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Spatial differences in fertility decline in Kenya: evidence from recent fertility surveys
The Social Science Journal 39 (2002) 265–276
Spatial differences in fertility decline in Kenya: evidence from recent fertility surveys Robert A. Wortham∗ Department of Sociology, North Carolina Central University, Durham, NC 27707, USA
Abstract Province level fertility and socioeconomic development indicators from the 1989 and 1993 Kenya Demographic and Health Surveys (KDHS) document the spatial pattern of Kenya’s recent fertility decline. Although the data suggest that substantial regional variations in fertility reduction exist, fertility reduction has been pervasive throughout the 1989–1993 period. More specifically, the 1989 and 1993 KDHS data indicate that low fertility levels characterize the Nairobi–Central Province core while high fertility levels characterize Coast, Rift Valley and Western Province. However, Western Province has experienced the greatest percentage reduction in fertility throughout the period suggesting that the regional gaps in fertility decline are closing. Persistent fertility decline has also occurred in rural and urban areas, and fertility limitation is supported by Kenyan males. Factors impacting continued fertility reduction efforts are identified. © 2002 Published by Elsevier Science Inc.
1. Introduction Evidence of a fertility decline in Kenya was first signaled by the decline in the total fertility rate (TFR) documented in the 1984 Kenya Contraceptive Prevalence Survey (KCPS). According to the 1979 census, the TFR was 7.9 children; whereas, the 1984 KCPS reported a TFR of 7.7 children. More substantial declines were noted in the 1989 and 1993 Kenya Demographic and Health Survey (KDHS) data where the TFR had declined to 6.7 children (1989) and 5.4 children (1993). Available, fertility data indicate that Kenya experienced a 32% reduction in the TFR over the 1979–1993 period. This reduction is substantial as Caldwell, Orubuloye and Caldwell (1992, p. 211) argue that an “irreversible fertility transition” is achieved once fertility declines 10%.
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Although national level data suggest that Kenya is experiencing a fertility transition, is this fertility transition pervasive regionally and within rural and urban areas? Also, do males support fertility reduction? Province level and rural–urban fertility indicators drawn from the 1989 and 1993 KDHS are utilized to document Kenya’s spatial pattern of fertility reduction and to verify male support of fertility limitation. 2. Sample comparability Questions regarding the comparability of the 1989 KDHS and the 1984 KCPS have been raised (Blacker, 1994, pp. 200–205). Blacker (1994, p. 201) argues that since 1989 data for rural households were based on lists comprised 4–5 years prior to the survey, fertility patterns of new households are not reflected fully in the 1989 survey. Additional weaknesses in the KDHS sampling design include an over sampling of urban areas and a bias toward inclusion of rural districts selected for the national family planning program (Jensen, 1995, p. 270). However, Blacker (1994, p. 204) maintains that evidence of fertility decline from the 1989 census would help validate the KDHS findings. In a study on the geography of fertility reduction in Kenya based on 1979 and 1989 district level census data, Wortham (1999, pp. 176–180) notes that reductions in the annual rate of population growth for the period in excess of 10% were experienced in 18 (44%) of Kenya’s then 41 districts. Five of these 18 districts are included in the 1989 KDHS. Although sample design problems exist, the districts included in the 1989 and 1993 KDHS are comparable (Fig. 1). Thirteen rural districts were included in the 1989 survey. These districts were Kilifi (Coast Province); Machakos and Meru (Eastern Province); Muranga, Kirinyaga and Nyeri (Central Province); Kisii, Siaya and South Nyanza (Nyanza Province); Kericho and Uasin Gishu (Rift Valley Province); and Bungoma and Kakamega (Western Province). Kirinyaga (Central Province) was omitted from the 1993 survey, and Nandi and Nakuru (Rift Valley Province) and Taita (Coast Province) were added. Nairobi and Mombasa, districts containing the two largest urban centers (Nairobi and Mombasa), are included in both surveys.1 The KDHS sampling design is representative to the extent that both surveys include districts from every province except North-Eastern Province, which accounts for less than 2% of the total population (Republic of Kenya. Ministry of Planning and National Development, 1994a, p. 1). There are several additional differences in the 1989 and 1993 KDHS samples. The 1993 survey includes a larger percentage of younger women aged 15–19 years (23.3% versus 20.9%) and aged 20–24 years (21.7% versus 18.5%) and a smaller percentage of women with no formal education (17.9% versus 25.1%).2 The breakdown by rural–urban residence (82% versus 18%) and province is roughly equivalent (Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems Inc. (USA) 1989, pp. 4–7; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, pp. 5, 17). 3. Cultural regions The province level data from the 1989 and 1993 KDHS are presented within a cultural region framework identified by Omondi-Odhiambo (1997) based on conformity to “traditional
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Fig. 1. Districts included in 1989 and 1993 Kenya demographic and health surveys.
reproductive practices.” Omondi-Odhiambo (1997, pp. 29, 38) maintains that Kenya is a strong patriarchal society. Strong culturally conservative stances toward reproduction are reflected in regions characterized by a desire for larger families, a large number of polygynous marriages, a young median age at first marriage and significant opposition to family planning.
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Utilizing these criteria Omondi-Odhiambo (1997) classifies Kenya’s regions (provinces) as exhibiting strong, intermediate or weaker acceptance of traditional reproductive practices. Nyanza, Coast and Western Province (see Fig. 1) are included in the strong category while Rift Valley Province is in the intermediate category and Nairobi, Central and Eastern Province are in the weaker category. Omondi-Odhiambo’s framework is adopted in this study as a means of portraying province level variations in fertility and socioeconomic development indicators.3
4. Regional variations in fertility reduction indicators 4.1. Female fertility 1989 and 1993 KDHS data documenting regional variations in the total fertility rate, mean ideal number of children and percent of currently married women utilizing family planning are presented in Table 1. The percent change in each variable over the 1989–1993 period is provided for each province except North-Eastern Province. Two basic patterns are observed among these data. First, the decline in fertility has continued and is pervasive. The lowest 1993 total fertility rates are recorded for the Nairobi–Central Province core (3.4 and 3.9 children) while the highest fertility levels are noted in Western Province (6.4 children). With the exception of Coast and Eastern Province, this regional fertility reduction pattern supports the regional pattern identified by Omondi-Odhiambo (1997). Second, although regional variations in fertility persist, substantial reductions in fertility have Table 1 Regional variation in persistent fertility decline in Kenya: 1989–1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Fertility reduction indicators Total fertility rateb
Mean ideal number of childrenc
Percent utilization of family planningd
1989
1993
Change (%)
1989
1993
Change (%)
1989
1993
4.2 6.0 7.2 7.0 6.9 8.1 5.4
3.4 3.9 5.9 5.7 5.8 6.4 5.3
−19.0 −35.0 −18.1 −18.6 −15.9 −21.0 −1.9
3.6 3.8 4.2 4.7 4.6 4.9 5.6
2.7 3.1 3.5 4.1 3.8 3.8 4.5
−25.0 −18.4 −16.7 −12.8 −17.4 −22.4 −19.6
33.5 39.5 40.2 29.6 13.8 13.7 18.1
45.4 56.0 38.4 27.8 23.8 25.1 20.2
Change (%) 35.5 41.8 −4.5 −6.1 72.5 83.2 11.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro System, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS. b 1989 and 1993 data are for the 3-year period preceding each survey. c For all women aged 15–49 years. d Current use of any family planning method by currently married women.
