Bolivia is one of the poorest countries in South America, and has one of the highest fertility and infant mortality rates and lowest average life expectancies in Latin America. The most recent Demographic and Health survey (DHS), conducted in 2008, shows some improvement in infant and child health. But use of effective family planning remains low and the total fertility rate (TFR) -- 3.5 lifetime births per woman -- declined little from the previous DHS in 2003.