In 2025, there are six countries, all in Sub-Saharan Africa, where the average woman of childbearing age can expect to have between 5-6 children throughout their lifetime. In fact, of the 20 countries in the world with the highest fertility rates, Afghanistan and Yemen are the only countries not found in Sub-Saharan Africa. High fertility rates in Africa With a fertility rate of almost six children per woman, Chad is the country with the highest fertility rate in the world. Population growth in Chad is among the highest in the world. Lack of healthcare access, as well as food instability, political instability, and climate change, are all exacerbating conditions that keep Chad's infant mortality rates high, which is generally the driver behind high fertility rates. This situation is common across much of the continent, and, although there has been considerable progress in recent decades, development in Sub-Saharan Africa is not moving as quickly as it did in other regions. Demographic transition While these countries have the highest fertility rates in the world, their rates are all on a generally downward trajectory due to a phenomenon known as the demographic transition. The third stage (of five) of this transition sees birth rates drop in response to decreased infant and child mortality, as families no longer feel the need to compensate for lost children. Eventually, fertility rates fall below replacement level (approximately 2.1 children per woman), which eventually leads to natural population decline once life expectancy plateaus. In some of the most developed countries today, low fertility rates are creating severe econoic and societal challenges as workforces are shrinking while aging populations are placin a greater burden on both public and personal resources.

For most of the past two centuries, falling birth rates have been associated with societal progress. During the demographic transition, where pre-industrial societies modernize in terms of fertility and mortality, falling death rates, especially among infants and children, are the first major change. In response, as more children survive into adulthood, women have fewer children as the need to compensate for child mortality declines. This transition has happened at different times across the world and is an ongoing process, with early industrial countries being the first to transition, and Sub-Saharan African countries being the most recent to do so. Additionally, some Asian countries (particularly China through government policy) have gone through their demographic transitions at a much faster pace than those deemed more developed. Today, in countries such as Japan, Italy, and Germany, birth rates have fallen well below death rates; this is no longer considered a positive demographic trend, as it leads to natural population decline, and may create an over-aged population that could place a burden on healthcare systems.

The statistic shows the 20 countries with the lowest fertility rates in 2024. All figures are estimates. In 2024, the fertility rate in Taiwan was estimated to be at 1.11 children per woman, making it the lowest fertility rate worldwide. Fertility rate The fertility rate is the average number of children born per woman of child-bearing age in a country. Usually, a woman aged between 15 and 45 is considered to be in her child-bearing years. The fertility rate of a country provides an insight into its economic state, as well as the level of health and education of its population. Developing countries usually have a higher fertility rate due to lack of access to birth control and contraception, and to women usually foregoing a higher education, or even any education at all, in favor of taking care of housework. Many families in poorer countries also need their children to help provide for the family by starting to work early and/or as caretakers for their parents in old age. In developed countries, fertility rates and birth rates are usually much lower, as birth control is easier to obtain and women often choose a career before becoming a mother. Additionally, if the number of women of child-bearing age declines, so does the fertility rate of a country. As can be seen above, countries like Hong Kong are a good example for women leaving the patriarchal structures and focusing on their own career instead of becoming a mother at a young age, causing a decline of the country’s fertility rate. A look at the fertility rate per woman worldwide by income group also shows that women with a low income tend to have more children than those with a high income. The United States are neither among the countries with the lowest, nor among those with the highest fertility rate, by the way. At 2.08 children per woman, the fertility rate in the US has been continuously slightly below the global average of about 2.4 children per woman over the last decade.

Today, globally, women of childbearing age have an average of approximately 2.2 children over the course of their lifetime. In pre-industrial times, most women could expect to have somewhere between five and ten live births throughout their lifetime; however, the demographic transition then sees fertility rates fall significantly. Looking ahead, it is believed that the global fertility rate will fall below replacement level in the 2050s, which will eventually lead to population decline when life expectancy plateaus. Recent decades Between the 1950s and 1970s, the global fertility rate was roughly five children per woman - this was partly due to the post-WWII baby boom in many countries, on top of already-high rates in less-developed countries. The drop around 1960 can be attributed to China's "Great Leap Forward", where famine and disease in the world's most populous country saw the global fertility rate drop by roughly 0.5 children per woman. Between the 1970s and today, fertility rates fell consistently, although the rate of decline noticeably slowed as the baby boomer generation then began having their own children. Replacement level fertility Replacement level fertility, i.e. the number of children born per woman that a population needs for long-term stability, is approximately 2.1 children per woman. Populations may continue to grow naturally despite below-replacement level fertility, due to reduced mortality and increased life expectancy, however, these will plateau with time and then population decline will occur. It is believed that the global fertility rate will drop below replacement level in the mid-2050s, although improvements in healthcare and living standards will see population growth continue into the 2080s when the global population will then start falling.

