Determinants of Fertility and Infertifility Rate Among Females Aged 15-49

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Table of Contents

  • Introduction
  • Non-Proximate Determinants of Fertility
  • Socio-economic Determinants of Fertility
    Level of education
  • Housing
  • Sexual Intercourse
  • Self Induced Pregnancy
  • Methods Attempted
  • Marriage as a Determinant of Fertility


South Africa is one of the countries that has the lowest fertility levels on the continent. Its fertility has declined in past years; it has shown a remarkable demographic achievement in those years. This literature reviews in depth analysis to study the relation between non-proximate and proximate determinants of fertility. The study highlighted the role of socio-economic level in fertility and a smaller number of studies has been done by analysing fertility distinctive. The purpose of this study, is to discuss the literature review on evaluation of the proximate determinants as done by Bongaart (1978) and the socio-economic and cultural factors which are non-proximate determinants of fertility.

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Non-Proximate Determinants of Fertility

Socio-economic Determinants of Fertility

Level of education

Birdsall (1988) refers education as an essential determinant of fertility decisions. Many demographers are interested in this determinant as it affects fertility strongly on fertility behaviour. According to Mason (2000), Families that have educated women with high qualifications from higher education tend to have lower fertility due to having conception of using contraceptives, knowledge about family planning and have less desire for children. On educational level, educated women have limited number of children than uneducated women, because educated women have power of making decisions of having children regardless of the cultural norms from different cultures and the conception of having more children to enlarge families. South African Department of health (1998), state that the fertility rate of education is 4,5, thus the replacement level is 1.9 below the fertility rate for women who have tertiary education.

Marriages are delayed due to an increase in educational level, which causes negative consequence on fertility and prevent the inceptive effect on fertility. Education influence the outcome of the wanted and unwanted fertility in different channels. The desire for having children and the closing gap between wanted and unwanted fertility are decreased by high level of education. Investments in women’s education have proven especially effective at lowering fertility rates, since better educated women tend to marry later and have fewer, healthier children. Studies on every continent show that as literacy rates rise, especially those of women, income levels, nutrition levels, and child survival rates rise as well. A study using data from 219 countries from 1970 to 2009 found that, for every one additional year of education for women of reproductive age, child mortality decreased by 9.5 per cent.


Age is the most important factor affecting woman’s chance of childbearing And having a healthier child. The possibilities of having a child for a woman younger than the age of 35 years and men younger than 40 years are much higher than for older men and women. As body of a woman ages ,the quality of eggs decrease where by their ovaries contains fewer and fewer eggs and also the remaining eggs in old woman are mostly likely to have abnormal chromosomes.Fertility rates decrease with increasing age of a women because sexual activity declines with age. As age increases, women are at higher risks of other disorders that can harmfully affect fertility such as tubal diseases, Miscarriage, fibroids and endometriosis.

It is a common misunderstanding that IVF treatment  can overcome age-related infertility. A woman’s age also affects the chance of success with IVF. The chance of a live birth resulting from one IVF cycle for women of different ages. Comparable data for men have not been available until recently, descriptive studies shows that there is a decline with age in male fertility around 40-45 years when sperm quality decrease.  If a man has other issues, such as low sperm count or poor motility, the decrease in sperm quality can spell disaster for his fertility. Increasing male age decrease the overall chances of pregnancy and increases time to pregnancy and the risk of miscarriage and fatal death.Children of fathers aged 40 or over have an increased risks of mental health problems.


Labor saving technology such as grain mills, tractors and mechanized water pumps are introduced during the first stages of economic development in many subsistence communities in the world. These technological changes have impacts in methods of obtaining and processing economic resources. If employed women can produce a higher quantity of output using advanced technologies which saves time and energy rather than producing less output using the same manual methods, the reallocation of these women’s time and energy could affect fertility in many ways.

The reproductive data that was collected more than ten years back shows that the introduction of equipment and machines that involves new advanced technology (Labor saving technology) has increased the number of women who begins child bearing at an acceptable young age. When labor efficiency is increasing, parents tend to reallocate the saved time to reproduce and increase their family members rather than producing more.

