Fertility

Factors affecting Fertility

Factor

Example

Description

Biological

Years in
marriage

Low fertility of many DCs is attributed to later

marriages. Couples nowadays may want to focus on
their career, or further their education first before
starting a family. Therefore this reduce the number of
childbearing years of a woman. People may also be in
sexual unions without the desire to have children.
Stability of marriage is declining especially in DCs.

Patterns of
sexual activity

DCs generally experiencing increasing prevalence of

divorce.

Some LDCs have low level of divorce. (Eg. Muslim

countries allow multiple marriages)

Studies have shown that sexual behaviour affects

female reproductive endocrinology
Women with increasingly greater degrees of infertility
showed increasingly later first coital ages.

Length of
breastfeeding

Breastfeeding is a natural contraceptive as the release

of reproductive hormones is suppressed.
Breastfeeding by females a few years after birth is
normal in many societies.
Most prominent in Sub Saharan Africa and also in
Indonesia where breast feeding is prolonged up to age
2 or 3. This reduces family size (6) and delays child
bearing of females

IVF

Technology has aided women who have problems

conceiving.
-

Only women who can afford it will be able to get

treatment.
Assisted conception can give rise to multiple
births
Largely limited to DCs

Use of
contraception

Technology of contraceptives has improved so that

women have more choices.
-

Has changed sexual patterns of DCs drastically

so that people are sexually active at a younger
age than before.
In DCs as contraceptives are easily available and
affordable, this contributes to low birth rate
Accessibility to contraception in LDCs has
increased therefore lowering the TFR.

Europe has the lowest TFR of 1.6 per women and 73%
of the women in child bearing years uses contraception
whilst in Africa the TFR is the highest with only 29% of
women using contraceptive. Hence there is indeed a
strong link between the TFR and the % of women using
contraception.
Induced
abortion

LDCs generally have more restrictive abortion policies

than DCs.
However, abortion rates vary more widely than do
policies
European abortion rates from under 6 per 1000 women
in Ireland and Spain to 78 in Romania.
African countries and other countries of high fertility
generally have low incidence of abortion
- Bangladesh: 3.8
- Tunisia: 8.6

Socio
Social value of
Economic children

In LDCs children are seen as a form of security and

source of labour, hence more children are seen as
desirable.
Sons are also preferred to daughters in many LDCs as
sons are able to carry on the family name.
On the other hand, children are considered a financial
drain in DCs with many couples opting not to have any
children at all or to have small families.

Status of
women
Levels of

Gender Equality in DCs

Access to education, career opportunities
Have the authority to decide when to marry, when to

education,
aspirations,
marriage age,
participation in
the labour
force

have children, how many children

Health issues

Better health and welfare provision in DCs which has

brought about a marked fall in infant mortality rates
and improved pre natal care means that there is a
lesser need to have more children in order to ensure
survival of a few.

LDCs: Womens place is at home, child-bearing is main

role.

Subfercundity (the inability to reproduce) due to

morbidity (disease and mmalnutrition) can reduce
fertility.
-

Economic
development

Infection disease such as smallpox, this has a greater

impact during reproductive ages.
Malnutrition causes cessation of ovulation, loss of
libido, reduction in production of sperms and eggs.

High level of economic development will lead to a

higher cost of living, and greater materialism.
Couples choose not to have too many children in order
to maintain high standards of living

Population
Policies
Institutio
nal

Policies can increase/decrease birth rate. However how

effective are they?
China: Stop at 1
Singapore 1966: Stop at 2
Singapore 2001: Have 3 if you can afford it.

DC Case Study: Germany

Population Structure of Germany:
Many European countries like Germany experienced a rapid increase in birth
rates from the end of the WWII until the economic boom of the 1960s.
In the 1960s the contraceptive pill became available and equality laws
changed society so that women could more easily follow career paths in full
time work. This reduced fertility rates. Current TFR=1.41

Life expectancy has also increased as living and working conditions have
improved and medical advances have been made. In Europe the baby boom
generation is large in number and living longer, there are fewer people in
younger generation to support them.
Highest old age dependency ratio of over 28% as of 2009.
Second oldest population with 20.7% of the nation population being over 64
years old.
Shrinking population. Face Natural decrease in population growth

Pro-natal policy in Germany

Childcare costs can be offset against tax
High maternity/paternity payments are made to encourage higher birth rates
14 weeks maternity leave and parental leave up to 36 months along with
child benefit payment of over 430 euros per month.
Pension credits are increased where there is a loss of income while parents
raise their children.
Family friendly policy : allow parents to have a more flexible working
arrangement.