The fertility rate in a country decreases with an increasing income level. For instance, the least developed and low-income countries had the highest fertility rates between 2000 and 2022, with 3.95 and 4.55 children per woman, respectively, as of 2022. On the other hand, high-income and upper-middle-income countries had fertility rates of *** and ****, respectively. Furthermore, fertility rates fell in all the countries worldwide, regardless of income level.

In the United States, non-Hispanic Black women currently have higher rates of twin births than any other ethnicity or race with **** per 1,000 live births being twins. There are two types of twins, identical and fraternal. Identical twins form when one fertilized egg splits and develops two babies, while fraternal twins form from two eggs that are fertilized by two sperm. Fraternal twins, although born at the same time, are no more alike than siblings born at different times. Twin births in the United States The birth rate for twins in the United States has increased over the past few decades, with around **** twin births per 1,000 live births in 2023. Factors that increase the odds of having a twin birth include race, genetics, the number of previous pregnancies, assisted reproductive techniques, and the age of the mother. Those aged 45 to 54 years have a significantly higher twin birth rate than younger women in the United States. The states with the highest average twin birth rates include Michigan, Mississippi, and Connecticut. Birth rates in the United States As is the case in many other developed countries, the birth rate in the United States has steadily decreased. In 2023, there were just **** births per 1,000 population, compared to **** births per 1,000 population in the year 1990. Unsurprisingly, the birth rate is highest among women aged 20 to 34 years, however women are increasingly having birth later in life.

Female fertility was the highest in Yemen in 2019 at an approximate of *** births per woman, followed by Iraq and Palestine at about *** and **** births per woman respectively. In comparison, the United Arab Emirates had the lowest fertility rate of about *** births per woman in 2019. Fertility rates over time Fertility rates have been declining over the years from *** in 2010 to *** in 2018 in the Middle East and Africa region. The population of a country starts declining due to the decline in fertility rates when the fertility rate drops below the threshold of approximately ***. This effect is more prominent in countries with high child mortality rates as child survival is one of the main factors affecting fertility rates. Parents are more likely to attempt to replace lost children or have more children as insurance when experiencing early child mortality. In the MENA region, child mortality witnessed a significant decline over the past decade. Factors affecting female fertility The variation in fertility rates across countries is very evident. Developed countries have lower fertility rates between *** and ***** births per female, while developing countries have higher rates that could reach ***** births per female. Female fertility rates drop as countries develop economically. It was found that a higher income and education decreases female fertility. Increasing the employment of women also reduces female fertility as it increases their opportunity cost of bearing children.

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited

Trends in adolescent fertility rates in Sierra Leone by different inequality dimensions, 2008–2019.

SPSS Data File Used in Analyses for Studies 1 and 2Related Publication: Li, N.P., Lim, A.J.Y., Tsai M.H. (2015) Too Materialistic to get Married and have Children? PLoS ONE 10(5): e0126543. http://dx.doi.org/10.1371/journal.pone.0126543. Full text available in InK: http://ink.library.smu.edu.sg/soss_research/1676/We developed new materials to induce a luxury mindset and activate materialistic values, and examined materialism’s relationship to attitudes toward marriage and having children in Singapore. Path analyses indicated that materialistic values led to more negative attitudes toward marriage, which led to more negative attitudes toward children, which in turn led to a decreased number of children desired. Results across two studies highlight, at the individual level, the tradeoff between materialistic values and attitudes toward marriage and procreation and suggest that a consideration of psychological variables such as materialistic values may allow for a better understanding of larger-scale socioeconomic issues including low fertility rates among developed countries. We discuss implications and describe how psychological factors relating to low fertility fit within evolutionary mismatch and life history theory frameworks.

