Research Project: Comparative Analysis of the Fertility Rate in Nigeria and Mali

Introduction

Nigeria and Mali are situated in West Africa. These countries are among the poorest countries in the world with the low level of human development. Moreover, both countries have the same social problem – excessively high fertility rate. Fertility rate is the number of children expected to be born to a woman over her lifetime. This information is essential for the development of health care policies and programs because of the following reasons. First, there are negative effects of high fertility on maternal and child health. Secondly, there is a relationship between the population growth and economic development, since the rapid population growth creates the potential to decrease the pace of socio-economic indicators and destroy the path out of poverty for many families. A decline in the fertility rate will put greater emphasis on the quality of the population development rather than its size. It can also create better educational opportunities for children and their mothers.

The paper is divided into two sections. Following the introduction, the fertility trends in Mali and Nigeria for the last 15 years are presented. This section also examines the factors that relate to high fertility in Mali and Nigeria, which helps to analyze the ways of the problem elimination. The second section contains the discussion of the steps that have been taken by the countries’ governmental and nom-governmental organizations to deal with the high fertility rate. It also describes the future trends in fertility rate based on the future changes in these factors related to the problem and on the fertility trends in both countries during the last 50 years.

Fertility Situation in Mali and Nigeria

Fertility Trends

Nigeria is the most populous country in West Africa with the population of nearly 178.5 million of citizens, while Mali has the current population of 15.8 million citizens (“Mali Population”, 2015; “Nigeria Population”, 2015). Despite the differences in the absolute numbers, both countries have similar population structure. Their population is very young. The 47% in Mali and 44% in Nigeria are below the age of 14 years, with almost a half of population (49% in Mali and 53% in Nigeria) of the countries’ population is between the ages of 15-64 years (The World Bank, 2015).

The explanation of such a structure lies in the relatively high fertility in both countries during the last years. According to the World Bank (2015), in 2001, the total number of births per woman in Mali was 6.822, and in Nigeria – 6.077; and nowadays, countries have reduced the fertility rate to 6.06 in Mali and 5.19 in Nigeria respectively. Despite this, rates in both countries are still very high as, for example, in 2015, Mali became the third country in the world among the 224 countries by the fertility rate, and Nigeria took the 13^th place (Central Intelligence Agency, 2015).

The stalling fertility in both countries can be explained by the increasing number of educated women there. Researchers agree that more educated women in countries with high fertility rates want significantly fewer children and have a significantly lower numbers of unwanted births (Goujon et al., 2015).

Most researchers refer high fertility rate to one of the factors that hinders socio-economic development of the country. For example, Arshraf et al. (2012) found for Nigeria that the reduction in the total fertility rate by one leads to doubling in GDP per capita. This statement is confirmed by the official statistics, according to which the GDP per capita in Mali has increased from $231 in the current prices in 2001 to $706 in 2014, and GDP per capita in Nigeria has increased from $350 to $3203 respectively (World Bank, 2015).

Factors Associated with the High Fertility in Mali and Nigeria

Fertility rate is conditioned by both biological and social factors that include the level of the child survival, marriage traditions, the familiarity with the different types of the contraceptives, religions’ prohibitions, and the level of female education as well as employment.

Child Survival

As well as the fertility rate, the mortality rate for children in Mali is higher than in Nigeria, but they are comparatively high in terms of the rest of the world. According to the World Bank (2015) report, in 2015 every, 114 children under 5 years per 1,000 died in Mali and 108 children in Nigeria. The infant mortality rate remains high too: 74 infant per 1,000 in Mali and 69 per 1,000 in Nigeria (The World Bank, 2015).

That is why one of the factors that determine fertility levels in countries is that both women and couples in the selected countries choose to have large families. Essentially, if couples expect that some of their children may die, they will intentionally have more. In case of improving the child survival, parents will become more confident about having fewer children. At the result, this will lead to a gradual reduction in the fertility rate and increasing the investing in the family wellbeing.

Marriage  

The facts that most women still get married in their teenage years and have an sexual debut significantly contribute to teenage pregnancies. The adolescent fertility rate was 175 births per 1,000 women aged 15-19 years in Mali and 111 in Nigeria in 2015, which has been decreased from 187 births per 1,000 women and 131 births per 1,000 women in 2001 (The World Bank, 2015).

