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 total fertility rate of the world has dropped from around five children per woman in 1950, to 2.3 children per woman in 2023, which means that women today are having fewer than half the number of children that women did 75 years ago. 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.

When broken down by continent, Africa is the only region with a fertility rate above the global average, while it and Oceania are the only regions with above replacement level fertility rates. Until the 1980s, women in Africa could expect to have almost seven children throughout the course of their lifetimes, and there are still eight countries in Africa where the average woman of childbearing age can still expect to have five or more children in 2023. Historically, Europe has had the lowest fertility rate 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.

This map shows the average number of children born to a woman during her lifetime. Data from Population Reference Bureau's 2017 World Population Data Sheet. The world's total fertility rate reported in 2017 was 2.5 as a whole. Replacement-Level fertility is widely recognized as 2.0 children per woman, so as to "replace" each parent in the next generation. Countries depicted in pink have a total fertility rate below replacement level whereas countries depicted in teal have a total fertility rate above replacement level. In countries with very high child mortality rates, a replacement level of 2.1 could be used, since not every child will survive into their reproductive years. Determinants of Total Fertility Rate include: women's education levels and opportunities, marriage rates among women of childbearing age (generally defined as 15-49), contraceptive usage and method mix/effectiveness, infant & child mortality rates, share of population living in urban areas, the importance of children as part of the labor force (or cost/penalty to women's labor force options that having children poses), and religious and cultural norms, among many other factors. This map was made using the Global Population and Maternal Health Indicators layer.

Following a spike to 2.5 children per woman in the mid-1960s (during the second wave of the post-WWII baby boom), Germany's fertility rate then fell sharply to around 1.5 children per woman in the 1970s, and it has fluctuated between 1.2 and 1.6 children per woman ever since. Germany's fertility rate has been below the natural replacement level of roughly 2.1 children per woman since 1970, meaning that long-term natural population growth is unsustainable. In fact, Germany has experienced a natural population decline in every year since 1972, and its population has only grown or been sustained at its current level through high net immigration rates.Find more statistics on other topics about Germany with key insights such as crude birth rate, life expectancy of women at birth, and total life expectancy at birth.

The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. From 1800 until 1865, Japan's fertility rate grew quite gradually, from 4.1 children per woman, to 4.8. From this point the fertility rate drops to 3.6 over the next ten years, as Japan became more industrialized. Towards the end of the nineteenth century, Japan's fertility rate grew again, and reached it's highest recorded point in the early 1920s, where it was 5.4 children per woman. Since this point it has been gradually decreasing until now, although it did experience slight increases after the Second World War, and in the early 1970s. In recent decades Japan's population has aged extensively, and today, Japan has the second oldest population and second highest life expectancy in the world (after Monaco). In contrast to this, Japan has a very low birth rate, and it's fertility rate is expected to fall below 1.4 children per woman in 2020.

Graph and download economic data for Fertility Rate, Total for the United States (SPDYNTFRTINUSA) from 1960 to 2022 about fertility, rate, and USA.

In 2024, there are six countries, all in Sub-Saharan Africa, where the average woman of childbearing age can expect to have around six or more children throughout their lifetime. In fact, of the 20 countries in the world with the highest fertility rates, Afghanistan is the only country not found in Sub-Saharan Africa. High fertility rates in Africa With a fertility rate of almost 7 children per woman, Niger is the country with the highest fertility rate in the world. Population growth in Niger 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 Niger'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 less-developed 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 four or 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

In 1800, the total fertility rate in the region of present-day Latvia was 5.2 children per woman; meaning woman born in Latvia in that year could expect to have just over five children on average during the course of their reproductive years. Fertility in Latvia would decline steadily in the 19th century, primarily due to advancements in healthcare and declining child mortality rates, and also due to economic improvements in the years following the agricultural reforms of 1849, which would see a significant improvement in the living standards of the country’s peasantry. Fertility would decline faster in the 1930s and 1940s, due to the instability and devastation caused by the Second World War and Great Depression.