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been experienced in Central and Western Province. Perhaps the regional gaps in fertility reduction are becoming less pronounced. A similar fertility reduction pattern is observed with the 1993 data for mean ideal number of children. The Nairobi–Central core is identified as the region with the lowest level of desired fertility, while desired fertility is highest in the Coast Province. However, the greatest percentage change in fertility reduction is observed in Nairobi (25.0%) and Western Province (22.4%) again suggesting that regional gaps in fertility reduction are closing. The high demand for children may be attributed partially to the maintenance of high fertility environments. Coast Province is characterized by a high degree of religious and cultural pluralism. Traditional religious communities are strong in Kilifi district while Mombasa district is characterized by a strong Islamic presence (Wortham, 1991). Caldwell and Caldwell (1987) maintain that high levels of fertility are legitimated and maintained by traditional belief systems where strong associations exist among lineage, descent and fertility. A high demand for children may also be supported by Islamic beliefs involving polygyny, women’s status and the children’s economy (Schildkrout, 1993, pp. 111–114; Simpson-Hebert, 1991, pp. 133–137; Stark, 1994, p. 177). However, the sizable decline (19.6%) in the ideal number of children desired by Coast Province women may signal some disagreement with the traditional role and status of women. The 1993 KDHS data reveal that utilization of family planning services is highest in the Nairobi–Central Province core and lowest in Coast Province. Although high levels of fertility persist in western Kenya, the most substantial percentage increases in the utilization of family planning services were observed in Western (83.2%) and Nyanza (72.5%) Province. The data for the three fertility reduction indicators summarized in Table 1 provide evidence of persistent fertility decline in the Nairobi–Central core and of substantial gains in fertility reduction in Western Province. This suggests that fertility reduction is pervasive and that regional gaps in fertility decline are closing. Regional differences in the utilization of modern and traditional family planning methods and in the ratio of modern to traditional contraceptive methods for the 1989–1993 period are documented in Table 2. The percentage of currently married women currently using modern methods (e.g., the pill) increased for each province during the 1989–1993 period while utilization of traditional contraceptive methods (e.g., periodic abstinence) declined in each province except Nairobi and Coast. The greatest current use of modern methods is observed in the Nairobi–Central Province core while the lowest level is recorded for Coast Province. Substantial gains in use of modern family planning methods are recorded for Nyanza and Western Province where utilization rates doubled from 1989 to 1993. The modern/traditional method ratio remained essentially unchanged for Nairobi and Coast Province while a continued traditional to modern contraceptive method transition is noted for the remaining provinces. The transition is most extensive in Nyanza followed by Central and Western Province again suggesting a possible reduction in the regional differences in fertility between western and central Kenya. 4.2. Male fertility In analyzing the 1989 KDHS data for males, Omondi-Odhiambo (1997, pp 29, 32–33, 36) concludes that Kenyan men participate in contraceptive use decisions and that they support
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Table 2 Percent of currently married women currently using modern or traditional family planning methods by province: 1989–1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Family planning method
Modern/traditional ratio
Modern methods (%)
Traditional methods (%)
1989
1993
1989
1993
1989
1993
27.9 30.8 19.5 18.1 10.2 10.0 14.8
37.8 49.7 30.5 21.0 21.5 21.7 16.6
5.6 8.7 20.7 11.5 3.6 3.7 3.3
7.7 6.3 7.9 6.9 2.3 3.4 3.6
5.0 3.5 0.9 1.6 2.8 2.7 4.5
4.9 7.9 3.9 3.0 9.3 6.4 4.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS.
family planning programs. Current contraceptive use is highest among male partners residing in Nairobi, Central and Eastern Province and in urban areas, among males with higher education and in professional and clerical jobs, among males who discuss contraceptive use with their spouses and in instances where neither spouse desires more children. Continued male support of family planning is reflected in the 1993 KDHS data. Province level male fertility indicators are summarized in Table 3. These data reveal that knowledge of any contraceptive method is almost universal among the males surveyed. Approval of family planning is observed among over 70% of the couples for each province. Although contraceptive use cannot be inferred directly from knowledge and/or approval of family planning, the 1993 KDHS data suggest that male support of contraceptive use has remained strong. At least Table 3 Male fertility indicators by province: 1993a Province
Know any contraceptive methodb (%)
Husband/wife approval of family planning (%)
Currently using any contraceptive methodc (%)
Currently using modern contraceptive methodc (%)
Nairobi Central Eastern Rift Valley Nyanza Western Coast
100.0 95.9 99.6 98.0 99.6 99.7 100.0
79.0 73.9 82.5 75.8 72.6 71.4 70.5
58.0 58.9 84.9 50.0 36.5 40.8 42.5
37.0 44.5 43.2 24.6 21.5 32.4 19.0
Source: Republic of Kenya. National Council for Population and Development(Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1993 KDHS. b For all men aged 20–54 years. c For currently married men aged 20–54 years.
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half of the currently married males aged 20–54 years are currently using a contraceptive method in Eastern (84.9%), Central (58.9%), Nairobi (58.0%) and Rift Valley (50%) Province. Furthermore, current use of modern contraceptive methods exceeds the current use of traditional methods by currently married men aged 20–54 years in every province except Rift Valley and Coast Province. Perhaps the utilization of western family planning methods is becoming more culturally acceptable among males. The spatial pattern of male contraceptive use identified in the 1993 KDHS data reinforces the regional male contraceptive resistance pattern noted by Omondi-Odhiambo in the 1989 KDHS data. Omondi-Odhiambo (1997, p. 33) observed that adherence to “traditional reproductive practices” was strongest in Nyanza, Coast and Western Province and weakest in Nairobi, Central and Eastern Province. Adherence was moderate in Rift Valley Province. This pattern is generally reflected in the 1993 KDHS data for couple approval of family planning and male current use of any contraceptive method. Male support for family planning appears to be persistent for the 1989–1993 period. 4.3. Socioeconomic indicators Demand theories of fertility decline suggest that changes in socioeconomic development affect the cost of children, intergenerational wealth flow, educational attainment and the status of women. These factors are associated with structural changes that favor fertility reduction (Berelson, 1978; Bongaarts, 1993, p. 437; Jensen, 1995, pp. 263–266; Okun, 1994, p. 193; Pritchett, 1994, pp. 39–42; Stark, 1994, pp. 550, 555; Uitto, 1992, pp. 185–188). Supply theories of fertility decline address contraceptive awareness, proximity to service delivery points and availability of contraceptive methods. These factors are believed to impact the utilization of family planning services (Bongaarts, 1993, p. 437; Jensen, 1995, pp. 263–266; Knowles, Akin, & Guilkey, 1994, pp. 611, 614; Okun, 1994, p. 193). The National Research Council’s (1993, pp. 158–159) analysis of the 1989 KDHS data provides support for demand and supply theories of fertility decline. The strongest predictors of contraceptive use identified are availability of family planning services (supply theory indicator), rural literacy (demand theory indicator) and households with electricity (demand theory indicator). Province level data from the 1993 KDHS for four measures of socioeconomic development are provided in Table 4. The measures included are percentage of households with electricity, public water and radios and women of reproductive age with secondary education. These data indicate that substantial regional inequality in socioeconomic development exists. As expected, availability of electricity and public water is highest among the households in the two urban provinces, Nairobi and Coast. However, the gap in access to electricity and public water between Nairobi and Central Province is noticeable suggesting that pronounced differences in socioeconomic development exist within the Nairobi–Central Province core. The extension of these basic amenities to the remaining rural areas has been minimal. Only 3–8% of households in the remaining four rural provinces have access to electricity, and only 12–26% of households have access to public water. Nyanza Province stands out as the least developed province where only 3.4% of households have access to electricity and 11.9% has access to public water. When the socioeconomic development data (Table 4) are compared with the fertility reduction data (Table 1), it appears that an inverse association exists between
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Table 4 Socioeconomic development indicators for Kenya by province: 1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Socioeconomic indicators Households with electricity (%)
Households with public waterc (%)
Households with radio (%)
50.8 9.8 4.1 7.1 3.4 7.6 16.9
92.3 38.1 26.4 25.7 11.9 19.7 53.2
68.9 55.3 51.6 49.3 42.3 56.8 46.4
Female secondary educationb (%)
48.0 31.3 21.3 21.7 18.2 25.8 17.5
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1993 KDHS. b Data are for women aged 15–49 years. c Figure includes water piped into residence and public tap.