Cortes et al. (2015) in the recent study state that despite of that fact that the legal age for marriage in both countries is 18 years for girls, the marriage can take place at earlier ages with parental consent. As a result, in Mali and Nigeria nearly 1 in 4 girls is married by the age 15 nationally (Cortez et al., 2015). The early marriage causes the adolescent pregnancies, as society traditionally expects that the new couple will have a child during for at list one year after marriage. The early childbearing often leads to mother and child health risk increasing (Adebowate & Palamuleni, 2014). However, women who marry at their teenage years are typically pregnant for a longer period, thus increasing the fertility rate.

Contraceptive Use

Both Mali and Nigeria show one of the lowest contraceptive prevalence rates in the world. According to the World Bank (2015), modern contraceptive prevalence in this is at or below 15%, Besides that, few Malian and Nigerian women use family planning. A 2013 national survey of the World Bank (2015) found that 28% of married women ages 15-49 used modern contraceptive methods in Mali and 48% in Nigeria. Still, nearly 26% of married Malian women ages 15-49 would like to space or limit future births but they do not use contraception, indicating an unmet need for family planning, while in Nigeria this number is less – only 16.1% (World Bank, 2015).

One of the tools that measure a country’s level of contraceptive security is the Contraceptive Security Index. Despite the insufficient level of this index (out of a possible score of 100), both countries show the statistically significant improvements. USAID (2010) reports that Mali has raised its index from 44.2 in 2003 and 46.42 in 2006 to 50.59 in 2009. Nigeria has improved its level of contraceptive security from 42.31 in 2003 and 48.62 in 2006 to 48.38 in 2009 (USAID, 2010).

According to the health surveys, women refuse to use the contraceptive for several reasons. First, they are not familiar with the methods of contraception or they consider that they will not get pregnant. Secondly, they refuse to use contraception because of the religious beliefs that reject the family planning. Thirdly, there is a lack of physical or financial access to the contraception. At last, a woman believes that she will have health problems in case of using the contraceptives (Cortez at al., 2015).

Religion

Adebowate and Palamuleni (2014) argue that religion connects the behavioral religion norms with the fertility behavior. The two key religions in Nigeria (Christianity and Islam) and a leading religion in Mali Islam disapprove the abortion and divorce, and they do not accept the birth control, in particular the use of the contraceptives. Therefore, the religious beliefs of the majority of the population encourage the childbearing.

Female Education and Employment

The researches state that higher proportion of educated women tends to lower the fertility rate in the community (Rabiu & Ahmad, 2014). This can be explained by that fact that women who spend a long time getting education are likely to marriage later than women without education, and consequently, they have fewer children. Goujon et al. (2015) also state that more educated women tend to shift from quantity of children to quality of their children’s lives. These women want fewer children with better life chances. Moreover, their rates of contraceptive use are higher than among women with no education. The reason for it is that educated women have more knowledge about contraception methods and more access to them as well as the greater autonomy in the reproductive decision-making.

The female participation in the labor force also can decline the fertility rates, as women have fewer children to attend to. The unemployment female rate has not changed during the last 15 years and still is high. Nowadays it is 11.7% in Mali and 7.4% in Nigeria (World Bank, 2015).

Efforts to Reduce or Eliminate the High Fertility Problem

Ways to Overcome the Problem

In both Mali and Nigeria, the reproductive health and family planning programs exist. Their primary purpose is to create conditions so that people can choose, acquire, and use different types of high-quality contraceptives (USAID, 2010).

Addressing the unmet need of contraception will prevent the unplanned pregnancies that result in maternal and child diseases and death. It is estimated that lower fertility will lead to the decrease in neonatal death and make the lives of mother and their children healthier.

Mali

Mali has an extensive national family planning policy supported by the strategy documents, plans, and guidelines. These documents include: Guide for constructive engagement of men in reproductive health and family planning, National action plan for family planning for 2011–2015, Operational plan for procurement and distribution of reproductive health products,  and Plan for the Security of reproductive health Products for 2011–2015 (Maiga, Diallo, McDavid, & Dissirama, 2012). Among these documents are also Reproductive health Law, Strategic plan for repositioning family planning, Strategic plan for reproductive and sexual health of adolescents and youth, Strategic plan for reproductive health communication (Maiga et al., 2012).

In fact, all government health institutes offer the family planning services all over the country. For example, the Ministry of Health initiatives make family planning services more accessible to the average citizen. The ministry promotes the reduction of prices on contraceptives for consumers and initiates the long-term family planning methods in health centers and through mobile services. It also engages males in family planning and the religious communities into the family planning studies, involves the private sector in different family planning services, and supports the social franchising.

