Contraceptive use and fertility transitions: The distinctive experience of sub-Saharan Africa

Background: Continued rapid population growth in sub-Saharan Africa is driven predominantly by high fertility. Contraceptive use was a key determinant of past fertility transitions. An analysis of this relationship in sub-Saharan Africa can yield a better understanding of the region’s prospects for fertility decline. Methods: Using global estimates and projections, we describe trends in contraceptive use and fertility and analyse the relationship between the two. Timing, pace, and level parameters derived from Bayesian hierarchical models of historic contraceptive and fertility transitions are used to investigate how the experience of sub-Saharan Africa may be distinctive. Results: Fertility in sub-Saharan Africa fell from 6.4 births per woman in 1990 to 4.6 in 2020, the highest among regions today. Contraceptive use among married/in-union women in sub-Saharan Africa increased from 13% to 33% over the same period, and remains the region with lowest use. At all levels of contraceptive use, countries of sub-Saharan Africa tend towards higher fertility compared to other regions. Transitions in contraceptive use and fertility have occurred later in sub-Saharan Africa, and have been slower in Middle and Western Africa (but not Eastern and Southern Africa), compared to the experience of Asia, Latin America, and the Caribbean. Contribution: Based on an analysis using Bayesian models, we demonstrate large differences across countries in the pace and timing of fertility and contraceptive use transitions, and we confirm that Middle and Western Africa are distinct. The findings from these separate and independent models are similar, lending additional support to the validity of these conclusions.