Effectiveness:
Despite lots of government investment in maternity and paternity pay and
promotion of family friendly policy the birth rate continues to decline.
Consequently Germany has increased charges for health insurance each
worker pays 15.5% of their wages and retirement ages have been increased.
This is done so as to reduce the tax burden on working class.
Whether problems or opportunities dominate depends on the policies (socioeconomic, birth rate, immigration) adopted and implemented by European
countries. Ageing populations will continue in Europe for most of this
century. However, after the baby boom generation passes, population
structures are likely to stabilize.

DC Case Study: Sweden

Pro-natal policies
Non-taxable family allowance paid to parents for each child, payment
continuing till 16 or 20 (if child is educated full-time), with rate of payment
increasing with more children (vs Sg only a sum of money)

4 months fully paid leave before childbirth, 12 months leave after child-birth
(80% pay), with 6 month unpaid (but with state welfare payment) leave
allowed afterwards
120 days leave for sick children (80% pay)
Daycare available for children aged 18 months to 6 years, with fees based
on parents ability to pay

Effectiveness:
Fertility rate increased from 1.6 to 2.1 in early 1990, currently near
replacement rate at 1.9 (2012)

LDC Case Study: Kenya

Anti-natal policies, improvements made by:

Availability of contraception and family planning services

More education and information services on family planning and

contraception

More training for health workers

Improving maternal health and IMR

Social developments to improve education and status of women

Countries and NGOs have helped financially (eg. Japan, UK, World Bank)
Family planning association receives $5m from government annually
AIDS affecting Kenya severely (13% of population), causing death rate to
increase from 9-13/1000, 25% increase in child mortality rates and fall in life
expectancy from 65-55

Natural Increase

Medical Facilities + Healthcare services and the peoples access to them

Housing

Hygiene

Water Supply

Sanitation

Nutrition

Mortality
Global Variations in Mortality Rates
The age-structure characteristics of the population is indicative of the
mortality rates
Most of the mortality rates in DCs are concentrated in the older age group of
the population due to ailing health and illness associated with old age. (eg.
heart attacks and cancers)
In LDCs, mortality rates concentrated in the young and infant, account for up
to 60% of all death rates in many sub-Sahara countries
Infant mortality rates generally lower in DCs compared to LDCs
Developed Countries

Less Developed Countries

Heart Disease and Strokes (diseases

associated with affluence)

Respiratory diseases: influenza,

pneumonia, tuberculosis (collectively
25% of all deaths)

Cancer

Parasitic Diseases: Malaria, Sleeping

sickness (15%)

International Wars (eg. 2 World Wars)

Civil Wars (eg. Ethiopia, Rwanda)

2 decades of war in Afghanistan, 3
million have died since the last
official census in 1988

Transport-related accidents

Natural disasters (eg. earthquakes)

AIDS (greater impact compared to

DCs) Kenya and

Factors

Reasons
LDCs have higher infant mortality rate and hence the younger age
group are more likely to have a higher mortality rate. In big families,
few children may survive due to malnutrition or diseases.
Infant and young in many sub-saharan countries account for up to
60% of all death rates.
In DCS, as life expectancies are higher, the older age group is
expected to have a higher mortality rate
Men have a lower life expectancy than women.

Demograp
hy

Males have a higher death rates than females at all ages, even
before they are born. (miscarriages disproportionately occur with
male fetuses)
These biological differences are likely to be exacerbated by social
factors.

Advances
in
healthcare
and
sanitation

Men are more likely to engage in risk taking behaviours such as

driving faster, which lead to higher death rates from accidents.

Men are also more like to smoke and drink alcohol increasing their
risk of lung cancer and liver disease.

