The effects of the pill,injectables and male condom on fertility in urban Zambia: evidence from the ZDHS 1992-2014
Fertility rate has declined in Zambia especially in urban areas. Contraceptive use has increased with the pill, injectables and male condom being the most widely used methods between 1992 and 2014. However, there is no evidence which clearly shows whether the use of these contraceptive methods has contributed to fertility reduction. Therefore, this study aimed at examining whether the pill, injectables, and male condom have contributed to reduction in children ever born (CEB) among urban women in Zambia. It also aimed at determining the demographic and socio-economic pathways in which these methods work to affect CEB. The study was undertaken to help fill the gap in knowledge on how use of these contraceptive methods have each influenced fertility in Zambia. A method identified as having contributed more significantly to fertility reduction in urban Zambia would affect policy; reducing costs in family planning services and in helping to focus provision of contraceptive methods especially rural areas where fertility is high. The Zambia Demographic and Health Survey (ZDHS) datasets of 1992, 1996, 2001-2, 2007 and 2013-14 and Stata 12.0 were used for the analysis. Descriptive analysis; bivariate and multivariate analysis using Poisson regression, producing Incidence Rate Ratios of CEB among women associated with contraceptive use by ZDHS year. The sample included urban women who reported using the pill, male condom, and injectables. Women who have never used any contraceptive method were a reference category. Findings from bivariate and multivariate analysis of CEB indicate that women using these contraceptive methods were associated with relatively more children than women who have never used any contraceptive method with similar education level, employment status, age, marital status and age at birth of first child. Women with secondary and tertiary education and were using the pill or male condom or injectables were associated with having significantly fewer children. The findings of this study have shown that the use of the pill, injectables, and male condom is associated with a minimal effect in reducing CEB among urban women. The use of contraceptive methods combined with secondary or tertiary education is associated with a reduction in CEB to women significantly. This is because women with tertiary education are likely to be more knowledgeable about the availability accessibility and of contraceptive methods. Further, these women are more likely to use contraceptive methods correctly and consistently, hence are able to limit the number of children. In conclusion, this study has found that fertility reduction in urban areas cannot be associated with increased use of the pill, injectables and male condom but other socio-demographic factors such as secondary or tertiary education combined with contraceptive use. Recommendations from the findings of this study include; providing an enabling environment for the attainment of tertiary education by women is vital if low levels of fertility are to be achieved. Further studies should be conducted in order to determine why women prefer these contraceptive methods and to fully understand how each method is influencing fertility level in Zambia. One main limitation of this study is that, the cross-sectional nature of survey data makes determining causality between the dependent and independent variables impossible but only association.