I have the following table from my preliminary Meatu district health data. It still blows my mind because it basically contradicts all my previously held thoughts about religion, Tanzania and contraceptives.

First of all, 67% of households interviewed did not identify with any religion, not even traditional beliefs. This contradicts everything my Swahili teacher told us about being a good East African ("one should always at least identify as a major religion, even if one never prays"). I guess not so in Meatu? People do report being largely fatalistic, though. 35% of women report that their fertility decisions (do you want another child?) are "up to God" and this group is made up of only one quarter of those that identify with a religion.

The real kicker, though, is the fact that couples who identified with a religion were more likely to use contraceptives. You can see from the number of households and the number of women reporting contraceptive use that the sample size is small. However, Catholics (88 households) have almost twice the overall rate of contraceptive use! Someone tell Paul Ryan?

My hypothesis on this second observation is that affiliation with a larger religion in these extremely rural villages is actually a signal of being more cosmopolitan. There's also a good chance that official doctrine in the Catechism of the Catholic Church isn't making its way all the way to Mwajidalala and Longalonhiga. I'm not complaining.

As for any explanation for the dearth of reported religious identification, my only hypothesis is that I asked the wrong person. I asked men. This time around, I'm asking women. I'm otherwise extremely surprised that individuals don't identify as more religious.

I'm accepting any and all theories, hypotheses and shots in the dark as to why.

From @CBlatts:

We investigate whether the show [16 and Pregnant] influenced teens’ interest in contraceptive use or abortion, and whether it ultimately altered teen childbearing outcomes. …We find that 16 and Pregnant led to more searches and tweets regarding birth control and abortion, and ultimately led to a 5.7 percent reduction in teen births in the 18 months following its introduction. This accounts for around one-third of the overall decline in teen births in the United States during that period.

One third?? Wow.

I'm hoping for a 20% increase in the uptake of contraceptives in my research district in Tanzania, which may not even translate into a reduction in teen births at all.  And my intervention includes real people visiting homes, an attempt at solidifying the impact of the intervention with a very clear and personal message. 16 and Pregnant, on the other hand was a) optional b) could be turned off at any point c) is interrupted with commercials and d) may have included unclear and varying messages that affect fertility behavior in different directions.

The effect of TV shows on fertility behavior is not new, however, Brazil's soap operas had the effect of reducing fertility by showing happy families than are much smaller than the realistic size in Brazil at the time. How does one show send a positive message about smaller families and one show send a negative message about teen pregnancy? Artistic choice, I suppose, and probably something economists won't ever know.

Bongaarts and Casterline in Population and Development Review explore whether sub-Saharan Africa's fertility is systematically different from the rest of the world, a theory first posited by Caldwell (1992). The authors reject Caldwell's hypothesis that these countries are experiencing a different type of transition in which declines in fertility are occurring at older ages. However, they do confirm some unique characteristics of sub-Saharan Africa's fertility experience. First of all, in many regions, the decrease in Total Fertility Rate (TFR) has stalled, in contrast to the pattern of steep TFR decline in the earliest stages of demographic transitions in Latin American and Asia. And secondly, the small decreases in TFR are mostly driven by larger birth intervals rather than a desire for smaller families.

Except Rwanda. The Rwandan DHS shows an unusual pattern in which unmet need (as defined by women who do not want to get pregnant and are not using contraception) declined by nearly a half between 2005 and 2010, to which the authors credit the invigoration of a national family planning program. Contraceptives use more than doubled between 2005 and 2010. This stands in stark contrast to other sub-Saharan countries (e.g. Ghana, Burkina Faso, Kenya and Nigeria) where use of contraceptives has basically stalled since the mid-1990s.

What this paper doesn't answer is how the drivers of unmet need (e.g. lack of knowledge of contraceptive methods and supply; low quality and limited availability of family planning services; cost of methods in travel and time; familial objections and concerns about acceptability) that are propping up that green curve, can be fixed.

To clarify, this graph shows frequency of previous contraceptives used for women who have hidden contraceptive use in the past across twelve villages in Meatu, Tanzania. So, while hiding a condom is obviously difficult, women who have hidden the pill from their partner have also used condoms in the past. Injections are extremely popular in this rural district, notably for their effective duration.

Easily the most interesting graph I've made in a while.

Some thoughts from the Breakthrough Institute and the Washington Post on the world's survival of the supposed population bomb. Some interesting points here (and fantastic images), but I turn to David Lam's 2011 presidential address at the Population Association of America conference for more.