Inequality measures of adolescent fertility rates in Sierra Leone, 2008–2019.

In 2024, the average number of children born per 1,000 people in China ranged at ****. The birth rate has dropped considerably since 2016, and the number of births fell below the number of deaths in 2022 for the first time in decades, leading to a negative population growth rate. Recent development of the birth rate Similar to most East-Asian countries and territories, demographics in China today are characterized by a very low fertility rate. As low fertility in the long-term limits economic growth and leads to heavy strains on the pension and health systems, the Chinese government decided to support childbirth by gradually relaxing strict birth control measures, that had been in place for three decades. However, the effect of this policy change was considerably smaller than expected. The birth rate increased from **** births per 1,000 inhabitants in 2010 to ***** births in 2012 and remained on a higher level for a couple of years, but then dropped again to a new low in 2018. This illustrates that other factors constrain the number of births today. These factors are most probably similar to those experienced in other developed countries as well: women preferring career opportunities over maternity, high costs for bringing up children, and changed social norms, to name only the most important ones. Future demographic prospects Between 2020 and 2023, the birth rate in China dropped to formerly unknown lows, most probably influenced by the coronavirus pandemic. As all COVID-19 restrictions were lifted by the end of 2022, births figures showed a catch-up effect in 2024. However, the scope of the rebound might be limited. A population breakdown by five-year age groups indicates that the drop in the number of births is also related to a shrinking number of people with child-bearing age. The age groups between 15 and 29 years today are considerably smaller than those between 30 and 44, leaving less space for the birth rate to increase. This effect is exacerbated by a considerable gender gap within younger age groups in China, with the number of females being much lower than that of males.

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representative survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health surveys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Philippine National Statistics Office (NSO). Technical assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Government of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. Analyze the direct and indirect factors which determine the levels and patterns of fertility. Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. Collect data on environmental health, utilization of health facilities, prevalence of common noncommunicable and infectious diseases, and membership in health insurance plans. Collect data on awareness of tuberculosis. Determine women's knowledge about HIV/AIDS and access to HIV testing. Determine the extent of violence against women. MAIN RESULTS FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Philippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substantially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fertility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On average, currently married women know eight methods of family planning. Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philippines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of demand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 percent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received antenatal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Delivery and Postnatal Care. Only 44 percent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth attendant or hilot. About 10 percent of births are delivered by C-section. The Department of Health (DOH) recommends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Currently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years before the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortality decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among children of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, respectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be introduced when a child is six months old to reduce the risk of malnutrition. More than half of children ages 6-9 months are eating complementary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in various age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for preventing transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmission. Knowledge of prevention methods is higher in urban areas than in rural areas and increases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. TUBERCULOSIS Knowledge of TB. While awareness of tuberculosis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent mentioned blood in sputum, and 30 percent cited coughing with sputum. WOMEN'S STATUS Women's Status and Employment.

