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.

The average for 2022 based on 195 countries was 18.38 births per 1000 people. The highest value was in Niger: 45.03 births per 1000 people and the lowest value was in Hong Kong: 4.4 births per 1000 people. The indicator is available from 1960 to 2022. Below is a chart for all countries where data are available.

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.

Niger had the highest birth rate in the world in 2024, with a birth rate of 46.6 births per 1,000 inhabitants. Angola, Benin, Mali, and Uganda followed. Except for Afghanistan, all the 20 countries with the highest birth rates in the world were located in Sub-Saharan Africa. High infant mortality The reasons behind the high birth rates in many Sub-Saharan African countries are manyfold, but a major reason is that infant mortality remains high on the continent, despite decreasing steadily over the past decades, resulting in high birth rates to counter death rates. Moreover, many nations in Sub-Saharan Africa are highly reliant on small-scale farming, meaning that more hands are of importance. Additionally, polygamy is not uncommon in the region, and having many children is often seen as a symbol of status. Fastest growing populations As the high fertility rates coincide with decreasing death rates, countries in Sub-Saharan Africa have the highest population growth rates in the world. As a result, with Africa's population forecast to increase from 1.4 billion in 2022 to over 3.9 billion by 2100.

The total fertility rate of the world has dropped from around 5 children per woman in 1950, to 2.2 children per woman in 2025, which means that women today are having fewer than half the number of children that women did 75 years ago. Replacement level fertility This change has come as a result of the global demographic transition, and is influenced by factors such as the significant reduction in infant and child mortality, reduced number of child marriages, increased educational and vocational opportunities for women, and the increased efficacy and availability of contraception. While this change has become synonymous with societal progress, it does have wide-reaching demographic impact - if the global average falls below replacement level (roughly 2.1 children per woman), as is expected to happen in the 2050s, then this will lead to long-term population decline on a global scale. Regional variations When broken down by continent, Africa is the only region with a fertility rate above the global average, and, alongside Oceania, it is the only region with a fertility rate above replacement level. Until the 1980s, the average woman in Africa could expect to have 6-7 children over the course of their lifetime, and there are still several countries in Africa where women can still expect to have 5 or more children in 2025. Historically, Europe has had the lowest fertility rates in the world over the past century, falling below replacement level in 1975. Europe's population has grown through a combination of migration and increasing life expectancy, however even high immigration rates could not prevent its population from going into decline in 2021.

The average for 2022 based on 192 countries was 2.51 births per woman. The highest value was in Niger: 6.75 births per woman and the lowest value was in Hong Kong: 0.7 births per woman. The indicator is available from 1960 to 2022. Below is a chart for all countries where data are available.

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.

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.

Background : Substantial differences between countries were observed in terms of Covid-19 death tolls during the past two years. It was of interest to find out how the epidemiologic and/or demographic history of the population may have had a role in the high prevalence of the Covid-19 in some countries. Objective : This observational study aimed to investigate possible relations between Covid-19 death numbers in 39 countries and the prepandemic history of epidemiologic and demographic conditions. Methods : We sought the Covid-19 death toll in 39 countries in Europe, America, Africa, and Asia. Records (2019) of epidemiologic (Cancer, Alzheimer's disease) and demographic (natality, mortality, and fetility rates, percentage of people aged 65 and over) parameters as well as data on alcohol intake per capita were retrieved from official web pages. Data was analysed by simple linear or polynomial regression by the mean of Microsoft Excell software (2016). Results : When Covid-19 death numbers were plotted against the geographic latitude of each country, a bell-shaped curve was obtained for both the first and second years (coefficient of determination R2=0.38) of the pandemic. In a similar manner, bell-shaped curves were obtained when latitudes were plotted against the scores of (cancer plus Alzheimer's disease, R² = 0,65,), the percentage of advanced age (R² = 0,52,) and the alcohol intake level (R² = 0,64,). Covid-19 death numbers were positively correlated to the scores of (cancer plus Alzheimer's disease) (R2= 0.41, P= 1.61x10-5), advanced age (R2= 0.38, P= 4.09x10-5) and alcohol intake (R2= 0.48, P= 1.55x10-6). Instead, inverted bell-shaped curves were obtained when latitudes were plotted against the birth rate/mortality rate ratio (R² = 0,51) and the fetility rate (R² = 0,33). In addition, Covid-19 deaths were negatively correlated with the birth rate/mortality rate ratio (R2= 0.67) and fertility rate (R2= 0.50). Conclusion : The results show that the 39 countries in both hemisphers in this study have different patterns of epidemiologic and demographic factors, and that the negative history of epidemiologic and demographic factors of the northern hemisphere countries, as well as their high alcohol intake, were very correlated with their Covid-19 death tolls. Hence, also nutritional habits may have had a role in the general health status of people in regard to their immunity against the coronavirus.