Men tend to neglect their health more than women as witnessed by

fewer visits to the doctor.

In DCs: Death rate decreased since pre-industralisation

1) Hygiene and Sanitation: Provision of safe drinking water
reduces the threat of water borne disease of cholera and
typhoid
2) Compulsory vaccination from childhood diseases such as
tuberculosis and small pox.
3) Medical technology: development in antibiotics, cancer fighting
druges and less invasive surgical procedures. (technology
imported to LDCs)
4) Diet: Development brings about affluence and improvements in
diet > decrease in malnutrition and under nourishment.

In LDCs: Decline in death rate may have been slower as

1) citizens are unable to even afford basic healthcare services,
government may not even have schemes for basic healthcare
provision for the developing regions
2) Even though advanced medical technology may be available in
LDCs, there is a problem of accessibility for the poor and needy
living in rural areas.
3) LDCs themselves are under debt and cannot afford to provide a
beneficial basic healthcare scheme.
The ratio of doctors to patients have increased greatly over the
years, esp. in DCs
Improved sanitation in most cities has also led to decline in mortality
rates (cleaning up of slums and ghettos)
Political

Civil wars will increase mortality rates due to battle wounds and
deaths.
Breakdown of the health system of the country, the collapse of
utilities and the outbreak of epidemics and pandemics brought about
by unsanitary conditions in the warring country.
Genocides such as the attempted extermination of the Jews in
Europe or the murder of 20% of Cambodias population from 1975-78
will drastically increase mortality rates.

Pandemics
/
Epidemics

Epidemic:
The Incidence rate (i.e new cases in a given human population,
during a given period) of a certain disease substantially exceed what
is expected base on recent experience.
SARs. Severe Acute Respiratory syndrome spread worldwide between
2002 and 2003 causing 916 deaths according to World health
organization
Pandemic is an epidemic of an infectious disease that spreads
through human population across a large region, eg. a continent
AIDS in mainly sub-saharan Africa, decreases life expectancies.
Botswana 64 years in 1990 decreased till 49 years in 2003.
Every hour, 3 children in Zimbabwe will die of Aids related diseases.

How is fertility linked to mortality??

Poverty and Inequality

Poverty means a lack of choice.

Clean water may be available in the area, but poor people do not have
the money to purchase this, resorting to drink from contaminated
sources.

Poor in developing nations suffer from diseases linked to poor hygiene,

poor diet and contaminated water supplies cholera, malaria,
diarrhea.

Low status of women

o Girls, esp. those with little or no education are drawn into the
sex industry with its associated sexually transmitted diseases
o Women tend to suffer more ill health, especially from
preventable illnesses.

Dangers of pregnancy and childbirth

Position within their society health is often not a

priority ):

Low levels of vaccination poor people in many developing areas

commonly suffer from potentially fatal childhood illnesses such as
measles and diphtheria.

Poorer diet, one that lacks the protein for healthy growth
o Impact on the ability to carry out physical work, such as farming,
and may result in lower levels of food production for the family.
o Diseases of malnutrition kwashiorkor and marasmus.

Without some investment in preventative medicine, such diseases can

create a negative cycle of poverty.
Even in wealthier nations, there is still a link between poverty and health.
The health problems caused by unclean water and poor sanitation have
largely been solved, but other diseases such as heart disease and cancers
persist, and incidences of these are higher in areas of deprivations. In poor
areas in developed nations, problems linked to living in poorly built, damp
and under-heated housing also cause respiratory diseases.

LDC Case Study: Pakistan and maternal health

A lack of care in pregnancy (linked to lack of medical facilities and low
educational levels of young mothers) and during birth can lead to obstructed
labour, when the baby cannot be delivered.
A caesarean operation is then needed, but many villages are miles away
from any hospital and transport infrastructure is too poor and families
cannot afford such care
Delay in accessing medical help means the baby usually dies and because of
the prolonged labour, fistulas occur between the birth canal and the bladder
and/or rectum of the mother permanently incontinent and then often
abandoned by family (can no longer perform their main role of child-bearing)
150,000 women suffer from fistulas in Pakistan, caused by an obstructed
birth. Annually 6,000 new cases occur, but only 800 women receive
corrective surgery.
Women in DCs rarely suffer from fistulas, but worldwide over 3.5 million
women experience the condition, which is 100% preventable.
Pakistan has a high occurrence because of
1. A lack of trained medical personnel
2. Low levels of education amongst rural women
3. Giving birth when too young
4. Poor general health
5. Womens health not considered a high priority in some sections of society