The 2006 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 8,531 women age 15-49 and 2,503 men age 15-54. The UDHS is the fourth comprehensive survey conducted in Uganda as part of the worldwide Demographic and Health Surveys (DHS) project. The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one in three households selected for the survey, women age 15-49, men age 15-54, and children under age 5 years were weighed and their height was measured. Women, men, and children age 6-59 months in this subset of households were tested for anaemia, and women and children were tested for vitamin A deficiency. The 2006 UDHS is the first DHS survey in Uganda to cover the entire country. The 2006 Uganda Demographic and Health Survey (UDHS) was designed to provide information on demographic, health, and family planning status and trends in the country. Specifically, the UDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, and breastfeeding practices. In addition, data were collected on the nutritional status of mothers and young children; infant, child, adult, and maternal mortality; maternal and child health; awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections; and levels of anaemia and vitamin A deficiency. The 2006 UDHS is a follow-up to the 1988-1989, 1995, and 2000-2001 UDHS surveys, which were also implemented by the Uganda Bureau of Statistics (UBOS). The specific objectives of the 2006 UDHS are as follows: To collect data at the national level that will allow the calculation of demographic rates, particularly the fertility and infant mortality rates To analyse the direct and indirect factors that determine the level and trends in fertility and mortality To measure the level of contraceptive knowledge and practice of women and men by method, by urban-rural residence, and by region To collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS, and to evaluate patterns of recent behaviour regarding condom use To assess the nutritional status of children under age five and women by means of anthropometric measurements (weight and height), and to assess child feeding practices To collect data on family health, including immunizations, prevalence and treatment of diarrhoea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding To measure vitamin A deficiency in women and children, and to measure anaemia in women, men, and children To measure key education indicators including school attendance ratios and primary school grade repetition and dropout rates To collect information on the extent of disability To collect information on the extent of gender-based violence. MAIN RESULTS Fertility : Survey results indicate that the total fertility rate (TFR) for the country is 6.7 births per woman. The TFR in urban areas is much lower than in the rural areas (4.4 and 7.1 children, respectively). Kampala, whose TFR is 3.7, has the lowest fertility. Fertility rates in Central 1, Central 2, and Southwest regions are also lower than the national level. Removing four districts from the 2006 data that were not covered in the 20002001 UDHS, the 2006 TFR is 6.5 births per woman, compared with 6.9 from the 2000-2001 UDHS. Education and wealth have a marked effect on fertility, with uneducated mothers having about three more children on average than women with at least some secondary education and women in the lowest wealth quintile having almost twice as many children as women in the highest wealth quintile. Family planning : Overall, knowledge of family planning has remained consistently high in Uganda over the past five years, with 97 percent of all women and 98 percent of all men age 15-49 having heard of at least one method of contraception. Pills, injectables, and condoms are the most widely known modern methods among both women and men. Maternal health : Ninety-four percent of women who had a live birth in the five years preceding the survey received antenatal care from a skilled health professional for their last birth. These results are comparable to the 2000-2001 UDHS. Only 47 percent of women make four or more antenatal care visits during their entire pregnancy, an improvement from 42 percent in the 2000-2001 UDHS. The median duration of pregnancy for the first antenatal visit is 5.5 months, indicating that Ugandan women start antenatal care at a relatively late stage in pregnancy. Child health : Forty-six percent of children age 12-23 months have been fully vaccinated. Over nine in ten (91 percent) have received the BCG vaccination, and 68 percent have been vaccinated against measles. The coverage for the first doses of DPT and polio is relatively high (90 percent for each). However, only 64 percent go on to receive the third dose of DPT, and only 59 percent receive their third dose of polio vaccine. There are notable improvements in vaccination coverage since the 2000-2001 UDHS. The percentage of children age 12-23 months fully vaccinated at the time of the survey increased from 37 percent in 2000-2001 to 44 percent in 2006. The percentage who had received none of the six basic vaccinations decreased from 13 percent in 2000-2001 to 8 percent in 2006. Malaria : The 2006 UDHS gathered information on the use of mosquito nets, both treated and untreated. The data show that only 34 percent of households in Uganda own a mosquito net, with 16 percent of households owning an insecticide-treated net (ITN). Only 22 percent of children under five slept under a mosquito net on the night before the interview, while a mere 10 percent slept under an ITN. Breastfeeding and nutrition : In Uganda, almost all children are breastfed at some point. However, only six in ten children under the age of 6 months are exclusively breast-fed. HIV/AIDS AND stis : Knowledge of AIDS is very high and widespread in Uganda. In terms of HIV prevention strategies, women and men are most aware that the chances of getting the AIDS virus can be reduced by limiting sex to one uninfected partner who has no other partners (89 percent of women and 95 percent of men) or by abstaining from sexual intercourse (86 percent of women and 93 percent of men). Knowledge of condoms and the role they can play in preventing transmission of the AIDS virus is not quite as high (70 percent of women and 84 percent of men). Orphanhood and vulnerability : Almost one in seven children under age 18 is orphaned (15 percent), that is, one or both parents are dead. Only 3 percent of children under the age of 18 have lost both biological parents. Women's status and gender violence : Data for the 2006 UDHS show that women in Uganda are generally less educated than men. Although the gender gap has narrowed in recent years, 19 percent of women age 15-49 have never been to school, compared with only 5 percent of men in the same age group. Mortality : At current mortality levels, one in every 13 Ugandan children dies before reaching age one, while one in every seven does not survive to the fifth birthday. After removing districts not covered in the 2000-2001 UDHS from the 2006 data, findings show that infant mortality has declined from 89 deaths per 1,000 live births in the 2000-2001 UDHS to 75 in the 2006 UDHS. Under-five mortality has declined from 158 deaths per 1,000 live births to 137.

