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Factors Behind Recent Fertility Plateauing in Jordan &

Factors Behind Recent Fertility Plateauing in Jordan & Challenges to Maintaining Future Fertility Decline by Issa Almasarweh Professor – Jordan University. Presentation Outlines. Jordan Fertility Trends Jordan Fertility Goals Factors Affecting Fertility Rates

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Factors Behind Recent Fertility Plateauing in Jordan &

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  1. Factors Behind Recent Fertility Plateauing in Jordan & Challenges to Maintaining Future Fertility Decline by Issa Almasarweh Professor – Jordan University

  2. Presentation Outlines • Jordan Fertility Trends • Jordan Fertility Goals • Factors Affecting Fertility Rates • Challenges to Sustained Decline in Jordan Fertility

  3. Current TFR in the Region Source: 2011 PRB WPDS

  4. Jordan Fertility Level is Plateauing DHS

  5. Wanted Fertility Increased DHS

  6. Early progression to first child 2009 DHS

  7. Fertility – a key component in Jordan future PG 3 million born in the last 20 years 2.3 are expected in the next 10 years RECENT09 Constant

  8. Reducing Fertility is a National Priority Goal for Jordan Births per couple RHAP2

  9. Direct Factors Affecting Fertility Rate 1) % of women 15-49 married 2) Contraceptive use 3) Postpartum insusceptibility 4) Induced abortion 5) Infertility Fertility

  10. (1) Marriage - % of Women 15-49 Ever-married DHS

  11. % Ever-married below the age of 30 years 2002 & 2009 DHS

  12. High Growth in Number of First Time Brides (4.3% annually) http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf

  13. Early Marriages<18= 14% of total 1st time brides15-19= 30% of total 1st time brides http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf

  14. Age Specific Fertility Rates 2002 & 2009 DHS

  15. Age Specific Fertility Rates - Urban 2002 & 2009 DHS

  16. (2) Contraceptive use has leveled off DHS

  17. Modern CPR by Sector -JCLS Based on JCLS

  18. Infertility increased = % of women 45-49 who are childless Based on JCLS

  19. Contraceptive Use needs to increase ! 65 % TotalFertilityRate FertilityPlateauing Contraceptive Prevalence Rate 3.0 FamPlan: File RECENT09

  20. Summary – Indexes of direct factors affecting fertility

  21. Challenges to raise contraceptive use and reduce fertility • Shrinking FP Choices / Access • Missed / Lost Opportunities • Churning – Discontinuation • Others

  22. Shrinking Choices / Access • Limited access to permanent & long-acting methods : Female Sterilization, Injectables, Implanon • Dominance of one and provider-based method (IUD) • Unmet preference for female providers (87%) • Disappearance of low-price OCs in the commercial sector • Uncertain role of major FP providers (JAFPP, RMS, Universities Hospitals)

  23. 2) Missed Opportunities • At premarital exam • At time of signing marriage contract • At delivery and postnatal period • low postnatal return • low postnatal counseling • no immediate IUDs insertion after delivery (providers fear of expulsion or lack training) • At child health care visits • At Schools and Colleges • At youth centers, clubs, camps • At Mosques • At Workplace • At pharmacies

  24. 2) Missing Opportunities • Low demand on available services at SDPs • High downtime at SDPs due to lack of appointment system • Exclusion of FP in private health insurance • Exclusion of important groups: men, newly married, unmarried youth • Unfriendly breastfeeding environment at private hospitals

  25. 3) Churning – Discontinuation • High FP discontinuation and failure rates • Quality of services - informed choice (poor treatment of side effects; inadequate and poor FP counseling) • High use of traditional methods • Unsatisfied users (20% want another method) • Son Preference • Family pressure (63% - 2007 DHS)

  26. 1st Year Discontinuation Rate (%)

  27. Reasons for Discontinuation 42 % Source: Contraceptive Dynamics Study

  28. Unmet need for FP use Source : 2009 DHS

  29. TFR and Unmet Need and Discontinuation HPC, 2011, Reducing Discontinuation of Contraceptive Use and Unmet Need for FP, policy Briefs

  30. 4) Other Challenges • Population Momentum – more than one million girl child exists now • Number of women 15-49 years will increase from 1.6 to 2.0 million by 2020 • The impact of this is shown in the next slide

  31. Projected Contraceptive Users (all methods) 42 % 19 % Current Users FamPlan: Files RECENT09 & RECENT09 Constant

  32. 4) Other Challenges • Divided civil society- politicalization of issues • Distortion of market forces through subsidies may delay the rationalization of childbearing decision by parents • Abuse of maternity leave by public sector servants

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