|Ngalinda, Innocent: Age at First Birth, Fertility, and Contraception in Tanzania |
The analyses of fertility based on DHS data show that although fertility levels in Africa are still the highest in the world, in several African countries a declining trend can be observed. Tanzania is among them. The fertility level has played a significant role in causing a high population growth rate, estimated to be around 3 percent per year. As a consequence, the government established a Tanzanian National Population Policy (TNPP), which, among other things, encourages a reduction in fertility.
It was essential therefore to undertake a study on the prevailing situation of fertility so as to be able to assess the TNPP in the future.<40> The 1991/92 and 1996 Tanzania Demographic and Health Surveys (TDHSs) provide the sets of data suitable for a detailed study of fertility and the use of family planning methods at the national level. In the TDHSs, two national representative samples of 9,238 (1991/92) and 8,120 women age 15 to 49 were interviewed. The responses given by these women have been used to examine the reproductive behaviour of Tanzanian women and to suggest potential measures that can be taken in order to reduce fertility. In addition to the TDHSs, data from the 1967, 1978 and 1988 censuses have been used to study fertility trends in Tanzania. Other issues discussed in detail in this study include age at first birth and its proximate determinants, contraceptive practices and unmet need for family planning, and premarital first births among adolescents. Besides Africa, DHSs were conducted in the Middle East, Asia, Central America/Caribbean, and South America. Efforts were made to compare our findings with other sub-Saharan Africa countries that conducted the DHS III between 1993 and 1996. In addition, we selected Brazil to represent South America, Bangladesh to represent South Asia, the Dominican Republic to represent Central America/Caribbean, and Egypt to represent North Africa and the Middle East. The choice of these countries was to some extent due to the fact that these countries conducted DHS III so far but also made the data available for scholarly analysis.
In order to provide insights into the mechanisms underlying fertility change, the components of fertility needed to be examined. Age at first intercourse, marriage, and birth were studied for this purpose. According to 1996 TDHS, mean<41> age at first sexual intercourse was found to be 16 years, age at first marriage was found to be 17.4 years while mean age at first birth was estimated to be 18.4 years. On average, Tanzanian woman marries one year after her first sexual experience and gets her first child after one year of marriage, i.e. two years after her first sexual intercourse. It was further found that 10 percent of the women had their first sexual intercourse below age 13.2, were married below age 13.7 and had their first child below age 15. Seventy five percent of the women had their first sexual intercourse below age 17.7, married below age 19.6 and became mothers for the first time below age 20. This indicates that 3 out of 4 mothers in Tanzania start child bearing during their adolescence. Only 25 percent of all mothers got their first child after adolescence.
The trend shows that age at first sexual intercourse has remained on the same level across the cohorts. However, there is a slight increase in the recent years as mean age at first intercourse, for women aged 40-44 is 15.9 years while for women aged 20-24, who represent recent periods, it is 16.4 years. This trend can be associated with the increasing number of girls attending school in conjunction with strict rules that do not permit visibly pregnant girls and young mothers to attend school. On the other hand, women are now getting married later than the generations of women in the past. This situation has made premarital births to be on the increase. This statement is confirmed by the finding that adolescents are more likely to have a premarital birth than women above age 20.
This study found that, in general early entrance into sexual relations means early entrance into child bearing and consequently high fertility in sub-Saharan Africa countries. On average women in sub-Saharan Africa experience sexual intercourse early, between age 15.0 in Côte dIvoire and 17.2 years in Zimbabwe. On average, women in sub-Saharan Africa marry early. Mean age at first marriage ranges between 15.6 in Uganda and 18.1 in Zimbabwe and Ghana. The mean age at first birth in sub-Saharan Africa ranges from 17.7 years in Uganda to 19.2 in the Comores. Egypt, Brazil, and the
264Dominican Republic have a higher age at first birth, 20.0, 20.6 and 19.5 years respectively than the selected countries in sub-Saharan Africa.