LDC Case Study: Kenya The need to tackle the causes of poor
health
Kenya has a high level of foreign debt and therefore cannot invest in
healthcare as much as it needs to. Due to financial limitations, it relies on
curative medicine, rather than getting to grips with underlying problems and
focusing on preventive measures.
In the long term, preventative measures such as education about disease
transmission, work out cheaper, as there is less need for drugs and
hospitalization in the future.
HIV/AIDS is a major problem in Kenya, esp. among the poor. There are 1.5
million HIV/AIDS sufferers in the country 7.4% of the adult population
1.2 million AIDS orphans being brought up by grandparents or have been
abandoned
Without intervention, the cycle of poverty and HIV/AIDS infection will
continue. Poor people cannot afford the retroviral drugs that can extend life,
and many do not have access to medical facilities in rural areas, so the
death rates for the poor are high.

LDC Case Study: China Regional Disparities (Urban/Rural

Disparity)
Rural vs Urban

Wealth is not evenly distributed, most being found in the eastern regions
Many of the western, rural and mountainous regions continue to suffer from
poverty and associated poor health levels
Maternal mortality rates 64/100,000 in rural areas vs 20/100,000 in urban
and eastern regions
Health being roughly 3 times worse in rural areas Infant Mortality Rates
Life expectancy lower
Lower health levels:

Poor transport infrastructure, isolated

Fewer hospitals and trained staff (low accessibility too due to ^)

Poor educational attainment

Living conditions more primitive:

Poor sanitation

Contaminated water supplies

Rate of vaccine preventable diseases, such as measles, us up to 6 times

higher in the poorer western regions than in the wealthier and more urban
eastern region
Decentralisation of funding has meant that local governments are
responsible for much of the healthcare but the areas with highest numbers
in poverty, invariably have the least money to try and improve health levels

Urban Rich vs Urban Poor

Government use health insurance system, most hospitals and clinics are
privately run
Poorest workers do not have jobs where their employer pays for the health
insurance, nor do they have spare money to pay for medical treatment
directly.
Difficult for a poor person who is seriously ill to access the necessary drugs
or modern medical care.

DC Case Study: Glasgow

DC Rich vs DC Poor

Kensington and Chelsea vs Glasglow, nearly 9 years difference in life

expectancy
Living on benefits and having less money less likely to be able to afford
good quality fresh fruit and vegetables and to have a balanced, healthy diet
(poor nutrition)
Poor health Fuel poverty, not possible to keep the home warm enough to
prevent moulds and damp, cause respiratory problems
Glasgow has areas of multiple deprivation, impact on health levels.
However, everyone in the UK has access to medical care via the NHS to deal
with illnesses as they occur.
Springburn

Lenzie: expect 17 more years of life

50% adults smoking, more likely to

suffer from asthma and other

7 times less likely to suffer from

coronary heart disease before 75:

respiratory problems

non-smoking environment

Higher IMR: Little breastfeeding, do

not benefit from natural immunity to
disease acquired via mothers milk

Breastfed more, healthier diet

Poverty: High levels of joblessness,

overcrowding, low levels of access to
a car and low educational attainment
child have fewer chances in life

Less crowded household, joblessness

rare

Good health is needed for economic and social productivity, leads to higher
productivity.
In industralised nations, although there has been high investment in health
systems, there is still inequality in health levels, linked to income. Uneven
access to health care and the growing income inequality need to be
addressed if improvements in health levels are to continue
Developing nations: greater investment in healthcare in order that all
sectors of the population can benefit from, and further contribute to
development
Pandemics often begin in poor overcrowded areas with limited sanitation,
and it is to everyones advantage if all sectors of humanity have the access
to and knowledge of healthcare in order to live as healthy lives as possible.