Volume 8, Number 13
31 March 2008

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ADOLESCENT HEALTH NEWS

Nigeria: Breastfeeding linked with lower childhood blood pressure
(News Article; Sub-Saharan Africa)
25 Mar 2008
Vanguard (Lagos)

Uganda: Parents tipped on sex education
(News Article; Sub-Saharan Africa)
23 Mar 2008
New Vision (Kampala)

ADOLESCENT HEALTH RESEARCH

From affected to infected? Orphanhood and HIV risk among female adolescents in urban Zimbabwe
(Abstract; subscription needed for full text; Sub-Saharan Africa)
AIDS. 2008 Mar 30;22(6):759-766.
Birdthistle IJ | Floyd S | Machingura A | Mudziwapasi N | Gregson S
Despite the 15 million children orphaned by AIDS, and fears of sexual vulnerability, little is known about the link between orphanhood and HIV risk. A random sample of 1283 15 to 19-year-old girls in a high-density suburb of Harare was identified in a cross-sectional survey in 2004. A total of 863 agreed to be interviewed and 839 provided a specimen for HIV and herpes simplex virus type-2 (HSV-2) testing. Sexual health outcomes, sexual behaviours and marriage were assessed by type and timing of orphanhood. Half of the participants were single or double orphans. Prevalence of HIV and/ or HSV-2 was higher among orphans than non-orphans [17 versus 12%; age-adjusted odds ratio (aOR) = 1.5; 95% confidence interval (CI) 1.0-2.3]. Associations with orphan status were only significant among the 743 never-married participants. In comparison with non-orphaned peers, increased sexual risk (defined as HSV2-positive, HIV-positive or ever pregnant) was seen among maternal orphans (aOR = 3.6; 95% CI, 1.7-7.8), double orphans (aOR = 2.4; 95% CI, 1.2-4.9), and girls who lost their father before age 12 (aOR = 2.1; 95% CI, 0.9-4.8) but not later (aOR = 0.8; 95% CI, 0.3-2.2). Maternal and double orphans were most likely to initiate sex early and to have had multiple partners. Maternal orphans were least likely to have used a condom at first sex, and to have a regular sexual partner. Experience of forced sex was high in all groups. In urban Zimbabwe, female adolescent orphans are at increased risk of HIV and HSV-2 infection. Infection rates vary by type and age of orphanhood, and marital status, and are associated with high-risk sexual behaviours.

Sexual behavior and STI/HIV status among adolescents in rural Malawi: An evaluation of the effect of interview mode on reporting
(Report; Sub-Saharan Africa)
2008;New York, NY, Population Council, 2008. (8)30 p. (Poverty, Gender, and Youth Working Paper No. 8)
Mensch BS | Hewett PC | Gregory R | Helleringer S
Our understanding of the dynamics of HIV transmission in developing countries is compromised by unreliable data concerning sexual behavior. This paper represents an effort to investigate young people's reporting of sexual behavior. It summarizes the results from an interview-mode experiment conducted with unmarried young women aged 15-21 in rural southern Malawi in which respondents were randomly assigned to either an audio computer-assisted self-interview (ACASI) or a conventional face-to-face (FTF) interview. In addition, biomarkers were collected for HIV and three STIs: gonorrhea, chlamydia, and trichomoniasis. Prior to collecting the biomarkers, nurses conducted a brief face-to-face interview with participants in which they repeated questions about sexual behavior asked earlier. The paper builds on earlier research among adolescents in Kenya where we first investigated the feasibility and effectiveness of ACASI. In both Kenya and Malawi, clear evidence indicates that the mode of interviewing and probing concerning various sexual partnerships affects respondents' reporting of their sexual activity. Yet, the results are not always in accordance with expectations. Reporting for "ever had sex" and "sex with a boyfriend" is higher in the FTF mode. When we ask about other partners as well as multiple lifetime partners, however, the reporting is consistently higher with ACASI, in many cases significantly so. As in Kenya, in Malawi the interview-administered mode produced more consistent reporting of sexual activity between the main interview and a subsequent interview. Finally, the association between infection status and reporting of sexual behavior is stronger in the FTF mode, although in both modes, some young women who denied ever having had sex tested positive for STIs/HIV.

