Determinants, Measures, and Global Variations in Fertility

Dr Abdirahman Abib

1
 Introduction
 Fertility is the actual reproductive
performance of a population shaped by
biology, culture, and health systems.

 It drives population growth and dependency

ratios in all societies.

 In Sub-Saharan Africa (SSA), fertility

accounts for over 70 % of population growth
each year.

 High fertility in Somalia increases maternal-

health challenges and pressure on
education and healthcare systems. 2
 Why Study Fertility
• Fertility trends show where a country stands in the demographic transition.
• Somalia’s total fertility rate of about 6.5 keeps its population doubling roughly every two
decades.
• Understanding fertility helps governments plan for schools, jobs, and health facilities.
• Fertility analysis supports Sustainable Development Goal 3.7 on universal access to
reproductive healthcare.
4
 Replacement level fertility

 It refers to the number of children that a woman (or monogamous couple) must have
to replace the existing population.
 Replacement level fertility is generally set at 2.1 children in a woman’s lifetime (this
number varies by geographic region, given different mortality rates).

 Why 2.1?

5
 Concept and Measurement
• Fertility is measured through CBR, GFR,
ASFR, TFR, GRR, and NRR.

• These indicators reveal wide gaps

between high-fertility and low-fertility
regions.

• Such measures guide national resource

allocation and family-planning policies.

• In Somaliland, incomplete civil

registration makes accurate fertility
6
 Crude Birth Rate
 The CBR is the number of live births per 1,000 people in a year.

 19 births per 1,000

 Somalia’s CBR is around 38 per 1,000, indicating very rapid population growth.

 Rural areas in SSA often exceed 45 births per 1,000 due to large family norms.

 Declining CBRs elsewhere show the impact of female education and family planning

If a city had 30,000 live births in one year and a

total population of 1,000,000 people, we can
calculate the crude birth rate?

7
General Fertility
Rate :
 The GFR measures births per 1,000 women aged 15–49.
 GFRs above 150 in most SSA countries indicate intense reproductive activity.
 Somalia’s GFR near 190 reflects early marriage and short birth intervals.
 Limited contraceptive use keeps GFR high, especially in rural communities

8
 Age-Specific Fertility Rate (ASFR)

 The ASFR shows births per 1,000 women in specific age groups.

 In Somalia, fertility peaks among women aged 15–24 due to adolescent marriage.

 Teenage fertility in SSA remains above 90 per 1,000—double the global average.

 Delaying the first birth by five years can reduce lifetime fertility by about one child.

If a city had 6,000 live births to women aged 20–24

years during the year, and there were 120,000 women in
that same age group living in the city, we can calculate the
Age-Specific Fertility Rate (ASFR

9
 Total Fertility Rate
 The TFR shows the average number
of children a woman would have in
her lifetime.
 Sub-Saharan Africa averages about
4.1; Somalia is among the world’s
highest at 6.9.
 The replacement-level fertility is 2.1,
so Somalia’s level is more than triple
replacement.
 Declines depend on improved child
survival and women’s empowerment.
Suppose a city has the following Age-Specific Fertility Rates
(ASFRs) per 1,000 women:

Age group (years) ASFR (per 1,000 women)

15–19 30
20–24 110
25–29 150 Calculating the Total Fertility Rate (TFR)
30–34 100
35–39 70
40–44 15
45–49 5

11
 Reproduction Rates (GRR & NRR)

• The GRR measures daughters per woman; the NRR adjusts for female survival.

• In most SSA countries, NRR > 1.5 ensures continued population growth.

• Somalia’s NRR is around 1.2, still above replacement even with high mortality.

• Long-term goal is gradual fertility reduction through voluntary, rights-based

approaches.

12
 Reproduction Rate(GRR & NRR)

Two cities, City A and City B, have very different

fertility and survival conditions

Indicator City A City B

Total Fertility Rate Calculate the Reproduction Rate (GRR and NRR)
1.6 6.5
(TFR)
Proportion of births
0.488 0.488
that are female (pf)
Female survival to
0.99 0.70
age 45

13
 Global Fertility Trends

• Global fertility fell from 5 to 2.3

children per woman since 1950.

• More than half of all countries are

now below replacement fertility.

