Changing fertility preferences in urban and rural Senegal: patterns and determinants Estelle Monique Sidze 1 *, Ilene Speizer 2, Blessing Mberu 1, Alex Ezeh 1, Mike Mutua 1, Cheikh M. Faye 1 Corresponding author Estelle Monique Sidze, PhD Post-doctoral researcher, African Population and Health Research Center (APHRC) APHRC Campus, Kirawa Road, off Peponi Road P.O. Box 10787-00100, Nairobi, Kenya Telephone: +254 20 400 1093, Fax: +254 20 400 1101, Email: esidze@aphrc.org 1 Post-doctoral researcher, African Population and Health Research Center (APHRC) 2 Department of maternal and child health, University of North Carolina, Gillings School of Global Public Health, 206 W. Franklin St., CB #8120, Chapel Hill, NC 27516, phone:+919 9667411, Email: ilene_speizer@unc.edu
ABSTRACT This study draws upon data collected in urban and rural Senegal and cohort analysis, to explore changes in women s fertility preferences and the contradiction between preferred and actual fertility behaviors. Regression analyses by cohorts is used to determine the factors affecting women fertility preferences over time. The total fertility rate in Senegal remains high at 5 children per woman and the country has one of the highest unmet needs for family planning services in the West Africa region. This study s findings therefore will provide policymakers with an understanding of the potential demand for fertility control and help in formulating policies to reduce fertility and improve maternal health. BACKGROUND High fertility rates and large family size have persisted in most sub-saharan African countries (Garenne 2008; Ngom and Fall 2005). Moreover, poverty remains widespread in the region, with nearly half of the population living on less than 1 US dollar per day and gloomy prospects for improvement in the near future (World Bank 2011). The relationship between family size and household economic welfare have long been an important theme in the demographic and development literature, as recently emphasized in the Millennium Development Goals (Potts & Fotso, 2007). The hypothesized negative correlation between family size and family welfare is thought to be a contributing factor in human capital formation and economic growth (Merrick, 2002). More recent investigations in developing countries have indicated that rapid childbearing inhibits economic prosperity and that these effects tend to persist over the life course (Aassve et al., 2005). This study uses large samples of urban and rural women to explore the changes in fertility over time in Senegal; one of the world's least developed countries and qualified for the Highly Indebted Poor Country Initiative in April 2004 (ADF 2004). It seeks to understand behavioral factors behind the persistence of preferences for large family sizes and to determine the main factors to pinpoint in the formulating of policies to reduce fertility. CONTEXT Located in the West Africa s Sudano-Sahelian region, Senegal is characterized by a rapid growth in population (2.6% per annum) and a high proportion of young people; 58% of the population is
under age 25 (ANSD and ICF, 2012). The total fertility rate, influenced by a relatively high demand for children and a low contraceptive prevalence, remains high at 5 children per woman. Senegal is also the country with one of the highest unmet need for family planning services in the West Africa region. The results from the last DHS-MICS 2011 (ANSD and ICF, 2012) show that only 8.9% of all women and 12% of currently married women are using a modern method of family planning, despite high levels of contraceptive knowledge (96% of all urban women and 90% of all rural women know at least one modern method of contraception). The most well-known methods among all women are the condom (77% of women), the pill (79% of women) and the injectables (75% of women). The highest prevalence of contraceptive use among currently married women is among women aged 25 to 44 years (about 14.5%). The total demand for contraception which includes current use and women reporting an unmet need (i.e., that they are sexually active, do not want to get pregnant and are not using contraception) is close to 43% but the unmet need is high at 28%. Senegal is one of the first countries in sub-saharan African to have designed an institutional framework for population issues. The first population policy (Déclaration de politique de population - DPP) was adopted in 1988 and one of the targets of the policy was to reduce the country s total fertility rate. Priorities and actions were envisioned at the region level in this