fertility and socioeconomic development for each province except Coast and perhaps Eastern Province.4 A slightly different picture emerges with the radio ownership and women’s secondary education data. Radio provides an avenue for the diffusion of westernization as educational, health care and family planning information can be disseminated via radio. As women’s educational attainment increases, their participation in the modern economy and their influence on fertility decisions may increase. Radio ownership and female secondary education is highest in the Nairobi–Central Province core and lowest in Nyanza and Coast Province. High levels of radio ownership and female secondary education are also noted in Western Province. Since mass communication and education impact fertility decline (Berelson, 1978; Cutright & Hargens, 1984, pp. 459–471; Stark, 1994, p. 550), it is not surprising that the Nairobi–Central Province core has experienced persistent fertility decline and that Western Province has experienced substantial gains in fertility reduction (see Table 1). 5. Rural–urban differences in fertility decline Fertility reductions in rural and urban areas have been noted in the 1989 KDHS data (National Research Council, 1993; Omondi-Odhiambo, 1997, p. 34; Robinson, 1992), but have these reductions continued into the 1990s? Rural–urban changes in indicators of fertility and socioeconomic development for the 1989–1993 period are summarized in Table 5. The fertility decline has continued in Kenya’s rural and urban regions. Declines in the total fertility rate and mean ideal number of children at or exceeding 15% are noted for rural and urban areas although the urban decline has been more extensive. In 1993 almost one in three currently married rural women of reproductive age utilized family planning services while four in ten urban women utilized these services. Rural and urban women have reached parity with regard to contraceptive knowledge, which is almost universal among currently married women.
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Table 5 Rural–urban differences in fertility reduction and socioeconomic development for Kenya: 1989–1993a Indicator
Place of residence Rural
Total fertility rate Mean ideal number of childrenb Utilization of family planningc Contraceptive knowledgec Households with electricity (%) Households with radio (%) Women’s secondary educationd
Urban
1989
1993
Change (%)
1989
1993
Change (%)
7.1 4.6 26.2 89.1 2.8 58.0 16.0
5.8 3.9 30.9 97.0 3.4 48.1 19.9
−18.3 −15.2 17.9 8.9 21.4 −17.1 24.4
4.5 3.8 30.5 94.1 45.2 77.6 41.4
3.4 2.9 43.4 98.5 42.5 67.7 45.8
−24.4 −23.7 42.3 4.7 −6.0 −12.8 10.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro System, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS. b For women aged 15–49 years. c Percentage of currently married women. d Percentage of women aged 15–49 years.
The last three indicators included in Table 5 are measures of socioeconomic development. The percentage increase in women’s secondary education exceeded 10% for rural and urban women, but only one in five rural women has obtained secondary education. The electricity access gap remains substantial. Only 3.4% of rural households have electricity compared to 42.5% of urban households surveyed. The rural–urban differences in socioeconomic development may contribute to the slower pace of fertility reduction in the rural areas. This is significant since 82% of Kenya’s population resides in rural areas (Republic of Kenya. Ministry of Planning and National Development, 1994b, p. 6). Finally, the percent of households with radios declined in the rural and urban areas. Although this decline may reflect differences in the 1989 and 1993 sample design,5 the decline in radio ownership could signal a decline in socioeconomic development. Per capita gross national product (GNP) in 1982 was US$390, but by 1995 per capita GNP was only US$280 (World Bank, 1984, 1997). Similarly, the annual growth rate in GNP for the 1985–1995 period was negligible at 0.1% (World Bank, 1997). Economic stagnation could limit the government’s ability to expand family planning services in the rural areas and at the district administrative level. This could impact sustained fertility decline and lengthen the time required to attain regional and rural–urban fertility parity.
6. Discussion Kenya’s fertility decline has persisted throughout the 1989–1993 period at the province level (Table 1) and in rural and urban areas (Table 5). The status of women is changing (Tables 4 and 5); men are supportive of family planning (Table 3), and the percentage of currently married women of reproductive age utilizing modern family planning methods has increased
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for every province during the 1989–1993 period (Table 2). Studies by the National Research Council (1993), Njoru (1991), Robinson (1992) and Uitto (1992) document fertility declines among women of different age groups and educational attainment levels, among rural and urban women and among women in many of the different geographic regions. However, recent economic stagnation could hinder further fertility reduction. The 1993 KDHS data indicate that low fertility levels and greater utilization of family planning characterize the Nairobi–Central Province core while high fertility levels and modest family planning utilization levels characterize Coast, Rift Valley and Western Province (Table 1). However, Western Province experienced the greatest percentage reduction in fertility over the 1989–1993 KDHS period (Table 1). Regional differences in fertility decline persist, but these differences may be diminishing. Finally, the Nairobi–Central Province core has experienced the greatest degree of socioeconomic development while Nyanza Province has experienced the least (Table 4). Some attention has been directed toward explaining the difference in fertility levels in central and western Kenya. Uitto (1992, pp. 185, 192–193, 195) maintains that Central Province’s lower fertility levels may be attributed to women’s higher educational attainment, the Kikuyu’s extensive contact with westernization, good communication networks, proximity to Nairobi and the development of commercial agriculture. Conversely, in traditional Kisii society, women are responsible for farm production. They may receive help from their children who may also provide care in old age. Women are treated as minors legally and can only accumulate wealth through their children. These conditions favor large families and high fertility levels (Caldwell & Caldwell, 1990, p. 120; Pillai, 1992, p. 267). In evaluating Kenya’s population policies, Pillai (1992, pp. 268–270) argues that family planning efforts can be enhanced if existing cultural traditions such as birth spacing are reinforced and if adequate maternal and child nutritional and health services are extended to the rural areas. Reviewing Kenya’s demographic history from 1965 through 1989, Kelley and Nobbe (1990, pp. 79–80) argue that population policies and programs could be strengthened by improving the effectiveness of existing family planning facilities, minimizing the perceived social and psychological costs associated with family planning and developing district level population programs and policies. The Kenyan government’s interest in family planning has remained strong in recent decades. The National Council for Population and Development was established in 1982 to help coordinate health care and family planning efforts as well as develop population policies and strategies (Harbison & Robinson, 1993, p. 8; Njoru, 1991, p. 84; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994), p. 3). More recently, the 1994–1996 Kenya Development Plan called for the increased availability of health care services, the consolidation of maternal/child health and family planning services, the securing of non-governmental and governmental health care funding sources and the expansion of preventive health measures (Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, pp. 3–4). These efforts should promote continued fertility decline and reduce regional gaps in fertility decline. However, declining socioeconomic development will affect Kenya’s ability to fund programs aimed at reducing fertility. The restrictive impact of budget limitations on the provision of health and education programs has been documented (Njoru, 1991, p. 96; Republic of
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Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, p. 4; Uitto, 1989, pp. 167, 172–174). The development of community-based (harambee)/government assisted health care and education projects and increased funding from the private sector and international agencies may partially alleviate this problem. On the other hand, persistent program funding problems could adversely affect continued fertility reduction and significantly delay the attainment of regional fertility decline parity.
