Shifting dynamics: Changes in the relationship between total fertility rate and contraceptive prevalence rate in Jordan between 2012 and 2017

Abstract

Background: Between the two most recent Population and Family Health Surveys, Jordan saw a dramatic decline in the Total Fertility Rate (TFR) from 3.5 to 2.7 in 5.5 years. Over the same period, modern contraceptive use also declined, from 61.2% to 51.8% among married women. This decrease in both TFR and the contraceptive prevalence rate (CPR) diverges from the typical relationship seen between these two factors whereby historically as CPR increases, TFR decreases. This paper explores this unique pattern using multiple methodologies. Methods: First, we validate the survey data using nationally collected data on fertility and contraceptive distribution. Second, we look to changes that have historically influenced changes in CPR and TFR, including changes in ideal family size and wanted fertility rates. Third, we explore proximate determinants and other influences on fertility and changes in contraception, examining the changes in the method mix and unmet need; marriage patterns, including the demographics of the married population, spousal separation, and time since last sex; postpartum insusceptibility; infecundity, both primary and secondary; and abortion, to see if any have shifted significantly enough to allow for fertility to decline with less contraceptive use. Results: We find that the decline in fertility in Jordan was driven by a reduction in mistimed or unwanted pregnancies and there was a significant increase in the share of reproductive aged women who are infecund. We also concluded that the changes in fertility and contraceptive use are driven by changes in Jordanian nationals, not by the growing Syrian refugee population. Conclusions: Jordan is not the only country to be experiencing a shift in the typical relationship between CPR and TFR. Results can inform both future approaches for family planning programs and our expectations regarding what kind of change our family planning investments might buy.

Keywords: Contraception; Fertility; Jordan.

Figure 1.. Annual total fertility rate, estimated using birth histories from the 2009, 2012 and 2017 Jordan Population and Family Health Survey.

Figure 2.. Age-specific fertility rates by year, 2017 Jordan Population and Family Health Survey.

Figure 3.. Annual national total fertility rate from 2015 census data.

Figure 4.. Trends in modern contraceptive prevalence rate and estimated modern use.

Figure 5.. Trends in couples’ use of protection.

Figure 6.. Modern contraceptive prevalence.

Figure 7.. Desire to limit by parity.

Figure 8.. Contraceptive use by method.

Figure 9.. Age and marriage by ethnicity, 2012 and 2017–18 JPFHS.

Figure 10.. Infecund/menopausal by age, 2012 and 2017–18 JPFHS.