CHILDBEARING EXPERIENCES

i " - , . : ~ ~ - Y " - - ~ . ' . : ~-, . . ~ 1 - ~ : : " .

_ . : : - i - ~ " . . . .

- L • A

. . . . , T

W H E N w o M E N B E C O M E M O T H E R S Many women who enter marriage as teen brides soon

become teen mothers. In 17 of the 21 countries surveyed in sub-Saharan Afiica, at least half of women had

their first child be36re 20years of age. As is the case in much of the world, early childbearing often restricts a woman's

opportunities. Women who postpone motherhood until after the teen years are more likely to have fewer children and stay in school longer.

Women in other regions tend to become mothers somewhat later than their counterparts in sub-Saharan Africa. In 19 of 20 countries surveyed in the other regions, the median age at first birth among women is at least 20.

The majority of these women have their first child when they axe in their early twenties. In Sri Lanka, half of women are 24 or older when they have their first child. The

exception is Guatemala, where the median age at first birth is 19.9 years.

20

AGE AT FIRST BIRTH Median age at first birth a m o n g w o m e n 25 to 49

SUB-3AHARAN AFRIC~

Botswana I988

Burkina Paso 1993

Burundi 1987

Cameroon 1991

Gbana 1988

Kenya 1993

Liberia 1986

Madagascar 1992

Malawi 1992

Mali 1987

Namibia 1992

Niger 1992

Nigeria 1990

Rwanda 1992

Senegal 1992/93

Sudan 1989/90

Tanzania 1991/92

Togo 1988

Uganda 1988/89

Zambia 1992

Zimbabwe I988/89

ASIA~NEAR F.AS T

Egypt 1992

Indonesia 1991

Jordan 1990/9I

Morocco 1992

Pakistan 1991)/91

Pbilippines 199_3

Sri Lanka 1987

Thailand 1987

Tunisia 1988

Yemen 1991/92

LA77N AMERICA/CARIBBEAN

Bolivia 1989

Brazil 1986"

Colombia 1990

Dominican Republic 1991

Ecuador 1987

Guatemala 1987"

Mexico 1987

Paraguay 1990

Peru 1991192

Trinidad & 7bbago 1987

0

"Women 2~ t~ q4

8

r

N

|

12.5 25

21

FAMILY S I Z E When women become mothers early in life, they also tend to have more children. Overall, women in sub-Saharan Africa have more children than anywhere else in

the world. In 15 of the 21 countries surveyed in the region, women have an average of six or more children. Women in Mall, Niger, and Uganda have more than seven children on average. The fertility rates are strikingly lower in Botswana, Kenya, Namibia, Sudan, and

Zimbabwe, where women have an average o f about five children. Although the highe~ fertility rate is faund in Yemen, where women have an average o f close

to eight children, family size elsewhere in Asia and the Near East is much The average woman in Sri Lanka or Thailand, for instance, might have two or three

children. Women in Latin America and the Caribbean also have smaller families. Most women in these countries might have three or four children, except in Bolivia and

Guatemala, where women have five or more children. Even though fertility has declined in many countries, most women are still having

larger families than those in more developed regions, where the fertility rate is estimated at

1.7 children per woman.*

*World Populauon Data Sheet, Population Refenence Bueeau. Washington. D.C.. April, 1994.

22

TOTAL FERTILITY RATE* Average number of births per woman 15 to 49**

23

S U B S A H A R A N A F H C A

Botswana 1988

Burkina Faso 1993

Burundi 1987

Cameroon 1991

Ghana 1988

Kenya 199,3

Liberia 1986

Madagascar 1992

Malawi 1992

Mali 1987

Namibia 1992

Niger 1992

Nigeria 1990

Rwanda 1992

Senegal 1992/93

Sudan 1989/90

Tanzania 1991/92

Togo 1988

Uganda 1988/89

Zambia 1992

Zimbabwe 1988/89

A S I A ~ N E A R E A S T

Egypt 1992

Indonesia 1991

Jordan 1990/91

Morocco 1992

Pakistan 1990/91

Philippines 1993

SH Lanka 1987

Thailand 1987

Tunisia 1988

Yemen 1991/92

L A T I N A M E R I C A / C A R I B B E A N

Bolivia 1989

Brazil 1986"**

Colombia 1990

Dominican Republig 1991

Ecuador 1987

El Salvador 1985

Guatemala 1987"*"

Mexico 1987

Paraguay 1990

Peru 1991/92

Trinidad & Tobago 1987

I , R

m

,[

0 4

*The total fertility rate is the number of children a woman would bear in her lifetime if current age-specific fertility ra~es remain constant **Refers to three years preceding the survey except for Niger and Pakastan, where rates refer to six years preceding the survey. ***Women 15 to 44

D U R A T I O N O F C H I L D B E A R I N G P E R I O D For many women, motherhood is the defining feature of adult life: Typically, a woman in the countries surveyed might spend anywhere fkom 11 to 20years in childbearing.

