyses exclude non-marital and premarital fertility which are seemingly increasing in recent times. The current study focused on women who had ever had sex so that only women exposed to the risk of pregnancy and childbirth are included in the analysis.
However, this inclusion criteria may represent a limitation of the study as there may have been under reporting or even refusal to report on sexual activities especially among adolescents who may fear to disclose freely disclose their sexual histories. In most cultures, unmarried young people are expected to abstain from sexual intercourse and thus such young people who are not married may decline to disclose their sexual activity status.
There is a possibility that some women who were and interviewed in the survey were again interviewed in Even if some women were interviewed both in and , there could have been changes in characteristics as well as reproductive behavior. Relatedly, a woman who was interviewed aged 20 years and who had not yet given birth in was aged 25 years in and could have even given birth.
There may be rural and urban disparities in the importance of the factors explored by this study. We propose that future studies explore the determinants of change in the rural and urban areas separately in order to understand the factors influencing fertility change in the two areas. The strength of this manuscript is that the analysis is based on survey data which is nationally representative.
The analysis technique used facilitates the portioning of change in an outcome over time into components attributable to changing socioeconomic and demographic characteristics of women and changing reproductive behaviors.
The decomposition technique quantified the contribution of changing characteristics and changing reproductive behavior of the women to the observed change in fertility pattern among women in and The key contributors to the change in fertility were; changes in age at first marriage, age of women, education level attained, ideal number of children, exposure to family planning messages, age at sexual debut, place of residence, wealth index and contraceptive use.
As Uganda continues to focus on harnessing its demographic dividend resulting from changes in the age structure of the population emanating from rapid fertility decline, it is important that the government continues its support for investments in education and wealth creation programs. The findings point to the need for government and its partners to increase the number of family planning service points and intensified outreaches focusing on fertility control.
Increasing support for family planning activities and especially efforts to ensure increased availability and accessibility of quality family planning methods and the intensification of mass media campaign efforts to provide messages on the benefits of family planning and fertility limitation will not only contribute to utilization of contraceptives but would also lead to changes in attitudes towards large families. Swanson, David A. Edward Stephan.
Siegel and D.
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