Ethiopia’s 2011 Demographic and Health Survey Shows Remarkable Fertility Decline, But Continued Rural Health Challenges
by Carl Haub, senior visiting scholar
Continuing my recent practice of posting a quick summary of results from new demographic surveys in developing countries, here is another new Demographic and Health Survey (DHS) preliminary report, this time from a sub-Saharan African country. This will help readers of this blog to stay right up-to-date with the latest developments.
The Ethiopia 2011 DHS interviewed 16,515 women ages 15 to 49 and 14,110 men ages 15 to 59 from September 2010 to June 2011. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 4.8 for the three-year period preceding the survey. For urban women, the TFR was 2.6 and for rural women, who were a little over 75 percent of the sample, 5.5. There appears to have been an acceleration of TFR decline from the 2005 to the 2011 survey compared with the 2000 DHS, which had a three-year TFR of 5.5.* In 1990, a government survey had shown the TFR as 6.4. The desire to continue or cease childbearing provides one insight into possible future fertility trends. Of the women with 5 living children, 55.8 percent said that they did not wish to have any more children; among women with 6 or more living children, 68.6 percent said that they also wished to ceased childbearing.
Note: TFRs are for the three years before the surveys, except five years before the 2000 survey
Source: Ethiopian Central Statistics Agency (CSA) and ICF Macro, Ethiopia Demographic and Health Survey (EDHS) 2011, Preliminary Report.
In the 2011 survey, 28.6 percent of currently married women said that they were using some form of family planning, 27.3 percent a modern method. Injectables were the most popular by far, with 20.8 percent of women using that method. Given that the use of modern methods was 13.9 percent in 2005, modern use has doubled in six years. The use of injectables more than doubled from 9.9 percent to 20.8 percent while that of contraceptive implants rose from 0.2 percent to 3.4 percent.
Infant and child mortality has declined sharply in the past 15 years. The infant mortality rate in the five years before the survey was 59 infant deaths below age 1 per 1,000 live births, down from 101 in the 10 to 14 years before the survey. There was a similar decline in mortality in the 1-to-4 age group, from 72 deaths per 1,000 to 31 deaths. Child nutrition remains a problem. Of children under age 5, 44.4 percent were stunted (height-for age) and 28.7 percent were underweight (weight-for-age). Nationally, only 24.3 percent of children, ages 12 to 23 months, had received all required child vaccinations, twice that figure in urban areas. But only 28.7 percent of women were able to produce a vaccination card so responses from the rest depended on the mother’s memory.
Levels of prenatal care and delivery assistance from a skilled provider (doctor, nurse, midwife, or other health personnel) remain low. Of births in the five years before the survey, only 33.9 percent of women had prenatal care from a skilled provider, although an additional 10.1 percent had care from a health extension worker. Only 10 percent had a skilled attendant at delivery and only 9.9 percent of births were in some type of health facility. Urban-rural differences were quite sharp. In urban areas, 76 percent of women had prenatal care from a skilled provider, compared with 26.4 in rural areas. At delivery, 50.8 percent of urban women had a skilled attendant at birth and 49.8 percent of births were in a health facility. Comparable figures for rural women were but 4 percent and 4.1 percent, respectively. Protection from neonatal tetanus had a significant increase; 48.3 percent of the most recent births were protected, up from 32.2 in the 2005 DHS.
The 2011 DHS shows a remarkable decline in fertility in Ethiopia but it is also clear that health care delivery to the large rural population remains challenging.
*For those familiar with earlier surveys in Ethiopia, the 2000 DHS showed a TFR of 5.9 in its report for a five-year period. The 5.5 TFR was adjusted to a three-year period to be comparable to the subsequent surveys.