Although Malawi’s total fertility rate (TFR) remains high at 5.7 births per woman as of 2010,
1
the country
appears to be at the incipient stage of a fertility transition. TFR fell from 6.7 in 1992,
2 while ever use of
modern contraception increased dramatically from 6.3% in 19922
to 61.8% in 2010.1
To understand
what is driving this transition, it is important to identify the characteristics of young women who use
contraception at the beginning of their reproductive lives, which will provide a clearer picture of the
changing nature of fertility in Malawi.3–5
There has been much debate in the demographic literature regarding the relative contributions of
access to quality family planning services vs. individual characteristics, such as women’s education, in
decreasing fertility in developing countries.6,7 Policymakers who believe greater use of contraception is
due to increasing individual demand advocate investments in economic and social development.7–11
Others assert that improving the accessibility, availability, and quality of family planning services will
increase contraceptive use.
8
Previous analyses attempting to quantify the effect of availability of family
planning services on fertility have typically focused on all reproductive aged women,
6,9,12 or have used
data from Asia,13,14 despite the fact that younger women may behave differently and have different
experiences interacting with family planning providers than older women, and despite the fact that subSaharan
Africa’s fertility transition may present unique challenges