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.

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.

Context

The United States Census Bureau’s international dataset provides estimates of country populations since 1950 and projections through 2050. Specifically, the dataset includes midyear population figures broken down by age and gender assignment at birth. Additionally, time-series data is provided for attributes including fertility rates, birth rates, death rates, and migration rates.

Querying BigQuery tables

You can use the BigQuery Python client library to query tables in this dataset in Kernels. Note that methods available in Kernels are limited to querying data. Tables are at bigquery-public-data.census_bureau_international.

Sample Query 1

What countries have the longest life expectancy? In this query, 2016 census information is retrieved by joining the mortality_life_expectancy and country_names_area tables for countries larger than 25,000 km2. Without the size constraint, Monaco is the top result with an average life expectancy of over 89 years!

standardSQL

SELECT age.country_name, age.life_expectancy, size.country_area FROM ( SELECT country_name, life_expectancy FROM bigquery-public-data.census_bureau_international.mortality_life_expectancy WHERE year = 2016) age INNER JOIN ( SELECT country_name, country_area FROM bigquery-public-data.census_bureau_international.country_names_area where country_area > 25000) size ON age.country_name = size.country_name ORDER BY 2 DESC /* Limit removed for Data Studio Visualization */ LIMIT 10

Sample Query 2

Which countries have the largest proportion of their population under 25? Over 40% of the world’s population is under 25 and greater than 50% of the world’s population is under 30! This query retrieves the countries with the largest proportion of young people by joining the age-specific population table with the midyear (total) population table.

standardSQL

SELECT age.country_name, SUM(age.population) AS under_25, pop.midyear_population AS total, ROUND((SUM(age.population) / pop.midyear_population) * 100,2) AS pct_under_25 FROM ( SELECT country_name, population, country_code FROM bigquery-public-data.census_bureau_international.midyear_population_agespecific WHERE year =2017 AND age < 25) age INNER JOIN ( SELECT midyear_population, country_code FROM bigquery-public-data.census_bureau_international.midyear_population WHERE year = 2017) pop ON age.country_code = pop.country_code GROUP BY 1, 3 ORDER BY 4 DESC /* Remove limit for visualization*/ LIMIT 10

Sample Query 3

The International Census dataset contains growth information in the form of birth rates, death rates, and migration rates. Net migration is the net number of migrants per 1,000 population, an important component of total population and one that often drives the work of the United Nations Refugee Agency. This query joins the growth rate table with the area table to retrieve 2017 data for countries greater than 500 km2.

SELECT growth.country_name, growth.net_migration, CAST(area.country_area AS INT64) AS country_area FROM ( SELECT country_name, net_migration, country_code FROM bigquery-public-data.census_bureau_international.birth_death_growth_rates WHERE year = 2017) growth INNER JOIN ( SELECT country_area, country_code FROM bigquery-public-data.census_bureau_international.country_names_area

Update frequency

Historic (none)

Dataset source

United States Census Bureau

Terms of use: This dataset is publicly available for anyone to use under the following terms provided by the Dataset Source - http://www.data.gov/privacy-policy#data_policy - and is provided "AS IS" without any warranty, express or implied, from Google. Google disclaims all liability for any damages, direct or indirect, resulting from the use of the dataset.

See the GCP Marketplace listing for more details and sample queries: https://console.cloud.google.com/marketplace/details/united-states-census-bureau/international-census-data

Bermuda BM: Fertility Rate: Total: Births per Woman data was reported at 1.401 Ratio in 2023. This records an increase from the previous number of 1.397 Ratio for 2022. Bermuda BM: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.764 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 3.630 Ratio in 1960 and a record low of 1.374 Ratio in 2018. Bermuda BM: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Bermuda – Table BM.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

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.

Macau MO: Fertility Rate: Total: Births per Woman data was reported at 1.311 Ratio in 2016. This records an increase from the previous number of 1.280 Ratio for 2015. Macau MO: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.499 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 4.772 Ratio in 1960 and a record low of 0.827 Ratio in 2004. Macau MO: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Macau SAR – Table MO.World Bank.WDI: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Argentina AR: Fertility Rate: Total: Births per Woman data was reported at 1.500 Ratio in 2023. This records an increase from the previous number of 1.482 Ratio for 2022. Argentina AR: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 2.974 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 3.359 Ratio in 1978 and a record low of 1.482 Ratio in 2022. Argentina AR: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Argentina – Table AR.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

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.

