Congo (Brazzaville) 2011 Demographic and Health Survey Shows No Fertility Decline, High Maternal Health
by Carl Haub, senior demographer
The Congo 2011-2012 Demographic and Health Survey (DHS) is the second DHS taken in the country and the preliminary report has just been released. The survey interviewed 10,819 women ages 15-49 and 5,145 men ages 15-59 from September 2011 to February 2012. A major finding of the survey was that fertility has not declined in the country since the previous DHS in 2005. The total fertility rate (TFR) report in the recent DHS for the three year period before the survey was 5.1 children per woman, 4.5 in urban areas and 6.5 in rural areas. This appears to represent an increase in the TFR since 2005 but the survey report cautions that there is likely to have been some understatement of the actual level of childbearing in the 2005 survey, particularly among women ages 25-29. Rural women accounted for two-thirds of those interviewed in the most recent survey of about 4 million population. The rather high TFR is reflected in the desire for large families. Among women with five living children, only 37.3 percent said they did not wish to have additional children. An additional 9.8 percent of that group said they were incapable of conceiving, however.
In the survey, 44.7 percent of currently married or in-union women said that they were using some form of family planning and 20 percent were using a modern method. The most common type of modern method was the male condom at 12.3 percent, a rather unusual pattern of contraceptive use in Africa. That was followed by the pill at 2.9 percent and injectables at 2.8 percent. This continues the often-observed preference in sub-Saharan Africa for methods to space births, not necessarily to limit them. The use of modern contraception was 24.6 percent in urban areas and 11.7 percent in rural areas. Modern contraception rose since the 2005 DHS when it was reported at 12.7 percent and the condom was also the most frequently used method at that time. The prevalence of HIV was reported in the 2009 AIDS Indicator Survey at 4.1 percent for women ages 15-49 and 2.1 percent of men of the same age group.
Indicators of maternal care reported in the survey were very good. Of mothers who had given birth in the five years before the survey, 92.6 percent had received prenatal care from a skilled provider; 93.6 percent had had a skilled attendant at delivery; and 91.5 percent had given birth in a health facility. Protection against neonatal tetanus, at 73.5 percent was good but needs improvement. Maternal health indicators were generally a little lower in rural areas but still quite good.
Of children under age 5, 24.4 percent were stunted (height-for age) and 8 percent were severely stunted (included in the 24.4 percent); the percent underweight (weight-for-age) was also low at 11.6 percent. Breastfeeding patterns were somewhat different than other countries. The World Health Organization (WHO) recommends that breastfeeding be supplemented with solid/mushy food at the child’s six month of age. In Congo, among mothers with children ages 0-1 months, only 34 percent were breastfeeding exclusively while the large majority of the rest were supplementing with some other liquid. By age 6-8 months, 86.3 percent of children were receiving supplementary food. The proportion of young children receiving all required basic vaccinations was not as high as would be hoped. Among children ages 12-23 months, only 45.5 percent had received all basic vaccinations (BCG, measles, three doses each of DPT and polio vaccine, excluding polio vaccine given at birth); the urban proportion was 49.3 percent and rural was 39.7 percent. Only 57.2 percent of mothers were able to produce vaccination cards. The possession of bed nets as a preventative measure against malaria was quite high at 83.9 percent but was much lower for bed nets treated with a long-acting insecticide at 26.6 percent.
This latest Congo DHS poses a significant prospect for future population growth in the country. There has been some TFR decline in the past, as it was reported to have been 5.9 in the 1984 Census. The 2007 Census measured it at 4.9. As a result, it appears that recent measurements of the TFR suggest a stall in fertility decline at about 5 children per woman.
The survey preliminary report is available on the MEASURE DHS website.