2011 Mozambique Demographic and Health Survey Shows No Decline in Fertility But Dramatic Decline in Infant and Child Mortality
by Carl Haub, senior demographer
The Mozambique 2011 Demographic and Health Survey (DHS) is the third DHS in a series that began in 1997. The preliminary report has just been released. A major finding of the survey is that there has been no perceived decline in the total fertility rate (TFR) since the first DHS, and that the TFR may actually have risen. The survey interviewed 13,745 women ages 15 to 49 and 4,035 men ages 15 to 59 from May to November 2011. The TFR obtained in the survey was 5.9 for the three-year period preceding the survey. For urban women, the TFR was 4.5 and, for rural women, who were 65.3 percent of the sample, 6.6. The reported TFR in the 2011 DHS was higher than that obtained in both the 1997 and 2003 DHS (see figure). The 2011 DHS TFR can also be compared with a TFR of 6.1 obtained in the 2008 Multiple Indicator Cluster Survey (MICS) conducted by UNICEF. In the survey, 46 percent of women with five living children said that did not wish to have any additional children and 59.4 percent of those with six or more children also said that they wished to cease childbearing. Of those two groups, the percentage who declared themselves to be sterile or who had been sterilized was 7.6 and 7.2, respectively. It would seem that the desire for small families is largely absent in Mozambique.
In the survey, 11.6 percent of currently married women or in union women said that they were using some form of family planning, with 11.1 percent using a modern method. Injection topped the list of modern methods at 5.1 percent, followed by 4.5 percent using the contraceptive pill, and 1.1 percent the male condom. Contraceptive use by method was very similar to that in the 2003 DHS, which was 16.5 percent for all methods and 11.7 percent for modern methods . These are methods commonly used for spacing births, not limiting their number, something frequently observed in sub-Saharan Africa.
The decline in infant and child mortality, as reported in surveys, has been rather dramatic. The infant mortality rate (IMR) in the five years before the 2011 DHS was 64 infant deaths below age 1 per 1,000 live births, down from 79 in the five to nine years before the survey and 106 in the 10 to 14 years before the survey. In the 2008 MICS, the IMR for the five years before the survey was 95, suggesting that it could possibly be higher than the 2011 DHS indicates. But decline in the IMR seems quite evident. The decline in the child death rate, ages 1 to 4, was slightly slower than for infant mortality, to 35 deaths per 1,000 five years before the survey from 46 five to nine years before the survey and 59 10 to 14 years before.
Of children under age 5, 42.6 percent were stunted (height-for age) and 19.7 percent severely stunted; 14.9 percent of the 42.6 percent stunted were underweight (weight-for-age). By and large, mothers followed the WHO recommendation of supplementing breastfeeding with solid/mushy food at the child’s six months of age. At 6 to 8 months of age, only 7.5 percent continued to breastfeed exclusively with 79.7 percent supplementing with solid food. By 9 to 11 months, 87.7 percent had supplemented. The proportion of young children receiving all required vaccinations was found to have fallen well short of a 100 percent goal. Among children ages 12 to 23 months, 64.1 percent had received all basic child vaccinations. A high proportion of mothers, 83.1 percent, were able to produce vaccination cards. Three-fourths of children in urban areas areas were fully vaccinated while the same figure for rural areas was 60 percent.
Levels of prenatal care and delivery assistance from a skilled provider (doctor, nurse, midwife, or other health personnel) were quite good. Of births in the five years before the survey, 90.6 percent of women had prenatal care from a skilled provider. But only 54.3 percent of births had had a skilled attendant at delivery; the urban proportion was much higher than the rural, 80.3 percent compared to 44.3. Rural births accounted for 72 percent of births recorded in the survey. Protection from neonatal tetanus was two-thirds of all births.
In a previous survey, the 2009 AIDS Indicator Survey (a part of the DHS program), the prevalence of HIV/AIDS among adults ages 15 to 49 was 11.5 percent, 13.1 percent among females, and 9.2 among males.
The prospect for fertility decline seems rather doubtful, at least given the TFR trend of past surveys. The United Nations Population Division estimates that the TFR around 1950 was about 6.6 so that there has been some small decrease over a very long period. Looking at the graph, there is some implication that the bulk of TFR decrease has been in urban areas and continuing urbanization may play a role. Still, this is yet another case where population projections for a sub-Saharan country will have to be re-evaluated.