Abstract

PIP: The results of recent fertility surveys prove that fertility decline (especially in urban areas) is occurring in more and more sub-Saharan African (SSA) countries. The countries first identified in the 1986-1988 Demographic and Health Surveys (DHS) as experiencing fertility decline were Botswana, Kenya, and Zimbabwe. Countries recently added to the list are Ghana, Rwanda, and Senegal. The increase in the marriage age, the increase in contraceptive use for birth spacing, a decline in infant mortality, an increase in school attendance among girls, and changes in cultural norms and family relationships contribute greatly to the fertility decline. 12 countries had, at the time of the DHS, lower fertility and 7 countries had a higher fertility than the lowest fertility rate projected by the UN in 1984 for 1990-1995. SSA country ministers have set a goal of 2% for the population growth rate in 2010 and a contraceptive use rate of 20% in 2000 and 40% in 2010. The conference in Cairo estimated that developing countries must assume 66% of the financial costs for family planning programs. Yet, the economic crisis has increased two fold and some countries are experiencing dramatic political crises. How can contraception be distributed properly when health services are weak? With civil servants and officials not having been paid for months, how can the government apply a policy? Family planning programs in many SSA countries have many problems: insufficient information distribution, bad quality relationships between the client and provider, no choice of methods, no respect for the privacy of clients, and difficulties with access. Until recently, programs targeted mainly married women who had their husband's consent. They need to address youth, men, and women not in a union. The quality of family planning programs and the pursuit of efforts in health and schooling will determine the speed of fertility decline.