In the Cook Islands in 2024, the population decreased by about 2.24 percent compared to the previous year, making it the country with the highest population decline rate in 2024. Of the 20 countries with the highest rate of population decline, the majority are island nations, where emigration rates are high (especially to Australia, New Zealand, and the United States), or they are located in Eastern Europe, which suffers from a combination of high emigration rates and low birth rates.

In 2024, Monaco was the European country estimated to have the highest fertility rate. The country had a fertility rate of 2.1 children per woman. Other small countries such as Gibraltar or Montenegro also came towards the top of the list for 2024, while the large country with the highest fertility rate was France, with 1.64 children per woman. On the other hand, Ukraine had the lowest fertility rate, averaging around one child per woman.

The main reasons for the negative consequences of demographic changes are: natural increase in the life span of the population, decline in fertility and emigration of unusual dimensions.

BackgroundThe birth rate is an important indicator of the health of the population. However, persistently low birth rate has become a pressing demographic challenge for many countries, including China. This has significant implications for sustainable population planning.MethodsThis study applied hot spot analysis and the spatiotemporal geographically weighted regression (GTWR) modeling, used panel data of 286 cities in China from 2012 to 2021 to explore the spatiotemporal heterogeneity of the relationship between the socioeconomic development and birth rate.ResultsThe research has found that 2017 was an important turning point in China’s demographic transition. The hot spot analysis reveals that the birth rate hot spots are characterized by a multipolar kernel distribution, shifting from spatial diffusion to convergence, with the cold spots mainly located in the northeast. And the GTWR modeling found that the relationship between socioeconomic development and birth rate varies and change dynamically over space and time. Key findings include: (1) the negative impact of GDP per capita on birth rates has intensified; (2) housing prices exhibit both wealth and crowding-out effects on birth rates, and there are obvious regional differences between the north and the south; (3) fiscal education expenditure on birth rates has the most pronounced income effect in the eastern region.ConclusionThis study adopts spatiotemporal perspective to reveal the spatiotemporal heterogeneity of the association between socioeconomic development and birth rate. It provides new evidence on the influence of macro factors on fertility in China. And emphasizes the importance of incorporating regional variations into population policy design.

The women in rural areas exercise aims to study the lifestyles and expectations (present and future) of rural Basque women; in other words, what elements (if any) define their ¿rural identity¿. In short, it seeks to document both the positive and negative factors encountered by women living in rural areas in their daily lives. More information in the https://www.euskadi.eus/gobierno-vasco/-/panoramica-juventud/ departmental statistical portal.

BackgroundKawasaki disease (KD) is a common cause of acquired paediatric heart disease in developed countries. KD was first identified in the 1960s in Japan, and has been steadily increasing since it was first reported. The aetiology of KD has not been defined, but is assumed to be infection-related. The present study sought to identify the factor(s) that mediate the geographical variation and chronological increase of KD in Japan.Methods and FindingsBased upon data reported between 1979 and 2010 from all 47 prefectures in Japan, the incidence and mean patient age at the onset of KD were estimated. Using spatial and time-series analyses, incidence and mean age were regressed against climatic/socioeconomic variables. Both incidence and mean age of KD were inversely correlated with the total fertility rate (TFR; i.e., the number of children that would be born to one woman). The extrapolation of a time-series regressive model suggested that KD emerged in the 1960s because of a dramatic decrease in TFR in the 1940s through the 1950s.ConclusionsMean patient age is an inverse surrogate for the hazard of contracting the aetiologic agent. Therefore, the observed negative correlation between mean patient age and TFR suggests that a higher TFR is associated with KD transmission. This relationship may be because a higher TFR facilitates sibling-to-sibling transmission. Additionally, the observed inverse correlation between incidence and TFR implies a paradoxical “negative” correlation between the incidence and the hazard of contracting the aetiologic agent. It was hypothesized that a decreasing TFR resulted in a reduced hazard of contracting the agent for KD, thereby increasing KD incidence.