Following the end of the war, fertility would resume its steady decline until the 1970s and 1980s, when Latvian authorities promoted population growth and implemented financial incentives for mothers. However, with the demographic shifts following the dissolution of the Soviet Union in 1991, and economic downturn following the adoption of the market economy, women across most former-Soviet states were much more reluctant to have children in the 1990s. By the turn of the millennium, Latvia's fertility rate had fallen to just over one child per woman in 2000. While fertility has recovered somewhat following Latvia’s ascension to the European Union in 2004, total fertility remains below replacement level in the country, and in 2020, it is estimated that the average woman born in Latvia will have just over 1.7 children over the course of her reproductive years.

Simulations of MCMC parameters and density distribution functions. (ZIP)

In 1925, the total fertility rate of Iran was just over seven children per woman, meaning that the average woman in Iran could expect to have seven children over the course of their reproductive years. The fertility rate would see little change from this figure until the late 1960s, when modernization and significant decreases in child mortality would lead the fertility rate to fall to just over 6.2 in 1975. However, fertility would begin to rise again in the 1980s, as the modernization policies of the Shah would be replaced by Islamic economic and social platforms with the 1979 Islamic Revolution in the country. The total fertility rate in the country would peak at just over 6.5 children per woman in 1985, in response to strong encouragement by the Iranian government promoting larger families to improve Iran’s manpower advantage over Iraq in the 1980-1988 Iraq-Iran War. Following the war’s end with a UN-brokered ceasefire in 1988, fertility would fall sharply in the country, falling to 2.4 by the turn of the century, and falling below replacement-level in 2005. However, after bottoming out at 1.82 in 2010, fertility has risen somewhat in recent years, as the Iranian government has rolled out a series of economic incentives aimed at increasing fertility in the country. As a result, in 2020, the total fertility rate in Iran is estimated to have risen slightly, to 2.15 children per woman, above replacement-level.

Projected TFR simulations for Spain.

While the BRICS countries are grouped together in terms of economic development, demographic progress varies across these five countries. In 2019, India and South Africa were the only BRICS countries with a fertility rate above replacement level (2.1 births per woman). Fertility rates since 2000 show that fertility in China and Russia has either fluctuated or remained fairly steady, as these two countries are at a later stage of the demographic transition than the other three, while Brazil has reached this stage more recently. Fertility rates in India are following a similar trend to Brazil, while South Africa's rate is progressing at a much slower pace. Demographic development is inextricably linked with economic growth; for example, as fertility rates drop, female participation in the workforce increases, as does the average age, which then leads to higher productivity and a more profitable domestic market.

In 1890, the total fertility rate in Ecuador was seven children per woman. This means that the average woman born in Ecuador in this time could be expected to have seven children over the course of her reproductive years. This fertility rate would gradually fall as Ecuador entered the 20th century, rising briefly in the 1920s during a period of economic and political instability. However, from the 1930s onwards, the fertility rate in Ecuador would begin falling, as medical advancements and increased access to healthcare saw child mortality rates fall; the fertility rate did plateau, however, during the global baby boom of the 1950s and 1960s, although the decline did resume in the 1960s. By the end of the century, fertility was at just 3.3 children per woman, and in the past two decades, it has fallen further, to 2.4 children per woman; which is above replacement level..

Chart and table of the Bulgaria fertility rate from 1950 to 2025. United Nations projections are also included through the year 2100.

The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. In Germany in 1800, the average woman of childbearing age would have 5.4 children over the course of their lifetime. It remained around this number until the late 1820s, when it then dropped to just under five, which was a long-term effect of the Napoleonic Period in Europe. From this point until the end of the nineteenth century, Germany's fertility rate was rather sporadic, reaching it's lowest point in 1855 with an average of 4.6 births per woman, and it's highest point in 1875 (just after the foundation of the German Empire in 1871), with an average of 5.4 live births per woman. From the beginning of the twentieth century until the end of the Second World War, Germany's fertility rate dropped from around 5 children per woman in 1900, to 1.9 in 1945. The only time where the fertility rate increased was in the inter-war years. Like other countries heavily involved in the Second World War, Germany (both East and West) experienced a Baby Boom from the late 1940s to the late 1960s, however it then dropped to it's lowest point of just 1.3 children per woman by 1995, shortly after the re-unification of Germany. In recent years, Germany's fertility rate has gradually been increasing again, and is expected to reach 1.6 in 2020, its highest rate in over forty years.

