Volume 37 - Article 6 | Pages 129–146  

The effect of contraception on fertility: Is sub-Saharan Africa different?

By John Bongaarts

Abstract

Background: Cross-sectional analyses of the relationship between contraceptive prevalence and the total fertility rate of developing countries show the expected strong negative correlation. However, this correlation is much weaker in Sub-Saharan Africa than in the developing world as a whole.

Objective: This paper aims to explain the unexpected weak effect of contraceptive use on fertility in sub-Sharan African countries by using different regression models to obtain unbiased effects.

Methods: Using DHS survey data from 40 developing countries, the analysis consists of three steps: 1) examine the conventional cross-sectional TFR-CPR relationship by region at the time of the latest available surveys, 2) remove known technical flaws in the comparisons of fertility and contraceptive prevalence and 3) analyze multiple observations of TFR and CPR per country using pooled OLS and fixed effect regressions.

Results: The conventional cross-sectional analyses produce biased results in part because technical factors, in particular post-partum overlap, create a downward bias in the effect of prevalence on fertility in sub-Saharan Africa. In addition, and more importantly, the cross-sectional regression OLS parameters have a bias due to confounding country fixed effects. Technical adjustments and the use of fixed effect models remove these biases.

Conclusions: A rise in contraceptive prevalence among fecund women has the same average effect on fertility in sub-Saharan Africa as in other regions of the developing world.

Contribution: This study solves a long-standing demographic puzzle and reassures policymakers and family planning program managers.

Author's Affiliation

• John Bongaarts - Population Council, International EMAIL

Other articles by the same author/authors in Demographic Research

Extramarital fertility in low- and middle-income countries
Volume 47 - Article 3

Modeling the fertility impact of the proximate determinants: Time for a tune-up
Volume 33 - Article 19

Five period measures of longevity
Volume 13 - Article 21

Most recent similar articles in Demographic Research

Educational trends in cohort fertility by birth order: A comparison of England and Wales, Scotland, and Northern Ireland
Volume 51 - Article 36    | Keywords: birth order, cohort analysis, cross-national study, England, family size, fertility, Northern Ireland, parity, Scotland, Wales

Children under 5 in polygynous households in sub-Saharan Africa, 2000 to 2020
Volume 51 - Article 32    | Keywords: children, Demographic and Health Surveys (DHS), family demography, polygyny, sub-Saharan Africa

Higher incomes are increasingly associated with higher fertility: Evidence from the Netherlands, 2008–2022
Volume 51 - Article 26    | Keywords: fertility, income, inequalities, Netherlands, parenthood

The short- and long-term determinants of fertility in Uruguay
Volume 51 - Article 10    | Keywords: fertility, panel data, stages of female reproductive life, time series, Uruguay

Using Respondent-Driven Sampling to measure abortion safety in restrictive contexts: Results from Kaya (Burkina Faso) and Nairobi (Kenya)
Volume 50 - Article 47    | Keywords: induced abortion, respondents-driven samples, social networks, sub-Saharan Africa