The association between contraceptive use transition and fertility dynamics in Zambia
The Zambian government has recognized family planning (FP) as a key strategy to reduce high fertility and teenage pregnancy rates. Over the years, contraceptive use has been increasing steadily in the country; however, the effects of increased contraceptive use on fertility dynamics have rarely been explored in Zambia. In this study, we examined the relationship between contraceptive transition and fertility dynamics using the Zambia Demographic and Health Surveys conducted from 1992 to 2018. We applied a Blinder–Oaxaca multivariable decomposition analysis technique to quantify the contribution of contraceptive transition to the observed reduction in fertility and teenage pregnancy rates. About 69% of the reduction in total fertility rate and 64% of the decline in teenage pregnancy rate were due to shifts in women’s sociodemographic characteristics. Specifically, the increase in contraceptive use rates from 14.2% to 45.0% accounted for 17.7% of the reduction in total fertility rate. Furthermore, 54.8% of teenage pregnancies were averted due to increased contraceptive use among teenagers in Zambia. The study establishes that contraceptive use significantly reduced fertility and teenage pregnancy rates. These trends can be predominantly attributed to an escalation in the proportion of females achieving secondary education, along with delays in age at first marriage and sexual initiation. This necessitates the enhancement of current sexual and reproductive health, and FP approaches to uphold the escalating levels of contraceptive utilization to further increase the impact on fertility dynamics in the country.
Ahmed, S., Choi, Y., Rimon, J.G., Alzouma, S., Gichangi, P., Guiella, G., et al. (2019). Trends in contraceptive prevalence rates in Sub-Saharan Africa since the 2012 London summit on family planning: Results from repeated cross-sectional surveys. The Lancet Global Health, 7(7):e904-e911. https://doi.org/10.1016/S2214-109X(19)30200-1
Akwara, E., Pinchoff, J., Abularrage, T., White, C., & Ngo, T.D. (2023). The urban environment and disparities in sexual and reproductive health outcomes in the global south: A scoping review. Journal of Urban Health, 100:525-561. https://doi.org/10.1007/s11524-023-00724-z
Alazbih, N., Kaya, A.H., Mengistu, M., & Gelaye, K. (2021). Age at first marriage and fertility decline in dabat health and demographic surveillance system site, northwest Ethiopia: Decomposition analysis. International Journal of Women’s Health, 13:1197-1206. https://doi.org/10.2147/IJWH.S334112
Anderson, K.G., & Leah, T. (2019). Age at First Birth and Fertility: Global Variation in Proximate Causes. Population Association of America Annual Meeting. Available from: https://paa2019.populationassociation.org/ abstracts/193348 [Last accessed on 23 Jan 2024].
Ariho, P., & Kabagenyi, A. (2020). Age at first marriage, age at first sex, family size preferences, contraception and change in fertility among women in Uganda: Analysis of the 2006- 2016 period. BMC Women’s Health, 20(1):8. https://doi.org/10.1186/s12905-020-0881-4
Beguy, D., Ezeh, A.C., Mberu, B.U., & Emina, J.B.O. (2017). Changes in use of family planning among the Urban poor: Evidence from nairobi slums: Changes in use of family planning among the Urban poor. Population and Development Review, 43:216-234. https://doi.org/10.1111/padr.12038
Bietsch, K., Arbaji, A., Mason, J., Rosenberg, R., & Al Ouri, M. (2021). Shifting dynamics: Changes in the relationship between total fertility rate and contraceptive prevalence rate in Jordan between 2012 and 2017. Gates Open Research, 4:160. https://doi.org/10.12688/gatesopenres.13188.2
Biney, A.A.E., Wright, K.J., Kushitor, M.K., Jackson, E.F., Phillips, J.E., Awoonor-Williams, J.K., et al. (2021). Being ready, willing and able: Understanding the dynamics of family planning decision-making through community-based group discussions in the Northern Region, Ghana. Genus, 77(1):1. https://doi.org/10.1186/s41118-020-00110-6
Blinder, A.S. (1973). Wage discrimination: Reduced form and structural estimates. The Journal of Human Resources, 8(4):436-455. https://doi.org/10.2307/144855
Bongaarts, J. (2009). Human population growth and the demographic transition. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1532):2985-2990. https://doi.org/10.1098/rstb.2009.0137
Bongaarts, J. (2017). The effect of contraception on fertility: Is sub- Saharan Africa different? Demographic Research, 37(6):129-145. https://doi.org/10.4054/DemRes.2017.37.6
Bongaarts, J. (2020). Trends in fertility and fertility preferences in Sub-Saharan Africa: The roles of education and family planning programs. Genus, 76(1):32. https://doi.org/10.1186/s41118-020-00098-z
Casterline, J.B., Bongaarts, J., & Hertrich, V. (2017). Trends in age at marriage and the onset of fertility transition in Sub-Saharan Africa. Population and Development Review, 43:112-137.