Abstract

The 2008 Sierra Leone Demographic and Health Survey (SLDHS) is the first DHS survey to be held in Sierra Leone. Teams visited 353 sample points across Sierra Leone and collected data from a nationally representative sample of 7,374 women age 15-49 and 3,280 men age 15-59. The primary purpose of the 2008 SLDHS is to provide policy-makers and planners with detailed information on Demography and health.

This is the first Demographic and Health Survey conducted in Sierra Leone and was carried out by Statistics Sierra Leone (SSL) in collaboration with the Ministry of Health and Sanitation. The 2008 SLDHS was funded by the Sierra Leone government, UNFPA, UNDP, UNICEF, DFID, USAID, and The World Bank. WHO, WFP and UNHCR provided logistical support. ICF Macro, an ICF International Company, provided technical support for the survey through the MEASURE DHS project. MEASURE DHS is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in obtaining information on key population and health indicators.

The purpose of the SLDHS is to collect national- and regional-level data on fertility and contraceptive use, marriage and sexual activity, fertility preferences, breastfeeding practices, nutritional status of women and young children, childhood and adult mortality, maternal and child health, female genital cutting, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections, adult health, and other issues. The survey obtained detailed information on these topics from women of reproductive age and, for certain topics, from men as well. The 2008 SLDHS was carried out from late April 2008 to late June 2008, using a nationally representative sample of 7,758 households.

The survey results are intended to assist policymakers and planners in assessing the current health and population programmes and in designing new strategies for improving reproductive health and health services in Sierra Leone.

MAIN RESULTS

FERTILITY

Survey results indicate that there has been little or no decline in the total fertility rate over the past two decades, from 5.7 children per woman in 1980-85 to 5.1 children per woman for the three years preceding the 2008 SLDHS (approximately 2004-07). Fertility is lower in urban areas than in rural areas (3.8 and 5.8 children per woman, respectively). Regional variations in fertility are marked, ranging from 3.4 births per woman in the Western Region (where the capital, Freetown, is located) to almost six births per woman in the Northern and Eastern regions. Women with no education give birth to almost twice as many children as women who have been to secondary school (5.8 births, compared with 3.1 births). Fertility is also closely associated with household wealth, ranging from 3.2 births among women in the highest wealth quintile to 6.3 births among women in the lowest wealth quintile, a difference of more than three births. Research has demonstrated that children born too close to a previous birth are at increased risk of dying. In Sierra Leone, only 18 percent of births occur within 24 months of a previous birth. The interval between births is relatively long; the median interval is 36 months.

FAMILY PLANNING

The vast majority of Sierra Leonean women and men know of at least one method of contraception. Contraceptive pills and injectables are known to about 60 percent of currently married women and 49 percent of married men. Male condoms are known to 58 percent of married women and 80 percent of men. A higher proportion of respondents reported knowing a modern method of family planning than a traditional method.

About one in five (21 percent) currently married women has used a contraceptive method at some time-19 percent have used a modern method and 6 percent have used a traditional method. However, only about one in twelve currently married women (8 percent) is currently using a contraceptive method. Modern methods account for almost all contraceptive use, with 7 percent of married women reporting use of a modern method, compared with only 1 percent using a traditional method. Injectables and the pill are the most widely used methods (3 and 2 percent of married women, respectively), followed by LAM and male condoms (less than 1 percent each).

