The integration of effective child survival interventions with family planning programmes can accelerate fertility decline in sub-Saharan Africa

Mizanur Rahman, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B)

In many sub-Saharan African countries, demand for children or desired family size is high, demand for and use of contraception is low, and thus fertility high. The persistent high child mortality is a cause of high demand for children, low demand for contraceptives, and thus high fertility. We use DHS data from 23 countries to examine the associations between child mortality, wanted and achieved fertility, demand for and use of contraceptives, and childhood vaccination. We find that child mortality is extremely high; and because of high child mortality women could not even achieve their desired fertility in 10 (43%) of the 23 countries. Child mortality is positively and significantly associated with wanted and actual fertility and negatively associated with demand for and use of contraception. Child mortality is negatively associated with child immunization. Child survival interventions should be priority of the family planning programs for an effective reduction of fertility.