2015年-世界发展银行全球_The_Gambia_Impact_Evaluation_Baseline_Report___Fertility_and_Family_Planning_3页_856kb

Technical Brief Summary: The Gambia - Fertility and Family Planning

Core Content

This technical brief summarizes the findings of the baseline impact evaluation report on fertility and family planning in The Gambia, conducted as part of the Maternal and Child Nutrition and Health Results Project (MCNHRP). The survey was carried out in three regions: Central River Region (CRR), Upper River Region (URR), and North Bank Region-West (NBR-W), between November 2014 and February 2015.

Key Findings

Total Fertility Rate (TFR)

• The TFR in The Gambia was 5.6 births per woman in 2013.
• Urban areas had a lower TFR (4.7) compared to rural areas (6.8).
• CRR, URR, and NBR had the highest fertility rates in the country.
• Teenage childbearing was particularly high in CRR and URR, with 15% of adolescent girls aged 15–19 already mothers or pregnant with their first child.

Family Planning Uptake

• Only 12% of women used modern contraceptives overall, with large regional variations.
  • URR: 4%
  • CRR: 10%
  • NBR-W: 27%
• Depo (injectable) was the most commonly used modern method, followed by oral contraceptive pills.
• Modern contraception use was higher among women in higher wealth quintiles.
• Traditional methods, such as breastfeeding, were commonly used, especially in URR.

Cultural Acceptability

• 40% of women did not approve of family planning.
• Approval was highest in NBR-W and lowest in URR.
• Literate women were more likely to approve of family planning methods (60%) than non-literate women (45%).
• Community attitudes strongly suggested that family planning should only be used by married women.
• Unmarried women faced social barriers to accessing contraceptives.
• Shame and religious beliefs were cited as potential reasons for avoiding family planning.

Decision-Making

• Less than 13% of women reported being the main decision-maker for contraceptive use.
• 40% of women reported that the decision was shared with their partner.
• 25% of women reported that their partner had primary control over contraceptive use.
• Fertility desires were high, with many women and men expressing a preference for at least six children, and some suggesting more than six was ideal.
• Preference for sons was a common reason for continuing childbearing.

Accessibility and Availability

• High availability of family planning supplies, but high stockout rates were reported.
• Stockouts were most frequently reported for Depo (96%), oral contraception (92%), and contraceptive implant (Jadelle) (92%).
• Only 20% of women in CRR knew where to access contraceptives, compared to higher proportions in other regions.
• Lower socioeconomic quintiles and women living further from health facilities had less knowledge of where to access family planning services.
• Community-based distribution of contraceptive supplies was suggested as a way to improve accessibility.
• Lack of trained health workers and equipment was cited as a limitation in providing family planning services.

Conclusion

The baseline report highlights low contraceptive prevalence, cultural resistance to family planning, and barriers to access in The Gambia. These findings suggest that the MCNHRP will need to address cultural perceptions, improve accessibility, and enhance training and resources for health workers to effectively promote and provide family planning services. The high fertility rates and strong social norms around childbearing indicate that a comprehensive approach is necessary to influence behavior and improve maternal and child health outcomes.