• Africa remains the main driver of

world population growth to 2050.

• The region’s median age under 19

highlights its youthful demographic
structure.
14
 Fertility Transition in Africa

 Most SSA countries are in Stage 2–3 of

the demographic transition.

 Fertility remains high due to limited

education and slow contraceptive uptake.

 Urban areas experience faster fertility

decline than rural regions.

 In Somalia, conflict and weak

infrastructure delay reproductive-health
progress.
15
 Determinants of Fertility Decline

•Education, urbanization, and child-survival improvements lower fertility.

•Somalia’s low female literacy slows this transition and sustains large families.

•Economic insecurity encourages high fertility as a social-security strategy.

•Women’s employment and gender equity accelerate fertility decline.

16
 Biological and Health Determinants
 Health, nutrition, and maternal age strongly influence fecundability.

 Somalia’s maternal-mortality rate over 600 per 100,000 fuels “replacement” births.

 Infections such as malaria and STIs increase infertility and pregnancy loss.

 Strengthening reproductive-health services reduces both infertility and high-risk fertility.

17
 Proximate Determinants (Bongaarts Model)

 Direct determinants include marriage, contraception, breastfeeding, abortion, and sterility.

 Somali women’s long breastfeeding periods widen spacing but fertility remains high.

 Very low contraceptive use limits the potential fertility-reducing effect.

 Raising marriage age by 3–5 years could lower TFR by roughly one child.

18
 Socioeconomic Determinants

 Fertility falls as education, income, and women’s employment rise.

 Cultural expectations for large families remain strong in Somaliland and rural SSA.

 Urbanization, cost of living, and migration reshape reproductive preferences.

 Empowering girls through schooling and property rights has proven fertility benefits.

19
 Contraception prevalence rate

 Contraceptive prevalence is the

percentage of women who are
currently using, or whose sexual
partner is currently using, at least
one method of contraception,
regardless of the method used

Global contraceptive prevalence rate

20
21
 Unintended Pregnancies

 Globally,45 % of pregnancies worldwide are unintended (≈ 121 million per year).

 Rate: 64 per 1,000 women aged 15–49.

 61 % of unintended pregnancies end in abortion.

 Declining trend since 1990 due to improved family-planning access and education.

 In many African countries, more than one-fourth of women would like to limit or delay
childbearing but are not using a family planning method. This discrepancy between
fertility preferences and contraceptive use is known as unmet need for contraception

• (WHO 2022; Guttmacher 2022)

22
 Contraceptive Use in Somalia
• Only 7 percent of Somali women use contraception, and fewer than 1 percent use modern
methods.

• Uptake is higher among educated, urban, and media-exposed women.

• Misconceptions about religion and side effects limit adoption in rural areas.

• Integrating family planning into maternal-health services can rapidly increase use.

23
Unmet Need for Contraception

 About 37 percent of married Somali women have an unmet need for

contraception.

 Older and urban women have less unmet need, reflecting unequal access.

 Expanding community-based distribution reduces unmet need effectively.

 Meeting current demand could avert hundreds of maternal deaths each year.

24
 Infertility and Reproductive Challenges in Sub-
Saharan Africa

 Around one in six couples experience infertility, yet access to treatment in SSA is
extremely limited.

 Tubal blockage from untreated infections and unsafe deliveries are major causes.

 In Somalia and Somaliland, infertility carries stigma and social isolation for women.

 Integrating infertility prevention and care within reproductive-health services ensures full
reproductive rights.

25
 Reproductive Rights and the Real Fertility
Crisis

 The real fertility crisis is people’s inability to achieve their desired

family size.
 Millions of women in SSA lack the agency to decide when or whether
to have children.
 Only about one in ten women globally can make independent
decisions on contraception.
 Expanding reproductive agency through education, finance, and
equal healthcare benefits families and economies.

26
Public Health Policy

 Infertility prevention and early treatment should be part of all public-health

programs.

 Governments should promote voluntary, rights-based family-planning

strategies.

 Investing in girls’ education and women’s employment is essential for

sustainable fertility decline.

 In Somalia and Somaliland, engaging religious leaders and media can

normalize birth spacing and safer motherhood.

27
• End

28