Notes 1. Although Nakuru is classified as a rural district, it includes Nakuru city, Kenya’s fourth largest city (Republic of Kenya. Ministry of Planning and National Development, 1994a, 1994b). 2. Some of the age and education differences may be attributed to differences in the geographic areas covered by each sample. 3. Western Province will follow Nyanza in the province list due to the geographical proximity of these provinces. 4. This finding does not mean that the inverse association between fertility and socioeconomic development holds for each district within each province. 5. The 1989 and 1993 KDHS do reflect differences in area coverage, but the rural–urban composition of the sample is essentially the same. Urban residents comprise 17.3% of the 1989 sample and 17.8% of the 1993 sample (Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (U.S.) 1989, p.7; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International, Inc. (U.S.) 1994, p. 17).
Acknowledgments Earlier versions of this study were presented at the 1998 and 1995 annual meetings of the Southern Sociological Society and the 1995 annual meeting of the Southern Demographic Association.
References Berelson, B. (1978). Prospects and programs for fertility reduction: What? Where? Population and Development Review, 4, 579–616. Blacker, J. (1994). Some thoughts on the evidence of fertility decline in eastern and southern Africa. Population and Development Review, 20, 200–205. Bongaarts, J. (1993). The supply-demand framework for the determinants of fertility: An alternative implementation. Population Studies, 47, 437–456. Caldwell, J. C., & Caldwell, P. (1987). The cultural context of high fertility in sub-Saharan Africa. Population and Development, 13, 409–437. Caldwell, J. C., & Caldwell, P. (1990). High fertility in sub-Saharan Africa. Scientific American, 262, 118–125.
276
R.A. Wortham / The Social Science Journal 39 (2002) 265–276
Caldwell, J., Orubuloye, I., & Caldwell, P. (1992). Fertility decline in Africa: A new type of transition? Population and Development Review, 13, 409–437. Cutright, P., & Hargens, L. (1984). The threshold hypothesis: Evidence from less developed Latin American countries, 1950 to 1980. Demography, 21, 459–473. Harbison, S. F., & Robinson, W. C. (1993). Components of the recent fertility decline in Kenya. Population Research Institute, The Pennsylvania State University working paper No. 1993-06. University Park, PA: Population Research Institute, The Pennsylvania State University. Jensen, A.-M. (1995). Prospect of a decline in fertility in sub-Saharan Africa: A review of the recent debate. Acta Sociologica, 38, 263–273. Kelley, A. C., & Nobbe C. E. (1990). Kenya at the demographic turning point? World Bank discussion paper No. 107. Washington, DC: The World Bank. Knowles, J. C., Akin, J. S., & Guilkey, D. (1994). The Impact of population policies: Comment. Population and Development Review, 20, 611–615. National Research Council. (1993). Population dynamics of Kenya. In W. Brass & C. L. Jolly (Eds.). Washington, DC: National Academy Press. Njoru, W. (1991). Trends and determinants of contraceptive use in Kenya. Demography, 28, 83–99. Okun, B. S. (1994). Evaluating methods for detecting fertility control: Coale and Trussell’s model and cohort parity analysis. Population Studies, 48, 193–222. Omondi-Odhiambo, (1997). Men’s participation in family planning decisions in Kenya. Population Studies, 51, 29–40. Pillai, V. K. (1992). Social change and family planning in Kenya. The Indian Journal of Social Work, 53, 267–272. Pritchett, L. H. (1994). Desired fertility and the impact on population policies. Population and Development Review, 20, 1–55. Republic of Kenya. Ministry of Planning and National Development. (1994a). Kenya population census, 1989 (Vol. 1). Nairobi: Government Printer. Republic of Kenya. Ministry of Planning and National Development. (1994b). Kenya population census, 1989 (Vol. 2). Nairobi: Government Printer. Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (USA) (1989). Kenya demographic and health survey 1989. Columbia, MD: National Development and Institute for Resource Development/Macro Systems, Inc., USA. Republic of Kenya. National Council for Population and Development (Kenya) and Macro International, Inc. (USA) (1994). Kenya demographic and health survey 1993. Calverton, MD: National Council for Population and Development, Central Bureau of Statistics and Macro International, Inc., USA. Robinson, W. (1992). Kenya enters the fertility transition. Population Studies, 46, 445–457. Schildkrout, E. (1993). Young traders of northern Nigeria. In E. Angeloni (Ed.), Anthropology annual editions 93/94 (pp. 111–114). Guilford, CT: The Duskin Publishing Group, Inc. Simpson-Hebert, M. (1991). Women, food, and hospitality in Iranian society. In E. Angeloni (Ed.), Anthropology annual editions 91/92 (pp. 133–137). Guilford, CT: The Duskin Publishing Group, Inc. Stark, R. (1994). Sociology (5th ed.). Belmont, CA: Wadsworth Publishing Company. Uitto, J. (1989). The Kenya conundrum: A regional analysis of population growth and primary education in Kenya. Lund: Lund University Press. Uitto, J. (1992). Fertility transition and socio-economic change in western Kenya. African Study Monographs, 13, 185–201. World Bank. (1984). World development report 1984. New York: Oxford University Press. World Bank. (1997). World development report 1997. New York: Oxford University Press. Wortham, R. (1991). Spatial development and religious orientation in Kenya. San Francisco: Mellen Research University Press. Wortham, R. (1999). The geography of fertility reduction in Kenya. The Social Science Journal, 36, 173–184.
