Between 1991 and 2021 there has been a clear trend of mothers having children later in life in the United Kingdom, with the average age of mothers in the increasing from 27.7 in 1991 to 30.9 by 2021.

The Sudan Demographic and Health Survey (SDHS) was conducted in two phases between November 15, 1989 and May 21, 1990 by the Department of Statistics of the Ministry of Economic and National Planning. The survey collected information on fertility levels, marriage patterns, reproductive intentions, knowledge and use of contraception, maternal and child health, maternal mortality, and female circumcision. The survey findings provide the National Population Committee and the Ministry of Health with valuable information for use in evaluating population policy and planning public health programmes. A total of 5860 ever-married women age 15-49 were interviewed in six regions in northern Sudan; three regions in southern Sudan could not be included in the survey because of civil unrest in that part of the country. The SDHS provides data on fertility and mortality comparable to the 1978-79 Sudan Fertility Survey (SFS) and complements the information collected in the 1983 census. The primary objective of the SDHS was to provide data on fertility, nuptiality, family planning, fertility preferences, childhood mortality, indicators of maternal health care, and utilization of child health services. Additional information was coUected on educational level, literacy, source of household water, and other housing conditions. The SDHS is intended to serve as a source of demographic data for comparison with the 1983 census and the Sudan Fertility Survey (SFS) 1978-79, and to provide population and health data for policymakers and researchers. The objectives of the survey are to: assess the overall demographic situation in Sudan, assist in the evaluation of population and health programmes, assist the Department of Statistics in strengthening and improving its technical skills for conducting demographic and health surveys, enable the National Population Committee (NPC) to develop a population policy for the country, and measure changes in fertility and contraceptive prevalence, and study the factors which affect these changes, and examine the basic indicators of maternal and child health in Sudan. MAIN RESULTS Fertility levels and trends Fertility has declined sharply in Sudan, from an average of six children per women in the Sudan Fertility Survey (TFR 6.0) to five children in the Sudan DHS survey flTR 5.0). Women living in urban areas have lower fertility (TFR 4.1) than those in rural areas (5.6), and fertility is lower in the Khartoum and Northern regions than in other regions. The difference in fertility by education is particularly striking; at current rates, women who have attained secondary school education will have an average of 3.3 children compared with 5.9 children for women with no education, a difference of almost three children. Although fertility in Sudan is low compared with most sub-Saharan countries, the desire for children is strong. One in three currently married women wants to have another child within two years and the same proportion want another child in two or more years; only one in four married women wants to stop childbearing. The proportion of women who want no more children increases with family size and age. The average ideal family size, 5.9 children, exceeds the total fertility rate (5.0) by approximately one child. Older women are more likely to want large families than younger women, and women just beginning their families say they want to have about five children. Marriage Almost all Sudanese women marry during their lifetime. At the time of the survey, 55 percent of women 15-49 were currently married and 5 percent were widowed or divorced. Nearly one in five currently married women lives in a polygynous union (i.e., is married to a man who has more than one wife). The prevalence of polygyny is about the same in the SDHS as it was in the Sudan Fertility Survey. Marriage occurs at a fairly young age, although there is a trend toward later marriage among younger women (especially those with junior secondary or higher level of schooling). The proportion of women 15-49 who have never married is 12 percentage points higher in the SDHS than in the Sudan Fertiliy Survey. There has been a substantial increase in the average age at first marriage in Sudan. Among SDHS. Since age at first marriage is closely associated with fertility, it is likely that fertility will decrease in the future. With marriages occurring later, women am having their first birth at a later age. While one in three women age 45-49 had her first birth before age 18, only one in six women age 20-24 began childbearing prior to age 18. The women most likely to postpone marriage and childbearing are those who live in urban areas ur in the Khartoum and Northern regions, and women with pest-primary education. Breastfeeding and postpartum abstinence Breastfeeding and postpartum abstinence provide substantial protection from pregnancy