Fact Sheet: Focus on Tanzania

1. OCTOBER 2015
SOCIAL AND ECONOMIC FACTORS
INFLUENCE CONTRACEPTIVE USE
Fact Sheet
Focus on
Tanzania
About the Population and
Poverty Research Initiative
The William and Flora Hewlett Foundation’s
Population and Poverty (PopPov) Research
Initiative, in partnership with other funders,
has supported a global group of researchers
looking at how population dynamics affect
economic outcomes. Research funded
through the PopPov Initiative sheds light
on pathways through which fertility, health,
and population growth affect economic
growth, providing insights and an evidence
base relevant to achieving the Sustainable
Development Goals (SDGs). Findings show
that investing in women’s health, education,
and empowerment improves economic
well-being for individuals and households,
and contributes to economic growth.
Family planning helps women prevent or delay
childbearing and space pregnancies for healthier
outcomes, but in Tanzania in 2010, only 27 percent
of married women ages 15 to 49 used a modern
contraceptive method. In the Mwanza region of
Tanzania, the rate was only 12 percent (see Figure).1
On average, women in Tanzania have more children
than they want, suggesting that women have an
unmet need for family planning.2
Male partners, as well as friends and family that make
up a woman’s social network, might influence her use
of family planning. Family planning use is also influenced
by economic shocks and knowledge of contraception.
FIGURE
Unmet Need for Family Planning Is Slightly Higher
in Mwanza Where Contraceptive Use Is Lower
Contraceptive Prevalence and Unmet Need for Family Planning
Among Married Women Ages 15 to 49
All Methods
Modern Methods
Unmet Need
Tanzania Mwanza Region
34%
15%
27%
12%
22%
27%
Source: Derek Chitama et al., “From Papers to Practices: District Level
Priority Setting Processes and Criteria for Family Planning, Maternal,
Newborn, and Child Health Interventions in Tanzania,” BMC Women’s
Health 11, no. 46 (2011); DOI: 10.1186/1472-6874-11-46.
Findings From the Research
KNOWLEDGE AND MISINFORMATION
Both men and women expressed concerns about the side
effects of family planning in focus groups conducted in the
Mwanza region.3
Some women shared that they switched
methods or discontinued their contraception because
of side effects such as heavy bleeding or headaches.
While some side effects are typical and expected for
some contraceptive methods, myths and misconceptions
persist. A few focus group participants associated
birth control use with infertility and physical deformities
in children conceived after using contraception, but
research has shown that birth control does not cause
permanent infertility or birth defects in children.4
Research from Tanzania and other sub-Saharan African
countries indicates that knowledge of contraception
is associated with its use.5
The more a woman knows
about contraception, the more likely she is to use it.
Additionally, women with higher levels of education
were found to be more likely to use contraception than
women with lower education levels.6
SOCIAL NETWORKS
Information about contraception and its social
acceptability travels through social networks to influence
individual decisions. Research from Tanzania finds
that approval from other women in the community is
more strongly associated with contraceptive use than
perceived partner approval.7
A smaller study in the
Mwanza region also found that women’s contraceptive
use tends to be similar to that of other women in their
network.8
The influence of a woman’s social network on her
contraceptive use is not unique to Tanzania. Women
from West African countries conform to the social
expectations of their networks—they choose not to use
contraception because others in their social network are
not using contraception.9

2. PRB is the Secretariat of the PopPov Research Network. For additional information, please visit www.poppov.org.
MALE INVOLVEMENT
Focus groups with men and women in the Mwanza region revealed
that men are generally viewed as decisionmakers on matters
concerning family planning and fertility—a practice that limits
women’s fertility decisionmaking. Women are expected to carry out
directives from male partners regarding family planning and fertility.10
Another study in the Mwanza region found that couples’
communication about family planning was positively associated
with its use.11
Encouraging couples to communicate about
fertility and family planning could empower women to engage in
contraceptive decisionmaking.
ECONOMIC SHOCKS
Evidence indicates economic shocks may influence contraceptive
use in two ways. Economic shocks can both disrupt financial access
to contraception or encourage greater contraceptive use as people
attempt to avoid the expenses associated with caring for a child.
In the Morogoro region, women who experienced an economic shock
were 12 percent more likely to have unprotected sex—a risk factor for
sexually transmitted infections and unintended pregnancy.12
Conversely,
an analysis of data from the Kagera region shows that an economic
shock such as agricultural crop loss increases a woman’s likelihood of
using contraception and a decline in the likelihood of pregnancy.13
NATIONAL INVESTMENT
Tanzania’s Ministry of Health and Social Welfare developed the
National Family Planning Costed Implementation Program to increase
contraceptive prevalence to 60 percent by 2015.14
The program
was estimated to spend US$98 million between 2010 and 2015 and
included components to improve contraceptive supply, quality of
service delivery, and affordability—all of which can increase women’s
access to contraception.