Spatial differences in fertility decline in Kenya: evidence from recent fertility surveys Robert A. Wortham∗ Department of Sociology, North Carolina Central University, Durham, NC 27707, USA
Abstract Province level fertility and socioeconomic development indicators from the 1989 and 1993 Kenya Demographic and Health Surveys (KDHS) document the spatial pattern of Kenya’s recent fertility decline. Although the data suggest that substantial regional variations in fertility reduction exist, fertility reduction has been pervasive throughout the 1989–1993 period. More specifically, the 1989 and 1993 KDHS data indicate that low fertility levels characterize the Nairobi–Central Province core while high fertility levels characterize Coast, Rift Valley and Western Province. However, Western Province has experienced the greatest percentage reduction in fertility throughout the period suggesting that the regional gaps in fertility decline are closing. Persistent fertility decline has also occurred in rural and urban areas, and fertility limitation is supported by Kenyan males. Factors impacting continued fertility reduction efforts are identified. © 2002 Published by Elsevier Science Inc.
1. Introduction Evidence of a fertility decline in Kenya was first signaled by the decline in the total fertility rate (TFR) documented in the 1984 Kenya Contraceptive Prevalence Survey (KCPS). According to the 1979 census, the TFR was 7.9 children; whereas, the 1984 KCPS reported a TFR of 7.7 children. More substantial declines were noted in the 1989 and 1993 Kenya Demographic and Health Survey (KDHS) data where the TFR had declined to 6.7 children (1989) and 5.4 children (1993). Available, fertility data indicate that Kenya experienced a 32% reduction in the TFR over the 1979–1993 period. This reduction is substantial as Caldwell, Orubuloye and Caldwell (1992, p. 211) argue that an “irreversible fertility transition” is achieved once fertility declines 10%.
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Although national level data suggest that Kenya is experiencing a fertility transition, is this fertility transition pervasive regionally and within rural and urban areas? Also, do males support fertility reduction? Province level and rural–urban fertility indicators drawn from the 1989 and 1993 KDHS are utilized to document Kenya’s spatial pattern of fertility reduction and to verify male support of fertility limitation. 2. Sample comparability Questions regarding the comparability of the 1989 KDHS and the 1984 KCPS have been raised (Blacker, 1994, pp. 200–205). Blacker (1994, p. 201) argues that since 1989 data for rural households were based on lists comprised 4–5 years prior to the survey, fertility patterns of new households are not reflected fully in the 1989 survey. Additional weaknesses in the KDHS sampling design include an over sampling of urban areas and a bias toward inclusion of rural districts selected for the national family planning program (Jensen, 1995, p. 270). However, Blacker (1994, p. 204) maintains that evidence of fertility decline from the 1989 census would help validate the KDHS findings. In a study on the geography of fertility reduction in Kenya based on 1979 and 1989 district level census data, Wortham (1999, pp. 176–180) notes that reductions in the annual rate of population growth for the period in excess of 10% were experienced in 18 (44%) of Kenya’s then 41 districts. Five of these 18 districts are included in the 1989 KDHS. Although sample design problems exist, the districts included in the 1989 and 1993 KDHS are comparable (Fig. 1). Thirteen rural districts were included in the 1989 survey. These districts were Kilifi (Coast Province); Machakos and Meru (Eastern Province); Muranga, Kirinyaga and Nyeri (Central Province); Kisii, Siaya and South Nyanza (Nyanza Province); Kericho and Uasin Gishu (Rift Valley Province); and Bungoma and Kakamega (Western Province). Kirinyaga (Central Province) was omitted from the 1993 survey, and Nandi and Nakuru (Rift Valley Province) and Taita (Coast Province) were added. Nairobi and Mombasa, districts containing the two largest urban centers (Nairobi and Mombasa), are included in both surveys.1 The KDHS sampling design is representative to the extent that both surveys include districts from every province except North-Eastern Province, which accounts for less than 2% of the total population (Republic of Kenya. Ministry of Planning and National Development, 1994a, p. 1). There are several additional differences in the 1989 and 1993 KDHS samples. The 1993 survey includes a larger percentage of younger women aged 15–19 years (23.3% versus 20.9%) and aged 20–24 years (21.7% versus 18.5%) and a smaller percentage of women with no formal education (17.9% versus 25.1%).2 The breakdown by rural–urban residence (82% versus 18%) and province is roughly equivalent (Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems Inc. (USA) 1989, pp. 4–7; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, pp. 5, 17). 3. Cultural regions The province level data from the 1989 and 1993 KDHS are presented within a cultural region framework identified by Omondi-Odhiambo (1997) based on conformity to “traditional
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Fig. 1. Districts included in 1989 and 1993 Kenya demographic and health surveys.
reproductive practices.” Omondi-Odhiambo (1997, pp. 29, 38) maintains that Kenya is a strong patriarchal society. Strong culturally conservative stances toward reproduction are reflected in regions characterized by a desire for larger families, a large number of polygynous marriages, a young median age at first marriage and significant opposition to family planning.
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Utilizing these criteria Omondi-Odhiambo (1997) classifies Kenya’s regions (provinces) as exhibiting strong, intermediate or weaker acceptance of traditional reproductive practices. Nyanza, Coast and Western Province (see Fig. 1) are included in the strong category while Rift Valley Province is in the intermediate category and Nairobi, Central and Eastern Province are in the weaker category. Omondi-Odhiambo’s framework is adopted in this study as a means of portraying province level variations in fertility and socioeconomic development indicators.3
4. Regional variations in fertility reduction indicators 4.1. Female fertility 1989 and 1993 KDHS data documenting regional variations in the total fertility rate, mean ideal number of children and percent of currently married women utilizing family planning are presented in Table 1. The percent change in each variable over the 1989–1993 period is provided for each province except North-Eastern Province. Two basic patterns are observed among these data. First, the decline in fertility has continued and is pervasive. The lowest 1993 total fertility rates are recorded for the Nairobi–Central Province core (3.4 and 3.9 children) while the highest fertility levels are noted in Western Province (6.4 children). With the exception of Coast and Eastern Province, this regional fertility reduction pattern supports the regional pattern identified by Omondi-Odhiambo (1997). Second, although regional variations in fertility persist, substantial reductions in fertility have Table 1 Regional variation in persistent fertility decline in Kenya: 1989–1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Fertility reduction indicators Total fertility rateb
Mean ideal number of childrenc
Percent utilization of family planningd
1989
1993
Change (%)
1989
1993
Change (%)
1989
1993
4.2 6.0 7.2 7.0 6.9 8.1 5.4
3.4 3.9 5.9 5.7 5.8 6.4 5.3
−19.0 −35.0 −18.1 −18.6 −15.9 −21.0 −1.9
3.6 3.8 4.2 4.7 4.6 4.9 5.6
2.7 3.1 3.5 4.1 3.8 3.8 4.5
−25.0 −18.4 −16.7 −12.8 −17.4 −22.4 −19.6
33.5 39.5 40.2 29.6 13.8 13.7 18.1
45.4 56.0 38.4 27.8 23.8 25.1 20.2
Change (%) 35.5 41.8 −4.5 −6.1 72.5 83.2 11.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro System, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS. b 1989 and 1993 data are for the 3-year period preceding each survey. c For all women aged 15–49 years. d Current use of any family planning method by currently married women.