FAMILY PLANNING NEWS

Vietnam: Indecision puts population goals at risk
(News Article; Asia)
26 Mar 2008
Vietnam News Service

India: More women popping the pill
(News Article; Asia)
23 Mar 2008
Khapre S, Daily News and Analysis

Uganda: Involve men in family planning, says expert
(News Article; Sub-Saharan Africa)
24 Mar 2008
Bugembe A, The New Vision

FAMILY PLANNING RESEARCH

Polygamy and the use of contraceptives
(Abstract; subscription needed for full text; Sub-Saharan Africa)
International Journal of Gynecology and Obstetrics. 2008 Apr;101(1):88-92.
Audu B | Yahya S | Geidam A | Abdussalam H | Takai I | Kyari O
The objectives was to compare contraceptive use among women in monogamous and polygamous marriages in Nigeria. Structured questionnaires administered to married women enquired about their marriage type, sociodemographic characteristics, and contraceptive use. Of the 532 respondents, 33.6% were in polygamous marriages. There was a statistically significant association between monogamy and nonutilization of contraception (P=0.03); however, women in polygamous marriages were more likely not to use contraception when they were older than 35 years, had 4 or more living children, had no male child, had 3 or more female children, or lived in rural areas. There was also a statistically significant association between nonutilization of contraception and number of male children of co-wives (P=0.003), number of female children of co-wives (P=0.05), and use of contraception by co-wives (P=0.002). Polygamy influences contraceptive use and the role of co-wives in this regard merits further study.

Pelvic inflammatory disease attributable to the IUD: Modeling risk in West Africa
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Contraception. 2008 Apr;77(4):227-229.
Stanback J | Shelton JD
In Africa, use of the intrauterine device (IUD) is avoided because of perceived risk of pelvic inflammatory disease (PID) associated with sexually transmitted infections (STI). However, one recent model suggests that the risk of PID attributable to the IUD is very low, only 0.15% or less than 1 in 600. The study design used rates from a 2004 study of cervical STI prevalence in Benin, Burkina Faso, Ghana, Guinea, and Mali; we calculate PID risk attributable to the IUD in West Africa. Based on 4.4% combined prevalence of chlamydial and gonococcal infections, we estimate the risk is 0.075%, or less than 1 in 1,300. In West Africa, PID risk from IUDs is extremely low. This should be better communicated to family planning providers in the region who may under-provide the IUD based on erroneous perceptions of PID risk.

Provider selection of evidence-based contraception guidelines in service provision: A study in India, Peru, and Rwanda
(Abstract; subscription needed for full text; Asia | South America | Sub-Saharan Africa)
Evaluation and the Health Professions. 2008 Mar;31(1):3-21.
Leon FR | Lundgren R | Jennings V
Providers underutilize evidence-based practice guidelines as they prescribe contraceptives. To discern biases in guideline utilization by 172 providers of three countries, this study used observations from simulated clients trained to choose oral contraceptives. Providers implemented less than one third of the guideline set, but they addressed, more frequently than other guidelines, items categorized as essential by expert opinion (p less than .01). Indian providers emphasized instructions on method use in 9-minute consultations, Rwandan providers emphasized contraindications in 29-minute sessions, and Peruvian providers did not emphasize any single guideline category. Providers should use job aids to improve guideline utilization. Those pressed for time need an evidence-based, rather than arbitrary, selection of essential guidelines that optimizes client outcomes. Practice-based research must be generated to meet this need.

Men's social networks and contraception in Ghana
(Abstract; subscription needed for full text; Sub-Saharan Africa)
Journal of Biosocial Science. 2008 May;40(3):413-429.
Avogo W | Agadjanian V
In this paper, longitudinal data from northern Ghana is used to assess the effects of encouragement to use family planning that men receive from their personal network partners on the adoption of modern contraception by their wives. The study tests a conceptual model that, in addition to the effect of men's network encouragement, incorporates the effect of encouragement to use family planning that women receive from their respective network partners and the effect of spousal communication on reproductive matters and approval of family planning. Results show that encouragement received by men from their social networks significantly increases the likelihood of subsequent contraceptive use by their wives but this effect operates primarily by galvanizing spousal communication on reproductive matters. The effect of encouragement received by women from their respective network partners is largely independent from the effect of male network encouragement but it influences contraceptive adoption both directly and through spousal communication.