Abstract

The second National Family Health Survey (NFHS-2), conducted in 1998-99, provides information on fertility, mortality, family planning, and important aspects of nutrition, health, and health care. The International Institute for Population Sciences (IIPS) coordinated the survey, which collected information from a nationally representative sample of more than 90,000 ever-married women age 15-49. The NFHS-2 sample covers 99 percent of India's population living in all 26 states. This report is based on the survey data for 25 of the 26 states, however, since data collection in Tripura was delayed due to local problems in the state.

IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992-93. Most of the types of information collected in NFHS-2 were also collected in the earlier survey, making it possible to identify trends over the intervening period of six and one-half years. In addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important policy implications, such as reproductive health, women's autonomy, domestic violence, women's nutrition, anaemia, and salt iodization.

The NFHS-2 survey was carried out in two phases. Ten states were surveyed in the first phase which began in November 1998 and the remaining states (except Tripura) were surveyed in the second phase which began in March 1999. The field staff collected information from 91,196 households in these 25 states and interviewed 89,199 eligible women in these households. In addition, the survey collected information on 32,393 children born in the three years preceding the survey. One health investigator on each survey team measured the height and weight of eligible women and children and took blood samples to assess the prevalence of anaemia.

SUMMARY OF FINDINGS

POPULATION CHARACTERISTICS

Three-quarters (73 percent) of the population lives in rural areas. The age distribution is typical of populations that have recently experienced a fertility decline, with relatively low proportions in the younger and older age groups. Thirty-six percent of the population is below age 15, and 5 percent is age 65 and above. The sex ratio is 957 females for every 1,000 males in rural areas but only 928 females for every 1,000 males in urban areas, suggesting that more men than women have migrated to urban areas.

The survey provides a variety of demographic and socioeconomic background information. In the country as a whole, 82 percent of household heads are Hindu, 12 percent are Muslim, 3 percent are Christian, and 2 percent are Sikh. Muslims live disproportionately in urban areas, where they comprise 15 percent of household heads. Nineteen percent of household heads belong to scheduled castes, 9 percent belong to scheduled tribes, and 32 percent belong to other backward classes (OBCs). Two-fifths of household heads do not belong to any of these groups.

Questions about housing conditions and the standard of living of households indicate some improvements since the time of NFHS-1. Sixty percent of households in India now have electricity and 39 percent have piped drinking water compared with 51 percent and 33 percent, respectively, at the time of NFHS-1. Sixty-four percent of households have no toilet facility compared with 70 percent at the time of NFHS-1.

About three-fourths (75 percent) of males and half (51 percent) of females age six and above are literate, an increase of 6-8 percentage points from literacy rates at the time of NFHS-1. The percentage of illiterate males varies from 6-7 percent in Mizoram and Kerala to 37 percent in Bihar and the percentage of illiterate females varies from 11 percent in Mizoram and 15 percent in Kerala to 65 percent in Bihar. Seventy-nine percent of children age 6-14 are attending school, up from 68 percent in NFHS-1. The proportion of children attending school has increased for all ages, particularly for girls, but girls continue to lag behind boys in school attendance. Moreover, the disparity in school attendance by sex grows with increasing age of children. At age 6-10, 85 percent of boys attend school compared with 78 percent of girls. By age 15-17, 58 percent of boys attend school compared with 40 percent of girls. The percentage of girls 6-17 attending school varies from 51 percent in Bihar and 56 percent in Rajasthan to over 90 percent in Himachal Pradesh and Kerala.

Women in India tend to marry at an early age. Thirty-four percent of women age 15-19 are already married including 4 percent who are married but gauna has yet to be performed. These proportions are even higher in the rural areas. Older women are more likely than younger women to have married at an early age: 39 percent of women currently age 45-49 married before age 15 compared with 14 percent of women currently age 15-19. Although this indicates that the proportion of women who marry young is declining rapidly, half the women even in the age group 20-24 have married before reaching the legal minimum age of 18 years. On average, women are five years younger than the men they marry. The median age at marriage varies from about 15 years in Madhya Pradesh, Bihar, Uttar Pradesh, Rajasthan, and Andhra Pradesh to 23 years in Goa.