This statistic shows the countries and territories with the lowest projected fertility rate between 2050 and 2055. Between 2050 and 2055, Singapore is projected to have the lowest fertility rate, with an average of 1.38 children born per woman.

Abstract

Different countries have different health outcomes that are in part due to the way respective health systems perform. Regardless of the type of health system, individuals will have health and non-health expectations in terms of how the institution responds to their needs. In many countries, however, health systems do not perform effectively and this is in part due to lack of information on health system performance, and on the different service providers.

The aim of the WHO World Health Survey is to provide empirical data to the national health information systems so that there is a better monitoring of health of the people, responsiveness of health systems and measurement of health-related parameters.

The overall aims of the survey is to examine the way populations report their health, understand how people value health states, measure the performance of health systems in relation to responsiveness and gather information on modes and extents of payment for health encounters through a nationally representative population based community survey. In addition, it addresses various areas such as health care expenditures, adult mortality, birth history, various risk factors, assessment of main chronic health conditions and the coverage of health interventions, in specific additional modules.

The objectives of the survey programme are to: 1. develop a means of providing valid, reliable and comparable information, at low cost, to supplement the information provided by routine health information systems. 2. build the evidence base necessary for policy-makers to monitor if health systems are achieving the desired goals, and to assess if additional investment in health is achieving the desired outcomes. 3. provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

Geographic coverage

The survey sampling frame must cover 100% of the country's eligible population, meaning that the entire national territory must be included. This does not mean that every province or territory need be represented in the survey sample but, rather, that all must have a chance (known probability) of being included in the survey sample.

There may be exceptional circumstances that preclude 100% national coverage. Certain areas in certain countries may be impossible to include due to reasons such as accessibility or conflict. All such exceptions must be discussed with WHO sampling experts. If any region must be excluded, it must constitute a coherent area, such as a particular province or region. For example if ¾ of region D in country X is not accessible due to war, the entire region D will be excluded from analysis.

Analysis unit

Households and individuals

Universe

The WHS will include all male and female adults (18 years of age and older) who are not out of the country during the survey period. It should be noted that this includes the population who may be institutionalized for health reasons at the time of the survey: all persons who would have fit the definition of household member at the time of their institutionalisation are included in the eligible population.

If the randomly selected individual is institutionalized short-term (e.g. a 3-day stay at a hospital) the interviewer must return to the household when the individual will have come back to interview him/her. If the randomly selected individual is institutionalized long term (e.g. has been in a nursing home the last 8 years), the interviewer must travel to that institution to interview him/her.

The target population includes any adult, male or female age 18 or over living in private households. Populations in group quarters, on military reservations, or in other non-household living arrangements will not be eligible for the study. People who are in an institution due to a health condition (such as a hospital, hospice, nursing home, home for the aged, etc.) at the time of the visit to the household are interviewed either in the institution or upon their return to their household if this is within a period of two weeks from the first visit to the household.

Kind of data

Sample survey data [ssd]

Sampling procedure

SAMPLING GUIDELINES FOR WHS

Surveys in the WHS program must employ a probability sampling design. This means that every single individual in the sampling frame has a known and non-zero chance of being selected into the survey sample. While a Single Stage Random Sample is ideal if feasible, it is recognized that most sites will carry out Multi-stage Cluster Sampling.

The WHS sampling frame should cover 100% of the eligible population in the surveyed country. This means that every eligible person in the country has a chance of being included in the survey sample. It also means that particular ethnic groups or geographical areas may not be excluded from the sampling frame.