Demand for family planning is rising: 2008 data sheet
(Report; Global | Global)
Washington, D.C., Population Reference Bureau, 2008. [15] p.
Kent MM
In nearly all developing countries, the number of women of reproductive age (ages 15 to 49) will grow between 2005 and 2015 because of the large numbers of young people in these countries. In addition, the demand for contraceptives is projected to grow due to couples' desires for smaller families. As a result, the total cost of contraceptive supplies to meet couples' needs is projected to rise by nearly 50 percent (in today's U.S. dollars) in countries such as Tanzania and Nepal. The costs are certain to grow throughout the developing world, placing pressure on governments to increase their family planning budgets, raise additional donor funds, obtain better prices for commodities, and/or shift a greater share of costs to users.

GENDER and HEALTH NEWS

Uganda: Gov't drafts policy on male circumcision
(News Article; Sub-Saharan Africa)
25 Mar 2008
Bugembe A | Komugisha L, New Vision (Kampala)

Rwanda: UN hails RDF on campaign against gender violence
(News Article; Sub-Saharan Africa)
26 Mar 2008
The New Times (Kigali)

Liberia: Special court for sexual violence underway
(News Article; Sub-Saharan Africa)
21 Mar 2008
UN IRIN

GENDER and HEALTH RESEARCH

Mental health of female survivors of human trafficking in Nepal
(Abstract; subscription needed for full text; Asia)
Social Science and Medicine. 2008 Apr;66(8):1841-1847.
Tsutsumi A | Izutsu T | Poudyal AK | Kato S | Marui E
Little is known about the mental health status of trafficked women, even though international conventions require that it be considered. This study, therefore, aims at exploring the mental health status, including anxiety, depression and post-traumatic stress disorder (PTSD), of female survivors of human trafficking who are currently supported by local non-governmental organizations (NGOs) in Katmandu, the capital of Nepal, through comparison between those who were forced to work as sex workers and those who worked in other areas such as domestic and circus work (non-sex workers group). The Hopkins Symptoms Checklist-25 (HSCL-25) was administered to assess anxiety and depression, and the PTSD Checklist Civilian Version (PCL-C) was used to evaluate PTSD. Both the sex workers' and the non-sex workers' groups had a high proportion of cases with anxiety, depression, and PTSD. The sex workers group tended to have more anxiety symptoms (97.7%) than the non-sex workers group (87.5%). Regarding depression, all the constituents of the sex workers group scored over the cut-off point (100%), and the group showed a significantly higher prevalence than the non-sex workers (80.8%). The proportion of those who are above the cut-off for PTSD was higher in the sex workers group (29.6%) than in the non-sex workers group (7.5%). There was a higher rate of HIV infection in the sex workers group (29.6%) than in the non-sex workers group (0%). The findings suggest that programs to address human trafficking should include interventions (such as psychosocial support) to improve survivors' mental health status, paying attention to the category of work performed during the trafficking period. In particular, the current efforts of the United Nations and various NGOs that help survivors of human trafficking need to more explicitly focus on mental health and psychosocial support.

Risk factors for intimate partner violence against women in St. Petersburg, Russia
(Abstract; subscription needed for full text; Asia)
Violence Against Women. 2008 Apr;14(4):483-495.
Stickley A | Timofeeva I | Sparen P
This exploratory study examines which risk factors are associated with intimate partner violence against women in St. Petersburg, Russia. Women attending two crisis centers and a birthing house constituted the study sample. The male partner's frequent alcohol consumption and seeing his father hit his mother in childhood were associated with an increased risk of violence, whereas living in a communal apartment reduced the risk of intimate partner violence. The importance of crisis centers in Russia is highlighted by the study, as the women who turn to them are likely to have experienced more severe forms of violence.

Enhancement of underused cervical cancer prevention services in rural Oaxaca, Mexico
(Abstract; subscription needed for full text; North America)
(You need Adobe Acrobat Reader to access this document)
Revista Panamericana de Salud Publica / Pan American Journal of Public Health. 2008 Feb;23(2):135-43.
Givaudan M | Leenen I | Pick S | Angulo A | Poortinga YH
In this article, we discuss a health education program, named Porque me quiero, me cuido, that was implemented in rural and indigenous populations in Valles Centrales in Oaxaca, one of Mexico's poorest and most rural states. The Valles Centrales region occupies a third of the state's territory. In Oaxaca, the mortality rate due to cervical cancer is 12.4 per 100 000 women. Hence, the goal of the program was to promote the use of screening services. The program is geared toward increasing knowledge and skills, enabling women to take preventive measures against cervical cancer, and promoting Pap smear tests. A first version of the program was implemented with support from the local health authorities in the state of Oaxaca. The first question to be answered in this article is whether the Porque me quiero, me cuido program had a demonstrable impact on health behavior, especially in the form of women seeking more Pap smear tests. A further question was to examine whether there was a demonstrable increase in knowledge, attitudes, and behaviors related to cervical cancer and prevention as a consequence of the program.