manner, but the lack of adequate financial resources hampered the progress made so far. The 1988 Population Policy has been updated in 2001 to include reproductive health. Part of the new strategies include the legalization of family planning and the reduction of maternal and child mortality. The new policy is supported by a progressive increase in the country s operating budget allocated to general health, from 8.25% in 1999 to 9.8% in 2004. DATA AND METHODS This study use two data sources: baseline data from the Measurement, Learning & Evaluation (MLE) project collected in 2011 for the evaluation of the Initiative Sénégalaise de Santé Urbaine (ISSU) in Senegal for the urban arm of the analysis and the Senegal 2011 DHS-MICS survey for the rural arm. ISSU is a five-year project (March 2010-March 2015) aimed at promoting family planning in Senegal s poor urban areas. The project is financed by the Bill & Melinda Gates
Foundation and implemented in six Senegalese cities (Dakar, Pikine, Guédiawaye, Mbao, Mbour and Kaolack). The household survey was conducted in the six cities to provide information needed to develop evidence-based family planning (FP) interventions and to establish a baseline for the evaluation of these interventions. A sample of 5,523 households was selected for the household survey, drawn from a two-stage stratified area sampling procedure. In all households selected, all identified women aged 15 to 49, habitual residents or visitors, were eligible for an individual interview. A total of 4,950 households and 9,614 women were successfully interviewed. Household characteristics data were used to compute a DHS-like wealth index using selected household assets and amenities. Households were also ranked based on their score on this variable and grouped into three equal groups of 33.3% households each. These data were then merged with the women s data and a sample of 5,330 currently married women was retained for the analysis. As for the Senegal 2011 DHS-MICS survey, we used the individual recode data for the Senegal DHS-MICSS 2010-2011 which has a sample of 15,688 women. A sub-population of all rural married women aged between 15 and 49 years was retained and include 7,313 women. Unlike the Senegal 2011 DHS-MICS survey, the data collected by the Measurement, Learning & Evaluation (MLE) project baseline household survey over-sampled disadvantaged urban population. Each site was stratified into privileged and disadvantaged areas, except for the site of Mbao, considered as a disadvantaged area. Using this dataset instead of the DHS urban sample provides a unique opportunity to analyze fertility preferences of urban populations living in poverty, an important but largely neglected dimension of urban fertility dynamics. The first part of the analysis is descriptive. The fertility preferences of urban and rural women were analyzed and figures for different generations of women compared. Three age-cohorts were considered: women aged 15-29 years, women aged 30-39 years, and women aged 40-49 years. Three indicators of fertility preferences were used: ideal number of children, desire to have more/limit children, and desired timing for next birth. The contradiction between preferred and actual fertility behaviors was assessed by comparing the ideal and actual number of children. In the second part of the analysis, we used multivariate regressions (not shown here) to determine the factors affecting women fertility preferences over time. The main independent variables include relevant socioeconomic characteristics (level of education, socioeconomic status,
religion, ethnic group, and number of co-wives) and reproductive characteristics (age at first marriage and use of modern contraception). Since the ISSU and DHS-MICS datasets are based on different sampling frameworks and survey implementation plans, we do not do statistical tests to compare the fertility preferences of urban women to those of rural women. Rather, the objective is to assess the changes over time within each sample of women and ultimately to compare the pace of change in behaviors in urban areas versus rural areas. PRELIMINARY RESULTS Both the urban and rural sample s socioeconomic characteristics reflect general characteristics of the Senegalese female population: most women have no or primary education, 90% is Muslim, and a greater percentage of older women have co-wives in both urban and rural areas. 