Macedonia MK: Fertility Rate: Total: Births per Woman data was reported at 1.533 Ratio in 2016. This records an increase from the previous number of 1.524 Ratio for 2015. Macedonia MK: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 2.269 Ratio from Dec 1960 (Median) to 2016, with 57 observations. The data reached an all-time high of 3.842 Ratio in 1960 and a record low of 1.461 Ratio in 2009. Macedonia MK: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Macedonia – Table MK.World Bank: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.; ; (1) United Nations Population Division. World Population Prospects: 2017 Revision. (2) Census reports and other statistical publications from national statistical offices, (3) Eurostat: Demographic Statistics, (4) United Nations Statistical Division. Population and Vital Statistics Reprot (various years), (5) U.S. Census Bureau: International Database, and (6) Secretariat of the Pacific Community: Statistics and Demography Programme.; Weighted average; Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Cuba CU: Fertility Rate: Total: Births per Woman data was reported at 1.439 Ratio in 2023. This records an increase from the previous number of 1.412 Ratio for 2022. Cuba CU: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.678 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 4.559 Ratio in 1963 and a record low of 1.402 Ratio in 2006. Cuba CU: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Cuba – Table CU.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Bulgaria BG: Fertility Rate: Total: Births per Woman data was reported at 1.810 Ratio in 2023. This records an increase from the previous number of 1.780 Ratio for 2022. Bulgaria BG: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 1.805 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 2.310 Ratio in 1960 and a record low of 1.090 Ratio in 1997. Bulgaria BG: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Bulgaria – Table BG.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

Author: K Swanson, educator, Minnesota Alliance for Geographic EducationGrade/Audience: high schoolResource type: lessonSubject topic(s): populationRegion: worldStandards: Minnesota Social Studies Standards

Standard 5. The characteristics, distribution and migration of human populations on the earth’s surface influence human systems (cultural, economic and political systems).Objectives: Students will be able to:

1. Identify the major demographic indicators that indicate a high or low population growth rate.
2. Compare/contrast the regions of the world using demographic indicators such as growth rate, natural increase, fertility rate, crude birth rates, and crude death rates
3. Identify the regions of the world with the highest and lowest birth rates.
4. Analyze the three means to control population growth: increase death rate, decrease birth rate and government laws.Summary: Students will analyze demographic data from the Population Reference Bureau and determine which areas of the world contain the fastest and slowest population growth rates. Students will determine that the fastest growth rates are in Northern and Eastern Africa and the slowest growth rates are found in Eastern Europe. Students will write an editorial on the best means to control population.

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 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, Africa's population is forecast to increase from 1.4 billion in 2022 to over 3.9 billion by 2100.

Armenia AM: Fertility Rate: Total: Births per Woman data was reported at 1.900 Ratio in 2023. This records an increase from the previous number of 1.700 Ratio for 2022. Armenia AM: Fertility Rate: Total: Births per Woman data is updated yearly, averaging 2.480 Ratio from Dec 1960 (Median) to 2023, with 64 observations. The data reached an all-time high of 4.786 Ratio in 1960 and a record low of 1.200 Ratio in 2002. Armenia AM: Fertility Rate: Total: Births per Woman data remains active status in CEIC and is reported by World Bank. The data is categorized under Global Database’s Armenia – Table AM.World Bank.WDI: Social: Health Statistics. Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with age-specific fertility rates of the specified year.;(1) United Nations Population Division. World Population Prospects: 2024 Revision; (2) Statistical databases and publications from national statistical offices; (3) Eurostat: Demographic Statistics.;Weighted average;Relevance to gender indicator: it can indicate the status of women within households and a woman’s decision about the number and spacing of children.