He justifies the 1960s era fear of the population bomb and his explanation is more robust than cultural exposure such as television. Namely 1) economic factors: Market responses, innovation (especially the green revolution), globalization and 2) demographic factors: urbanization, fertility decline and investment in children.

When we see growth rates of food output or GDP of 7% and 10% per year we can see how countries like Vietnam, China, and India outraced the Malthusian devil in recent decades. The point is not that population growth does not create challenges for economic development, but that these challenges can be overcome when forces like market liberalization lead to this kind of rapid economic growth.

It may seem that fertility decline alone is a simple explanation for surviving the population bomb, but this would undermine the effect of economic factors and incentives on fertility. Even as someone who studies the effect of simple access to family planning on fertility, I know they're all related.

Hat tip: NAJ, DL

I arrived in Tanzania on Monday and by lunch on Wednesday, I was in Swahili Sexual Education. For my dissertation research, I’m evaluating the effect of a community-based distributor family planning program in a rural northern district called Meatu. Three dynamic facilitators from the Ministry of Health are leading this two-week training session for community distributors (all women) from eight different villages.  It’s only been a couple of days, but this training is an awesome way to jump right into my research. 

I’m completely immersed in the language and it basically feels like I never left this town, so my Swahili is coming back and expanding with health vocabulary and sexual jokes. Sadly, I still don’t get the sexual jokes, but I pretend to. This usually makes everyone laugh even more.

The training is extremely comprehensive. In addition to photos and explanation about each method, there are demonstrations as well. The women (who will shortly become distributors of family planning education) can hold a dose of Depo Provera in their hand and see what the injection needle looks like. I’m learning more about the methods and mechanics of family planning than I ever did in school (and I didn’t even go to a Catholic school).

In addition to the humor and practical knowledge, this training actually seems to be serving as much of a role in empowering these young women as educating them. I never entirely sold this family planning program as empowerment, it’s a lofty concept and very difficult to teach. However, one of the trainers is incredible and I would be selling her short to say that she is not empowering. She led a participatory conversation about women taking control of their bodies, in terms of child-bearing and sexuality.  By the end of it, the distributors were chanting, “Tunaweza! Tunaweza!” (we can!). I got chills.

For IPUMS-International, I look at a lot of international census data. And I make a lot of household wealth indices using dwelling characteristics, utilities and household assets. Most census questionnaires ask about assets as an indicator of socioeconomic status, especially in developing countries. And most of these assets are common across countries: cell phone, TV, car, bicycle, cart, fan, computer, fridge, radio etc.

But, Haiti 2003 gave me two new indicators of wealth: machetes and excavators.

Some interesting food for thought concocted during a literature review adventure.

Demographers use the term "unmet need for family planning" to refer to couples who report not wanting any more children, yet are not using any form of contraceptives. This is actually incredibly common. In my sample of couples in northern Tanzania (n=650), 20% of women say that they do not want any more children however they are not using any form of contraceptives.

However, this very notion of "unmet need" is debatable. Linguistically incorrect and paternalistic, Lant Pritchett might say:

Although general linguistic usage would rank "needs" higher in the hierarchy of wants than "demands" or "desires," in calculating "unmet need" all women not wanting a child who report not using contraception ... are classified as "needing" contraception. In sub-Saharan Africa, only 37 percent of those with "unmet need" intend to use contraception, even though 85 percent know of a modern method. Therefore, women who have no demonstrated demand or expressed desire for family planning are reported as "needing" it. "Unmet need" does not reflect just women who want contraceptives (a supply need) but also those women who require motivation to want what they are presumed to need. This usage is consistent only with either a very broad, or very paternalistic, definition of "need."

Development achievements in Bangladesh, in part due to opportunities for women and family planning:

When the country became independent, population-control policies were all the rage (this was the period of China’s one-child policy and India’s forced sterilisations). Happily lacking the ability to impose such savage restrictions, the government embarked instead upon a programme of voluntary family planning. It was stunningly successful. It not only halved the rate of fertility within a generation, but also increased women’s influence within their own households. For the first time, wives controlled the size of families.

This program is called Matlab (Note to academics, that's Maht-lab, not Matt-lab) and it was remarkably successful. In fact, the distributive community health model is still being replicated, including in Tanzania where I am doing my research.

Hat tip: BM