Specifically, the plan included activities to ensure that family planning
was accessible to all, including the economically disadvantaged.
Program activities included increasing the number of facilities that
offered family planning services, strengthening existing facilities,
and researching and recommending ways to overcome barriers to
access among the economically disadvantaged. Plans for evaluating
the program are in place and overall success will be measured by
the contraceptive prevalence rate reported in the next Tanzania
Demographic and Health Survey which is currently underway.
Policy Implications
Both social and economic factors influence contraceptive use. In
particular, knowledge about contraception, partner communication
about fertility and family planning, and the affordability and acces-
sibility of contraception are influencing factors. Action is needed to
reduce unmet need among women in Tanzania and to empower them
to have the families they want.
• Investments that expand and strengthen family planning services
should remain a priority. Helping people afford and access modern
contraception, especially during an economic shock, could help
reduce unmet need.
• Exploring activities and programs to engage men and encourage
couples’ communication about fertility could help identify
ways to increase women’s empowerment in family planning
decisionmaking.
• Improving knowledge about family planning—through activities,
programs, and services—could help dispel myths and miscon-
ceptions. This information can travel through social networks and
influence family planning use.
References
1 Derek Chitama et. al., “From Papers to Practices: District Level Priority
Setting Processes and Criteria for Family Planning, Maternal, Newborn
and Child Health Interventions in Tanzania,” BMC Women’s Health 11,
no. 46 (2011); DOI: 10.1186/1472-6874-11-46.
2 Dieudonné Ndaruhuye Muhoza, Annelet Broekhuis, and Pieter Hooimeijer,
“Variations in Desired Family Size and Excess Fertility in East Africa,”
International Journal of Population Research (2014): 5-9.
3 Idda Mosha, Ruerd Ruben, and Deodatus Kakoko, “Family Planning
Decisions, Perceptions, and Gender Dynamics Among Couples in
Mwanza, Tanzania: A Qualitative Study,” BMC Public Health 13 (2013);
DOI: 10.1186/1471-2458-13-523.
4 Kate Barnhart and Courtney Schreiber, “Return to Fertility Following
Discontinuation of Oral Contraceptives,” Fertility and Sterility 91, no. 3
(2011): 659-63; Kenneth Rothman and Carol Louik, “Oral Contraceptives
and Birth Defects,” New England Journal of Medicine 299 (1978): 522-52.
5 Idda Mosha and Ruerd Ruben, “Communication, Knowledge, Social
Network, and Family Planning Utilization Among Couples in Mwanza,
Tanzania,” African Journal of Reproductive Health 17, no. 3 (2013):
57-69; Abiba Longwe, Janine Huisman, and Jeroen Smits, “Effects of
Knowledge, Acceptance, and Use of Contraceptives on Household
Wealth in 26 African Countries,” Nijmegen Center for Economics working
paper 12‐109, Radboud University, The Netherlands (2013).
6 Rob Stephenson et al., “Contextual Influences on Modern Contraceptive
Use in Sub-Saharan Africa,” American Journal of Public Health 97, no.
7 (2007): 1233-40; and John Cleland, Robert Ndugwa, and Eliya Zulu,
“Family Planning in Sub-Saharan Africa: Progress or Stagnation?” Bulletin
of the World Health Organization 89 (2011): 137-43.
7 Stephenson et al., “Contextual Influences on Modern Contraceptive Use
in Sub-Saharan Africa.”
8 Mosha and Ruben, “Communication, Knowledge, Social Network, and
Family Planning Utilization Among Couples in Mwanza, Tanzania.”
9 Mosha and Ruben, “Communication, Knowledge, Social Network, and
Family Planning Utilization Among Couples in Mwanza, Tanzania.”
10 Mosha, Ruben, and Kakoko, “Family Planning Decisions, Perceptions,
and Gender Dynamics Among Couple in Mwanza, Tanzania.”
11 Mosha and Ruben, “Communication, Knowledge, Social Network and
Family Planning Utilization Among Couples in Mwanza, Tanzania.”
12 Damien de Walque, William H. Dow, and Erick Gong, “Coping With Risk:
The Effects of Shocks on Reproductive Health and Transactional Sex in
Rural Tanzania,” World Bank policy research working paper 6751 (2014).
13 Shamma Adeeb Alam and Claus C. Pörtner, “Income Shocks,
Contraceptive Use, and Timing of Fertility,” paper submitted to “Seventh
Annual PopPov Conference on Population, Reproductive Health, and
Economic Development,” Jan. 23-26, 2013.
14 Ministry of Health and Social Welfare, United Republic of Tanzania,
National Family Planning Costed Implementation Program 2010-2015
(March 2010), accessed at www.fhi360.org/sites/default/files/media/
documents/national-fp-costed-implementation-plan-tanzania-main-text.
pdf, on Oct. 9, 2015.