Behavioural and biological determinants of fertility transition in sub-Saharan Africa.

In the transition from high to low fertility, different biological and behavioural proximate determinants play roles of varying importance in mediating the change. In most regions of the world, the practice of contraception has come to play the major role, so much so that there is a close relationship worldwide between the level of practice of contraception and the level of fertility. In sub-Saharan Africa, the prevalence of contraceptive practice is low, and fertility levels are exceptionally high for recorded levels of contraceptive practice, even where levels of contraceptive practice are comparable to other regions. The discrepancies are explained to a very large extent by differences between Africa and other regions in other proximate determinants--notably exposure to the risk of pregnancy, and abstinence after delivery. It would seem that transition in African countries will follow one of two patterns that are different to the pattern of transition observed in all other regions. First, fertility may rise before it declines, due to abandonment of traditional fertility regulation for some time prior to the eventual adoption of contraceptive practice. Second, the prevalence of contraceptive practice may rise for a time before there is an observable decline in fertility, because at the same time that contraception is adopted, traditional regulation of fertility is being abandoned, offsetting any effect on fertility. Kenya is an example of the first pattern, while Botswana, Ghana, and Zimbabwe are probably examples of the second.