15% to 57% of women have one or two co-wives (Table 1). As for the reproductive characteristics, the results summarized in Table 2 show that first marriage occurs at young ages in Senegal. In urban areas, over 49% of women aged 40-49 years were married before age 20. The proportion is 53% among urban women aged 15-29 years. On the other hand, 71% of rural women aged 40-49 years and 82% of rural women aged 15-29 were married before age 20. Early ages at first marriage expose Senegalese women to a long duration of pregnancy risk and high odds to give birth to numerous children. Indeed, 61% of urban women aged 40-49 years old have 5 or more children ever born. The percentage is 31% (about a half) for urban women aged 30-39 years. The respective proportions are 68% and 50% among rural women. As regard to the total number of children that women would like to have in their lifetime, 36% of urban women aged 40-49 years and 40% of urban women aged 30-39 years expressed the desire for large family sizes (5+ children). What is striking in the results is that 40% of urban women in the youngest generation also expressed the desire for having 5 children or more, only 1.5% is in favor of having 1 or 2 children. The same pattern of results can be seen for rural women. However, the issue of short birth intervals is less crucial over the years in urban Senegal with great proportions of women in the youngest generation wanting to wait 2 to 3 years before the next birth. The issue remained pertinent among rural women with 37% of women in
the youngest generation wanting to have the next birth in an interval of less than 2 years as compared to 18% of women in the oldest generation. The proportions of women wanting more children according to the number of living children are displayed in Table 3. In urban areas generally, the proportion of women wanting another child decreases with increasing number of living children. One important finding is that quite high proportions of women aged 30-39 years (49%) and women aged 15-29 (63%) with currently 5 or more children desire to have another soon or later. Similar patterns can be noted among women in rural Senegal; the proportion of women of the youngest generation wanting more children is however higher (75.8%). These facts indicate that the fertility level in urban will most probably remain the same for the next few years, unless family planning programs are deployed and efficiently meet the unmet need for limiting expressed on the other hand by 19.9% of women aged 30-39 years (41.1% among those with 5 children or more) and 2.4% of women aged 15-29 years (41.1% among those with 5 children or more). When comparing women ideal number of children and actual number of children, it can be noted that quite important proportions of women do not realize their fertility preferences (Table 4). Among urban women aged 40-49 years old and having 5 and more children for instance, only 36% had an ideal of 5 or more children, 20% had an ideal of 3 to 4 children and 2.7% had an ideal of 1 to 2 children. While keeping in mind the issue of post-rationalization bias in responses about the ideal number of children, this discrepancy in the ideal number of children and the current number of children might still reflect the lack of affordable and accessible family planning services in earlier years in Senegal. Among the youngest generation of urban women, it can also be noted that 46% who desire 5 children or more have already reached that number. This means that, without access to family planning services for limiting, they still have additional reproductive years to add more children to their families. SOME IMPLICATIONS OF THE PRELIMINARY RESULTS Senegal is without doubt a pro-natalist country where the high total fertility rate is fuelled by young ages at first marriage, women s preferences for large family sizes and possibly lack of accessibility to family planning programs. Based on the preliminary results presented here, we can conclude that women s preferences for a high number of children (5 or more) have not
significantly changed across the different generations in both urban and rural areas. One encouraging finding is that, in urban areas, more women in the youngest generation desire to have longer intervals between births. There are also quite important proportions of women who want to limit their fertility both in urban and rural areas. Initiatives such as the Initiative Sénégalaise de Santé Urbaine (ISSU) undertaken with a view to increasing the availability, use and quality of family planning services are therefore crucial, especially to target the pockets of poor urban women with fertility behaviors contributing to the stagnation of fertility levels in urban areas.