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been experienced in Central and Western Province. Perhaps the regional gaps in fertility reduction are becoming less pronounced. A similar fertility reduction pattern is observed with the 1993 data for mean ideal number of children. The Nairobi–Central core is identified as the region with the lowest level of desired fertility, while desired fertility is highest in the Coast Province. However, the greatest percentage change in fertility reduction is observed in Nairobi (25.0%) and Western Province (22.4%) again suggesting that regional gaps in fertility reduction are closing. The high demand for children may be attributed partially to the maintenance of high fertility environments. Coast Province is characterized by a high degree of religious and cultural pluralism. Traditional religious communities are strong in Kilifi district while Mombasa district is characterized by a strong Islamic presence (Wortham, 1991). Caldwell and Caldwell (1987) maintain that high levels of fertility are legitimated and maintained by traditional belief systems where strong associations exist among lineage, descent and fertility. A high demand for children may also be supported by Islamic beliefs involving polygyny, women’s status and the children’s economy (Schildkrout, 1993, pp. 111–114; Simpson-Hebert, 1991, pp. 133–137; Stark, 1994, p. 177). However, the sizable decline (19.6%) in the ideal number of children desired by Coast Province women may signal some disagreement with the traditional role and status of women. The 1993 KDHS data reveal that utilization of family planning services is highest in the Nairobi–Central Province core and lowest in Coast Province. Although high levels of fertility persist in western Kenya, the most substantial percentage increases in the utilization of family planning services were observed in Western (83.2%) and Nyanza (72.5%) Province. The data for the three fertility reduction indicators summarized in Table 1 provide evidence of persistent fertility decline in the Nairobi–Central core and of substantial gains in fertility reduction in Western Province. This suggests that fertility reduction is pervasive and that regional gaps in fertility decline are closing. Regional differences in the utilization of modern and traditional family planning methods and in the ratio of modern to traditional contraceptive methods for the 1989–1993 period are documented in Table 2. The percentage of currently married women currently using modern methods (e.g., the pill) increased for each province during the 1989–1993 period while utilization of traditional contraceptive methods (e.g., periodic abstinence) declined in each province except Nairobi and Coast. The greatest current use of modern methods is observed in the Nairobi–Central Province core while the lowest level is recorded for Coast Province. Substantial gains in use of modern family planning methods are recorded for Nyanza and Western Province where utilization rates doubled from 1989 to 1993. The modern/traditional method ratio remained essentially unchanged for Nairobi and Coast Province while a continued traditional to modern contraceptive method transition is noted for the remaining provinces. The transition is most extensive in Nyanza followed by Central and Western Province again suggesting a possible reduction in the regional differences in fertility between western and central Kenya. 4.2. Male fertility In analyzing the 1989 KDHS data for males, Omondi-Odhiambo (1997, pp 29, 32–33, 36) concludes that Kenyan men participate in contraceptive use decisions and that they support
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Table 2 Percent of currently married women currently using modern or traditional family planning methods by province: 1989–1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Family planning method
Modern/traditional ratio
Modern methods (%)
Traditional methods (%)
1989
1993
1989
1993
1989
1993
27.9 30.8 19.5 18.1 10.2 10.0 14.8
37.8 49.7 30.5 21.0 21.5 21.7 16.6
5.6 8.7 20.7 11.5 3.6 3.7 3.3
7.7 6.3 7.9 6.9 2.3 3.4 3.6
5.0 3.5 0.9 1.6 2.8 2.7 4.5
4.9 7.9 3.9 3.0 9.3 6.4 4.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS.
family planning programs. Current contraceptive use is highest among male partners residing in Nairobi, Central and Eastern Province and in urban areas, among males with higher education and in professional and clerical jobs, among males who discuss contraceptive use with their spouses and in instances where neither spouse desires more children. Continued male support of family planning is reflected in the 1993 KDHS data. Province level male fertility indicators are summarized in Table 3. These data reveal that knowledge of any contraceptive method is almost universal among the males surveyed. Approval of family planning is observed among over 70% of the couples for each province. Although contraceptive use cannot be inferred directly from knowledge and/or approval of family planning, the 1993 KDHS data suggest that male support of contraceptive use has remained strong. At least Table 3 Male fertility indicators by province: 1993a Province
Know any contraceptive methodb (%)
Husband/wife approval of family planning (%)
Currently using any contraceptive methodc (%)
Currently using modern contraceptive methodc (%)
Nairobi Central Eastern Rift Valley Nyanza Western Coast
100.0 95.9 99.6 98.0 99.6 99.7 100.0
79.0 73.9 82.5 75.8 72.6 71.4 70.5
58.0 58.9 84.9 50.0 36.5 40.8 42.5
37.0 44.5 43.2 24.6 21.5 32.4 19.0
Source: Republic of Kenya. National Council for Population and Development(Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1993 KDHS. b For all men aged 20–54 years. c For currently married men aged 20–54 years.
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half of the currently married males aged 20–54 years are currently using a contraceptive method in Eastern (84.9%), Central (58.9%), Nairobi (58.0%) and Rift Valley (50%) Province. Furthermore, current use of modern contraceptive methods exceeds the current use of traditional methods by currently married men aged 20–54 years in every province except Rift Valley and Coast Province. Perhaps the utilization of western family planning methods is becoming more culturally acceptable among males. The spatial pattern of male contraceptive use identified in the 1993 KDHS data reinforces the regional male contraceptive resistance pattern noted by Omondi-Odhiambo in the 1989 KDHS data. Omondi-Odhiambo (1997, p. 33) observed that adherence to “traditional reproductive practices” was strongest in Nyanza, Coast and Western Province and weakest in Nairobi, Central and Eastern Province. Adherence was moderate in Rift Valley Province. This pattern is generally reflected in the 1993 KDHS data for couple approval of family planning and male current use of any contraceptive method. Male support for family planning appears to be persistent for the 1989–1993 period. 4.3. Socioeconomic indicators Demand theories of fertility decline suggest that changes in socioeconomic development affect the cost of children, intergenerational wealth flow, educational attainment and the status of women. These factors are associated with structural changes that favor fertility reduction (Berelson, 1978; Bongaarts, 1993, p. 437; Jensen, 1995, pp. 263–266; Okun, 1994, p. 193; Pritchett, 1994, pp. 39–42; Stark, 1994, pp. 550, 555; Uitto, 1992, pp. 185–188). Supply theories of fertility decline address contraceptive awareness, proximity to service delivery points and availability of contraceptive methods. These factors are believed to impact the utilization of family planning services (Bongaarts, 1993, p. 437; Jensen, 1995, pp. 263–266; Knowles, Akin, & Guilkey, 1994, pp. 611, 614; Okun, 1994, p. 193). The National Research Council’s (1993, pp. 158–159) analysis of the 1989 KDHS data provides support for demand and supply theories of fertility decline. The strongest predictors of contraceptive use identified are availability of family planning services (supply theory indicator), rural literacy (demand theory indicator) and households with electricity (demand theory indicator). Province level data from the 1993 KDHS for four measures of socioeconomic development are provided in Table 4. The measures included are percentage of households with electricity, public water and radios and women of reproductive age with secondary education. These data indicate that substantial regional inequality in socioeconomic development exists. As expected, availability of electricity and public water is highest among the households in the two urban provinces, Nairobi and Coast. However, the gap in access to electricity and public water between Nairobi and Central Province is noticeable suggesting that pronounced differences in socioeconomic development exist within the Nairobi–Central Province core. The extension of these basic amenities to the remaining rural areas has been minimal. Only 3–8% of households in the remaining four rural provinces have access to electricity, and only 12–26% of households have access to public water. Nyanza Province stands out as the least developed province where only 3.4% of households have access to electricity and 11.9% has access to public water. When the socioeconomic development data (Table 4) are compared with the fertility reduction data (Table 1), it appears that an inverse association exists between
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Table 4 Socioeconomic development indicators for Kenya by province: 1993a Province
Nairobi Central Eastern Rift Valley Nyanza Western Coast
Socioeconomic indicators Households with electricity (%)
Households with public waterc (%)
Households with radio (%)
50.8 9.8 4.1 7.1 3.4 7.6 16.9
92.3 38.1 26.4 25.7 11.9 19.7 53.2
68.9 55.3 51.6 49.3 42.3 56.8 46.4
Female secondary educationb (%)
48.0 31.3 21.3 21.7 18.2 25.8 17.5
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1993 KDHS. b Data are for women aged 15–49 years. c Figure includes water piped into residence and public tap.