As part of an increasing emphasis on gender issues, NFHS-2 asked women about their participation in household decisionmaking. In India, 91 percent of women are involved in decision-making on at least one of four selected topics. A much lower proportion (52 percent), however, are involved in making decisions about their own health care. There are large variations among states in India with regard to women's involvement in household decisionmaking. More than three out of four women are involved in decisions about their own health care in Himachal Pradesh, Meghalaya, and Punjab compared with about two out of five or less in Madhya Pradesh, Orissa, and Rajasthan. Thirty-nine percent of women do work other than housework, and more than two-thirds of these women work for cash. Only 41 percent of women who earn cash can decide independently how to spend the money that they earn. Forty-three percent of working women report that their earnings constitute at least half of total family earnings, including 18 percent who report that the family is entirely dependent on their earnings. Women's work-participation rates vary from 9 percent in Punjab and 13 percent in Haryana to 60-70 percent in Manipur, Nagaland, and Arunachal Pradesh.

FERTILITY AND FAMILY PLANNING

Fertility continues to decline in India. At current fertility levels, women will have an average of 2.9 children each throughout their childbearing years. The total fertility rate (TFR) is down from 3.4 children per woman at the time of NFHS-1, but is still well above the replacement level of just over two children per woman. There are large variations in fertility among the states in India. Goa and Kerala have attained below replacement level fertility and Karnataka, Himachal Pradesh, Tamil Nadu, and Punjab are at or close to replacement level fertility. By contrast, fertility is 3.3 or more children per woman in Meghalaya, Uttar Pradesh, Rajasthan, Nagaland, Bihar, and Madhya Pradesh. More than one-third to less than half of all births in these latter states are fourth or higher-order births compared with 7-9 percent of births in Kerala, Goa, and Tamil Nadu.

Efforts to encourage the trend towards lower fertility might usefully focus on groups within the population that have higher fertility than average. In India, rural women and women from scheduled tribes and scheduled castes have somewhat higher fertility than other women, but fertility is particularly high for illiterate women, poor women, and Muslim women. Another striking feature is the high level of childbearing among young women. More than half of women age 20-49 had their first birth before reaching age 20, and women age 15-19 account for almost one-fifth of total fertility. Studies in India and elsewhere have shown that health and mortality risks increase when women give birth at such young ages?both for the women themselves and for their children. Family planning programmes focusing on women in this age group could make a significant impact on maternal and child health and help to reduce fertility.

INFANT AND CHILD MORTALITY

NFHS-2 provides estimates of infant and child mortality and examines factors associated with the survival of young children. During the five years preceding the survey, the infant mortality rate was 68 deaths at age 0-11 months per 1,000 live births, substantially lower than 79 per 1,000 in the five years preceding the NFHS-1 survey. The child mortality rate, 29 deaths at age 1-4 years per 1,000 children reaching age one, also declined from the corresponding rate of 33 per 1,000 in NFHS-1. Ninety-five children out of 1,000 born do not live to age five years. Expressed differently, 1 in 15 children die in the first year of life, and 1 in 11 die before reaching age five. Child-survival programmes might usefully focus on specific groups of children with particularly high infant and child mortality rates, such as children who live in rural areas, children whose mothers are illiterate, children belonging to scheduled castes or scheduled tribes, and children from poor households. Infant mortality rates are more than two and one-half times as high for women who did not receive any of the recommended types of maternity related medical care than for mothers who did receive all recommended types of care.

