Understanding the Paradox between High Level of Contraceptive Use and High Fertility Rate in Malawi

Eunice M. Williams , University of Southampton
Sabu S. Padmadas, University of Southampton

Evidence shows that use of modern contraceptive methods is an important driver of large-scale fertility declines, with a strong negative association between contraceptive use and fertility. This study investigates the paradox in the massive increase in contraceptive use in Malawi, against a persistently high total fertility rate (TFR). Observed fertility decline rate is substantially slower than would be expected based on contraceptive use. Modern contraceptive prevalence rates (CPR) increased at an average of 3.9 percentage points per year between 1992 and 2015, from 12.5% to 58.1%, positioning Malawi amongst countries with the highest CPR, while TFR dropped by about two children, with the largest decline between 2010 and 2015. Estimating the proximate fertility determinants using Bongaarts Model could not fully explain this anomaly. We therefore hypothesise that; 1)fertility intention and socioeconomic conditions offset the fertility inhibiting effect of modern contraceptives; and 2)modern contraceptive use is associated with stopping than limiting or spacing behaviour. Analysis shows that although women start using contraceptives early, its mostly for spacing purposes, and limiting the number usually becomes a consideration only after 5–6 children. Most women below age 34 only report unmet need for spacing, rather than limiting. In addition, majority of girls marry and begin child bearing early, thus are exposed to longer child bearing duration. Further analysis will focus on regressing fertility on fertility intentions and CPR, characterising women who want 3-4,5-6 or more children and those who want to stop altogether based on the contraceptive method and the level of use.

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 Presented in Session P1. Poster Session Fertility, Family and the Life Course