In the sub-Saharan countries, women nearing the end of their childbearing period had an average span of 16 to 20 years between their first and last child. These women might

have had a first child at around 19 years of age and their last child at 38 or 39. Women in other regions, however, typically spend less of their adult lives in child-

bearing. In Asia, the Near East, and Latin America and the Caribbean, the average time

women spend in childbearing ranges from 11 to 17 years.

D U R A T I O N OF C H I L D B E A R I N G PERIOD Average number of years between first and last births among ever-married women 40 to 49

25

'7~ B 5A[I,.t lTA:V A/ -RICA

Bofstoctllel 198~

Burkina Faso t993

Burundi 198~

Cameroon 199l

Gbana l 9<~8

Kenya 1993

Liberia 1986

Madagascar 1992

Malawi 1992

Mali 1987

Namibia 1992

Niger 1992

Nigeria 1990

Rwanda 1992

Senegal 1992/9.3

Sudan 1989190

lanzania 1991/92

Togo 1988

Uganda 1988/89

Zambia 1992

Zimbabwe 1988189

ASIA/NEAR EAST

Egypt I992

Indonesia 1991

Jordan 1990/9l

Morocco 1992

Pakistan 1990/91

Philippines 1993

Sri Lanka 1987

77miland 1987

Tunisia 1988

Yemen 1991/92

7~t T / N AMERI(L41(24 R I B B E A N

Bolivia 1989

Brazil 1986"

Colombia 1990

Dominican Republic 199l

L~uador 1987

Guatemala 1987"

Mexico 1987

Paraguay 1990

Peru 1991192

lHnidad & 7bbago 1987

"Ever m , l r l i e d women 4 0 t o 4~

"8

. - -

I I

I I

I 11

|

i

I |

q l

f l l ' l

i1

I

|

, ? |

,fl

II

11

i l l

12~ 25

TIME WOMEN SPEND WITH YOUNG CHILDREN Women ~end manyyears caring fbr young children who require close attention. In sub-Saharan African countries, women spend between 15 and 23 years of their lives with at least one child under age six.

In the other regions, where fertility rates are typically lower, women spend between 10 and 21 years of their lives caring for young children. The shortest period was found in

Thailand, where women spend 10.5 years caring for small children.

26

TIME WOMEN SPEND V~qTH YOUNG CHILDREN N u m b e r o f y e a r s w o m e n 1 5 t o 4 9 s p e n d w i t h a c h i l d u n d e r a g e 6 "

SUB 5 ~ t H A R A N A[:RIC4

Botcwana 1988

Burkina Faso 199.3

Burundi 1987

Cameroon 1991

Ghana 1988

Kenya 1993

Liberia 1986

Madagascar 1992

Malawi 1992

Mali 1987

Namibia 1992

Niger 1992

Nigeria 1990

Rwanda 1992

Senegal 1992/93

Sudan 1989190

Tanzania 1991192

Togo 1988

Uganda 1988/89

Zambia 1992

Zimbabwe 1988789

ASIA~NEAR F A S T

Egypt 1992

Indonesia 1991

Jordan 1990/9l

Morocco 1992

Pakistan 1990/91

Philippines 1993

Sri Lanka 1987

77miland 1987

Tunisia 1988

Yemen 1991/92

I A 7 7 N A M E R I C A ~ C A R I B B E A N

Bolivia 1989

Brazil 1986"*

Colombia 1990

Dominican Republic 1991

Ecuador 1987

Guatemala 1987""

Mexico 1987

Paraguay 1990

Peru 1R91/92

Trinidad & Tobago 3987

,L

i*l=--

r

,d

I'!

T

1

|

n

I

I'1

I

!

N

!

I 2 . 5 25

'A~erage number o1 years between age~ 15 to 4 9 a w~mlan w<mld spend ~ith at least one child under age six it currem age spc~dlc pmporttons ¢~ woFilen with a child under six rcmahl co11%callc **Women 15 to 44

27

C H I L D B E A R I N G T R E N D S In many countries, women are spending fewer years having children.

Factors such as later age at marriage and increased use o f contraception contribute to lower

fertility, and less time in childbearing.

Comparisons with previous surv~s indicate that the total years women spend with small chiMren has decreased by more than two years in nine out of 15 countries surveyed. The declines

are more substantial in some countries. In Mexico, for instance, the time women spend car-

ing for at least one child under age six fell by almost one-third, from 21.5 years in 1976 to

14.6 years in I987.