HEALTH, HEALTH CARE, AND NUTRITION

Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme of the Government of India. One goal is for each pregnant woman to receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of iron and folic acid supplementation. In India, mothers of 65 percent of the children

The data collection contains population projections for UK ethnic groups and all local area by age (single year of age up to 100+) and sex. Included in the data set are also input data to the cohort component model that was used to project populations into the future-fertility rates, mortality rates, international migration flows and internal migration probabilities. Also included in data set are output data: Number of deaths, births and internal migrants. All data included are for the years 2011 to 2061. We have produced two ethnic population projections for UK local authorities, based on information on 2011 Census ethnic populations and 2010-2011-2012 ethnic components. Both projections align fertility and mortality assumptions to ONS assumptions. Where they differ is in the migration assumptions. In LEEDS L1 we employ internal migration rates for 2001 to 2011, including periods of boom and bust. We use a new assumption about international migration anticipating that the UK may leave the EU (BREXIT). In LEEDS L2 we use average internal migration rates for the 5 year period 2006-11 and the official international migration flow assumptions with a long term balance of +185 thousand per annum.

This project aims to understand and to forecast the ethnic transition in the United Kingdom's population at national and sub-national levels. The ethnic transition is the change in population composition from one dominated by the White British to much greater diversity. In the decade 2001-2011 the UK population grew strongly as a result of high immigration, increased fertility and reduced mortality. Both the Office for National Statistics (ONS) and Leeds University estimated the growth or decline in the sixteen ethnic groups making up the UK's population in 2001. The 2011 Census results revealed that both teams had over-estimated the growth of the White British population and under-estimated the growth of the ethnic minority populations. The wide variation between our local authority projected populations in 2011 and the Census suggested inaccurate forecasting of internal migration. We propose to develop, working closely with ONS as our first external partner, fresh estimates of mid-year ethnic populations and their components of change using new data on the later years of the decade and new methods to ensure the estimates agree in 2011 with the Census. This will involve using population accounting theory and an adjustment technique known as iterative proportional fitting to generate a fully consistent set of ethnic population estimates between 2001 and 2011.

We will study, at national and local scales, the development of demographic rates for ethnic group populations (fertility, mortality, internal migration and international migration). The ten year time series of component summary indicators and age-specific rates will provide a basis for modelling future assumptions for projections. We will, in our main projection, align the assumptions to the ONS 2012-based principal projection. The national assumptions will need conversion to ethnic groups and to local scale. The ten years of revised ethnic-specific component rates will enable us to study the relationships between national and local demographic trends. In addition, we will analyse a consistent time series of local authority internal migration. We cannot be sure, at this stage, how the national-local relationships for each ethnic group will be modelled but we will be able to test our models using the time series.

Of course, all future projections of the population are uncertain. We will therefore work to measure the uncertainty of component rates. The error distributions can be used to construct probability distributions of future populations via stochastic projections so that we can define confidence intervals around our projections. Users of projections are always interested in the impact of the component assumptions on future populations. We will run a set of reference projections to estimate the magnitude and direction of impact of international migrations assumptions (net effect of immigration less emigration), of internal migration assumptions (the net effect of in-migration less out-migration), of fertility assumptions compared with replacement level, of mortality assumptions compared with no change and finally the effect of the initial age distribution (i.e. demographic potential).

The outputs from the project will be a set of technical reports on each aspect of the research, journal papers submitted for peer review and a database of projection inputs and outputs available to users via the web. The demographic inputs will be subject to quality assurance by Edge Analytics, our second external partner. They will also help in disseminating these inputs to local government users who want to use them in their own ethnic projections. In sum, the project will show how a wide range of secondary data sources can be used in theoretically refined demographic...

The fertility rate of a country is the average number of children that women from that country will have throughout their reproductive years. In the United States in 1800, the average woman of childbearing age would have seven children over the course of their lifetime. As factors such as technology, hygiene, medicine and education improved, women were having fewer children than before, reaching just two children per woman in 1940. This changed quite dramatically in the aftermath of the Second World War, rising sharply to over 3.5 children per woman in 1960 (children born between 1946 and 1964 are nowadays known as the 'Baby Boomer' generation, and they make up roughly twenty percent of todays US population). Due to the end of the baby boom and increased access to contraception, fertility reached it's lowest point in the US in 1980, where it was just 1.77. It did however rise to over two children per woman between 1995 and 2010, although it is expected to drop again by 2020, to just 1.78.