If our assumption holds that married women are sexually active and do not contracept to delay first births, primary sterility does not seem to be a problem in Tanzania as only 1.4 percent of the women, married for 5 years and still living in the first union, are childless. This procedure however, might underestimate primary sterility in Tanzania, as never married women were not included. Perhaps some of them could not get married due to the fact that they are sterile. Since parenthood is the ultimate goal of marriage in Tanzania, primary sterility might be the cause of divorce for those who declared in the survey to be divorcees. However, only 13 percent of divorcees have never had any live birth. This topic is an area for further research.
Unsafe abortions to avoid premarital births are on the increase in sub-Saharan Africa. It was estimated that 26 out of 1,000 women have an abortion annually. Most of these abortions concern young women. The consequences of induced unsafe abortions can range from infertility to the death of these young women. Even in countries where abortion is not restricted, unsafe abortions are performed due to several factors ranging from the cost and accessibility of the service to poor women in rural areas. Legalising abortion does not seem to be the only solution for this problem. The main alternative is to provide family planning services not only to married but also to unmarried young women who are mostly adolescents. Moreover, juvenile women should be particularly encouraged to use modern contraceptives, especially condoms that have a dual means of function as a contraceptive method and as protection against STI/STD.
According to the 1996 TDHS, premarital first conceptions amount to 34 percent of all first births to ever married women in Tanzania. However, half of these women got married before the birth of their first child. Generally 41 percent of all first live births in Tanzania resulted from premarital pregnancies at the time of conception. Out-of-wedlock births accounted for 24 percent of all first births. Births to single mothers at the time of the survey accounted for 30 percent of all out-of-wedlock births; 70 percent of all mothers who gave birth out of wedlock in the past were eventually married at the time of survey. This is an indication that the old norm of premarital virginity has lost its importance in Tanzania. It seems that nowadays fecundity is a prerequisite of marriage instead of men
265insisting on premarital virginity. This is confirmed by the fact that out of all women with a premarital conception only 17 percent were still unmarried at the time of the survey. However, from the data we cannot conclude whether these women married the father of their first child or somebody else. Out of wedlock births have been slightly on the increase in Tanzania as the 1991/92 TDHS recorded 22 percent of all births to be out of wedlock while the 1996 TDHS recorded 24 percent.
It was found that current age and age at first intercourse are positively related to age at first motherhood. Age at first intercourse and education were found to be major factors determining age at first birth for Tanzanian women. This suggests that in the absence of contraception in delaying first unwanted births, delaying first intercourse might raise the age at first birth. However, it is not plausible to formulate a policy to delay first sexual intercourse. This means early age at first birth will continue to be a problem unless the use of contraception to delay first birth is promoted among adolescents. On the other hand, this study has revealed that encouraging women to spend more years in school will have an impact on age at first birth. As long as pregnant girls are not allowed into school, many juvenile schoolgirls will refrain from having sexual relationships. Changing the regulation that pregnant schoolgirls must be expelled from school might result in more premarital births, lower age at first birth and eventually a rise in fertility. The proprietors of the abolishment of this law should first concentrate on raising contraceptive use among adolescents, and then the abolishment of this law should follow. The most important thing should be to avoid unwanted pregnancies for schoolgirls and other adolescents. In the US, where pregnant schoolgirls are allowed to continue with schooling, it is documented that only about 3 in every 10 adolescent mothers ultimately obtain a high school diploma by the age of 30.<42> Therefore if this system is adopted in our society, the chance of achieving the intended goal is very slim.
Moslems have a slightly lower age at first birth in comparison to women of other religious affiliation. It was also found that Moslem women are more likely to have a premarital birth than other believers. Therefore Moslem leaders should try to encourage their followers to use contraceptives in preventing premarital conceptions and early motherhood by discouraging early marriage. Bivariate and multivariate analyses show a
266higher age at first birth for Catholics than for others. Education was found to be strongly related to age at first birth. Secondary school leavers have a higher age at first birth than others while women without education have the lowest age at first birth. Women residing in Dar es Salaam have the lowest age at first birth compared to women residing in other parts of Tanzania i.e. Dar es Salaam women have lower age at first birth than women in rural areas. Urban residents living in other towns than Dar es Salaam have the highest age at first birth. A study should be conducted to look at specific factors that make Dar es Salaam women start child bearing at an earlier age despite being the capital city. The NFPP should put emphasis in these areas.