Croft, T.N., Marshall, A.M.J., Allen, C.K. (2018). Guide to DHS Statistics. Rockville, The DHS Program, Maryland, USA: ICF. Available from: https://www.dhsprogram.com [Last accessed on 2024 Jan 23].
Dasgupta, A., Wheldon, M., Kantorová, V., & Ueffing, P. (2022). Contraceptive use and fertility transitions: The distinctive experience of Sub-Saharan Africa. Demographic Research, 46:97-130. https://doi.org/10.4054/DemRes.2022.46.4
De-Boer, P., & Rodrigues, J.F.D. (2020). Decomposition analysis: When to use which method? Economic Systems Research, 32(1):1-28. https://doi.org/10.1080/09535314.2019.1652571
Easterlin, R.A. (1975). An economic framework for fertility analysis. Studies in Family Planning, 6(3):54-63. https://doi.org/10.2307/1964934
Galor, O. (2012). The demographic transition: Causes and consequences. Cliometrica (Berl), 6(1):1-28. https://doi.org/10.1007/s11698-011-0062-7
Garenne, M. (2018). Family planning and fertility decline in Africa: From 1950 to 2010. In: Amarin, Z.O., (eds.). Family Planning. Londres: IntechOpen. https://doi.org/10.5772/intechopen.71029
Götmark, F., & Andersson, M. (2020). Human fertility in relation to education, economy, religion, contraception, and family planning programs. BMC Public Health, 20(1):265. https://doi.org/10.1186/s12889-020-8331-7
Hertrich, V. (2017). Trends in age at marriage and the onset of fertility transition in Sub-Saharan Africa. Population and Development Review, 43:112-137. https://doi.org/10.1111/padr.12043
Kalinda, C., Phiri, M., Chimpinde, K., Ishimwe, M.C.S., & Simona, S.J. (2022). Trends and socio-demographic components of modern contraceptive use among sexually active women in Rwanda: A multivariate decomposition analysis. Reproductive Health, 19(1):226. https://doi.org/10.1186/s12978-022-01545-0
Karra, M., Canning, D., & Wilde, J. (2017). The effect of fertility decline on economic growth in Africa: A macrosimulation model. Population and Development Review, 43:237-263. https://doi.org/10.1111/padr.12009
Lenze, J., & Klasen, S. (2017). Does women’s labor force participation reduce domestic violence? Evidence from Jordan. Feminist Economics, 23(1):1-29. https://doi.org/10.1080/13545701.2016.1211305
Macunovich, D.J. (1998). Fertility and the easterlin hypothesis: An assessment of the literature. Journal of Population Economics, 11(1):53-111. https://doi.org/10.1007/s001480050058
Malunga, G., Sangong, S., Saah, F.I., & Bain, L.E. (2023). Prevalence and factors associated with adolescent pregnancies in Zambia: A systematic review from 2000-2022. Archives of Public Health, 81(1):27. https://doi.org/10.1186/s13690-023-01045-y
Manlove, J., Karpilow, Q., Welti, K., & Thomas, A. (2015). Linking changes in contraceptive use to declines in teen pregnancy rates. Societies, 6(1):1-14. https://doi.org/10.3390/soc6010001
Mapoma, C., Phiri, M., & Nyirenda, E. (2018). Female Education And Fertility. Zambia: UNZA Press. https://dspace.unza.zm/handle/123456789/6062
Masiano, S.P., Green, T.L., Dahman, B., & Kimmel, A.D. (2019). The effects of community-based distribution of family planning services on contraceptive use: The case of a national scale-up in Malawi. Social Science and Medicine, 238:112490. https://doi.org/10.1016/j.socscimed.2019.112490
May, J.F. (2017). The politics of family planning policies and programs in Sub-Saharan Africa. Population and Development Review, 43:308-329. https://doi.org/10.1111/j.1728-4457.2016.00165.x
Mback, C. (2017). The persistence of high fertility in Sub-Saharan Africa: A comment. Population and Development Review, 43:330-337. https://doi.org/10.1111/padr.12052
Mberu, BU., & Ezeh, AC. (2017). The population factor and economic growth and development in Sub-Saharan African countries. African Population Studies, 31:3833-3844. https://doi.org/10.11564/31-2-1056
Mbizvo, M.T., Kasonda, K., Muntalima, N.C., Rosen, J.G., Inambwae, S., Namukonda, E.S., et al. (2023) . Comprehensive sexuality education linked to sexual and reproductive health services reduces early and unintended pregnancies among in-school adolescent girls in Zambia. BMC Public Health, 23(1):348. https://doi.org/10.1186/s12889-023-15023-0
Ministry of National Development Planning. (2019). Zambia National Population Policy. Indonesia: Ministry of National Development Planning. Available from: https://www.mndp. gov.zm [Last accessed on 10 Mar 2023].
