Health Policy and Planning; 8(1): 1-18
© 1993
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Fertility and contraceptive use in poor urban areas of developing countries
1Department of Public Health and Policy,London School of Hygiene and Tropical Medicine UK
2Department of Epidemiology and Population Sciences, London School of Hygiene and Tropical Medicine UK
Correspondence: Dr Paul Garner, Urban Health Programme, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
The population in urban areas of developing countries continues to grow rapidly. Poor urban areas may have high growth rates through a number of mechanisms including continued migration, a youthful age structure, high age-specific fertility rates, and population movement. Fertility among the urban poor varies between and within cities, and is affected by many factors. Those with fertility-enhancing effects include decreases in breastfeeding and sexual abstinence taboos. Reasons behind these changes may include ideas of modernity, increases in women's employment, the need for further child labour, and the breakdown of the extended family. Factors with fertility-reducing effects include the proportions marrying, age at first marriage, increased spousal separation and increased use of contraception. These in turn are driven by increased access to contraception, smaller norms for family size, increases in female education and employment, improved child survival and, possibly, changes in family structure and earning power.
This paper characterizes both these factors and those which influence fertility and family planning in urban settings, particularly in poor urban areas. It examines policy options for improving access to contraception, taking into account issues important in the unban context, including HIV infection and adolescent pregnancy.
Despite the potential social marketing and family planning have of reaching large numbers of people in a small area, contraceptive use remains low in many cities, and inaccessible or poor quality services are often given as the reason. Services need to promote choice through improved contraceptive accessibility and quality and by strategic planning, recognizing the marginalized nature of many of the urban poor and the economic constraints under which many of them operate.
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