Abstract

The 2006-07 Sri Lanka Demographic and Health Survey (SLDHS) is the fourth in a series of DHS surveys to be held in Sri Lanka-the first three having been implemented in 1987, 1993, and 2000. Teams visited 2,106 sample points across Sri Lanka and collected data from a nationally representative sample of almost 20,000 households and over 14,700 women age 15-49.

A nationally representative sample of 21,600 housing units was selected for the survey and 19,872 households were enumerated to give district level estimates (excluding Northern Province). Detailed information was collected from all ever-married women aged 15-49 years and about their children below five years at the time of the survey. Within the households interviewed, a total of 15,068 eligible women were identified, of whom 14,692 were successfully interviewed.

The Department of Census and Statistics (DCS) carried out the 2006-07 SLDHS for the Health Sector Development Project (HSDP) of the Ministry of Healthcare and Nutrition, a project funded by the World Bank. The objective of the survey is to provide data needed to monitor and evaluate the impact of population, health, and nutrition programmes implemented by different government agencies. Additionally, it also aims to measure the impact of interventions made under the HSDP towards improving the quality and efficiency of health care services as a whole.

All 25 districts of Sri Lanka were included at the design stage. The final sample has only 20 districts, however, after dropping the 5 districts of the Northern Province (Jaffna, Kilinochchi, Mannar, Vavuniya, and Mullativu), due to the security situation there.

OBJECTIVES

The objective of this report is to publish the final findings of the 2006-07 SLDHS. This final report provides information mainly on background characteristics of respondents, fertility, reproductive health and maternal care, child health, nutrition, women's empowerment, and awareness of HIV/AIDS and prevention. It is expected that the content of this report will satisfy the urgent needs of users of this information.

MAIN RESULTS

FERTILITY Survey results indicate that there has been a slight upturn in the total fertility rate since the 2000 SLDHS. The total fertility rate for Sri Lanka is 2.3, meaning that, if current age-specific fertility rates were to remain unchanged in the future, a woman in Sri Lanka would have an average of 2.3 children by the end of her childbearing period. This is somewhat higher than the total fertility rate of 1.9 measured in the 2000 SLDHS.

Fertility is only slightly lower in urban areas than in rural areas (2.2 and 2.3 children per woman, respectively); however, it is higher in the estate areas (2.5 children per woman). Interpretation of variations in fertility by administrative districts is limited by the small samples in some districts. Nevertheless, results indicate that Galle and Puttalam districts have fertility rates of 2.1 or below, which is at what is known as “replacement level” fertility, i.e., the level that is necessary to maintain population size over time. Differences in fertility by level of women's education and a measure of relative wealth status are minimal.

FAMILY PLANNING According to the survey findings, knowledge of any method of family planning is almost universal in Sri Lanka and there are almost no differences between ever-married and currently married women. Over 90 percent of currently married women have heard about pills, injectables, female sterilization, and the IUD. Eight out of ten respondents know about some traditional method of delaying or avoiding pregnancies.

Although the proportion of currently married women who have heard of at least one method of family planning has been high for some time, knowledge of some specific methods has increased recently. Since 1993, knowledge of implants has increased five-fold-from about 10 percent in 1993 to over 50 percent in 2006-07. Awareness about pill, IUD, injectables, implants, and withdrawal has also increased. On the other hand, awareness of male sterilization has dropped by 14 percentage points.

CHILD HEALTH The study of infant and child mortality is critical for assessment of population and health policies and programmes. Infant and child mortality rates are also regarded as indices reflecting the degree of poverty and deprivation of a population. Survey data show that for the most recent five-year period before the survey, the infant mortality rate is 15 deaths per 1,000 live births and under-five mortality is 21 deaths per 1,000 live births. Thus, one in every 48 Sri Lankan children dies before reaching age five. The neonatal mortality rate is 11 deaths per 1,000 live births and the postneonatal mortality rate is 5 deaths per 1,000 live births. The child mortality rate is 5 deaths per 1,000 children surviving to age one year.