HIV/AIDS and STIs NEWS

Uganda: Youth still HIV ignorant
(News Article; Sub-Saharan Africa)
24 Mar 2008
Kazooba C, The East African (Nairobi)

South Africa: Men urged to be more visible in HIV, AIDS fight
(News Article; Sub-Saharan Africa)
16 Mar 2008
BuaNews

NIAID to convene HIV vaccine summit
(Press Release; Global)
20 Mar 2008
NIAID Office of Communications

HIV/AIDS and STIs RESEARCH

HIV related risks among Croatian migrant workers 2004 -- 2006
(Abstract; subscription needed for full text; Europe)
AIDS Care. 2008 Mar;20(3):361-369.
Stulhofer A
Two waves of a cross-sectional research study focusing on HIV-related risks in a population of migrant workers were carried out in 2004 and 2006. The research focused on changes in HIV knowledge, beliefs about condom use and risk-taking behaviours. The study included 552 migrant workers in 2004 and 671 in 2006. Using a self-administered questionnaire, data was collected in occupational health offices in nine cities during the process of medical examination required for licensing. Three major changes were observed in the 2004-2006 period. HIV knowledge improved and an increase in condom use at last sexual intercourse with casual partner and at last anal sex was reported. The changes in condom use were observed only among participants who were married or in a relationship. No significant change was recorded in the rates of HIV testing. In 2006, marital status, occupation, beliefs about condom use and personal HIV concerns were found significant predictors of HIV-related behavioural change. Overall, the findings suggest a small reduction in HIV-related sexual risks among migrant workers in Croatia.

Perceptions and attitudes in relation to reproductive tract infections including sexually transmitted infections in rural Vietnam: A qualitative study
(Abstract; subscription needed for full text; Asia)
Health Policy. 2008 May;86(2-3):308-317.
Lan PT | Faxelid E | Chuc NT | Mogren I | Lundborg C
The objective was to explore perceptions, attitudes and health-seeking patterns for reproductive tract infections including sexually transmitted infections (RTI/STI) among men and women in rural Vietnam. Ten focus group discussions (FGDs) were conducted with 46 women and 27 men aged 15-49 in Bavi district, northern Vietnam. A pre-designed discussion guide was used during the discussions. Content analysis was applied for data analysis. Each sentence/paragraph was coded. Similar codes were clustered and collapsed into sub-categories and categories. Two main themes 'community perceptions of RTI/STI' and 'attitudes towards RTI/STI' were created, based on the relationship between categories. Complex terminology with many different terms was used by participants to describe and discuss RTI/STI. "Inflammation" [RTI], Gonorrhoea, Syphilis was described as three stages of STI. Health-seeking patterns for RTI/STI were reported to differ between men and women: self-medication was mentioned as a common practice among women, while men were more likely to seek health care from private providers. Complaints were voiced about clinicians' negative attitudes towards RTI/STI patients. Rural dwellers in a district of Vietnam expressed a variety of misconceptions regarding RTI/STI. Designing health education strategies to provide comprehensive RTI/STI information to the community and improving communication between RTI/STI patients and clinicians are urgently needed.

Anti-tuberculosis therapy-induced hepatotoxicity among Ethiopian HIV-positive and negative patients
(Research Article; Sub-Saharan Africa)
PLoS One. 2008;3(3):e1809.
Yimer G | Aderayae G | Amogne W | Makonnen E | Aklillu E
To assess and compare the prevalence, severity and prognosis of anti-TB drug induced hepatotoxicity (DIH) in HIV positive and HIV negative tuberculosis (TB) patients in Ethiopia. In this study, 103 HIV positive and 94 HIV negative TB patients were enrolled. All patients were evaluated for different risk factors and monitored biochemically and clinically for development of DIH. Sub-clinical hepatotoxicity was observed in 17.3% of the patients and 8 out of the 197 (4.1%) developed clinical hepatotoxicity. Seven of the 8 were HIV positive and 2 were positive for HBsAg. Sub-clinical hepatotoxicity was significantly associated with HIV co-infection (p = 0.002), concomitant drug intake (p = 0.008), and decrease in CD4 count (p = 0.001). Stepwise restarting of anti TB treatment was also successful in almost all the patients who developed clinical DIH. We therefore conclude that anti-TB DIH is a major problem in HIV-associated TB with a decline in immune status and that there is a need for a regular biochemical and clinical follow up for those patients who are at risk.