The major non-government organization working in family planning sector is a Groupe Pivot. It is the network that unites more than 150 non-government organizations. The other large organizations are: Association Malienne pour la Protection et la Promotion de la Famille, Jigi, the Association Malienne pour la Protection et le Développement de l’Environnement au Sahel, and Association de Soutien au Développement des Activités de Population (Maiga et al., 2012).

Among the non-governmental organizations that are engaged in the family planning and reproductive health programs there is the Marie Stopes International Mali. It offers a full range of sexual reproductive health services that which include family planning, emergency contraception, pre- and post-natal care, sexually transmitted diseases diagnosis and treatment, pregnancy testing, and voluntary HIV counseling and testing.

The international organization USAID also implements the Family Planning and Reproductive Health Program in Mali. This U.S. Government agency has the goal to end the global poverty. This organization provides the family planning counseling and services, organizes trainings with the purpose to reduce the unmet need for family planning and supplies the contraceptive products to the Malians.

Nigeria

The strategy that meets challenges posed by rapid population growth in Nigeria is The National policy on population and sustainable development (NPPSD). One of the significant ways of promoting the family planning and reproductive health services in Nigeria is the Family life and HIV education school program for 10-17 year adolescents. The program is based on the National reproductive health policy and strategy (2001) and nowadays is the Nigeria’s largest sexual and reproductive health education program (Cortez et al., 2015).

The Marie Stopes International is also presented in Nigeria and is one of the only providers in Nigeria who offer access to high quality long-acting and permanent family planning services. Organization works on the improvement of access to family planning services and providing the reliable information to women about the existing contraceptive methods.

The private sector is also presented by the WellBeing Foundation of Nigeria. This foundation has created the commitment “Every Woman Every Child” whose aim is to develop the financial, advocacy and corporate social responsibility commitments from business and philanthropic leaders in Nigeria.

Nigeria’s government also focuses on the female job creation and reduction of the high female unemployment rate. For example, the Community Services Women and Youth Employment Project is designed as a short-term job creation measure for youths, women and persons living with disabilities. Not only does this initiative improve the socio-economic well-being of their communities, but it also empowers the beneficiaries economically. Thereby, it prepares them to exist into more sustainable income by the services they render.

The Results of the Steps for Eliminating the Fertility Problem

Mali

During the last decade, Mali has made progress in creating an enabling environment for the family planning and mother- and childcare. According to Maiga et al. (2012) study, the family planning program has the following results in Mali. First, the resources for the family planning have increased. Nowadays, they are allocated and spent more effectively. Secondly, the coordination between the government and non-government organizations in the sphere of design, implementation, and financing the family planning programs has also increased. Thirdly, the policies that improve access to high-quality family planning services and information have been adopted. For example, the Marie Stopes International (2014) reports that its programs in Mali offered contraceptive for nearly 189,000 users, averted 60,000 of the unsafe abortions and 66,000 of the unintended pregnancies.

The other organization, USAID, reports that Family Planning and Reproductive Health has provided the 870,102 couple years of protection (USAID, 2015). This indicator characterizes the estimated protection provided by family planning methods during a one-year period. The USAID has also engaged the 77,530 new users into modern family planning methods among women between 15-49 years of age and trained 828 people in family planning or reproductive health services (USAID, 2015).

Despite the strong improvement of family planning process Mali, many steps remain to be done to strengthen ongoing activities to reposition.

Nigeria

The Family Life and HIV Education program in schools resulted in the contraceptive awareness increase, but the use of contraception remains low. Only 17 % of sexually active boys and 5 % of sexually active girls use contraceptives (Cortez et al., 2015). The key reason for this is the social stigma, as a girl who asks her partner to use condoms can be blamed for infidelity or promiscuity. In addition to that, the program has been implemented countrywide, but the recent data suggests that it has reached only 13 % of adolescents who attend school (Cortez et al., 2015). It can be explained by the fact that only 45% of teachers have ever heard of the program (Cortez et al., 2015).

The other leading non-governmental organization, the Marie Stopes International, (2014) reports the following results of its family planning programs: 179,000 unsafe abortions averted and 328 social franchisees created. The Community Services Women and Youth Employment Project has attracted nearly 43,266 females. All received the monthly stipends for rendering services at their rural communities (Subsidy Re-Investment Program, 2014).

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