The study found that age at first birth is inversely related to fertility as those women who start their child bearing early have higher fertility. Women with late age at first birth also have lower fertility. Although late age at child bearing has also been found in this study to be a factor in reduced levels of fertility, and ultimately population growth, Pebley (1981) found that differences in age of entry into motherhood under age 20 have relatively little effect on completed fertility. Hobcraft and Casterline (1983) also observed that a postponement of child bearing until at least age 20 is necessary before substantial effects on fertility could be observed. This was clearly confirmed in this study (Table A- 3).
Age at first birth can be associated with child survival for the first births. Children born to women experiencing first births before 15 years of age are at a greater risk of infant and child mortality than those of women who had their first births when they were older than 20 years. However, infant deaths to these mothers cannot simply be explained by biological factors but are closely linked to socio-economic factors. Early age at first motherhood is also associated with a higher risk of maternal deaths, but this need to be further investigated.
In Chapter 5 we tried to associate findings of Chapter 4 with fertility in Tanzania. According to the 1996 TDHS it was found that on average a Tanzanian woman bears 5.6 children until the end of her child-bearing years. This level of fertility is still very high in comparison with other countries in the developing world. However, some decline in fertility has been observed during the recent past. The 1978 population census data give a TFR of 7.4, the 1988 census gives a TFR of 6.5. The 1991/92 TDHS data give TFR of
2676.1. Therefore, it can be concluded that the Tanzanian fertility has declined by about 2 children per woman from the late 1970s to the mid-1990s. This can be regarded as a substantial decline in fertility.
This study gives evidence that any change in the level of fertility is necessarily related to changes in one or more proximate determinants. The two major proximate determinants of fertility in Tanzania are universal and prolonged breastfeeding through its effect on postpartum infecundability, and marriage. As it is in many other sub-Saharan Africa countries, the use of contraception is not widespread in Tanzania. Therefore, its effect in reducing fertility is minimal. Unfortunately, the importance of induced abortions, as a fertility-inhibiting variable could not be assessed in this study because of the non-availability of data. Abortion is likely to affect the estimation of the total fecundity rate as the number of induced abortions is known to be rising in Tanzania (Justesen et al., 1992; Mpangile et al., 1993).
Bongaarts and Potter (1983) argued that the transition of fertility decline could easily be explained by the transition of a population from natural to controlled fertility. In this study it was established that the TFR declined by 8.2 percent between 1991/92 and 1996. The proportion of women married decreased, the duration of postpartum infecundibility shortened, and contraceptive practice increased. From these findings, we can conclude that Tanzanias demographic reproduction is changing from natural fertility to more controlled fertility, hence is in the transition of declining. The underlying factor obviously is the willingness and ability of a growing number of women to limit the number of their children and to increase the period between births.
The analysis of the determinants of the number of children ever born suggests that the decline in fertility in the recent past is a result of a rise in age at first birth and age at marriage, and a decline in infant and child mortality. It has been observed that women in monogamous marriages have a higher fertility than women in polygamous marriages even after controlling for other variables. Similar results were found by Henin's (1979) study on Tanzania. This is likely to be due to the fact that women in polygamous marriages have a reduced frequency of sexual intercourse compared with women in monogamous marriages.
268There is a strong relationship between age at first birth and the lifetime fertility of a woman. This study found that starting having children at age 20 to 21 reduce the number of children they were expected to have by one birth less compared to those who started child bearing before attaining age 15. Women who become mothers only after attaining age 25, get almost 3 children less compared to those who start child bearing before age 15. Infant mortality also plays a role. Women who lost one or more children have a higher number of children ever born than those without any loss. It seems that almost each child who died is being replaced by another birth. This means child survival will directly reduce fertility.
