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Factors Behind Recent Fertility Plateauing in Jordan & Challenges to Maintaining Future Fertility Decline by Issa Almasarweh Professor – Jordan University. Presentation Outlines. Jordan Fertility Trends Jordan Fertility Goals Factors Affecting Fertility Rates
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Factors Behind Recent Fertility Plateauing in Jordan & Challenges to Maintaining Future Fertility Decline by Issa Almasarweh Professor – Jordan University
Presentation Outlines • Jordan Fertility Trends • Jordan Fertility Goals • Factors Affecting Fertility Rates • Challenges to Sustained Decline in Jordan Fertility
Current TFR in the Region Source: 2011 PRB WPDS
Early progression to first child 2009 DHS
Fertility – a key component in Jordan future PG 3 million born in the last 20 years 2.3 are expected in the next 10 years RECENT09 Constant
Reducing Fertility is a National Priority Goal for Jordan Births per couple RHAP2
Direct Factors Affecting Fertility Rate 1) % of women 15-49 married 2) Contraceptive use 3) Postpartum insusceptibility 4) Induced abortion 5) Infertility Fertility
% Ever-married below the age of 30 years 2002 & 2009 DHS
High Growth in Number of First Time Brides (4.3% annually) http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf
Early Marriages<18= 14% of total 1st time brides15-19= 30% of total 1st time brides http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf
Age Specific Fertility Rates 2002 & 2009 DHS
Age Specific Fertility Rates - Urban 2002 & 2009 DHS
Modern CPR by Sector -JCLS Based on JCLS
Infertility increased = % of women 45-49 who are childless Based on JCLS
Contraceptive Use needs to increase ! 65 % TotalFertilityRate FertilityPlateauing Contraceptive Prevalence Rate 3.0 FamPlan: File RECENT09
Challenges to raise contraceptive use and reduce fertility • Shrinking FP Choices / Access • Missed / Lost Opportunities • Churning – Discontinuation • Others
Shrinking Choices / Access • Limited access to permanent & long-acting methods : Female Sterilization, Injectables, Implanon • Dominance of one and provider-based method (IUD) • Unmet preference for female providers (87%) • Disappearance of low-price OCs in the commercial sector • Uncertain role of major FP providers (JAFPP, RMS, Universities Hospitals)
2) Missed Opportunities • At premarital exam • At time of signing marriage contract • At delivery and postnatal period • low postnatal return • low postnatal counseling • no immediate IUDs insertion after delivery (providers fear of expulsion or lack training) • At child health care visits • At Schools and Colleges • At youth centers, clubs, camps • At Mosques • At Workplace • At pharmacies
2) Missing Opportunities • Low demand on available services at SDPs • High downtime at SDPs due to lack of appointment system • Exclusion of FP in private health insurance • Exclusion of important groups: men, newly married, unmarried youth • Unfriendly breastfeeding environment at private hospitals
3) Churning – Discontinuation • High FP discontinuation and failure rates • Quality of services - informed choice (poor treatment of side effects; inadequate and poor FP counseling) • High use of traditional methods • Unsatisfied users (20% want another method) • Son Preference • Family pressure (63% - 2007 DHS)
Reasons for Discontinuation 42 % Source: Contraceptive Dynamics Study
Unmet need for FP use Source : 2009 DHS
TFR and Unmet Need and Discontinuation HPC, 2011, Reducing Discontinuation of Contraceptive Use and Unmet Need for FP, policy Briefs
4) Other Challenges • Population Momentum – more than one million girl child exists now • Number of women 15-49 years will increase from 1.6 to 2.0 million by 2020 • The impact of this is shown in the next slide
Projected Contraceptive Users (all methods) 42 % 19 % Current Users FamPlan: Files RECENT09 & RECENT09 Constant
4) Other Challenges • Divided civil society- politicalization of issues • Distortion of market forces through subsidies may delay the rationalization of childbearing decision by parents • Abuse of maternity leave by public sector servants