MATERNAL AND CHILD HEALTH NEWS

Nigeria: 'Mothers, most vulnerable in N'delta crisis'
(News Article; Sub-Saharan Africa)
22 Mar 2008
Ugah N, This Day (Lagos)

India: MAMTA scheme to care mother and infant
(News Article; Asia)
28 Mar 2008
NewsTrack India

MATERNAL AND CHILD HEALTH RESEARCH

Reproductive and child health inequities in Chandigarh Union Territory of India
(Abstract; subscription needed for full text; Asia)
Journal of Urban Health. 2008 Mar;85(2):291-299.
Gupta M | Thakur JS | Kumar R
Health inequity is an emerging issue all over the world. Some populations living in specific geographic areas may have less access to basic health facilities. Therefore, a sample survey of households was carried out to study access of different population groups to reproductive and child health. Cluster sampling technique was used to select 30 clusters (18 urban, 9 slum, and 3 rural) from Chandigarh Union Territory in India. From each of these clusters, 40 households were selected randomly. Data were collected using a standard questionnaire developed by UNICEF from April to June 2006 by graduate male and female field workers who were specially recruited and trained for this purpose. A total of 5383 individuals were studied in 1200 sample households with proportionate representation from urban (56%), slum (33%), and rural (11%) areas. Literacy rate was higher (94.3%) in urban than the rural (80.6%) and slum (65.3%) areas. About 68% of the deliveries were at home and not assisted by a skilled birth attendant (nurse, midwife, or doctor) in the slums, compared to 21% and 7% in rural and urban areas (p less than 0.001), respectively. Fully immunized children at the age of 2 years were 30% in slums as compared to 74% and 62.5% in urban and rural areas (p less than 0.001), respectively. Hib vaccination, which is to be bought at a considerable cost, was nil in slum areas compared to 79% in urban and 45% in rural area. Contraceptive prevalence was significantly more in urban (73%) and rural areas (75%) compared to the slum areas (53.4%) (p less than 0.05). It was concluded that reproductive and child health service coverage has large differences in various population groups. Special interventions should be undertaken on a priority basis to bridge the gaps so as to achieve millennium development goals in all population groups.

Association of education and the occurrence of low birthweight in rural southern China during the early and late 1990s
(Abstract; subscription needed for full text; Asia)
American Journal of Public Health. 2008 Apr;98(4):687-691.
Liu Y | Liu J | Ye R | Ren A | Li S
We examined whether education-related inequalities were associated with the occurrence of low birthweight in 6 counties in southern China in the early and late 1990s. The study population consisted of 111181 women (65669 in the early 1990s and 45482 in the late 1990s) in a population-based Perinatal Health Care Surveillance System. We used the x/2 test, logistic regression, and concentration index for our analyses. From the early to late 1990s, the mean maternal education level increased significantly, and the percentage of low-birthweight births declined among all groups, for both male and female births, and at all levels of the mother's education. Relative to those with less than 9 years of formal education, there was a decreasing risk of low birthweight among those with 9 to 11 years of formal education (range in adjusted odds ratio=0.69-0.82) and with 12 or more years of formal education (range in adjusted odds ratio=0.51-0.74). Between the early and late 1990s, the concentration index changed from -0.0778 to -0.0656 for male births and from -0.0717 to -0.0813 for female births. Education-related inequalities associated with low birthweight persisted from the early to the late 1990s in surveyed areas.

