Columnists Features

Facing the challenge of high fertility

JUSTIN Sakala, of Lusaka’s Chainda township, lost his wife over two years ago, leaving him with 10 children to take care of.  

In many high-density areas of Zambia, especially in rural areas, family planning remains a challenge. It is still a common belief that the more children one has, the wealthier they are.

In the year 2016, the Planned Parenthood Association of Zambia (PPAZ) provided sexual reproductive health services totaling 1, 445, 199 through its health centres in the towns of Lusaka, Choma, Livingstone and Kitwe. However, despite this impressive figure, Zambia’s fertility rate remains high.
According to the Zambia Demographic Health Survey of 2013-2014, the fertility rate for Zambia currently stands at 5.35 births per woman. This rate contrasts sharply with the average total fertility rates for most developed countries and far exceeds the level of 2.2 children required to replace the population.
The total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her child-bearing years and bear children in accordance with current age-specific fertility rates.
Planned Parenthood Association of Zambia (PPAZ) executive director Nang’andu Kamwale says the high unmet need for sexual reproductive health services is a major trigger of the high fertility rate in Zambia.
“Unmet needs for sexual reproductive health services is especially high among groups such as young women who are fertile and sexually active but are not using any method of contraception,” Mrs Kamwale explains.
She says this has been a challenge, especially in rural areas, where access to family planning services remains limited.
The situation is exacerbated by the geographical location of some health facilities in rural areas which hinders women from accessing family planning services of their choice.
There is also the challenge of myths and misconceptions surrounding sexual reproductive health, including fears of the side- effects or health risks arising from the use of contraceptives. This is especially common in rural areas where certain beliefs regarding reproductive health still need to be demystified.
“It is common in rural areas for women or others close to them to oppose contraception and to carry the belief that they do not need or should not use contraception if they are breastfeeding,” Mrs Kamwale says.
As it relates to the Zambian situation, the country’s population is a young one. There are over 14,000 teenage pregnancies that have been recorded each year in Zambia for the last five years.
Centre for Reproductive Health executive director Amos Mwale says not only does Zambia have a relatively young population but its young people are also sexually active.
These young people, he says, become sexually active from a tender age. Notably, the highest number of school drop-outs due to teenage pregnancies are recorded below Grade Nine. This has directly impacted the fertility rate because young people are having children while very young themselves.
Mr Mwale does not sugarcoat the reality. “The first challenge is the issue of young people getting pregnant. We need to ask if sexual reproductive health services are friendly enough to give young people the information they need,” he says.
He argues that the more young people have access to different services and drugs such as contraceptives and condoms, the more the fertility rate can be reduced as teenage pregnancies can be avoided.
He cites the Family Planning 2020, a commitment Zambia made at the 2012 London Summit on Family Planning, as a scale-up plan devised to push family planning accessibility from 33 percent (where it was when the programme began) to 58 percent.
Presently, accessibility stands at 42 percent, meaning hard work is necessary in the next three years to ensure more people have access and the target is reached.
“Family planning is quantified for married couples but looking at the high number of teenage pregnancies, the needs of young people in terms of family planning are not being addressed,” Mr Mwale says.
The other challenge that exists is that in Zambia, family planning services and products are highly donor-dependent.
“Donors fund almost 75 percent of family planning programmes and drugs which means we need to own family planning programmes if the government and Zambians want to see the fertility rate reduce,” Mr Mwale emphasises.
The World Bank provides data showing that the total fertility rate for Zambia from 1960 to 2014 was 6.64 births per woman with a minumum of 5.35 births per woman in 2014 and a maximum of 7.45 births per woman in 1972.
Between 1990 and 2014, there has been only a slow decline in the total fertility rate from 6.5 children in 1990 to 6.0 children per woman in 2013.  
In order for Zambia to realise a demographic dividend – the accelerated economic growth that may result from a decline in a country’s birth and death rates and the subsequent change in the age structure of the population – fertility must decline significantly.
Combined with the right investments in health, education, and job creation, a decline in fertility could open a window of opportunity for economic growth.
Botswana is one country being referenced today for its significant success in reducing its fertility rate while the total fertility rate in sub-Saharan Africa remains high. During 1980-2006, Botswana experienced the greatest fertility decline in the sub-Saharan region. Today, Botswana’s fertility rate stands at 2.7.
A major attributing factor to Botswana’s low fertility rate is her national family programme, much lauded by institutions such as the World Bank for being the strongest in Africa.
Other factors that have been cited regarding the Botswana example include increased age at first birth, prolonged breastfeeding, increased female education, women’s participation in the labour force and improved survival of children.
Zambia’s progress has been slower especially because its population age structure has not changed significantly in the last 40 years. Total fertility rates remain high and, in general, each working adult supports several dependants.
Success in achieving a steady decline in the fertility rate would therefore heavily depend on the government’s commitment to making it a reality by scaling up interventions in both rural and urban areas.
Teenagers also need to become a key target group of such sexual reproductive health programmes.
If Zambia can make substantial investments in reproductive health and family planning, fertility levels can begin to decline more significantly, and children will be more likely to achieve better basic levels of health.
With additional investments in health and education and economic initiatives to facilitate job creation, Zambia may be able to experience faster economic growth and benefit from a more productive population.


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