Uganda 2011 Demographic and Health Survey Shows Fertility Decline, Increase in Family Planning Use, and Continued Decline in Infant and Under-Five Mortality
by Carl Haub, senior demographer
The Uganda 2011 Demographic and Health Survey (DHS) is the latest demographic survey taken in the country and the preliminary report has just been released. The survey interviewed 8,674 women ages 15-49 and 2,295 men ages 15-54. The results show that the total fertility rate (TFR) for the three-year period before the survey was 6.2, 3.8 in urban areas and 6.7 in rural areas. This represents a decline in the TFR since 2006 when the TFR was reported as 6.7 in a country where some have referred to the TFR as being stubbornly high. Rural women accounted for 80 percent of those interviewed. The desire for large families remains rather high, however. Among women with five living children, 53.3 percent said they did not wish to have additional children. An additional 6.2 percent said they were incapable of conceiving or had been sterilized.
In the survey, 30 percent of currently married women said that they were using some form of family planning and 26 percent were using a modern method. As in much of sub-Saharan Africa, “spacing” methods predominate. The most commonly used modern method of family planning was injectables, with 14.1 percent of women using that method, followed by the pill and female sterilization at 2.9 percent each. There has been a steady increase in family planning use, from 15 percent in 1995 and from 24 percent in 2006.
The decline in infant and child mortality, as reported in earlier surveys, has continued. The infant mortality rate (IMR) in the five years before the 2011 DHS was 54 infant deaths below age 1 per 1,000 live births, down from 81 in the 1995 DHS and 76 in the 2006 DHS. The level of the child death rate, ages 1-4, however, remains somewhat higher than might be expected at 38. It was 72 in 1995, not very different from infant mortality.
Of children under age 5, 33.4 percent were stunted (height-for age) and 13.7 percent were severely stunted (included in the 33.4 percent); 13.7 percent were underweight (weight-for-age). Mothers follow the WHO recommendation of supplementing breastfeeding with solid/mushy food at the child’s six months of age quite well. At 6-8 months age, only 9.8 percent continued to be breastfed exclusively with 74.1 percent supplementing with solid food. By 9-11 months, 89.3 percent had supplemented. The proportion of young children receiving all required basic vaccinations needs improvement. Among children 12-23 months of age, only 51.6 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 60.8 percent and rural was 50.2 percent. And only 59.2 percent of mothers were able to produce vaccination cards.
Maternal care indicators were generally good. Fully 94.9 percent of most-recent births received antenatal care from a skilled provider and 84.3 percent were protected against neonatal tetanus. Still, only 59.3 percent were attended by a skilled provider and a bit over half took place in a health facility, 57.4 percent. Maternal indicators were far better in urban areas than in rural.
The 2011 Uganda DHS certainly contains a suggestion that real fertility decline is underway in the country, an expectation given more plausibility given the increasing use of family planning.