Women who experience their first sexual intercourse within marriage have higher fertility compared to those who had the same experience before marriage. Marriage after age 25 reduces the number of children a woman might bear by almost one child in comparison with the number of children of a woman who marries before attaining age 15. This implies that a policy which would raise age at first marriage will have an impact on fertility. Currently married women have higher fertility than those who are not married.
Education plays a big role in reducing fertility. Completing primary education reduces the number of children a woman would have in comparison with those who did not attend school. However, secondary education seems to have a non-linear relationship with the number of children ever born; it is not statistically significant.<43> The partners educational level also influences the cumulative fertility of a woman. This might be due to the fact that most of educated women would not prefer to be married to uneducated men. A result of the partners education is highly correlated to the level of education of a woman. From this study we can conclude that raising a womans educational level would raise her age at first intercourse since schoolgirls are less likely to become mothers due to strict rules on pregnancy in schools. In general, education raises womens age at first birth, reduces infant and child deaths, improves womens social status, and creates an additional incentive to use modern contraceptives.
269It was found in this study that Moslems bear children at an earlier age compared with Catholics. But it is interesting to note that Moslem women have a slightly smaller number of children ever born in comparison to Catholic women. This was also confirmed in the analysis done in this study of women in Moslemic countries like Egypt, Bangladesh, and the Comores who tend to bear children early but have a relatively lower fertility. This might be attributed to the restrictions of Catholics on the use of contraceptives. Although rural women were found to have higher age at first birth than urban women, urban residents have a smaller mean number of children ever born than rural women. These two findings suggest that early age at child bearing is an important factor in influencing fertility for a society with low contraceptive prevalence. However, age at first motherhood cannot have an effect on fertility if the majority of women are effectively contracepting.
In Chapter 4 we found that women in Tanzania use contraceptives to delay their first births. This result contradicts the conventional knowledge that women in Tanzania use contraceptives only for spacing or limiting purpose. It was found that 14 percent of unmarried women are doing something to delay or avoid premarital pregnancies and 9 percent use modern methods of contraception. These women use mostly condoms to avoid pregnancies and to protect themselves from STDs. However, in Chapter 6 we examined levels and determinants of contraceptive use in Tanzania to space or limit the number of births. Women were analysed in two separate groups: never married women and currently married women. The 1996 TDHS reveals that 13.3 percent of the currently married women and 5.6 percent of the never married women were using modern contraceptives at the time of interview. However, 15.3 percent of non-pregnant, currently married women use contraceptives and 5.8 percent of non-pregnant never married women contracept. These levels are very low compared with the level of knowledge of at least one method of contraception that is 88 percent for currently married women and 70 percent for never married women. Mturi and Hinde (1994), by using the 1991/92 TDHS, estimated that 10.4 percent of the currently married women and 5.9 percent of the never married women use contraceptives in Tanzania
Family planning methods are mainly used for spacing purposes in Tanzania; the pill being the leading method followed by injections. While female sterilisation is more common among older women, the condom is popular among younger women. This might be associated with the campaign of HIV/AIDS prevention. It is interesting to note that
270periodic abstinence is more popular among younger women, while other traditional methods like strings are only used by older women. The use of condoms was stated to be the second most popular modern method (after the pill) among never married women. It is interesting to note that periodic abstinence is popular among never married women too. This suggests a lack of family planning services offered to these women. Unmarried women used not to have access to family planning services. Although the government has tried to reverse its policy concerning these women, it is still difficult for a teenage schoolgirl or an adolescent in general to visit a family planning clinic. Furthermore, the integration of MCH-services and family planning services complicate the accessibility of these crucial services to unmarried women especially those who have never given birth. MCH is considered by the society as a service for mothers and children, and family planning services are for spacing and limiting births rather than preventing first births. Another hindrance of the accessibility of family planning services to juvenile and unmarried women generally is the conservativeness of the staff members in family planning clinics. They follow the unwritten rule that family planning advice can be given only to married clients who have a child. On the other hand, staff members often have negative attitudes towards modern contraceptives such that they portray a bad example to their clients. Furthermore, there are common reservations that contraception to childless women leads to primary and secondary infertility. Due to misconceptions about contraceptives being numerous which inhibit their use, there is a need for better counselling as well as a need for an improvement and update of the education of counsellors and service providers of family planing services. Nevertheless it is essential for the NFPP to focus more on young and unmarried women since premarital sexuality and child bearing seem to be a serious problem in Tanzania (see Chapter 4).