Table 1 Socio-demographic characteristics of the study participants, currently married women Urban, MLE 2011 Rural, SDHS-MICS 2010-11 Variable 15-29 30-39 40-49 15-29 30-39 40-49 Level of education No education 42.7 40.2 44.3 81.3 86.1 93.8 Primary 34.9 37.9 32.8 14.6 11.3 5.5 Secondary 18.1 18.0 19.3 4.1 2.5 0.8 Higher 4.3 3.8 3.6 0.1 0.1 0.0 Socioeconomic status poor 38.8 32.8 27.3 49.1 44.3 47.6 Middle 35.0 31.7 34.6 35.2 36.8 36.2 Rich 26.1 35.5 38.1 15.8 19.0 16.2 Religion Muslim 97.0 91.8 91.8 97.6 96.6 96.7 Others 3.0 8.2 8.2 2.4 3.4 3.3 Ethnic group Wolof/Lebou 36.8 38.2 40.1 38.5 41.8 40.1 Poular 20.9 21.2 18.6 33.9 30.0 28.1 Serer 20.5 17.0 16.6 13.7 15.8 17.9 Others 21.8 23.7 24.6 13.9 12.4 13.9 Number of co-wives 0 83.5 66.4 56.5 74.5 51.5 37.7 1-2 15.3 27.3 29.3 24.8 45.9 57.7 3+ 1.1 6.3 14.2 0.7 2.6 4.5 Don't Know 0.0 0.0 0.0 0.0 0.0 0.2 Number of women 2321 1894 1115 3706 2260 1347
Table 2. Reproductive characteristics of the study participants, currently married women Urban, MLE 2011 Rural, SDHS-MICS 2010-11 Variable 15-29 30-39 40-49 15-29 30-39 40-49 Age at first marriage >20 53.0 34.5 48.7 82.1 67.3 71.2 20-24 38.3 36.4 26.9 16.3 21.1 19.2 25-29 8.4 20.4 13.1 1.7 8.5 5.8 >= 30 NA 8.4 11.2 NA 3.0 3.8 Missing 0.2 0.4 0.1 - - - Number of living children # None 23.1 7.9 2.6 16.3 3.7 2.3 1-2 54.5 28.2 12.1 48.7 15.2 9.7 3-4 19.2 33.1 24.3 28.4 31.0 20.0 >= 5 3.1 30.8 61.0 6.6 50.2 68.0 Ideal number of children None 0.0 0.0 0.0 1.1 1.2 1.2 1-2 1.5 3.8 3.2 1.0 1.9 2.3 3-4 33.3 33.9 26.5 18.0 15.0 11.8 >= 5 40.5 39.6 35.8 57.5 55.4 50.1 Non-numeric responses 24.6 22.8 34.5 22.3 26.5 34.6 Desire to have more children Yes 96.6 77.2 29.5 95.5 69.5 25.3 No 2.4 19.9 55.9 3.5 25.8 57.4 Declared unfecund/sterilized 0.0 0.3 11.3 0.2 1.4 14.8 Don t Know/Undecided 0.9 2.4 3.2 0.8 3.2 2.5 Missing 0.0 0.1 0.0 - - - Desired timing of next birth <2 years 5.7 4.0 1.6 37.3 28.6 18.1 2-3 years 35.0 25.5 3.3 36.4 23.6 3.8 4-5 years 22.9 13.6 2.2 13.8 10.7 1.5 >5 years 4.1 2.2 0.1 1.5 1.7 0.1 Don t Know 4.0 6.1 4.6 4.2 5.2 3.0 No more children 2.4 19.9 55.9 3.5 25.8 57.4 Can t get pregnant/other timing 25.8 28.4 32.3 3.2 4.5 16.0 Missing 0.1 0.2 0.0 - - - Use modern contraception Yes 23.4 30.6 29.3 4.8 8.2 7.9 No 76.6 69.4 70.7 95.2 91.8 92.1 Unmet need for limiting Yes 0.3 4.5 21.2 0.9 11.7 21.8 No 99.7 95.5 78.8 99.1 88.3 78.2 Unmet need for spacing Yes 23.0 15.6 5.4 29.9 24.5 3.9 No 77.0 84.4 94.6 70.1 75.5 96.1 Number of women 2321 1894 1115 3706 2260 1347 First marriage or first cohabitation # The number of living children includes current pregnancy for women NA= Not Applicable No missing values
