Injectable Contraceptives, Fertility, and HIV: A Stover Fertility Decomposition of Malawi’s Total Fertility Rate

• In Event: 546 - Section on Sociology of Population Roundtable Session (one-hour).
  In Refereed Roundtable: Table 02. Fertility in Poorer Nations

Abstract

In the sub-Saharan African country of Malawi, injectables are the most commonly used form of contraception with 33 percent of sexually active women using injectable contraceptives in 2010. In 2011, research emerged that showed an increased risk of HIV transmission and acquisition when women use hormonal contraception, particularly injectables. Leaders in the global health community responded with concern and disdain over these findings. This paper asks: how would the total fertility rate (TFR) of Malawi change if women stopped using injectables or changed their patterns of contraceptive use due to fear of HIV infection or change in global support for injectables? Using the 2010 Malawi Demographic and Health Survey, I decompose the TFR using Stover’s method of fertility decomposition. My findings indicate that ceasing use of injectables would greatly increase the TFR to pre-1980s levels. The TFR also changes when women adjust their contraceptive behaviors without stopping use of contraception entirely. Lastly, I find that the gradual fertility decline in Malawi should continue if levels of injectable use follow the current trends. These findings should inform future fertility research and policy related to injectable contraceptive use, as to prevent a potential burden of unwanted births and increased HIV infection.

Author

• Hannah E. Furnas, Pennsylvania State University