CHILD HEALTH

Examination of levels of infant and child mortality is essential for assessing population and health policies and programmes. Infant and child mortality rates are also used as indices reflecting levels of poverty and deprivation in a population. The 2008 survey data show that over the past 15 years, infant and under-five mortality have decreased by 26 percent. Still, one in seven Sierra Leonean children dies before reaching age five. For the most recent five-year period before the survey (approximately calendar years 2003 to 2008), the infant mortality rate was 89 deaths per 1,000 live births and the under-five mortality rate was 140 deaths per 1,000 live births. The neonatal mortality rate was 36 deaths per 1,000 live births and the post-neonatal mortality rate was 53 deaths per 1,000 live births. The child mortality rate was 56 deaths per 1,000 children surviving to age one year. Mortality rates at all ages of childhood show a strong relationship with the length of the preceding birth interval. Under-five mortality is three times higher among children born less than two years after a preceding sibling (252 deaths per 1,000 births) than among children born four or more years after a previous child (deaths 81 per 1,000 births).

MATERNAL HEALTH

Almost nine in ten mothers (87 percent) in Sierra Leone receive antenatal care from a health professional (doctor, nurse, midwife, or MCH aid). Only 5 percent of mothers receive antenatal care from a traditional midwife or a community health worker; 7 percent of mothers do not receive any antenatal care.

In Sierra Leone, over half of mothers have four or more antenatal care (ANC) visits, about 20 percent have one to three ANC visits, and only 7 percent have no antenatal care at all. The survey shows that not all women in Sierra Leone receive antenatal care services early in pregnancy. Only 30 percent of mothers obtain antenatal care in the first three months of pregnancy, 41 percent make their first visit in the fourth or fifth month, and 17 percent in have their first visit in the sixth or seventh month. Only 1 percent of women have their first ANC visit in their eighth month of pregnancy or later.

BREASTFEEDING AND NUTRITION

Poor nutritional status is one of the most important health and welfare problems facing Sierra Leone today and particularly afflicts women and children. The data show that 36 percent of children under five are stunted (too short for their age) and 10 percent of children under five are wasted (too thin for their height). Overall, 21 percent of children are underweight, which may reflect stunting, wasting, or both. For women, at the national level 11 percent of women are considered to be thin (body mass index <18.5); however, only 4 percent of women are considered severely thin. At the other end of a spectrum, 20 percent of women age 15-49 are considered to be overweight (body mass index 25.025.9) and 9 percent are considered obese (body mass index =30.0).

HIV/AIDS

The HIV/AIDS pandemic is one of the most serious health concerns in the world today because of its high case-fatality rate and the lack of a cure. Awareness of AIDS is relatively high among Sierra Leonean adults age 15-49, with 69 percent of women and 83 percent of men saying that they have heard about AIDS. Nevertheless, only 14 percent of women and 25 percent of men are classified as having 'comprehensive knowledge' about AIDS, i.e., knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the chances of getting HIV/AIDS, knowing that a healthy-looking person can have HIV (the virus that causes AIDS), and knowing that HIV cannot be transmitted by sharing food/utensils with someone who has HIV/AIDS, or by mosquito bites.

Such a low level of knowledge about HIV/AIDS implies that a concerted effort is needed to address misconceptions about the transmission of HIV in Sierra Leone. Comprehensive knowledge is substantially lower among respondents with no education and those who live in the poorest households. Programmes could be targeted to populations in rural areas, and especially women in the Northern and Southern regions and men in the Eastern Region, where comprehensive knowledge is lowest. A composite indicator on stigma towards people who are HIV positive shows that only 5 percent of women and 15 percent of men age 15-49 expressed accepting attitudes towards persons living with HIV/AIDS.

FEMALE CIRCUMCISION

The 2008 SLDHS collected data on the practice of female circumcision (or female genital cutting) in Sierra Leone. Awareness of the practice is universally high. Almost all (99 percent) of Sierra Leonean women and 96 percent of men age 15-49 have heard of the practice. The prevalence of female circumcision is high (91 percent). Most women (82 percent) reported that the cutting involves the removal of flesh. The most radical procedure, infibulation-when vagina is sewn closed during the circumcision-is reported by only 3 percent of women. The survey results indicate that almost all of the women were circumcised by traditional practitioners (95 percent); only a small proportion of circumcisions were performed by a trained health professional (0.3 percent).

Among Sierra Leonean adults age 15-49 who have heard of female circumcision, more men than women oppose the practice (41 and 26 percent, respectively), which is similar to patterns in other West African countries.