The sample size of the WHS in each country is 5000 persons (exceptions considered on a by-country basis). An adequate number of persons must be drawn from the sampling frame to account for an estimated amount of non-response (refusal to participate, empty houses etc.). The highest estimate of potential non-response and empty households should be used to ensure that the desired sample size is reached at the end of the survey period. This is very important because if, at the end of data collection, the required sample size of 5000 has not been reached additional persons must be selected randomly into the survey sample from the sampling frame. This is both costly and technically complicated (if this situation is to occur, consult WHO sampling experts for assistance), and best avoided by proper planning before data collection begins.

All steps of sampling, including justification for stratification, cluster sizes, probabilities of selection, weights at each stage of selection, and the computer program used for randomization must be communicated to WHO

STRATIFICATION

Stratification is the process by which the population is divided into subgroups. Sampling will then be conducted separately in each subgroup. Strata or subgroups are chosen because evidence is available that they are related to the outcome (e.g. health, responsiveness, mortality, coverage etc.). The strata chosen will vary by country and reflect local conditions. Some examples of factors that can be stratified on are geography (e.g. North, Central, South), level of urbanization (e.g. urban, rural), socio-economic zones, provinces (especially if health administration is primarily under the jurisdiction of provincial authorities), or presence of health facility in area. Strata to be used must be identified by each country and the reasons for selection explicitly justified.

Stratification is strongly recommended at the first stage of sampling. Once the strata have been chosen and justified, all stages of selection will be conducted separately in each stratum. We recommend stratifying on 3-5 factors. It is optimum to have half as many strata (note the difference between stratifying variables, which may be such variables as gender, socio-economic status, province/region etc. and strata, which are the combination of variable categories, for example Male, High socio-economic status, Xingtao Province would be a stratum).

Strata should be as homogenous as possible within and as heterogeneous as possible between. This means that strata should be formulated in such a way that individuals belonging to a stratum should be as similar to each other with respect to key variables as possible and as different as possible from individuals belonging to a different stratum. This maximises the efficiency of stratification in reducing sampling variance.

MULTI-STAGE CLUSTER SELECTION

A cluster is a naturally occurring unit or grouping within the population (e.g. enumeration areas, cities, universities, provinces, hospitals etc.); it is a unit for which the administrative level has clear, nonoverlapping boundaries. Cluster sampling is useful because it avoids having to compile exhaustive lists of every single person in the population. Clusters should be as heterogeneous as possible within and as homogenous as possible between (note that this is the opposite criterion as that for strata). Clusters should be as small as possible (i.e. large administrative units such as Provinces or States are not good clusters) but not so small as to be homogenous.

In cluster sampling, a number of clusters are randomly selected from a list of clusters. Then, either all members of the chosen cluster or a random selection from among them are included in the sample. Multistage sampling is an extension of cluster sampling where a hierarchy of clusters are chosen going from larger to smaller.

In order to carry out multi-stage sampling, one needs to know only the population sizes of the sampling units. For the smallest sampling unit above the elementary unit however, a complete list of all elementary units (households) is needed; in order to be able to randomly select among all households in the TSU, a list of all those households is required. This information may be available from the most recent population census. If the last census was >3 years ago or the information furnished by it was of poor quality or unreliable, the survey staff will have the task of enumerating all households in the smallest randomly selected sampling unit. It is very important to budget for this step if it is necessary and ensure that all households are properly enumerated in order that a representative sample is obtained.