The determinants of contraceptive use in Tanzania as found in this study are very similar to those found elsewhere in the developing world. It can be concluded that Catholic rural women, with less than 7 years of schooling, married to a men with less than 7 years of schooling, involved in polygamous marriages or unions are the least likely to use any method of contraception. Unmarried illiterate adolescent women in rural areas, and young non-Moslems are also less likely to use contraception than other unmarried women. All these women need to be given special attention by the NFPP in order for the contraceptive acceptance rate in Tanzania to rise.
271This study also dealt with unmet need and the demand for family planning (see Chapter 6). A major focus was to examine the proportion of women who are exposed to the risk of unwanted pregnancy but are not practising contraception. In most societies this has been a very serious problem since the impact of unmet need on fertility over a period of time may be very significant even if the magnitude of unmet need at any point in time is small. The method developed by Westoff (1988) and later adopted as DHS methodology (Westoff and Ochoa, 1991) was applied to investigate the unmet need for family planning for Tanzanian women.
The total unmet need was estimated to be 27.5 percent among currently married women. Most of these women have an unmet need for spacing births (15.7 percent) rather than for limiting births (11.8 percent). The total demand for family planning in Tanzania is therefore 40.8 percent by including the percentage of women who are currently contracepting. It was found that in Tanzania the probabilities of having an unmet need for spacing is much higher than that for limiting. However, women who were married before age 15 and women aged 35 years and above have high probabilities of having an unmet need for limiting fertility. Women observed to have the highest probability of having an unmet need for spacing are rural Moslem adolescents in monogamous unions who have at least one living child, and having completed primary education. Women with the highest probabilities of having unmet need for limiting include married women who have a larger number of surviving children and live in a rural setting.
In Chapter 7 we concentrated on adolescents who are a very important segment of the Tanzanian population. Our main focus was sexual activity and child bearing before first marriage. Its consequences range from terminating their education, which results in lowering their social status, and it sometimes leads to the death of the young mother as their reproductive organs are not mature yet. Furthermore, children born out-of-wedlock to adolescent mothers are generally severely disadvantaged because their mothers tend to be illiterate, poor, and in a poorer health condition than others.
We observed a high rate of first premarital adolescent pregnancies among all adolescent women in Tanzania (47 percent). Some 12.2 percent of adolescents who became pregnant out-of-wedlock got married before the birth of their first child; 6.6 percent got married after the birth of their first child, and the remaining 28.3 were still not married
272at the time of the survey. The study found that premarital first pregnancies were prevailing in most sub-Saharan Africa countries. For example this study found that, in Kenya 72 percent of all adolescent births were conceived as premarital pregnancies, 16 percent got married during the first pregnancy. In all adolescent first births in Kenya, 44 percent of all young mothers (15-19) were singles at the time of the survey, 42 percent in Côte dIvoire, 28 percent in Tanzania, and 25 percent in Zambia.
In this study we found that literate adolescent women had a higher likelihood of having premarital sexual intercourse than illiterates. However, literacy raises age at first birth for adolescents. Literate adolescents, on the other hand, are more likely to be displeased with the timing of their first birth than illiterate adolescent women. The more years an adolescent attends school, the higher the age at first birth. Urban adolescent woman had a higher likelihood to experience premarital sexual intercourse than rural adolescents. Protestant unmarried adolescent women are less likely to experience sexual intercourse compared to Moslems. Moslem adolescents have the first birth earlier than Christians.