The 1998 Philippines National Demographic and Health Survey (NDHS). is a nationally-representative survey of 13,983 women age 15-49. The NDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. It was implemented by the National Statistics Office in collaboration with the Department of Health (DOH). Macro International Inc. of Calverton, Maryland provided technical assistance to the project, while financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. Fieldwork for the NDHS took place from early March to early May 1998. The primary objective of the NDHS is to Provide up-to-date information on fertility levels; determinants of fertility; fertility preferences; infant and childhood mortality levels; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health and family planning services in the country. MAIN RESULTS Survey data generally confirm patterns observed in the 1993 National Demographic Survey (NDS), showing increasing contraceptive use and declining fertility. FERTILITY Fertility Decline. The NDHS data indicate that fertility continues to decline gradually but steadily. At current levels, women will give birth an average of 3.7 children per woman during their reproductive years, a decline from the level of 4.1 recorded in the 1993 NDS. A total fertility rate of 3.7, however, is still considerably higher than the rates prevailing in neighboring Southeast Asian countries. Fertility Differentials. Survey data show that the large differential between urban and rural fertility levels is widening even further. While the total fertility rate in urban areas declined by about 15 percent over the last five years (from 3.5 to 3.0), the rate among rural women barely declined at all (from 4.8 to 4.7). Consequently, rural women give birth to almost two children more than urban women. Significant differences in fertility levels by region still exist. For example, fertility is more than twice as high in Eastern Visayas and Bicol Regions (with total fertility rates well over 5 births per woman) than in Metro Manila (with a rate of 2.5 births per woman). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 5.0 children in their lifetime, compared to 2.9 for women with at least some college education. Women with either elementary or high school education have intermediate fertility rates. Family Size Norms. One reason that fertility has not fallen more rapidly is that women in the Philippines still want moderately large families. Only one-third of women say they would ideally like to have one or two children, while another third state a desire for three children. The remaining third say they would choose four or more children. Overall, the mean ideal family size among all women is 3.2 children, identical to the mean found in 1993. Unplanned Fertility. Another reason for the relatively high fertility level is that unplanned pregnancies are still common in the Philippines. Overall, 45 percent of births in the five years prior to the survey were reported to be unplanned; 27 percent were mistimed (wanted later) and 18 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in the Philippines would be 2.7 births per woman instead of the actual level of 3.7. Age at First Birth. Fertility rates would be even higher if Filipino women did not have a pattem of late childbearing. The median age at first birth is 23 years in the Philippines, considerably higher than in most other countries. Another factor that holds down the overall level of fertility is the fact that about 9 or 10 percent of women never give birth, higher than the level of 3-4 percent found in most developing countries. FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in the Philippines has been the gradual but fairly steady increase in contraceptive use over the last three decades. The contraceptive prevalence rate has tripled since 1968, from 15 to 47 percent of married women. Although contraceptive use has increased since the 1993 NDS (from 40 to 47 percent of married women), comparison with the series of nationally representative Family Planning Surveys indicates that there has been a levelling-off in family planning use in recent years. Method Mix. Use of traditional methods of family planning has always accounted for a relatively high proportion of overall use in the Philippines, and data from the 1998 NDHS show the proportion holding steady at about 40 percent. The dominant changes in the "method mix" since 1993 have been an increase in use of injectables and traditional methods such as calendar rhythm and withdrawal and a decline in the proportions using female sterilization. Despite the decline in the latter, female sterilization still is the most widely used method, followed by the pill. Differentials in Family Planning Use. Differentials in current use of family planning in the 16 administrative regions of the country are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao and Central Luzon. Contraceptive use varies considerably by education of women. Only 15 percent of married women with no formal education are using a method, compared to half of those with some secondary school. The urban-rural gap in contraceptive use is moderate (51 vs. 42 percent, respectively). Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in the Philippines for some time and the NDHS results indicate that 99 percent of currently married women age 15-49 have heard of at least one method of family planning. More than 9 in 10 married women know the pill, IUD, condom, and female sterilization, while about 8 in 10 have heard of injectables, male sterilization, rhythm, and withdrawal. Knowledge of injectables has increased far more than any other method, from 54 percent of married women in 1993 to 89 percent in 1998. Unmet Need for Family Planning. Unmet need for family planning services has declined since I993. Data from the 1993 NDS show that 26 percent of currently married women were in need of services, compared with 20 percent in the 1998 NDHS. A little under half of the unmet need is comprised of women who want to space their next birth, while just over half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 47 percent to 70 percent of married women. Currently, about three-quarters of this "total demand" for family planning is being met. Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. NDHS data indicate that about 40 percent of contraceptive users in the Philippines stop using within 12 months of starting, almost one-third of whom stop because of an unwanted pregnancy (i.e., contraceptive failure). Discontinuation rates vary by method. Not surprisingly, the rates for the condom (60 percent), withdrawal (46 percent), and the pill (44 percent) are considerably higher than for the 1UD (14 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifty-two percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. MATERNAL AND CHILD HEALTH Childhood Mortality. Survey results show that although the infant mortality rate remains unchanged, overall mortality of children under five has declined somewhat in recent years. Under-five mortality declined from 54 deaths per 1,000 births in 1988-92 to 48 for the period 1993-97. The infant mortality rate remained stable at about 35 per 1,000 births. Childhood Vaccination Coverage. The 1998 NDHS results show that 73 percent of children 12- 23 months are fully vaccinated by the date of the interview, almost identical to the level of 72 percent recorded in the 1993 NDS. When the data are restricted to vaccines received before the child's first birthday, however, only 65 percent of children age 12-23 months can be considered to be fully vaccinated. Childhood Health. The NDHS provides some data on childhood illness and treatment. Approximately one in four children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, 58 percent were taken to a health facility for treatment. Seven percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that four-fifths of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Breastfeeding Practices. Almost all Filipino babies (88 percent) are breastfed for some time, with a median duration of breastfeeding of 13 months. Although breastfeeding has beneficial effects on both the child and the mother, NDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in the Philippines. For example, among newborns less than two months of age, 19 percent were already receiving supplemental foods or liquids other than water. Maternal Health Care. NDHS data point to several areas regarding maternal health care in which improvements could be made. Although most Filipino mothers (86 percent) receive prenatal care from a doctor, nurse, or midwife, tetanus toxoid coverage is far from universal and