Muhoza, D.N., Broekhuis, A., & Hooimeijer, P. (2018). Regional variations in contraceptive use in rwanda: A multilevel analysis of readiness, willingness and ability. Journal of Population and Social Studies [JPSS], 26(3):248-261. https://doi.org/10.25133/JPSSv26n3.018
Munakampe, M.N., Michelo, C., & Zulu, J.M. (2021). A critical discourse analysis of adolescent fertility in Zambia: A postcolonial perspective. Reproductive Health, 18(1):75. https://doi.org/10.1186/s12978-021-01093-z
Nanvubya, A., Wanyenze, R.K., Abaasa, A., Nakaweesa, Y., Mpendo, J., Kawoozo, B., et al. (2022). Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of lake victoria in Uganda: A randomized controlled trial. BMC Health Services Research, 22(1):506. https://doi.org/10.1186/s12913-022-07898-3
Neumark, D. (1988). Employers’ discriminatory behavior and the estimation of wage discrimination. The Journal of Human Resources, 23(3):279-295.https://doi.org/10.2307/145830
Odimegwu, C., Phiri, M., Tapera, T., & Simona, S. (2023). Patterns and correlates of intention to use contraceptives among fecund sexually active women in developing countries. Global Health Action, 16(1):2255043. https://doi.org/10.1080/16549716.2023.2255043
Okoli, C.I., Hajizadeh, M., Rahman, M.M., Velayutham, E., & Khanam, R. (2022). Socioeconomic inequalities in teenage pregnancy in Nigeria: Evidence from demographic health survey. BMC Public Health, 22(1):1729. https://doi.org/10.1186/s12889-022-14146-0
Olowolafe, T.A., Adebowale, A.S., Fagbamigbe, A.F., Akinyemi, J.O., Onwusaka, O.C., & Agbeja, I.O. (2023). Proximate determinants and decomposition of changes in fertility levels across Nigeria regions: Evidence from Nigeria demographic health survey, 2003-2018. African Journal of Reproductive Health, 27(3):77-86. https://doi.org/10.29063/ajrh2023/v27i3.10
Orwa, J., Gatimu, S.M., Ariho, P., Temmerman, M., & Luchters, S. (2023). Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: An analysis of Kenya demographic health surveys. BMC Public Health, 23(1):718. https://doi.org/10.1186/s12889-023-15620-z
Phiri, M., Kasonde, M.E., Moyo, N., Sikaluzwe, M., & Simona, S. (2023). A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001-2018). Reproductive Health, 20(1):16. https://doi.org/10.1186/s12978-023-01567-2
Phiri, M., Odimegwu, C., & Adewoyin, Y. (2024). Social context of contraceptive use transition among sexually active women in Zambia (1992-2018): A decomposition analysis. PLoS One, 19(4):e0300506. https://doi.org/10.1371/journal.pone.0300506
Powers, D.A., Yoshioka, H., & Yun, MS. (2011). Multivariate decomposition for nonlinear response models. The Stata Journal, 11(4):556-576.