Sub-Saharan Africa countries are characterised by low contraceptive prevalence (see Appendix A1). Low TFR can be associated with a high contraceptive prevalence rate. Countries like Kenya with low mean ages at first intercourse, marriage and birth have a lower TFR (less than 6) because its contraceptive prevalence rate is higher than 30 percent. It seems that countries with a prevalence rate of more than 40 percent have a TFR of less than 5. This is true even for other selected developing countries analysed in this study.
This study tried to develop a model that can be used to study fertility in Tanzania based on the findings in this study (Chapter 2). By using this model we found that in Dar es Salaam age at first intercourse influences age at first birth. The increase of age at first sexual intercourse by 5 years leads to an increase in age at first birth for Moslems by 2 years, and for Catholics by 3 years. The increase of Moslems education by 5 levels leads to a rise in age at first birth by 1 year. But for Protestants and Catholics in Dar es Salaam education is not a significant factor in raising age at first birth.
In urban centres, excluding Dar es Salaam, age at first intercourse also plays a significant role in explaining age at first birth. A rise in age at first sexual intercourse by
2735 years results in an increase of 3 years in age at first birth for Moslems and Protestants. The same increase of 5 years in age at first sexual intercourse raises Catholics age at first birth by 3.5 years. Education also plays a significant role in raising age at first birth for Moslems. For urban Moslems, an increase by 5 levels of education raises age at first birth by 1 year. However, for Protestants an increase of 10 levels of education raises age at first birth by only 1 year. For Catholics, educational levels are not a significant factor in raising age at first birth.
In rural areas, age at first sexual intercourse plays a significant role in raising age at first birth. An increase of age at first sexual intercourse of 5 years raises age at first birth by 1.5 years for Moslems, 2.0 years for Catholics and 2.5 years for Protestants. Education although significant for Moslems and Catholics in rural areas, it does not play a big role since an increase of 10 levels of education raise age at first birth by 1.0 year.
Therefore, it can be concluded that a rise in the age at first sexual intercourse plays a significant role in delaying age at first birth for Tanzanian women, while education, when controlling for all other factors plays a smaller role mainly in urban areas but not in rural areas.
On the part of fertility, age at first birth and child loss explains excess fertility for Moslems in Dar es Salaam. The number of children ever born decreases with increasing age at first birth. Women who started child bearing at age 20-21 have almost 2 births less than those who had their first birth before attaining age 15. Those who start child bearing above 24 years of age have almost 4 births less than those who started their child bearing when they were younger than 15 years of age. Child survival also plays an important role.
In urban areas, raising age at first marriage decreases the number of children ever born. Raising age at first marriage between age 22 to 24 decreases the number of children ever born by 1.3 compared to those who got married with less than 15 years. Those who marry with more than 24 years have 2 births less than those who got married when they were younger than 15 years old. Late age at first birth for Moslems and somehow for Catholics plays a significant role in reducing the number of children a woman will bear
274during her lifetime. Catholic women in polygamous unions have lower fertility compared to women in monogamous unions.
In rural areas age at first marriage of more than 24 years reduces the number of children ever born to a woman by one birth for all women regardless of the religion they belong to. Again, age at first birth and child loss explain the excess fertility of women in rural areas. It seems that Catholics and Protestants in polygamous unions have a lower fertility in comparison with those who live in monogamous unions.
This study attempted to shed some light on Tanzanian fertility and the related aspects. The individual level analysis carried out has answered a number of questions on the levels, trends, and determinants of fertility in Tanzania. A very clear point from this study is that fertility in Tanzania is still high but has started to decline. The effort by the government to encourage a reduction of fertility among the Tanzanian people should be supported fully so as to reduce the population growth rate. The imbalance between population growth and economic growth in Tanzania has been discussed in Chapter 1.
In this study, we have found that most women in Tanzania start child bearing during adolescence. We further found that out-of-wedlock child bearing increases as the age at first marriage have been increasing. Moreover, a substantial proportion of pregnancies and births to these adolescents are mistimed or unwanted. Adolescents often resort to unsafe, clandestine abortions as a means to end unwanted pregnancies. This study pointed out problems of increasing premarital sexual activity with its consequences: the spread of sexually transmitted diseases, premature termination of schooling, high abortion rates that result to some extent from the necessity to hide an unintended conception in order to continue schooling, and the economic and social consequences of early child bearing as documented in this study. However, even married adolescents face many health problems which are exacerbated by customs that are culturally embedded, such as marriage at or close to puberty. This means there is a need to give attention to the health and wellbeing of adolescents.