Globally, about 25 percent of the population is under 15 years of age and 10 percent is over 65 years of age. Africa has the youngest population worldwide. In Sub-Saharan Africa, more than 40 percent of the population is below 15 years, and only three percent are above 65, indicating the low life expectancy in several of the countries. In Europe, on the other hand, a higher share of the population is above 65 years than the population under 15 years. Fertility rates The high share of children and youth in Africa is connected to the high fertility rates on the continent. For instance, South Sudan and Niger have the highest population growth rates globally. However, about 50 percent of the world’s population live in countries with low fertility, where women have less than 2.1 children. Some countries in Europe, like Latvia and Lithuania, have experienced a population decline of one percent, and in the Cook Islands, it is even above two percent. In Europe, the majority of the population was previously working-aged adults with few dependents, but this trend is expected to reverse soon, and it is predicted that by 2050, the older population will outnumber the young in many developed countries. Growing global population As of 2025, there are 8.1 billion people living on the planet, and this is expected to reach more than nine billion before 2040. Moreover, the global population is expected to reach 10 billions around 2060, before slowing and then even falling slightly by 2100. As the population growth rates indicate, a significant share of the population increase will happen in Africa.

"The 1965 National Fertility Study was an attempt to measure four fertility variables: 1) the number of children a woman intends to have; 2) the number she expects to have; 3) the number she would really desire; and 4) the number she considers ideal for the average American family.""The 1965 NFS is compatible with the earlier 1955 and 1960 Growth of American Families survey and the basic measures reported in these GAF studies have been replicated in the 1965 survey. One of the principa l departures of the 1965 NFS from its predecessors is that the latter focused in part on the task of devising a variable for forecasting fertility-expected parity as a way to complete the fertility histories of the younger and therefore incomplete cohorts of United State women. Factual questions include information on the following: age; education; income; occupation and employment history; residence history; religious preference and attendance; and parent's religion, education and nationality."

