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<p>Across sub-Saharan Africa, social and infrastructural inequalities mean that children are born into dramatically different contraceptive contexts: some children reside in places where contraceptive use is widespread as others reside in contexts where exceedingly few women use contraception. Although high contraceptive prevalence is often treated as a proxy for lower societal fertility and, by extension, improved child health, the empirical basis for this assumed relationship remains unclear. In this study, we analyze the Demographic and Health Survey Program data (<i>n</i> = 31,934 children aged 6 to 23&#xa0;months in 281 regions of 27 African countries) to examine the relevance of the contraceptive context to three measures of children’s physical health: stunting, wasting, and anemia. Multilevel models show variable spillover of contraception on each child health outcome, which is not fully explained by fertility levels. These findings challenge fertility-centered frameworks and underscore the need to study contraceptive prevalence as a distinct dimension of the fertility landscape.</p>

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On the Population Reach of Contraception: An Analysis of Child Health in Sub-Saharan Africa

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月8日

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  • Yingyi Lin,
  • Emily Smith-Greenaway,
  • Laura Ferguson

摘要

Across sub-Saharan Africa, social and infrastructural inequalities mean that children are born into dramatically different contraceptive contexts: some children reside in places where contraceptive use is widespread as others reside in contexts where exceedingly few women use contraception. Although high contraceptive prevalence is often treated as a proxy for lower societal fertility and, by extension, improved child health, the empirical basis for this assumed relationship remains unclear. In this study, we analyze the Demographic and Health Survey Program data (n = 31,934 children aged 6 to 23 months in 281 regions of 27 African countries) to examine the relevance of the contraceptive context to three measures of children’s physical health: stunting, wasting, and anemia. Multilevel models show variable spillover of contraception on each child health outcome, which is not fully explained by fertility levels. These findings challenge fertility-centered frameworks and underscore the need to study contraceptive prevalence as a distinct dimension of the fertility landscape.