Article

The Long-Term Fertility Impact of the Navrongo Project in Northern Ghana

Studies in Family Planning (Impact Factor: 1.28). 08/2012; DOI: 10.1111/j.1728-4465.2012.00316.x

ABSTRACT Total fertility rates in Africa's Sahelian region are double the levels prevailing elsewhere in the developing world, and the Sahel has the lowest contraceptive prevalence in Africa and in any region worldwide. This type of setting has long been viewed as challenging for family planning programs (Van de Walle and Foster 1990). Although survey data from the Sahel suggest that unmet need for contraception exists, demand for fertility regulation is focused on desire to space rather than limit childbear-ing (Westoff and Bankole 1995; Biddlecom, Tagoe, and Adazu 1997; Casterline and Sinding 2001). Traditional child-spacing practices arise from spousal separation and prolonged breastfeeding, constraining the prospects of incremental demographic effects from family planning practice (Bledsoe et al. 1994 and 1998). The Sahel is the last frontier in the long-standing policy debate concerning the demographic potential of family planning programs in high-fertility settings. Recent evidence of the stagnation of fertility transitions in Africa has generated renewed interest in the popula-tion debate (Bongaarts and Sinding 2009). Prospects for family planning programs to induce and sustain demo-graphic transition remain the subject of challenge on theoretical and empirical grounds, however. Various researchers have questioned whether demand for family planning in Africa is sufficient to justify policies promot-ing organized family planning programs in the region (Frank 1987; Frank and McNicoll 1987; van de Walle and Foster 1990). Others have noted that public invest-ment in family planning service delivery is intrinsically inefficient because demand for services is constrained (Pritchett 1994). Qualitative research on marriage and family-building customs in West Africa has suggested that African reproductive beliefs and customs promote traditional child-spacing practices that will continue to impede fertility transition (Caldwell and Caldwell 1987, 1988, and 1990). A study from the Gambia has shown that contraceptive use can increase without affecting fer-tility levels (Bledsoe et al. 1994).

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