after the birth uf a child. In addition to the health benefits to the child, breastfeeding prolongs the length of postpartum amenorrhea. In Sudan, almost all women breastfeed their children; 93 percent of children are still being breastfed 10-11 months after birth, and 41 percent continue breastfeeding for 20-21 months. Postpartum abstinence is traditional in Sudan and in the first two months following the birth of a child 90 percent of women were abstaining; this decreases to 32 percent after two months, and to 5 percent at~er one year. The survey results indicate that the combined effects of breastfeeding and postpartum abstinence protect women from pregnancy for an average of 15 months after the birth of a child. Knowledge and use of contraception Most currently married women (71 percent) know at least one method of family planning, and 59 percent know a source for a method. The pill (70 percent) is the most widely known method, followed by injection, female sterilisation, and the IUD. Only 39 percent of women knew a traditional method of family planning. Despite widespread knowledge of family planning, only about one-fourth of ever-married women have ever used a contraceptive method, and among currently married women, only 9 percent were using a method at the time of the survey (6 percent modem methods and 3 percent traditional methods). The level of contraceptive use while still low, has increased from less than 5 percent reported in the Sudan Fertility Survey. Use of family planning varies by age, residence, and level of education. Current use is less than 4 percent among women 15-19, increases to 10 percent for women 30-44, then decreases to 6 percent for women 45-49. Seventeen percent of urban women practice family planning compared with only 4 percent of rural women; and women with senior secondary education are more likely to practice family planning (26 percent) than women with no education (3 percent). There is widespread approval of family planning in Sudan. Almost two-thirds of currently married women who know a family planning method approve of the use of contraception. Husbands generally share their wives's views on family planning. Three-fourths of married women who were not using a contraceptive method at the time of the survey said they did not intend to use a method in the future. Communication between husbands and wives is important for successful family planning. Less than half of currently married women who know a contraceptive method said they had talked about family planning with their husbands in the year before the survey; one in four women discussed it once or twice; and one in five discussed it more than twice. Younger women and older women were less likely to discuss family planning than those age 20 to 39. Mortality among children The neonatal mortality rate in Sudan remained virtually unchanged in the decade between the SDHS and the SFS (44 deaths per 1000 births), but under-five mortality decreased by 14 percent (from 143 deaths per 1000 births to 123 per thousand). Under-five mortality is 19 percent lower in urban areas (117 per 1000 births) than in rural areas (144 per 10(30 births). The level of mother's education and the length of the preceding birth interval play important roles in child survival. Children of mothers with no education experience nearly twice the level of under-five mortality as children whose mother had attained senior secondary or nigher education. Mortality among children under five is 2.7 times higher among children born after an interval of less than 24 months than among children born after interval of 48 months or more. Maternal mortality The maternal mortality rate (maternal deaths per 1000 women years of exposure) has remained nearly constant over the twenty years preceding the survey, while the maternal mortality ratio (number of maternal deaths per 100,000 births), has increased (despite declining fertility). Using the direct method of estimation, the maternal mortality ratio is 352 maternal deaths per 100,000 births for the period 1976-82, and 552 per 100,000 births for the period 1983-89. The indirect estimate for the maternal mortality ratio is 537. The latter estimate is an average of women's experience over an extended period before the survey centred on 1977. Maternal health care The health care mothers receive during pregnancy and delivery is important to the survival and well-being of both children and mothers. The SDHS results indicate that most women in Sudan made at least one antenatal visit to a doctor or trained health worker/midwife. Eighty-seven percent of births benefitted from professional antenatal care in urban areas compared with 62 percent in rural areas. Although the proportion of pregnant mothers seen by trained health workers/midwives are similar in urban and rural areas, doctors provided antenatal care for 42 percent and 19 percent of births in urban and rural areas, respectively. Neonatal tetanus, a major cause of infant deaths in developing countries, can be prevented if mothers receive tetanus toxoid vaccinations.