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 born in the three years preceding NFHS-2 received at least one antenatal

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Abstract

The 1996 Uzbekistan Demographic and Health Survey (UDHS) is a nationally representative survey of 4,415 women age 15-49. Fieldwork was conducted from June to October 1996. The UDHS was sponsored by the Ministry of Health (MOH), and was funded by the United States Agency for International Development. The Institute of Obstetrics and Gynecology implemented the survey with technical assistance from the Demographic and Health Surveys (DHS) program.

The 1996 UDHS was the first national-level population and health survey in Uzbekistan. It was implemented by the Research Institute of Obstetrics and Gynecology of the Ministry of Health of Uzbekistan. The 1996 UDHS was funded by the United States Agency for International development (USAID) and technical assistance was provided by Macro International Inc. (Calverton, Maryland USA) through its contract with USAID.

OBJECTIVES AND ORGANIZATION OF THE SURVEY

The purpose of the 1996 Uzbekistan Demographic and Health Survey (UDHS) was to provide an information base to the Ministry of Health for the planning of policies and programs regarding the health of women and their children. The UDHS collected data on women's reproductive histories, knowledge and use of contraception, breastfeeding practices, and the nutrition, vaccination coverage, and episodes of illness among children under the age of three. The survey also included, for all women of reproductive age and for children under the age of three, the measurement of the hemoglobin level in the blood to assess the prevalence of anemia and measurements of height and weight to assess nutritional status.

A secondary objective of the survey was to enhance the capabilities of institutions in Uzbekistan to collect, process and analyze population and health data so as to facilitate the implementation of future surveys of this type.

MAIN RESULTS

• Fertility Rates. Survey results indicate a total fertility rate (TFR) for all of Uzbekistan of 3.3 children per woman. Fertility levels differ for different population groups. The TFR for women living in urbml areas (2.7 children per woman) is substantially lower than for women living in rural areas (3.7). The TFR for Uzbeki women (3.5 children per woman) is higher than for women of other ethnicities (2.5). Among the regions of Uzbekistan, the TFR is lowest in Tashkent City (2.3 children per woman).
• Family Planning. Knowledge. Knowledge of contraceptive methods is high among women in Uzbekistan. Knowledge of at least one method is 89 percent. High levels of knowledge are the norm for women of all ages, all regions of the country, all educational levels, and all ethnicities. However, knowledge of sterilization was low; only 27 percent of women reported knowing of this method.
• Fertility Preferences. A majority of women in Uzbekistan (51 percent) indicated that they desire no more children. Among women age 30 and above, the proportion that want no more children increases to 75 percent. Thus, many women come to the preference to stop childbearing at relatively young ages when they have 20 or more potential years of childbearing ahead of them. For some of these women, the most appropriate method of contraception may be a long-acting method such as female sterilization, However, there is a deficiency of both knowledge and use of this method in Uzbekistan. In the interest of providing couples with a broad choice of safe and effective methods, information about this method and access to it should be made available so that informed choices about its suitability can be made by individual women and couples.
• Induced Aboration : Abortion Rates. From the UDHS data, the total abortion rate (TAR)--the number of abortions a woman will have in her lifetime based on the currently prevailing abortion rates--was calculated. For Uzbekistan, the TAR for the period from mid-1993 to mid-1996 is 0.7 abortions per woman. As expected, the TAR for Uzbekistan is substantially lower than recent estimates of the TAR for other areas of the former Soviet Union such as Kazakstan (1.8), Romania (3.4 abortions per woman), and Yekaterinburg and Perm in Russia (2.3 and 2.8, respectively).
• Infant mortality : In the UDHS, infant mortality data were collected based on the international definition of a live birth which, irrespective of the duration of pregnancy, is a birth that breathes or shows any sign of life (United Nations, 1992).
• Mortality Rates. For the five-year period before the survey (i.e., approximately mid- 1992 to mid- 1996), infant mortality in Uzbekistan is estimated at 49 infant deaths per 1,000 births. The estimates of neonatal and postneonatal mortality are 23 and 26 per 1,000.
• Maternal and child health : Uzbekistan has a well-developed health system with an extensive infrastructure of facilities that provide maternal care services. This system includes special delivery hospitals, the obstetrics and gynecology departments of general hospitals, women's consulting centers, and doctor's assistant/midwife posts (FAPs). There is an extensive network of FAPs throughout rural areas.
• Nutrition : Breastfeeding. Breastfeeding is almost universal in Uzbekistan; 96 percent of children born in the three years preceding the survey are breastfed. Overall, 19 percent of children are breastfed within an hour of delivery and 40 percent within 24 hours of delivery. The median duration of breastfeeding is lengthy (17 months). However, durations of exclusive breastfeeding, as recommended by WHO, are short (0.4 months).
• Prevalence of anemia : Testing of women and children for anemia was one of the major efforts of the 1996 UDHS. Anemia has been considered a major public health problem in Uzbekistan for decades. Nevertheless, this was the first anemia study in Uzbekistan done on a national basis. The study involved hemoglobin (Hb) testing for anemia using the Hemocue system. Women. Sixty percent of the women in Uzbekistan suffer from some degree of anemia. The great majority of these women have either mild (45 percent) or moderate anemia (14 percent). One percent have severe anemia.

