Abstract
BackgroundIdjwi, an island of approximately 220,000 people, is located in eastern DRC and functions semi-autonomously under the governance of two kings (mwamis). At more than 8 live births per woman, Idjwi has one of the highest total fertility rates (TFRs) in the world. Rapid population growth has led to widespread environmental degradation and food insecurity. Meanwhile family planning services are largely unavailable.MethodsAt the invitation of local leaders, we conducted a representative survey of 2,078 households in accordance with MEASURE DHS protocols, and performed ethnographic interviews and focus groups with key informants and vulnerable subpopulations. Modelling proximate determinates of fertility, we evaluated how the introduction of contraceptives and/or extended periods of breastfeeding could reduce the TFR.ResultsOver half of all women reported an unmet need for spacing or limiting births, and nearly 70% named a specific modern method of contraception they would prefer to use; pills (25.4%) and injectables (26.5%) were most desired. We predicted that an increased length of breastfeeding (from 10 to 21 months) or an increase in contraceptive prevalence (from 1% to 30%), or a combination of both could reduce TFR on Idjwi to 6, the average desired number of children. Increasing contraceptive prevalence to 15% could reduce unmet need for contraception by 8%.ConclusionsTo meet women’s need and desire for fertility control, we recommend adding family planning services at health centers with NGO support, pursuing a community health worker program, promoting extended breastfeeding, and implementing programs to end sexual- and gender-based violence toward women.
Highlights
Idjwi, an island of approximately 220,000 people, is located in eastern Democratic Republic of Congo (DRC) and functions semi-autonomously under the governance of two kings
With a total fertility rate (TFR) of 8.3 births per woman, and roughly 2,075 people living per square mile, high population density and rapid population growth are often associated with environmental degradation and major nutritional deficiencies on Idjwi
The wealthiest 20% of households earn US$293.25 purchasing power parity (PPP) in hard currency each month, 1,600 times more than the poorest 20% of households which earn just US$0.18 PPP in hard currency each month
Summary
An island of approximately 220,000 people, is located in eastern DRC and functions semi-autonomously under the governance of two kings (mwamis). With a total fertility rate (TFR) of 8.3 births per woman, and roughly 2,075 people living per square mile, high population density and rapid population growth are often associated with environmental degradation and major nutritional deficiencies on Idjwi. In 2010, at the invitation of Idjwi’s leaders, a multidisciplinary team from Harvard’s public health, medical, This comprehensive assessment identified several urgent health problems; among the most urgent was lack of family planning services. Are sexual and reproductive health services core to the provision of public health [1], a lack of family planning services is intimately related to several other identified health concerns including sexual- and gender-based violence against women [2], poor child health [3], and household food insecurity from population pressure [4]. A national Demographic and Health Survey (DHS) conducted in the DRC in 2007 did not include Idjwi [12]
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