Abstract

The 1998 Kenya Demographic and Health Survey (KDHS) is a nationally representative survey of 7,881 wo 881 women age 15-49 and 3,407 men age 15-54. The KDHS was implemented by the National Council for Population and Development (NCPD) and the Central Bureau of Statistics (CBS), with significant technical and logistical support provided by the Ministry of Health and various other governmental and nongovernmental organizations in Kenya. Macro International Inc. of Calverton, Maryland (U.S.A.) provided technical assistance throughout the course of the project in the context of the worldwide Demographic and Health Surveys (DHS) programme, while financial assistance was provided by the U.S. Agency for International Development (USAID/Nairobi) and the Department for International Development (DFID/U.K.). Data collection for the KDHS was conducted from February to July 1998. Like the previous KDHS surveys conducted in 1989 and 1993, the 1998 KDHS was designed to provide information on levels and trends in fertility, family planning knowledge and use, infant and child mortality, and other maternal and child health indicators. However, the 1998 KDHS went further to collect more in-depth data on knowledge and behaviours related to AIDS and other sexually transmitted diseases (STDs), detailed “calendar” data that allows estimation of contraceptive discontinuation rates, and information related to the practice of female circumcision. Further, unlike earlier surveys, the 1998 KDHS provides a national estimate of the level of maternal mortality (i.e. related to pregnancy and childbearing).The KDHS data are intended for use by programme managers and policymakers to evaluate and improve health and family planning programmes in Kenya. Fertility. The survey results demonstrate a continuation of the fertility transition in Kenya. At current fertility levels, a Kenyan women will bear 4.7 children in her life, down 30 percent from the 1989 KDHS when the total fertility rate (TFR) was 6.7 children, and 42 percent since the 1977/78 Kenya Fertility Survey (KFS) when the TFR was 8.1 children per woman. A rural woman can expect to have 5.2 children, around two children more than an urban women (3.1 children). Fertility differentials by women's education level are even more remarkable; women with no education will bear an average of 5.8 children, compared to 3.5 children for women with secondary school education. Marriage. The age at which women and men first marry has risen slowly over the past 20 years. Currently, women marry for the first time at an average age of 20 years, compared with 25 years for men. Women with a secondary education marry five years later (22) than women with no education (17).The KDHS data indicate that the practice of polygyny continues to decline in Kenya. Sixteen percent of currently married women are in a polygynous union (i.e., their husband has at least one other wife), compared with 19 percent of women in the 1993 KDHS, 23 percent in the 1989 KDHS, and 30 percent in the 1977/78 KFS. While men first marry an average of 5 years later than women, men become sexual active about onehalf of a year earlier than women; in the youngest age cohort for which estimates are available (age 20-24), first sex occurs at age 16.8 for women and 16.2 for men. Fertility Preferences. Fifty-three percent of women and 46 percent of men in Kenya do not want to have any more children. Another 25 percent of women and 27 percent of men would like to delay their next child for two years or longer. Thus, about three-quarters of women and men either want to limit or to space their births. The survey results show that, of all births in the last three years, 1 in 10 was unwanted and 1 in 3 was mistimed. If all unwanted births were avoided, the fertility rate in Kenya would fall from 4.7 to 3.5 children per woman. Family Planning. Knowledge and use of family planning in Kenya has continued to rise over the last several years. The 1998 KDHS shows that virtually all married women (98 percent) and men (99 percent) were able to cite at least one modern method of contraception. The pill, condoms, injectables, and female sterlisation are the most widely known methods. Overall, 39 percent of currently married women are using a method of contraception. Use of modern methods has increased from 27 in the 1993 KDHS to 32 percent in the 1998 KDHS. Currently, the most widely used methods are contraceptive injectables (12 percent of married women), the pill (9 percent), female sterilisation (6 percent), and periodic abstinence (6 percent). Three percent of married women are using the IUD, while over 1 percent report using the condom and 1 percent use of contraceptive implants (Norplant). The rapid increase in use of injectables (from 7 to 12 percent between 1993 and 1998) to become the predominant method, plus small rises in the use of implants, condoms and female sterilisation have more than offset small decreases in pill and IUD use. Thus, both new acceptance of contraception and method switching have characterised the 1993-1998 intersurvey period. Contraceptive use varies widely among geographic and socioeconomic subgroups. More than half of currently married women in Central Province (61 percent) and Nairobi Province (56 percent) are currently using a method, compared with 28 percent in Nyanza Province and 22 percent in Coast Province. Just 23 percent of women with no education use contraception versus 57 percent of women with at least some secondary education. Government facilities provide contraceptives to 58 percent of users, while 33 percent are supplied by private medical sources, 5 percent through other private sources, and 3 percent through