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