fertility and socioeconomic development for each province except Coast and perhaps Eastern Province.4 A slightly different picture emerges with the radio ownership and women’s secondary education data. Radio provides an avenue for the diffusion of westernization as educational, health care and family planning information can be disseminated via radio. As women’s educational attainment increases, their participation in the modern economy and their influence on fertility decisions may increase. Radio ownership and female secondary education is highest in the Nairobi–Central Province core and lowest in Nyanza and Coast Province. High levels of radio ownership and female secondary education are also noted in Western Province. Since mass communication and education impact fertility decline (Berelson, 1978; Cutright & Hargens, 1984, pp. 459–471; Stark, 1994, p. 550), it is not surprising that the Nairobi–Central Province core has experienced persistent fertility decline and that Western Province has experienced substantial gains in fertility reduction (see Table 1). 5. Rural–urban differences in fertility decline Fertility reductions in rural and urban areas have been noted in the 1989 KDHS data (National Research Council, 1993; Omondi-Odhiambo, 1997, p. 34; Robinson, 1992), but have these reductions continued into the 1990s? Rural–urban changes in indicators of fertility and socioeconomic development for the 1989–1993 period are summarized in Table 5. The fertility decline has continued in Kenya’s rural and urban regions. Declines in the total fertility rate and mean ideal number of children at or exceeding 15% are noted for rural and urban areas although the urban decline has been more extensive. In 1993 almost one in three currently married rural women of reproductive age utilized family planning services while four in ten urban women utilized these services. Rural and urban women have reached parity with regard to contraceptive knowledge, which is almost universal among currently married women.
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Table 5 Rural–urban differences in fertility reduction and socioeconomic development for Kenya: 1989–1993a Indicator
Place of residence Rural
Total fertility rate Mean ideal number of childrenb Utilization of family planningc Contraceptive knowledgec Households with electricity (%) Households with radio (%) Women’s secondary educationd
Urban
1989
1993
Change (%)
1989
1993
Change (%)
7.1 4.6 26.2 89.1 2.8 58.0 16.0
5.8 3.9 30.9 97.0 3.4 48.1 19.9
−18.3 −15.2 17.9 8.9 21.4 −17.1 24.4
4.5 3.8 30.5 94.1 45.2 77.6 41.4
3.4 2.9 43.4 98.5 42.5 67.7 45.8
−24.4 −23.7 42.3 4.7 −6.0 −12.8 10.6
Source: Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro System, Inc. (USA) (1989); Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994). a North-Eastern Province was excluded from the 1989 and 1993 KDHS. b For women aged 15–49 years. c Percentage of currently married women. d Percentage of women aged 15–49 years.
The last three indicators included in Table 5 are measures of socioeconomic development. The percentage increase in women’s secondary education exceeded 10% for rural and urban women, but only one in five rural women has obtained secondary education. The electricity access gap remains substantial. Only 3.4% of rural households have electricity compared to 42.5% of urban households surveyed. The rural–urban differences in socioeconomic development may contribute to the slower pace of fertility reduction in the rural areas. This is significant since 82% of Kenya’s population resides in rural areas (Republic of Kenya. Ministry of Planning and National Development, 1994b, p. 6). Finally, the percent of households with radios declined in the rural and urban areas. Although this decline may reflect differences in the 1989 and 1993 sample design,5 the decline in radio ownership could signal a decline in socioeconomic development. Per capita gross national product (GNP) in 1982 was US$390, but by 1995 per capita GNP was only US$280 (World Bank, 1984, 1997). Similarly, the annual growth rate in GNP for the 1985–1995 period was negligible at 0.1% (World Bank, 1997). Economic stagnation could limit the government’s ability to expand family planning services in the rural areas and at the district administrative level. This could impact sustained fertility decline and lengthen the time required to attain regional and rural–urban fertility parity.
6. Discussion Kenya’s fertility decline has persisted throughout the 1989–1993 period at the province level (Table 1) and in rural and urban areas (Table 5). The status of women is changing (Tables 4 and 5); men are supportive of family planning (Table 3), and the percentage of currently married women of reproductive age utilizing modern family planning methods has increased
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for every province during the 1989–1993 period (Table 2). Studies by the National Research Council (1993), Njoru (1991), Robinson (1992) and Uitto (1992) document fertility declines among women of different age groups and educational attainment levels, among rural and urban women and among women in many of the different geographic regions. However, recent economic stagnation could hinder further fertility reduction. The 1993 KDHS data indicate that low fertility levels and greater utilization of family planning characterize the Nairobi–Central Province core while high fertility levels and modest family planning utilization levels characterize Coast, Rift Valley and Western Province (Table 1). However, Western Province experienced the greatest percentage reduction in fertility over the 1989–1993 KDHS period (Table 1). Regional differences in fertility decline persist, but these differences may be diminishing. Finally, the Nairobi–Central Province core has experienced the greatest degree of socioeconomic development while Nyanza Province has experienced the least (Table 4). Some attention has been directed toward explaining the difference in fertility levels in central and western Kenya. Uitto (1992, pp. 185, 192–193, 195) maintains that Central Province’s lower fertility levels may be attributed to women’s higher educational attainment, the Kikuyu’s extensive contact with westernization, good communication networks, proximity to Nairobi and the development of commercial agriculture. Conversely, in traditional Kisii society, women are responsible for farm production. They may receive help from their children who may also provide care in old age. Women are treated as minors legally and can only accumulate wealth through their children. These conditions favor large families and high fertility levels (Caldwell & Caldwell, 1990, p. 120; Pillai, 1992, p. 267). In evaluating Kenya’s population policies, Pillai (1992, pp. 268–270) argues that family planning efforts can be enhanced if existing cultural traditions such as birth spacing are reinforced and if adequate maternal and child nutritional and health services are extended to the rural areas. Reviewing Kenya’s demographic history from 1965 through 1989, Kelley and Nobbe (1990, pp. 79–80) argue that population policies and programs could be strengthened by improving the effectiveness of existing family planning facilities, minimizing the perceived social and psychological costs associated with family planning and developing district level population programs and policies. The Kenyan government’s interest in family planning has remained strong in recent decades. The National Council for Population and Development was established in 1982 to help coordinate health care and family planning efforts as well as develop population policies and strategies (Harbison & Robinson, 1993, p. 8; Njoru, 1991, p. 84; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) (1994), p. 3). More recently, the 1994–1996 Kenya Development Plan called for the increased availability of health care services, the consolidation of maternal/child health and family planning services, the securing of non-governmental and governmental health care funding sources and the expansion of preventive health measures (Republic of Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, pp. 3–4). These efforts should promote continued fertility decline and reduce regional gaps in fertility decline. However, declining socioeconomic development will affect Kenya’s ability to fund programs aimed at reducing fertility. The restrictive impact of budget limitations on the provision of health and education programs has been documented (Njoru, 1991, p. 96; Republic of
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Kenya. National Council for Population and Development (Kenya) and Macro International Inc. (USA) 1994, p. 4; Uitto, 1989, pp. 167, 172–174). The development of community-based (harambee)/government assisted health care and education projects and increased funding from the private sector and international agencies may partially alleviate this problem. On the other hand, persistent program funding problems could adversely affect continued fertility reduction and significantly delay the attainment of regional fertility decline parity.