28

SUB-5~4HARAN AFRIC2q

Ghana 19"9/80-1988

Kenya 1977/78-1993

TRENDS IN TIME WOMEN SPEND WITH YOUNG CHILDREN N u m b e r o f years w o m e n 15 to 49 spend with a child under age 6*

\kFS \Xbrld Ferlillfy 3uric, • l)FtS=Dcmogtaphl, and tle.dth ~urxc?

2O.8

1819

lu 3~negal 1978-1992/93 2o. 1

Sudan 1978/79-1989/90 15.8

ASIA~NEAR E A S T

Egypt 1980 1992 1£2

Morocco 1980-1992

Sri Lanka 1975-1987 11.0

14,6

Ttmiland 1975-1987 10.5

Tunisia 1978~1988 14.3

LATIN AMERICA~CARIBBEAN

Colombia 1976-1990 12.2

Dominican Republic 1975-1991 12.4

Ecuador 1979/80-1987 1£5

Mexico 1976/77 1987 14.6

Peru 1977/78-1991/92 13.9

Trinidad & Tobago 1977-1987 12.0

0 12.5 25

"Average number o1 years a woman between the ages of 15 and 49 would spend wtth at least one chdd under stx i f ¢Ullerlt age-$pecitqc propor tions of w0men with a child under six remain constant.

29

WOMEN .~T-R-ISK I N C H I L D B E A R I N G For women in the childbearing years, pregnancy- related complications can pose some of the greatest hazards to health and well-being. Even with the technology to make motherhood safer, pregnancy-related complications continue to

result in serious illness and premature death among women and their children. High-risk births are those for which the mother: • is under 18 years of age at the time o f the birth ("too young"); • is over 34 years of age at the time of tbe birth ("too old"); • has had a previous live birth within the past 24 months ("too soon"); or

• has already had three or more live births ("too many"). These characteristics can affect the survival chances of both child and mother.

Mortality rates are often higher among those children whose mothers have one or more of

the above risk factors. Additionally, the mother faces a greater chance of dying ifsbe is "too young," "too old," or has had "too many" children at the time of birth.

In 35 out o f 42 countries surveyed, 60 percent or more currently married women fall into at least one o f these high-risk categories.

30

W O M E N AT RISK Percentage of currently married women 15 to 49 in at least one high-risl~ birth catego~'

31

SUB %4HAlCIN AFR]C~

Botswana 1988

Burkina Faso 1993

Burundi 1987

C~meroon 199l

Ghana 1988

Kenya 1993

Liberia 1986

Madagascar 1992

Malawi 1992

Mah 1987

Namibia 1992

Niger 1992

Nigeria 1990

Rwanda 1992

Senegal I992/93

Sudan 1989190

Tanzania 1991/92

Togo 1988

Uganda 1988/89

Zambia 1992

Zimbabwe 1988/89

A S I A / N E A R E A S T

Egypt 1992

Indonesia 1991

Jordan 1990/91

Morocco 1992

Pakisean 1990/91

Philippines 1993

Sri Lanka 1987

Tbailond 1987

Tuni*ia 1988

Yemen 1991/92

L A T I N A M E R I ( L ~ / C A R 1 B B E A N

Bolivia 1989

Brazil 1986"

Colombia 1990

Dominican Republic 199l

Ecuador 1987

El Salvador 1985

Guatemala 1987"

Mexico 1987

Paraguay 1990

Peru 1991/92

"I~inidad & Tobago 1987

0

"( urrend~ roamed w~men 15 m ~4

25 50 " 5 IO0

M A T E R N A L M O R T A L I T Y Some ,oome. c a n n o t take for granted that they will survive a pregnancy. Little, however, is actually known about how many women die and what goes wrong

in their pregnancies. In five out o f the six sub-Saharan Africa countries surveyed, more than 500

women died per 100,000 births.

Maternal mortality ratios were lower in Bolivia, Morocco, Namibia, Peru, and the

Philippines, ranging from 197 to 371 deaths per 100,000 births. In contrast, the risk of pregnancy-related death for women in developed countries is estimated at less than 30

per 100,000 births.*

.TERNAL MORTALITY real ~ t h , per 100,000 live births

S UB-SA HARAN AFRICA

MadagaJcar 1986-1992

Malatol 1986-1992

Namlhla 1983-1992

Niger 1986-1992

Senegal 1986-1992

Sudan 1983-1989

ASIA/NEAR EAST

Morocco 1985-1991

Philippints 1987-1993"

LATIN AMERICA/CARIBBEAN

Bolivia 1982-1988

peru 1985-1991

209

0 200 400 600

"Ratio adi t~t t'd fo r ¢ v ~ pregnant

800

*Lettenmaier, C., Liskin, L, Church. C., and Harris, J. Mothem" Lives Matter: Maternal Health in the Communi~ Population Reports, Series L, Number 7, p. 2. Baltimore, Johns Hopkins University, Population Information Program, September, 1988.