Table 3. Percent distribution of currently married women by desire for more children, according to number of living children, by generations. Urban, MLE 2011 Number of living children # Desire for children 15-29 30-39 40-49 None 1-2 3-4 >= 5 Overall None 1-2 3-4 >= 5 Overall None 1-2 3-4 >= 5 Overall Have another soon 66.1 18.5 8.4 7.4 27.2 70.9 42.8 20.8 10.6 27.8 87.3 54.6 24.3 7.3 19.3 Have another later 25.5 74.0 73.4 55.8 62.1 20.4 39.7 50.4 38.6 41.4 0.0 5.4 9.4 4.3 5.6 Want no more 0.1 0.3 6.9 29.4 2.4 0.0 5.5 17.1 41.1 19.9 1.4 19.3 46.4 69.4 55.9 Declared unfecund 0.0 0.0 0.0 0.5 0.0 0.0 0.0 0.1 0.9 0.3 7.3 6.3 9.8 13.1 11.3 Don t know/undecided 2.7 3.4 7.1 4.8 4.0 3.2 5.5 8.2 5.1 6.1 4.0 9.3 4.6 3.7 4.6 Other timing 5.5 3.8 4.1 2.1 4.2 5.5 6.4 3.4 3.6 4.5 0.0 5.0 5.4 2.2 3.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 490 1223 506 102 2321 134 476 652 632 1894 34 126 244 711 1115 Rural, DHS-MICS 2010-11 Number of living children # Desire for children 15-29 30-39 40-49 None 1-2 3-4 >= 5 Overall None 1-2 3-4 >= 5 Overall None 1-2 3-4 >= 5 Overall Have another soon 85.2 33.9 19.2 22.1 37.3 82.6 56.3 32.3 14.0 28.6 58.1 45.8 32.1 8.8 18.1 Have another later 7.6 57.4 67.0 53.7 51.8 1.9 29.5 43.4 35.8 35.9 0.0 3.0 5.8 5.8 5.4 Want no more 0.3 1.3 6.4 15.2 3.5 0.0 3.4 14.6 41.4 25.8 8.7 19.3 39.7 69.7 57.4 Declared unfecund 0.3 0.2 0.1 0.5 0.2 10.5 1.6 1.2 0.9 1.4 33.3 26.5 17.2 11.9 14.8 Don t know/undecided 2.6 4.3 4.8 5.2 4.2 0.0 3.6 5.1 6.0 5.2 0.0 3.6 2.8 3.1 3.0 Other timing 4.1 3.0 2.5 3.1 3.0 5.0 5.6 3.4 1.9 3.0 0.0 1.8 2.4 0.7 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 564 1808 1075 259 3706 73 328 702 1157 2260 30 125 265 927 1347 Wants next birth within two years Wants to delay next birth for two or more years # The number of living children includes current pregnancy for women
Table 4. Mean ideal number of children for currently married women, according to number of living children, by generations. Urban, MLE 2011 Number of living children # Mean ideal number of 15-29 30-39 40-49 children None 1-2 3-4 >= 5 None 1-2 3-4 >= 5 None 1-2 3-4 >= 5 None NA NA NA NA NA NA NA NA NA NA NA NA 1-2 2.2 1.5 0.9 0.5 11.0 2.9 3.0 3.7 2.7 7.9 2.0 2.7 3-4 36.1 35.4 25.6 23.4 35.8 49.4 31.3 21.9 28.6 38.2 36.8 20.0 >= 5 40.0 41.6 37.1 46.1 30.4 23.5 48.0 47.5 18.8 26.5 41.5 36.1 Non-numeric responses 21.6 21.5 36.3 30.0 22.8 24.2 17.7 26.9 49.9 27.4 19.7 41.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 490 1223 506 102 134 476 652 632 34 126 244 711 Rural, DHS-MICS 2010-11 Number of living children # Mean ideal number of children 15-29 30-39 40-49 None 1-2 3-4 >= 5 None 1-2 3-4 >= 5 None 1-2 3-4 >= 5 None 0.7 1.3 1.0 0.6 2.4 0.4 1.4 1.2 0.0 0.0 1.9 1.2 1-2 1.9 0.7 0.4 3.5 2.3 1.7 1.6 2.2 13.1 1.0 1.6 2.4 3-4 20.4 22.4 11.5 8.3 24.8 23.5 14.3 12.1 19.7 22.8 12.1 9.9 >= 5 54.4 54.3 63.4 64.5 42.6 51.6 55.2 57.5 36.1 47.5 51.3 50.5 Non-numeric responses 22.7 21.3 23.7 23.2 27.9 22.8 27.5 26.9 31.1 28.7 33.1 36.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 564 1808 1075 259 73 328 702 1157 30 125 265 927 # The number of living children includes current pregnancy for women NA= Not Applicable (No women in these two age groups reported wanting no children)
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