Rapid population growth on small scaled societies during the early stages of economic growth may be implicated by conditions or improvements such as labor saving technologies. The fertility reduction during the later stage of demographic transition has been regularly documented and the courses where debate (Borgahoff Mulder 1998; Caldwell 1976; Kaplan and Lancaster 2000; Law 2000).

Less is known about the earlier stages of demographic transition theory and the factors that widened between declined fertility and declining mortality. The common reason that has delayed generation after generation in fertility adjustment but parents maintains the same rate of children who survived. Economic development is connected to fertility reduction because more cost of children result in less demand for them (Bulato and lee 1983), in explanation it is supposed that small families are world widely desired but it can also have effects on local demography.

The research among Maya of the pucc region of the Yucatan Peninsula, Mexico (Kramer and McMillan 1994, 1998, 1999), shows that the introduction of modern labor saving technology lowered the age at the very first birth to allow women if they choose to bear an additional child over the period of their reproductive careers. Age at the first birth is the indicator of family size in natural fertility populations (Bogart’s 2002; Campbell and Wood 1998; Smallwood 2002), and now the same women in the first study have completed their reproduction careers to have an opportunity to test this effect. This study draws on recent census and reproduction history data to analyses the question of the interrelation between labor saving technology, economic development and fertility patterns.


Fertility was compared to age, which is why the findings in a study conducted in Khayelitsha, South Africa in 1990 (Pick & Makhlouf-Obermeyer,1996). However, women are different from other women depending on how they take care of themselves and their health. According to Cooper,the discovered number of pregnancies reported were fewer than in studies elsewhere in South Africa (Cooper et al., 1991), while Roberts and his partner Rib concluded that the relationship between reported fertility and education is complex (Roberts& Rip, 1984; Ketkar, 1978; Lotter,1979). Fertility is caused by eating the right amounts of food and nutrients fruits and vegetables, and by that being said is avoiding junk food, drinking alcohol, not doing regular health checkups and not exercising.

Infertility rate and fertility rate goes hand in hand with one another. Infertility’s reportings of gynaecological illness is clearly not surprising, a lot of women are suffering from infertility are likely to seek gynaecological attention and advice, but are equally more likely to have had pelvic inflammatory disease, which is said to be the common cause of infertility in Africa. The number of women using contraception and the pattern of contraception, it is said that especially the use of injectable contraceptives, found in this study is similar to that found in other South African studies and reflects the former government’s family planning policy (Mostert & Van Tonder, 1986).

The percentage of women (90%) who had not taken themselves treated for PAP smears is getting as much higher than expected, but the number of women who have had PAP smears done was much less. An awareness or experience of PAP smears and education that was found in this study is both striking and complex. Women who were found not using contraception had less knowledge about PAP smears, which are done at family planning clinics.

Cervical cancer is the most powerful disease to strike in for every women who is already sexually involved, and the death rate continues to get higher each year in South Africa which is why this needs to be addressed as soon as possible. (South African Medical Research Council, 1987). It is said that mortality from cervical cancer in South Africa is to be decreased. At least women with higher earnings were able to report gynaecological illness, which it increased their awareness of gynaecological disease. However, this left women who are not working and from poor background out of the question.


The decision in the fertility is influenced by the price of housing as an important factor and relatively neglected candidate. In responds the family fertility is effected by the housing conditions including the price of the house itself that the family already have . the rentals are more likely to have less children concerning the rising in rent every now and then. Home-owners are likely to have more children in respond to higher house and low substitution, but fewer children otherwise. All that is said is that the the more the houses are, the more the fertility will be in a population. (Ferrer A, Clark J. The Effect of Housing Price Changes on Fertility:Evidence from Canada. University of Waterloo,Department of Economics Working Papers,2016).

According to the canonical models,as the housing wealth decreases, the fertility is negatively impacted.the theoretical model suggests that a decrease in housing ends up having a astronomic striking on the probability of childbearing than the equal increase(Iwata.S, Naoi.M. The asymmetric housing wealth effect on childbirth. Review of Economics of the Household 15(14),1373-1397,2017).