community-based distribution (CBD) agents. This represents a significant shift in sourcing away from public outlets, a decline from 68 percent estimated in the 1993 KDHS. While the government continues to provide about two-thirds of IUD insertions and female sterilisations, the percentage of pills and injectables supplied out of government facilities has dropped from over 70 percent in 1993 to 53 percent for pills and 64 percent for injectables in 1998. Supply of condoms through public sector facilities has also declined: from 37 to 21 percent between 1993 and 1998. The survey results indicate that 24 percent of married women have an unmet need for family planning (either for spacing or limiting births). This group comprises married women who are not using a method of family planning but either want to wait two year or more for their next birth (14 percent) or do not want any more children (10 percent). While encouraging that unmet need at the national level has declined (from 34 to 24 percent) since 1993, there are parts of the country where the need for contraception remains high. For example, the level of unmet need is higher in Western Province (32 percent) and Coast Province (30 province) than elsewhere in Kenya. Early Childhood Mortality. One of the main objectives of the KDHS was to document current levels and trends in mortality among children under age 5. Results from the 1998 KDHS data make clear that childhood mortality conditions have worsened in the early-mid 1990s; this after a period of steadily improving child survival prospects through the mid-to-late 1980s. Under-five mortality, the probability of dying before the fifth birthday, stands at 112 deaths per 1000 live births which represents a 24 percent increase over the last decade. Survival chances during age 1-4 years suffered disproportionately: rising 38 percent over the same period. Survey results show that childhood mortality is especially high when associated with two factors: a short preceding birth interval and a low level of maternal education. The risk of dying in the first year of life is more than doubled when the child is born after an interval of less than 24 months. Children of women with no education experience an under-five mortality rate that is two times higher than children of women who attended secondary school or higher. Provincial differentials in childhood mortality are striking; under-five mortality ranges from a low of 34 deaths per 1000 live births in Central Province to a high of 199 per 1000 in Nyanza Province. Maternal Health. Utilisation of antenatal services is high in Kenya; in the three years before the survey, mothers received antenatal care for 92 percent of births (Note: These data do not speak to the quality of those antenatal services). The median number of antenatal visits per pregnancy was 3.7. Most antenatal care is provided by nurses and trained midwives (64 percent), but the percentage provided by doctors (28 percent) has risen in recent years. Still, over one-third of women who do receive care, start during the third trimester of pregnancy-too late to receive the optimum benefits of antenatal care. Mothers reported receiving at least one tetanus toxoid injection during pregnancy for 90 percent of births in the three years before the survey. Tetanus toxoid is a powerful weapon in the fight against neonatal tetanus, a deadly disease that attacks young infants. Forty-two percent of births take place in health facilities; however, this figure varies from around three-quarters of births in Nairobi to around one-quarter of births in Western Province. It is important for the health of both the mother and child that trained medical personnel are available in cases of prolonged labour or obstructed delivery, which are major causes of maternal morbidity and mortality. The 1998 KDHS collected information that allows estimation of mortality related to pregnancy and childbearing. For the 10-year period before the survey, the maternal mortality ratio was estimated to be 590 deaths per 100,000 live births. Bearing on average 4.7 children, a Kenyan woman has a 1 in 36 chance of dying from maternal causes during her lifetime. Childhood Immunisation. The KDHS

While the standard image of the nuclear family with two parents and 2.5 children has persisted in the American imagination, the number of births in the U.S. has steadily been decreasing since 1990, with about 3.67 million babies born in 2022. In 1990, this figure was 4.16 million. Birth and replacement rates A country’s birth rate is defined as the number of live births per 1,000 inhabitants, and it is this particularly important number that has been decreasing over the past few decades. The declining birth rate is not solely an American problem, with EU member states showing comparable rates to the U.S. Additionally, each country has what is called a “replacement rate.” The replacement rate is the rate of fertility needed to keep a population stable when compared with the death rate. In the U.S., the fertility rate needed to keep the population stable is around 2.1 children per woman, but this figure was at 1.67 in 2022. Falling birth rates Currently, there is much discussion as to what exactly is causing the birth rate to decrease in the United States. There seem to be several factors in play, including longer life expectancies, financial concerns (such as the economic crisis of 2008), and an increased focus on careers, all of which are causing people to wait longer to start a family. How international governments will handle falling populations remains to be seen, but what is clear is that the declining birth rate is a multifaceted problem without an easy solution.