1. Factors Behind Recent Fertility Plateauing in Jordan & Challenges to Maintaining Future Fertility Decline by Issa Almasarweh Professor – Jordan University

2. Presentation Outlines  Jordan Fertility Trends  Jordan Fertility Goals  Factors Affecting Fertility Rates  Challenges to Sustained Decline in Jordan Fertility

3. Current TFR in the Region Source: 2011 PRB WPDS

4. Jordan Fertility Level is Plateauing DHS

5. Wanted Fertility Increased DHS

6. Early progression to first child 2009 DHS

7. Fertility – a key component in Jordan future PG 3 million born in the last 20 years 2.3 are expected in the next 10 years RECENT09 Constant

8. Reducing Fertility is a National Priority Goal for Jordan Births per couple RHAP2

9. Direct Factors Affecting Fertility Rate 1) % of women 15- 49 married 2) Contraceptive use 3) Postpartum insusceptibility 4) Induced abortion 5) Infertility Fertility

10. (1) Marriage - % of Women 15-49 Ever-married DHS

11. % Ever-married below the age of 30 years 2002 & 2009 DHS

12. High Growth in Number of First Time Brides (4.3% annually) http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf

13. Early Marriages <18= 14% of total 1 st time brides 15-19= 30% of total 1 st time brides http://www.dos.gov.jo/sdb_pop/sdb_pop_a/ehsaat/alsokan/marri_divo/Marriages6.pdf

14. Age Specific Fertility Rates 2002 & 2009 DHS

15. Age Specific Fertility Rates - Urban 2002 & 2009 DHS

16. (2) Contraceptive use has leveled off DHS

17. Modern CPR by Sector -JCLS Based on JCLS

18. Infertility increased = % of women 45-49 who are childless Based on JCLS

19. Contraceptive Prevalence Rate Total Fertility Rate 65 % 3.0 Contraceptive Use needs to increase ! Fertility Plateauing FamPlan: File RECENT09

20. Summary – Indexes of direct factors affecting fertility

21. Challenges to raise contraceptive use and reduce fertility  Shrinking FP Choices / Access  Missed / Lost Opportunities  Churning – Discontinuation  Others

22. 1)Shrinking Choices / Access  Limited access to permanent & long-acting methods : Female Sterilization, Injectables, Implanon  Dominance of one and provider-based method (IUD)  Unmet preference for female providers (87%)  Disappearance of low-price OCs in the commercial sector  Uncertain role of major FP providers (JAFPP, RMS, Universities Hospitals)

23. 2) Missed Opportunities  At premarital exam  At time of signing marriage contract  At delivery and postnatal period low postnatal return low postnatal counseling no immediate IUDs insertion after delivery (providers fear of expulsion or lack training)  At child health care visits  At Schools and Colleges  At youth centers, clubs, camps  At Mosques  At Workplace  At pharmacies

24. 2) Missing Opportunities  Low demand on available services at SDPs  High downtime at SDPs due to lack of appointment system  Exclusion of FP in private health insurance  Exclusion of important groups: men, newly married, unmarried youth  Unfriendly breastfeeding environment at private hospitals

25. 3) Churning – Discontinuation  High FP discontinuation and failure rates – Quality of services - informed choice (poor treatment of side effects; inadequate and poor FP counseling) – High use of traditional methods – Unsatisfied users (20% want another method) – Son Preference – Family pressure (63% - 2007 DHS)

26. 1 st Year Discontinuation Rate (%)

27. Reasons for Discontinuation 42 % Source: Contraceptive Dynamics Study

28. Unmet need for FP use Source : 2009 DHS

29. TFR and Unmet Need and Discontinuation HPC, 2011, Reducing Discontinuation of Contraceptive Use and Unmet Need for FP, policy Briefs

30. 4) Other Challenges  Population Momentum – more than one million girl child exists now Number of women 15-49 years will increase from 1.6 to 2.0 million by 2020 The impact of this is shown in the next slide

31. Projected Contraceptive Users (all methods) Current Users 19 % FamPlan: Files RECENT09 & RECENT09 Constant 42 %

32. 4) Other Challenges  Divided civil society- politicalization of issues  Distortion of market forces through subsidies may delay the rationalization of childbearing decision by parents  Abuse of maternity leave by public sector servants