Geographic coverage

National Seven raions were excluded from the survey because they were considered too remote and sparsely inhabited.

Analysis unit

• Household
• Women age 15-49

Universe

The population covered by the 1996 UDHS is defined as the universe of all women age 15-49 in Uzbekistan

Kind of data

Sample survey data

Sampling procedure

The UDHS employed a probability sample of women age 15 to 49, representative of 98.7 percent of the country. Seven raions were excluded from the survey because they were considered too remote and sparsely inhabited. These raions are: Kungradskiyi, Muyinakskiyi, and Takhtakupyrskiyi in Karakalpakstan; Uchkudukskiyi, Tamdynskiyi, and Kanimekhskiyi in Navoiiskaya; and Romitanskiyi in Bukharskaya. The remainder of the country was divided into five survey regions. Tashkent City constituted a survey region by itself, while the remaining four survey regions consisted of groups of contiguous oblasts. The five survey regions were defined as follows: Region 1: Karakalpakstan and Khoresmskaya. Region 2: Navoiyiskaya, Bukharskaya, Kashkadarinskaya, and Surkhandarinskaya. Region 3: Samarkandskaya, Dzhizakskaya, Syrdarinskaya, and Tashkentskaya. Region 4: Namanganskaya, Ferganskaya, and Andizhanskaya. Region 5: Tashkent City.

CHARACTERISTICS OF THE UDHS SAMPLE

The sample for the UDHS was selected in three stages. In the rural areas, the primary sampling units (PSUs) corresponded to the raions which were selected with probabilities proportional to size, the size being the 1994 population. At the second stage, one village was selected in each selected raion. A complete listing of the households residing in each selected village was carried out. The lists of households obtained were used as the frame for third-stage sampling, which is the selection of the households to be visited by the UDHS interviewing teams during the main survey fieldwork. In each selected household, women between the ages of 15 and 49 were identified and interviewed.

In the urban areas, the PSUs were the cities and towns themselves. In the second stage, one health block was selected from each town except in self-representing cities (large cities that were selected with certainty), where more than one health block was selected. The selected health blocks were segmented prior to the household listing operation which provided the household lists for the third-stage selection of households.

SAMPLE ALLOCATION

The regions, stratified by urban and rural areas, were the sampling strata. There were thus nine strata with Tashkent City constituting an entire stratum. A proportional allocation of the target number of 4,000 women to the 9 strata would yield the sample distribution.

The proportional allocation would result in a completely self-weighting sample but would not allow for reliable estimates for at least two of the five survey regions, namely Region 1 and Tashkent City. Results of other demographic and health surveys show that a minimum sample of 1,000 women is required in order to obtain estimates of fertility and childhood mortality rates at an acceptable level of sampling errors. Given that the total sample size for the UDHS could not he increased so as to achieve the required level of sampling errors, it was decided that the sample would be divided equally among the five regions, and within each region, it would be distributed proportionally to the urban and the rural areas. With this type of allocation, demographic rates (fertility and mortality) could not be produced for regions separately.

The number of sample points (or clusters) to be selected for each stratum was calculated by dividing the