32

T H E PHILIPPINES N A T I O N A L SAFE M O T H E R H O O D SURVEY lh,, Ph i lippi n e s

National Sa~' Motherhood Surve> investigated x~omcn's reploducmc health stares. Sul~c~

findings IcvcaIed that more than one out of l0 ~omcn experienced ai least one maior complication during a recent birth. About one-halfof ihe births m ~omcn ~itll serious

complications took place at a medical faci]irxv where x~omcn arc more likch to rcccixc potcn

tially lilc-sa~ing prot~'ssional care. in contrasE, 28 pcrccm ot normal deliveries occurred in

a health f~lcilir?.'. ,Most women in the Philippines give birth at home, typically assisted by a tradi-

tional birth attendant or a trained nurse/midwife. If a woman giving bird/ at home

experiences complications during delivery', it is critical d/at she bc refi.,rrcd m a health f~tcilit?:

Hal t of the women who experienced complications, however, were not rdcrred to

a health f~lcility by" the person providing delivery assistance.

1 9 9 3 N A T I O N A L S A F E M O T H E R H O O D S U R V E Y R E S U L T S

Finding~ are based on vmmen's reporU of pregTmncies that took place in the three-year pemod prior to the survey. • Women who reported symptoms of

at least one major obstetric complica- tion (hemorrhage, obstructed labor, infection or eclampsia) 12 percent

• Proportion of births to women with complications that occurned in health facilities 51 percent

• Proportion of births to women with- out complications that occurred in health facilities 28 percent

• Percent of women in labor more than 12 hours who were referred to a hospital or clinic 48percent

• Percent o f women with excessive bleed- ing during delivery who wen: refened to a hospital or dinic 55percent

33

HEALTH CP~RE-DURING PREGNANCY AND CHILDBIRTH Childbearing might take its heaviest toll on those women with the least access to maternity care services.

Prenatal care, which ranges from nutrition education to monitoring for potential

complications, increases the likelihood of a healthy pregnancy and baby. Doctors generally recommend that women start prenatal care at three months of pregnancy and make a total

of about 12 visits. In 10 out of 41 countries surveyed, women received prenatal care )~r at least 90 percent

of their recent births. In seven other countries, however, fewer than half of births were cov- ered by prenatal care. Women were more likely to receive prenatal care from nurses or

midwives than from doctors. Professional assistance at childbirth is also important, especially since a number of

pregnancy-related complications cannot be predicted in advance. Many women, however, deliver children without the assistance of a trained profes-

sional such as a doctor, nurse, or midwife. In 18 countries, women received professional medical assistance fbr fewer than half of deliveries. Women in only two countries, the Dominican Republic and Trinidad and Tobago, received delivery care for more than 90

percent of their recent births.

34

F!

; j

!l

4

35

H E A L T H C A R E D U R I N G P R E G N A N C Y A N D C H I L D B I R T H Percentage of births during five )*ears preceding smwey receipting medical care

SUB-5~,IItAtGtN AFRICA

Botawana 1988 m,

Bu rkina Faso 199 ~

Burundi 1987 V#

Cameroon 1991 Wa

Ghana 1988 ml

Kenya 199_3 m'l

Liberia 1986 • ,

Madagascar 1992 m

Malawi 1992 WF

Mali 1987

Namibia 1992 •

Niger 1992

Nigeria 1990

Rwanda 1992 BI

Senegal 1992/9~3

Sudan 1989/90 m

~anzania 1991/92 Ww

Togo 1988

Uganda 1988/89 •

Zambia 1992 mrr

Zimbabwe 1988/89 ~r

ASIA/NF~R E A S T

Egypt 1992

htdonesia 1991 mrm

Jordan 1990/91 m;I

Morocco 1992

Pakistan 1990/9I

Philippines 1993 i

Sri Lanka 1987 •

Thailand 1987

Tunisia 1988

Yemen 1991/92

LA TIN AMERICa~CARIBBEAN

Bolivia 1989

Brazil 1986"

Colombia 1990 I ,

Dominican Republic 1991

Ecuador 1987

El 3aloador 1985 *

Guatemala 1987

Mexico 1987

Paraguay 1990 |I

Peru 1991/92

7~znidad & Tobago 1987 IF"

100

"Data rl<)t collected m survey

Pt~r~,ual • l)ctl,cr,

19

18

n 15

26

42

40

45

38

64

58

58

55

68

47

69

53

46

52

70

n m 19

16

41

32

31

53

87

87

m

m m"f

42

29

6I

70

53

81

92

86

9 8

50 0 50 I00