It is always best to have as many clusters in the PSU as possible. The reason for this is that the fewer the number of respondents in each PSU, the lower will be the clustering effect which

ABSTRACT Background : The Covid-19 pandemic associated with the SARS-CoV-2 has caused very high death tolls in many countries, while it has had less prevalence in other countries of Africa and Asia. Climate and geographic conditions, as well as other epidemiologic and demographic conditions, were a matter of debate on whether or not they could have an effect on the prevalence of Covid-19. Objective : In the present work, we sought a possible relevance of the geographic location of a given country on its Covid-19 prevalence. On the other hand, we sought a possible relation between the history of epidemiologic and demographic conditions of the populations and the prevalence of Covid-19 across four continents (America, Europe, Africa, and Asia). We also searched for a possible impact of pre-pandemic alcohol consumption in each country on the two year death tolls across the four continents. Methods : We have sought the death toll caused by Covid-19 in 39 countries and obtained the registered deaths from specialized web pages. For every country in the study, we have analysed the correlation of the Covid-19 death numbers with its geographic latitude, and its associated climate conditions, such as the mean annual temperature, the average annual sunshine hours, and the average annual UV index. We also analyzed the correlation of the Covid-19 death numbers with epidemiologic conditions such as cancer score and Alzheimer score, and with demographic parameters such as birth rate, mortality rate, fertility rate, and the percentage of people aged 65 and above. In regard to consumption habits, we searched for a possible relation between alcohol intake levels per capita and the Covid-19 death numbers in each country. Correlation factors and determination factors, as well as analyses by simple linear regression and polynomial regression, were calculated or obtained by Microsoft Exell software (2016). Results : In the present study, higher numbers of deaths related to Covid-19 pandemic were registered in many countries in Europe and America compared to other countries in Africa and Asia. The analysis by polynomial regression generated an inverted bell-shaped curve and a significant correlation between the Covid-19 death numbers and the geographic latitude of each country in our study. Higher death numbers were registered in the higher geographic latitudes of both hemispheres, while lower scores of deaths were registered in countries located around the equator line. In a bell shaped curve, the latitude levels were negatively correlated to the average annual levels (last 10 years) of temperatures, sunshine hours, and UV index of each country, with the highest scores of each climate parameter being registered around the equator line, while lower levels of temperature, sunshine hours, and UV index were registered in higher latitude countries. In addition, the linear regression analysis showed that the Covid-19 death numbers registered in the 39 countries of our study were negatively correlated with the three climate factors of our study, with the temperature as the main negatively correlated factor with Covid-19 deaths. On the other hand, cancer and Alzheimer's disease scores, as well as advanced age and alcohol intake, were positively correlated to Covid-19 deaths, and inverted bell-shaped curves were obtained when expressing the above parameters against a country’s latitude. Instead, the (birth rate/mortality rate) ratio and fertility rate were negatively correlated to Covid-19 deaths, and their values gave bell-shaped curves when expressed against a country’s latitude. Conclusion : The results of the present study prove that the climate parameters and history of epidemiologic and demographic conditions as well as nutrition habits are very correlated with Covid-19 prevalence. The results of the present study prove that low levels of temperature, sunshine hours, and UV index, as well as negative epidemiologic and demographic conditions and high scores of alcohol intake may worsen Covid-19 prevalence in many countries of the northern hemisphere, and this phenomenon could explain their high Covid-19 death tolls. Keywords : Covid-19, Coronavirus, SARS-CoV-2, climate, temperature, sunshine hours, UV index, cancer, Alzheimer disease, alcohol.

With an average of *** births per woman, Afghanistan had the highest fertility rate throughout the Asia-Pacific region in 2024. Pakistan and Papua New Guinea followed with the second and third-highest fertility rates, respectively. In contrast, South Korea and Hong Kong had the lowest fertility rates across the region. Contraception usage Fertility rates among women in the Asia-Pacific region have fallen throughout recent years. A likely reason is an increase in contraception use. However, contraception usage varies greatly throughout the Asia-Pacific region. Although contraception prevalence is set to increase across South Asia by 2030, women in both East Asia and Southeast Asia had higher contraception usage compared to South Asia in 2019. Women in APAC With the rise of feminism and the advancement of human rights, attitudes towards the role of women have changed in the Asia-Pacific region. Achieving gender equality has become a vital necessity for both men and women throughout the region. Alongside changes in traditional gender roles, women in certain Asia-Pacific countries, such as New Zealand, have become more inclined to marry later in life. Furthermore, the focus for younger women appears to be with having stability in their lives and securing an enjoyable job. This was displayed when female high school students in Japan were questioned about their future life aspirations.

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.