Rahimi, E., & Hashemi Nazari, S.S. (2021). A detailed explanation and graphical representation of the blinder-oaxaca decomposition method with its application in health inequalities. Emerging Themes in Epidemiology, 18:12. https://doi.org/10.1186/s12982-021-00100-9
Sarnak, D.O., Tsui, A., Makumbi, F., Kibira, S.P.S., & Ahmed, S. (2021). A panel study of fertility preferences and contraceptive dynamics in the presence of competing pregnancy risks in Uganda. Demography, 58(1):295-320. https://doi.org/10.1215/00703370-8937285
Schoumaker, B. (2019). Stalls in fertility transitions in Sub‐ Saharan Africa: Revisiting the evidence. Studies in Family Planning, 50(3):257-278. https://doi.org/10.1111/sifp.12098
Shasha, L., Phiri, M., Namayawa, S., Sikaluzwe, M., Nakazwe, C., Lemba, M., et al. (2023). Prevalence and factors associated with early childbearing in Sub-Saharan Africa: Evidence from demographic and health surveys of 31 countries. BMC Women’s Health, 23(1):430. https://doi.org/10.1186/s12905-023-02581-z
Shumba, S., Moonga, V., Miyoba, T.O., Jere, S., Nkonde, J.M., & Mumba, P. (2024). Socio-economic disparities and predictors of fertility among adolescents aged 15 to 19 in Zambia: Evidence from the zambia demographic and health survey (2018). PLoS Global Public Health, 4(3):e0002739. https://doi.org/10.1371/journal.pgph.0002739
Sikaluzwe, M., Phiri, M., Lemba, M., Shasha, L., & Muhanga, M. (2024). Trends in prevalence and factors associated with unintended pregnancies in Zambia (2001-2018). BMC Pregnancy and Childbirth, 24(1):148. https://doi.org/10.1186/s12884-024-06311-7
Sinning, M., Hahn, M., & Bauer, K.T. (2008). The blinder-oaxaca decomposition for nonlinear regression models. The Stata Journal, 8(4):480-492. https://doi.org/10.1177/1536867X0800800402
Szreter, S. (1993). The idea of demographic transition and the study of fertility change: A critical intellectual history. Population and Development Review, 19(4):659-701. https://doi.org/10.2307/2938410
Tetteh, J., Ekem-Ferguson, G., Yamson, P., Yarney, E., Quansah, H., DeGraft-Amoah, D., et al. (2022). Understanding the trend and patterns of teenage pregnancy in Ghana: Evidence from the Ghana demographic and health survey from 1993-2014. Cogent Public Health, 9(1):2111840. https://doi.org/10.1080/27707571.2022.2111840
The African Union Commission. (2016). Maputo Plan of Action 2016-2030. Ethiopia: African Union. Available from: https://au.int/sites/default/files/pages/32895-file-maputo-plan-of-action-english.pdf [Last accessed on 23 Jan 2025].
United Nations. (2022). The Sustainable Development Goals Report 2022. United States: United Nations. Available from: https://unstats.un.org/sdgs/report/2022 [Last accessed on 23 Jan 2025].
Wasswa, R., Kabagenyi, A., Kananura, R.M., Jehopio, J., & Rutaremwa, G. (2021). Determinants of change in the inequality and associated predictors of teenage pregnancy in uganda for the period 2006-2016: Analysis of the uganda demographic and health surveys. BMJ Open, 11(11):e053264. https://doi.org/10.1136/bmjopen-2021-053264
Yared, W. (2012). A Decade of Change in Contraceptive Use in Ethiopia. United States: United Nations Population Fund. https://doi.org/10.13140/RG.2.1.3679.0480
Yussuf, M.H., Elewonibi, B.R., Rwabilimbo, M.M., Mboya, I.B., & Mahande, M.J. (2020). Trends and predictors of changes in modern contraceptive use among women aged 15-49 years in Tanzania from 2004-2016: Evidence from tanzania demographic and health surveys. PLoS One, 15(6):e0234980. https://doi.org/10.1371/journal.pone.0234980
Zambia Statistics Agency, Ministry of Health (MOH) Zambia, and ICF. (1993). Zambia Demographic and Health Survey 1992 [Survey Report]. Zambia: Zambia Statistics Agency, Ministry of Health, ICF.
Zambia Statistics Agency, Ministry of Health (MOH) Zambia, and ICF. (2019). Zambia Demographic and Health Survey 2018 [Survey Report]. Zambia: Zambia Statistics Agency, Ministry of Health, ICF.
Zulu, R., Musonda, E., Ugwu, N.H., & Phiri, M. (2025). Determinants of the desire to limit childbearing among married women in Sub-Saharan African countries. International Journal of Population Studies:5584. https://doi.org/10.36922/ijps.5584