Zimbabwe’s 2010-2011 Demographic and Health Survey Shows Fertility Increase, Stagnant Progress on Health

by Carl Haub, senior visiting scholar

The new Demographic and Health Survey (DHS) in Zimbabwe presents evidence that the country’s progress on reproductive and maternal and child health has stagnated in recent years.

The 2010-2011 Zimbabwe DHS interviewed 9,171 women ages 15 to 49 and 7,480 men ages 15 to 54. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 4.1 for the three-year period preceding the survey and is an increase from the previous DHS in 2005-2006. For urban women, the TFR was 3.1 and, for rural women, who were 61.3 percent of the sample, 4.8. The TFR has been relatively stable since the 1994 DHS, particularly in rural areas. But there has been a noticeable resurgence in the TFR in urban areas in the past five years. The proportion of women who say that they do not wish to have any more children can be an indicator of childbearing intentions. When asked about their future childbearing desires, 49.5 percent of  percent of married women with three living children said that they wanted no more and, among women with four living children, 65.2 percent said that they wanted no more. It would seem that the very large families of the past are no longer desired.

Note: TFRs are for the three years before the surveys, except the 1988 survey, which is for five years.

Reported contraceptive use among married women was high, 58.5 percent for all methods and 57.3 percent for modern methods. This did represent a slight decline from the 2005-2006 DHS when it was 68.2 percent and 58.4 percent, respectively. The contraceptive pill was by far the most frequently used method at 41.3 percent, followed by injectables (8.3 percent), and the male condom (3.1 percent). Among births in the past five years, 89.8 percent of women had had antenatal care from a skilled provider (doctor, nurse, or nurse midwife) and 66.2  percent of deliveries were attended by a skilled provider. Over two-thirds of births took place in a health facility. But both of those proportions were down somewhat from the previous DHS. Among the most recent births, the percentage that were protected against neonatal tetanus also declined, from 57.6 percent in the 2005-2006 DHS to 48.5 percent in 2010-2011. The proportion of children, ages 12 to 23 months, who had received all required childhood vaccinations, however, rose from 41 percent to 64.3 percent with the rural proportion only slightly lower than the urban. Just over two-thirds of women were able to produce vaccination cards.

While childhood mortality has declined to a relatively low level compared to the past, the new DHS indicates that it is no longer decreasing and has actually risen, an unusual trend in most surveys. The infant mortality rate in the 2010-2011 DHS was 57 deaths to infants below age 1 per 1,000 live births in the five years before the survey, but that was up from 51 deaths per 1,000 live births five to nine years before the survey and 46 deaths per 1,000 live births 10 to 14 years before the survey. A similar trend was observed in the child death rate, ages 1 to 4.  The survey also found that 31.9 percent of children under age 5 were stunted (height-for-age), up from 29.4 percent in the previous survey and that 9.7 percent were underweight. However, that was an improvement from 16.6 percent in the previous survey.

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