Rotavirus morbidity and mortality in children in Brazil
(Abstract; subscription needed for full text; South America)
Revista Panamericana de Salud Publica / Pan American Journal of Public Health. 2008 Feb;23(2):92-100.
Sartori AM | Valentim J | de Soarez PC | Novaes HM
The objective was to study the epidemiology of rotavirus and estimate rotavirus-associated morbidity and mortality in children less than or equal to 5 years of age in Brazil in 2004 before introducing the rotavirus vaccine in Brazil's National Immunization Program (Programa Nacional de Imunizacoes, PNI). To estimate rotavirus morbidity, published studies (1999-2006) addressing incidence of acute diarrhea among children less than or equal to 5 years of age and frequency of rotavirus infection among children with diarrhea in Brazil were reviewed. Diarrhea episodes were divided into three categories of severity by level of care: mild cases requiring only home-based care; moderate cases requiring a visit to an outpatient healthcare facility; and severe cases requiring hospitalization. To estimate rotavirus mortality, information on the number of registered deaths from diarrhea in children less than or equal to 5 years of age was obtained from the Mortality Information System (Sistema de Informacao sobre Mortalidade, SIM) of Brazil's public healthcare system (Sistema Unico de Saude, SUS) and the proportion of deaths due to rotavirus was calculated. Rotavirus infections were estimated to cause 3 525 053 episodes of diarrhea, 655 853 visits to outpatient healthcare facilities, 92 453 hospitalizations, and 850 deaths of children less than or equal to 5 years of age each year in Brazil. Rotavirus infections are an important cause of child morbidity and mortality in Brazil.

POPULATION/FERTILITY/DEMOGRAPHY NEWS

China: 'Supercities' to tackle urbanization challenge
(News Article; Asia)
26 Mar 2008
China Daily

POPULATION/FERTILITY/DEMOGRAPHY RESEARCH

Migration and Remittances Factbook 2008
(News Article; Global)
Washington, D.C., World Bank, 2008.
Ratha D | Xu Z
Related News Article: India tops list of highest migrant remittances, says World Bank
The Migration and Remittances Factbook 2008 attempts to present numbers and facts behind the stories of international migration and remittances, drawing on authoritative, publicly available data. It provides a snapshot of statistics on immigration, emigration, skilled emigration, and remittance flows for 194 countries, and 13 regional and income groups. Some interesting facts from the Factbook: (1) Nearly 200 million people or 3 percent of the world population live outside their countries of birth. Current migration flows, relative to population, are weaker than those of the last decades of the nineteenth century. (2) The volume of South--South migration is almost as large as that of South--North migration. (3) International migration is dominated by voluntary migration, which is driven by economic factors. In 2005, refugees numbered only 13.5 million, or just over 7 percent of international migrants. The share of refugees in the population of low-income countries was more than five times larger than the share in high-income OECD countries. (4) Worldwide remittance flows are estimated to have exceeded $318 billion in 2007, of which developing countries received $240 billion. The true size including unrecorded flows through formal and informal channels, is believed to be significantly larger.

Rapid fertility decline in Iran: Analysis of intermediate variables
(Abstract; subscription needed for full text; Middle East)
Journal of Biosocial Science. 2008 May;40(3):459-478.
Erfani A | McQuillan K
The remarkable decline in fertility in Iran, which saw the total fertility rate fall from 7 children per woman in 1986 to 2 in 2000, has received only limited analysis in the demographic literature. Using the 2000 Iran Demographic and Health Survey and Bongaarts' age-specific fertility model, this paper examines the role of the major proximate determinants of fertility in bringing about the rapid decrease in fertility in Iran. The analysis indicates that contraception had the largest effect on fertility, accounting for 61% of the reduction in fertility from its theoretical maximum. The fertility-inhibiting effect of marriage patterns accounted for an additional 31% reduction, and was most important among the young. Further analysis of contraceptive behaviour suggests that the current period fertility rate of 2-0 children per woman is an outcome of a synchronization of delaying and spacing of births among younger women with stopping of childbearing among women in the middle and late reproductive ages. The policy implications of the results are discussed.

Fertility transitions in developing countries: Progress or stagnation?
(Working Paper; Global)
New York, NY, Population Council, 2008. 15 p. (Poverty, Gender, and Youth Working Paper No. 7)
Bongaarts J
Over the past quarter century fertility has declined rapidly in many developing countries. Projections typically assume that this trend will continue until the replacement level is reached. However, recent evidence suggests that ongoing fertility declines may have slowed or stalled in a number of countries in transition. This study examines the pace of fertility change in developing countries that have multiple DHS surveys to determine whether ongoing transitions are decelerating or stalling. The main findings are that in sub-Saharan African countries, the average pace of decline in fertility is lower around 2000 than in the mid-1990s, and more than half the countries in transition in this region have stalled.

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Johns Hopkins Bloomberg School of Public Health: The INFO Project

Volume 8, Number 1331 March 2008