REPRODUCTIVE HEALTH The survey shows that virtually all mothers (99 percent) in Sri Lanka receive antenatal care from a health professional (doctor specialist, doctor, or midwife). The proportion receiving care from a skilled provider is remarkably uniform across all categories for age, residence, district, woman's education, and household wealth quintile. Even in the estate sector, antenatal care usage is at the same high level. Although doctors are the most frequently seen provider (96 percent), women also go to public health midwives often for prenatal care (44 percent).

BREASTFEEDING AND NUTRITION Poor nutritional status is one of the most important health and welfare problems facing Sri Lanka today and particularly affects women and children. The survey data show that 17 percent of children under five are stunted or short for their age, while 15 percent of children under five are wasted or too thin for their height. Overall, 21 percent of children are underweight, which may reflect stunting, wasting, or both. As for women, at the national level, 16 percent of women are considered to be thin (with a body mass index < 18.5); however, only 6 percent of women are considered to be moderately or severely thin.

Poor breastfeeding and infant feeding practices can have adverse consequences for the health and nutritional status of children. Fortunately, breastfeeding in Sri Lanka is universal and generally of fairly long duration; 97 percent of newborns are breastfed within one day after delivery and 76 percent of infants under 6 months are exclusively breastfed, lower than the recommended 100 percent exclusive breastfeeding for children under 6 months. The median duration of any breastfeeding is 33 months in Sri Lanka and the median duration of exclusive breastfeeding is 5 months.

HIV/AIDS The HIV/AIDS pandemic is a serious health concern in the world today because of its high case fatality rate and the lack of a cure. Awareness of AIDS is almost universal among Sri Lankan adults, with 92 percent of ever-married women saying that they have heard about AIDS. Nevertheless, only 22 percent of ever-married women are classified as having “comprehensive knowledge” about AIDS, i.e., knowing that consistent use of condoms and having just one faithful partner can reduce the chance of getting infected, knowing that a healthy-looking person can be infected, and knowing that AIDS cannot be transmitted by sharing food or by mosquito bites. Such a low level of knowledge about AIDS implies that a concerted effort is needed to address misconceptions about HIV transmission. Programs might be focused in the estate sector and especially in Batticaloa, Ampara, and Nuwara Eliya districts where comprehensive knowledge is lowest.

Moreover, a composite indicator on stigma towards HIV-infected people shows that only 8 percent of ever-married women expressed accepting attitudes toward persons living with HIV/AIDS. Overall, only about one- half of ever-married women age 15-49 years know where to get an HIV test.

WOMEN'S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES The 2006-07 SLDHS collected data on women's empowerment, their participation in decisionmaking, and attitudes towards wife beating. Survey results show that more than 90 percent of currently married women, either alone or jointly with their husband, make decisions on how their income is used. However, husbands' control over women's earnings is higher among women with no education (15 percent) than among women with higher education (4 percent).

In Sri Lanka, the husband is usually the main source of household income; two-thirds of women earn less than their husband. Although the majority of women earn less than their husband, almost half have autonomy in decisions about how to spend their earnings.

The survey also collected information on who decides how the husband's cash earnings are spent. The majority of couples (60 percent) make joint decisions on how the husband's cash income is used. More than 1 in 5 women (23 percent) reported that they decide how their husband's earnings are used; another 16 percent of the women reported that their husband mainly decides how his earnings are spent.

Geographic coverage

A nationally representative sample of 21,600 housing units was selected for the survey and 19,872 households were enumerated to give district level estimates (excluding Northern Province).

Analysis unit

• Household
• Women age 15-49
• Children under five

Universe

In principle, the sample was designed to cover private households in the areas sampled. The population residing in institutions and institutional households was excluded. For the detailed individual interview, the eligibility criteria wereall ever-married women aged 15-49 years who slept in the household the previous night and about their children below five years at the