Sexual Intercourse

The effects of frequent sexual intercourse on fertility in South Africa between women ages of 15 to 49 show a decline in marital sexual incidence and frequency sexual intercourse. Several factors contribute to this decline, including biological aging, declined health, and habituation to sex. In multivariate analyses, age was the single factor most highly associated with marital sexual frequency. Marital happiness was the second most important predictor and some factors found to be related to sexual frequency are associated with life changes that reduce or increase the opportunity to have sex, including pregnancy, the presence of small children, and sterilization. Controlling for age and many other factors, we found that cohabiters, married individuals who had cohabited before marriage, and those who were in their second or later marriage had more frequent sex than their counterparts who had not experienced these events. The effect of missing responses on the validity of aggregate information on sexual frequency is considered.

The frequency of sexual intercourse showed that increasing sexual frequency differs with age and relationship duration and Sexual frequency did decrease with age for women, although almost a quarter of partnered women over age 70 had sex more than 4 times a week. Even if men and women do have sex more frequently, it doesn’t mean they are happier. On average, couples who conceive quickly (measured in number, months or menstrual cycles) are more fertile than couples who take longer to conceive. If the fertility rate is high, more people will start engaging in frequent sexual intercourse leading to over population, and in most cases some are poverty-stricken meaning that they have no access to adequate water, sanitation and health facilities.

Therefore based on economic perspective, you find that the more children are conceived, the more social grants will be paid for them and you also find that there might be only one person working in the family so they cannot provide. The sexual habit in overcrowded places leads to the spread of diseases such as HIV/AIDS, STDs and STIs. Furthermore, when looking on educational perspective, low sexual frequency was associated with significantly higher rates of union dissolution among cohabiters than married couples and this could be one of the social problems leading to unemployment. However, if people are educated, the fertility rate decreases because they will be having knowledge about the negative and positive results from having sexual intercourse frequently rather than those who are not educated. Looking in positive perspective, more population means most people will contribute to the economy according to the skills they have and some will be because of entrepreneurship and their level of education from their job descriptions and how they contribute to the economy.

Self Induced Pregnancy

SELF INDUCED PREGNANCY Is an abortion that is performed by the pregnant woman herself or with the help of others, it does not include any medical assistance. It also refers to efforts of terminating a pregnancy though alternatives , sometimes more dangerous and such practises may present the threat to the life of pregnant women for example if the abortion is does not result in the termination of the pregnancy , damage to the foetus may occur.

Methods Attempted

  • Lifting of heavy weights
  • Consumption of mutton marrow
  • Consumption of papaya seeds
  • Physical exertion designed to bring about a miscarriage
  • Attempting piercing of the foetus with a knitting needle inserted in the uterus through the cervix

Marriage as a Determinant of Fertility

Marriage is a legal union between two people and is used as one of the important determinant of fertility rate in South Africa. In most societies marriage is used to prevent women from having children out of wedlock and also to determine how many children the women should have or how old the women should be when she reach menopause. Marriage can decrease or increase the rate of fertility thus is considered to be one of the determinants of fertility rate ( Bongaarts and Potter 1983).

Marriage is universal and it often takes place at an early age in most countries. Higher fertility rate can be caused by lack of contraceptives, universal and early marriage while lower fertility result when women marry late; and this decreases the chance of being pregnant.

In South Africa this is not always the case; marriage happens late in life and motherhood start at an early age made by a high adolescent fertility rate. According to the 1998 SADHS, many children were born in less than three years in a survey to women who are younger than 20 years ( DoH 1998).

People who are married can control how many children they want or need. The rate is usually low than that of unmarried because of some actors affecting them. But it can also be high, according to other religions which encourage large families and that a woman shows her status by bearing many children. Some women, especially in rural areas believe that when they married they need to stay at home and bear more children and this increase the rate of fertility.

There is low fertility rate to married women because of employment opportunities, women wanting to change their status, education and legislature that prevent early marriage. Most women nowadays postpone starting a family due to modernization of doing things. Many children result from a longer reproductive span.

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