Geographic coverage

The survey used a

In 1930, the average woman of childbearing age in Kenya would have had just under seven children over the course of their reproductive years. This rate would steadily increase until the end of the 1960s, peaking at just over eight children per woman in 1970. Following this peak, a combination of strong national and international promotion of family planning in Kenya and an expansion of contraceptive use would lead to a sharp decrease in the fertility rate, resulting in an average of 3.19 children in 2024. Teenage fertility in Kenya In 2022, most teenage pregnancies occurred among 19-year-olds. There is a strong correlation between adolescents who had ever been pregnant and those who had no education. Additionally, those who form part of the highest wealth quintile in the country were less likely to have ever been pregnant. Overall decreasing trends in Kenya’s fertility ratesAlthough fertility rates in Kenya have dropped considerably since 1989, the global fertility rate is significantly lower. Kenyans living in rural areas have a higher total fertility rate compared to those living in urban areas. This is reportedly due to differences in the level of education, the use of contraception, and the desire to live a quality life. Between 1995 and 2000, the decline in fertility rates in Kenya slowed somewhat, partly due to the government prioritizing and reallocating healthcare resources towards combatting the then-emerging HIV/AIDS epidemic. However, resources for contraceptives and family planning commenced once more around 2003, and as a result, the total fertility rate began to fall steadily again.

In 2024, the average life expectancy for those born in more developed countries was 76 years for men and 82 years for women. On the other hand, the respective numbers for men and women born in the least developed countries were 64 and 69 years. Improved health care has lead to higher life expectancy Life expectancy is the measure of how long a person is expected to live. Life expectancy varies worldwide and involves many factors such as diet, gender, and environment. As medical care has improved over the years, life expectancy has increased worldwide. Introduction to health care such as vaccines has significantly improved the lives of millions of people worldwide. The average worldwide life expectancy at birth has steadily increased since 2007, but dropped during the COVID-19 pandemic in 2020 and 2021. Life expectancy worldwide More developed countries tend to have higher life expectancies, for a multitude of reasons. Health care infrastructure and quality of life tend to be higher in more developed countries, as is access to clean water and food. Africa was the continent that had the lowest life expectancy for both men and women in 2023, while Oceania had the highest for men and Europe and Oceania had the highest for women.

In 2022, Bulgaria had the highest share of births to teenage mothers in Europe, at almost 10.2 percent of all births in the country. Furthermore, in Slovakia and Moldova, over five percent of births in both countries were to mothers aged below 20 years. The share of teenage births was particularly low in Switzerland, Andorra, and Norway. Falling teenage births In Europe, the share of births to teenage mothers has been trending downwards. Across the whole European region, the share of adolescent births fell from almost *** percent in 1980 to ***** percent in 2021. More specifically, in the European Union, teenagers accounted for fewer than *** percent of all births in 2021. Access to contraception In developed countries, the average age for women giving birth has increased over time, and in general, women are choosing to have fewer children. One of the main reasons is improved access to contraception, which allows women greater autonomy over their bodies. Luxembourg, which was rated as having the best access to modern contraception, also has the highest average childbearing age in Europe. Next on the contraception ranking; Belgium, France, and the UK also had a mean age of around ** for mothers.

The fertility rate in Norway declined since 2010. In 2024, a woman in her child-bearing years had an average of 1.44 children in Norway. The development in Norway is a part of a trend observed in most developed countries.

As of 2023, the countries with the highest life expectancy included Switzerland, Japan, and Spain. As of that time, a new-born child in Switzerland could expect to live an average of **** years. Around the world, females consistently have a higher average life expectancy than males, with females in Europe expected to live an average of *** years longer than males on this continent. Increases in life expectancy The overall average life expectancy in OECD countries increased by **** years from 1970 to 2019. The countries that saw the largest increases included Turkey, India, and South Korea. The life expectancy at birth in Turkey increased an astonishing 24.4 years over this period. The countries with the lowest life expectancy worldwide as of 2022 were Chad, Lesotho, and Nigeria, where a newborn could be expected to live an average of ** years. Life expectancy in the U.S. The life expectancy in the United States was ***** years as of 2023. Shockingly, the life expectancy in the United States has decreased in recent years, while it continues to increase in other similarly developed countries. The COVID-19 pandemic and increasing rates of suicide and drug overdose deaths from the opioid epidemic have been cited as reasons for this decrease.