The Ukraine Demographic and Health Survey (UDHS) is a nationally representative survey of 6,841 women age 15-49 and 3,178 men age 15-49. Survey fieldwork was conducted during the period July through November 2007. The UDHS was conducted by the Ukrainian Center for Social Reforms in close collaboration with the State Statistical Committee of Ukraine. The MEASURE DHS Project provided technical support for the survey. The U.S. Agency for International Development/Kyiv Regional Mission to Ukraine, Moldova, and Belarus provided funding. The survey is a nationally representative sample survey designed to provide information on population and health issues in Ukraine. The primary goal of the survey was to develop a single integrated set of demographic and health data for the population of the Ukraine. The UDHS was conducted from July to November 2007 by the Ukrainian Center for Social Reforms (UCSR) in close collaboration with the State Statistical Committee (SSC) of Ukraine, which provided organizational and methodological support. Macro International Inc. provided technical assistance for the survey through the MEASURE DHS project. USAID/Kyiv Regional Mission to Ukraine, Moldova and Belarus provided funding 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 2007 UDHS collected national- and regional-level data on fertility and contraceptive use, maternal health, adult health and life style, infant and child mortality, tuberculosis, and HIV/AIDS and other sexually transmitted diseases. The survey obtained detailed information on these issues from women of reproductive age and, on certain topics, from men as well. The results of the 2007 UDHS are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of Ukrainians and health services for the people of Ukraine. The 2007 UDHS also contributes to the growing international database on demographic and health-related variables. MAIN RESULTS Fertility rates. A useful index of the level of fertility is the total fertility rate (TFR), which indicates the number of children a woman would have if she passed through the childbearing ages at the current age-specific fertility rates (ASFR). The TFR, estimated for the three-year period preceding the survey, is 1.2 children per woman. This is below replacement level. Contraception : Knowledge and ever use. Knowledge of contraception is widespread in Ukraine. Among married women, knowledge of at least one method is universal (99 percent). On average, married women reported knowledge of seven methods of contraception. Eighty-nine percent of married women have used a method of contraception at some time. Abortion rates. The use of abortion can be measured by the total abortion rate (TAR), which indicates the number of abortions a woman would have in her lifetime if she passed through her childbearing years at the current age-specific abortion rates. The UDHS estimate of the TAR indicates that a woman in Ukraine will have an average of 0.4 abortions during her lifetime. This rate is considerably lower than the comparable rate in the 1999 Ukraine Reproductive Health Survey (URHS) of 1.6. Despite this decline, among pregnancies ending in the three years preceding the survey, one in four pregnancies (25 percent) ended in an induced abortion. Antenatal care. Ukraine has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. Overall, the levels of antenatal care and delivery assistance are high. Virtually all mothers receive antenatal care from professional health providers (doctors, nurses, and midwives) with negligible differences between urban and rural areas. Seventy-five percent of pregnant women have six or more antenatal care visits; 27 percent have 15 or more ANC visits. The percentage is slightly higher in rural areas than in urban areas (78 percent compared with 73 percent). However, a smaller proportion of rural women than urban women have 15 or more antenatal care visits (23 percent and 29 percent, respectively). HIV/AIDS and other sexually transmitted infections : The currently low level of HIV infection in Ukraine provides a unique window of opportunity for early targeted interventions to prevent further spread of the disease. However, the increases in the cumulative incidence of HIV infection suggest that this window of opportunity is rapidly closing. Adult Health : The major causes of death in Ukraine are similar to those in industrialized countries (cardiovascular diseases, cancer, and accidents), but there is also a rising incidence of certain infectious diseases, such as multidrug-resistant tuberculosis. Women's status : Sixty-four percent of married women make decisions on their own about their own health care, 33 percent decide jointly with their husband/partner, and 1 percent say that their husband or someone else is the primary decisionmaker about the woman's own health care. Domestic Violence : Overall, 17 percent of women age 15-49 experienced some type of physical violence between age 15 and the time of the survey. Nine percent of all women experienced at least one episode of violence in the 12 months preceding the survey. One percent of the women said they had often been subjected to violent physical acts during the past year. Overall, the data indicate that husbands are the main perpetrators of physical violence against women. Human Trafficking : The UDHS collected information on respondents' awareness of human trafficking in Ukraine and, if applicable, knowledge about any household members who had been the victim of human trafficking during the three years preceding the survey. More than half (52 percent) of respondents to the household questionnaire reported that they had heard of a person experiencing this problem and 10 percent reported that they knew personally someone who had experienced human trafficking.