1.1  Uncontrolled fertility

This session starts by highlighting the issue of uncontrolled fertility and its effect on the health of mothers and children. Uncontrolled fertility can be defined as when an individual or couple fail to plan their future family size to match the economic level of their family. As a result, fertility is often higher in developing countries than in developed ones, which means that women living in poorer countries, like Ethiopia, tend to have more children in their lifetime.

It is estimated that, on average, African women have 5.6 live births during their reproductive period, and the average number of live births per Ethiopian woman is currently 5.4. This average varies across rural and urban areas of the country. For instance, the fertility rate is as low as 1.4 in Addis Ababa, while it is as high as 7.4 in the Oromia Region.

  • From your own experience, what do you think are contributing factors for having too many children?

  • Some of the factors that contribute to high fertility are early marriage, low literacy, limited use of family planning methods, religious and cultural influences.

As a result of the high fertility rate, poor health conditions in general, and inadequate availability of medical care, the risks of pregnancy are higher in Africa than anywhere else. An African woman’s chance of dying from pregnancy-related causes, such as obstructed labour, post-partum haemorrhage, hypertensive disorders of pregnancy, post-partum infections, and unsafe abortion, averages 900 per 100,000 live births.

In contrast, the risk of maternal death in the industrialised nations averages 27 per 100,000 live births. In Ethiopia, for instance, an average of 673 women per 100,000 live births die from pregnancy-related causes. Similarly, in developing countries, including Ethiopia, high fertility carries the highest risk of death in children under five years of age because it is usually difficult for African families to provide all their children with enough food and health care. Therefore, the children can be easily affected by severe malnutrition and infections, both of which are the most common causes of under five mortality. For every 1,000 live births, there are 140 deaths of children under five years in sub-Saharan Africa and 127 in Ethiopia.

In general, compared to countries with lower fertility rates, countries that have high fertility rates often have higher maternal, child, and infant death rates.

Learning Outcomes for Study Session 1

1.2  Population size and growth