The need for policy initiatives that increase educational opportunities is especially great among juvenile women who are poor and are therefore more likely to leave school,
275marry and begin child bearing at an earlier age than better-off adolescents. The difficulty of implementing policies that promote change in the behaviour of people and broaden their opportunities cannot be underestimated. Yet, it is imperative for governments, communities, and families to take responsibility for and actively work toward creating an environment that will enable and inspire young people to better themselves and the environment surrounding them.
The study has revealed a positive relationship between age at first birth and fertility. Raising the age at which women start child bearing will lower fertility. However, legislation on raising age at first birth might not sound plausible. However, this study found the relationship between age at first sexual intercourse and marriage (for those whose first sexual intercourse follows marriage) to be positively related with age at first birth. The only way to raise age at first birth is to encourage the use of and give access to contraceptives to young married as well as to unmarried women. Adolescents are aware of contraceptives (81.0 percent). In contrast, very few use contraceptives (7.2 percent). Furthermore, even fewer of the unmarried, sexually active adolescents report using condoms (4.5 percent). This suggests that few sexually active adolescent women are protected from sexually transmitted diseases and HIV/AIDS. The use of condoms must be promoted not only as prevention against STD/STI but also because adolescents might experience provider bias, particularly against methods that are thought to impair future fertility. Hence, further studies must be carried out to understand factors that prevent adolescents from using modern methods of contraception, especially condoms.
We also found that there is the societal expectation that marriage is an institution of childbirth.<44> The only way to raise the age at first marital births is to increase the age at marriage. The government should come up with well-defined policies that will directly or indirectly raise the age at first birth by strengthening the legislation on age at marriage. More efforts should be directed towards the improvement of the status of women. This can be done through improving female education. More vocational training and secondary schools for girls should be provided in all parts of the country.
276This will motivate girls to continue with secondary education rather than dropping out of school. Those who fail to continue with secondary schooling should have the possibility to join vocational training for not less than 3 years. In doing so, women will stay in school for a longer time and therefore delay marriage and subsequently first birth.
Traditionally initiations helped to give sexual education to adolescents. However, today young women are caught at cultural cross roads due to the gradual disappearance of traditional values. Older women no longer give guidance to girls as far as sexual matters are concerned. The traditional initiations (Unyago) have been given up in many parts of the country, especially in urban areas. Yet the governmental organisations, the church and non-governmental organisations involved in family planning are reluctant to incorporate the youth in their programmes due to social norms which define a ‘good woman as one who is ignorant about sexuality and sexually passive. This comes about due to an assumption that communication about sexuality and birth control is strongly influenced by young womens perception of how socially acceptable their knowledge about sexuality is. In this respect, a young woman may be unwilling to ask questions concerning sexual intercourse and child bearing. Therefore, there is a need for family life education programmes. These could be integrated into the school curriculum. They could also be extended to cater for those girls who have no opportunity of being in the school system due to a lack of money. Family life education therefore can be extended to these groups of people through youth camps, trade centres, women associations and community centres.
The study has also shown that various sub-groups of the population are less disadvantaged in terms of controlling their reproductive patterns. The level of awareness of family planning methods is high but few women are actually using contraceptives. The NFPP has the task to provide family planning services to all those who need them. If every woman, who is a potential contraceptive user, is offered the facilities, the contraceptive prevalence rate will rise to at least 41 percent. The total demand for delaying first birth was also found to be 41 percent. It seems therefore that the majority of motivated women do not have access to the family planning services in order to delay, space, or limit their births. As an initial step, this group of women should be targeted.