Notes 1. Although Nakuru is classified as a rural district, it includes Nakuru city, Kenya’s fourth largest city (Republic of Kenya. Ministry of Planning and National Development, 1994a, 1994b). 2. Some of the age and education differences may be attributed to differences in the geographic areas covered by each sample. 3. Western Province will follow Nyanza in the province list due to the geographical proximity of these provinces. 4. This finding does not mean that the inverse association between fertility and socioeconomic development holds for each district within each province. 5. The 1989 and 1993 KDHS do reflect differences in area coverage, but the rural–urban composition of the sample is essentially the same. Urban residents comprise 17.3% of the 1989 sample and 17.8% of the 1993 sample (Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (U.S.) 1989, p.7; Republic of Kenya. National Council for Population and Development (Kenya) and Macro International, Inc. (U.S.) 1994, p. 17).
Acknowledgments Earlier versions of this study were presented at the 1998 and 1995 annual meetings of the Southern Sociological Society and the 1995 annual meeting of the Southern Demographic Association.
References Berelson, B. (1978). Prospects and programs for fertility reduction: What? Where? Population and Development Review, 4, 579–616. Blacker, J. (1994). Some thoughts on the evidence of fertility decline in eastern and southern Africa. Population and Development Review, 20, 200–205. Bongaarts, J. (1993). The supply-demand framework for the determinants of fertility: An alternative implementation. Population Studies, 47, 437–456. Caldwell, J. C., & Caldwell, P. (1987). The cultural context of high fertility in sub-Saharan Africa. Population and Development, 13, 409–437. Caldwell, J. C., & Caldwell, P. (1990). High fertility in sub-Saharan Africa. Scientific American, 262, 118–125.
276
R.A. Wortham / The Social Science Journal 39 (2002) 265–276
Caldwell, J., Orubuloye, I., & Caldwell, P. (1992). Fertility decline in Africa: A new type of transition? Population and Development Review, 13, 409–437. Cutright, P., & Hargens, L. (1984). The threshold hypothesis: Evidence from less developed Latin American countries, 1950 to 1980. Demography, 21, 459–473. Harbison, S. F., & Robinson, W. C. (1993). Components of the recent fertility decline in Kenya. Population Research Institute, The Pennsylvania State University working paper No. 1993-06. University Park, PA: Population Research Institute, The Pennsylvania State University. Jensen, A.-M. (1995). Prospect of a decline in fertility in sub-Saharan Africa: A review of the recent debate. Acta Sociologica, 38, 263–273. Kelley, A. C., & Nobbe C. E. (1990). Kenya at the demographic turning point? World Bank discussion paper No. 107. Washington, DC: The World Bank. Knowles, J. C., Akin, J. S., & Guilkey, D. (1994). The Impact of population policies: Comment. Population and Development Review, 20, 611–615. National Research Council. (1993). Population dynamics of Kenya. In W. Brass & C. L. Jolly (Eds.). Washington, DC: National Academy Press. Njoru, W. (1991). Trends and determinants of contraceptive use in Kenya. Demography, 28, 83–99. Okun, B. S. (1994). Evaluating methods for detecting fertility control: Coale and Trussell’s model and cohort parity analysis. Population Studies, 48, 193–222. Omondi-Odhiambo, (1997). Men’s participation in family planning decisions in Kenya. Population Studies, 51, 29–40. Pillai, V. K. (1992). Social change and family planning in Kenya. The Indian Journal of Social Work, 53, 267–272. Pritchett, L. H. (1994). Desired fertility and the impact on population policies. Population and Development Review, 20, 1–55. Republic of Kenya. Ministry of Planning and National Development. (1994a). Kenya population census, 1989 (Vol. 1). Nairobi: Government Printer. Republic of Kenya. Ministry of Planning and National Development. (1994b). Kenya population census, 1989 (Vol. 2). Nairobi: Government Printer. Republic of Kenya. National Council for Population and Development (Kenya) and Institute for Resource Development/Macro Systems, Inc. (USA) (1989). Kenya demographic and health survey 1989. Columbia, MD: National Development and Institute for Resource Development/Macro Systems, Inc., USA. Republic of Kenya. National Council for Population and Development (Kenya) and Macro International, Inc. (USA) (1994). Kenya demographic and health survey 1993. Calverton, MD: National Council for Population and Development, Central Bureau of Statistics and Macro International, Inc., USA. Robinson, W. (1992). Kenya enters the fertility transition. Population Studies, 46, 445–457. Schildkrout, E. (1993). Young traders of northern Nigeria. In E. Angeloni (Ed.), Anthropology annual editions 93/94 (pp. 111–114). Guilford, CT: The Duskin Publishing Group, Inc. Simpson-Hebert, M. (1991). Women, food, and hospitality in Iranian society. In E. Angeloni (Ed.), Anthropology annual editions 91/92 (pp. 133–137). Guilford, CT: The Duskin Publishing Group, Inc. Stark, R. (1994). Sociology (5th ed.). Belmont, CA: Wadsworth Publishing Company. Uitto, J. (1989). The Kenya conundrum: A regional analysis of population growth and primary education in Kenya. Lund: Lund University Press. Uitto, J. (1992). Fertility transition and socio-economic change in western Kenya. African Study Monographs, 13, 185–201. World Bank. (1984). World development report 1984. New York: Oxford University Press. World Bank. (1997). World development report 1997. New York: Oxford University Press. Wortham, R. (1991). Spatial development and religious orientation in Kenya. San Francisco: Mellen Research University Press. Wortham, R. (1999). The geography of fertility reduction in Kenya. The Social Science Journal, 36, 173–184.