277The issue of unmarried women too should be addressed more critically since most of these women are sexually active. As documented in this study, more than 50 percent of unmarried adolescents are sexually experienced and only 6.7 of the sexually active adolescents contracept. In this study we found a high prevalence of premarital sexuality which results in an increasing rate of premarital child bearing. As noted earlier, these women are still not free to use contraceptives even if they want to. The perception of family planning service providers (particularly MCH and UMATI staff members) that family planning services are for married women only should be very strongly criticised. There is a need to improve and update the education of the family planning staff.
Different ways of motivating young women, who are sexually active, to use contraception should be developed. Among the first attempts perhaps should be to introduce sex education in primary and secondary schools. The second step is to create an environment suitable for these unmarried women to access family planning services easily. The provision of family planning services to unmarried women should be separated from MCH clinics since the definition (Maternal and Child Health) does not include women who are not pregnant nor have ever given birth. Youth centres and groups can offer family planning services for unmarried women.
This study found that adolescent sexual activity and premarital sexual activity are a fact of life in Tanzania as is the case in many Western societies. In such a situation, it is necessary to educate juvenile women about the responsibilities associated with sexual activity and the potential consequences. Therefore, politicians and religious leaders should be sensitised in order to change their negative attitude towards the introduction of sex education in schools. A thorough study should be carried out to incorporate traditional sexuality education (initiations) with the proposed sex education in schools in order to mix culture and modernisation.
Initiators known as ‘Walombo should also be sensitised in order to appreciate methods of modern contraception. Eventually they might become proprietors of family planning in their role as traditional sex educators in places where this culture still exists as not all parts in Tanzania used to have this kind of set-up.
278Although breast-feeding practice contributed to the decline in fertility in Tanzania, the study found that there was a shortening of the duration of breastfeeding practice between two TDHSs. This has to be compensated with greater contraceptive use for a further decline of fertility in Tanzania. The government on the other hand should continue to encourage women to breastfeed their children for a longer duration along with contraceptive use.
There are various areas that need further research. This study has highlighted Tanzanian fertility at the national-level. Many issues discussed therefore need further analysis to obtain a better understanding of the reproductive behaviour of Tanzanian women. The onset of the fertility transition observed in this study is by no means conclusive. Efforts should be made to confirm the magnitude of fertility decline and the factors responsible for this decline. There is a need to use prospective data for this purpose. Since regional variations in fertility are obvious, a thorough understanding as to why there are differences between the regions should be addressed. This will assist planners and policy makers to distribute the limited resources adequately.
In this study, we had a shortage of variables in investigating age at first birth due to the fact that many important questions were not asked in the TDHSs. In the forthcoming TDHS in 1999, this study recommends that questions should be include about age at menarche, abortion, use of contraceptives before first birth, and socio-economic characteristics of the respondent before her first birth. Studies on maternal mortality due to first births, and primary sterility will supplement this study for updating of our national population policy.
It has been stated that the rationale for providing family planning services in Tanzania is to improve the health of mothers and children. The present study has examined only one aspect, i.e. the determinants of contraceptive use and unmet need. It will be interesting to examine the relationship between infant mortality rates, maternal mortality rates and family planning policies. This area has not received much attention in the literature because of a lack of data on maternal mortality. But, there is a chance that family planning programmes are effective in reducing maternal mortality rates, and improving
279child survival. It is particularly important to investigate whether a reduction of higher parity births, and lower and higher maternal age at first births have any impact on maternal mortality.
The Population Planning Unit of the Planning Commission intends to review the TNPP in the future.
Trimean as defined in chapter 3.
From www.cfoc.org/factsheet.html of April 1997.
The question about education level in the TDHS could have been interpreted wrongly in Kiswahili. It seems that those women who attended informal education were coded as if they attended formal schools. This was concluded from the fact that some women either got married or had birth before attaining age 15 while they were categorised as having completed secondary education.
After the first few months of the first marriage close relatives in Tanzania will start asking ‘ndoa imejibu? which literally means ‘has the marriage answered? or in other words ‘is the newly married woman pregnant?. From the fact that people start asking whether the newly married woman is pregnant, one can see that many people still consider marriage as the initiation of parenthood.
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