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Hadley, Michael

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Hadley

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Hadley, Michael

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2012 - 20152

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Author's Publications: search.filters.isAuthorOfPublication.21a3732c-bc4e-4ad4-a0a8-69b5fd811160

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    Modeling Strategic Interventions in a Population With a Total Fertility Rate of 8.3: A Cross-Sectional Study of Idjwi Island, DRC - With Appendix Detailing Patterns of Poverty and Disease Among the Bany'Idjwi People
    (2015-05-13) Hadley, Michael
    Idjwi Island, DRC, has a total fertility rate of 8.3, one of the highest in the world. Rapid population growth has led to widespread environmental degradation and food insecurity. Meanwhile family planning services are largely unavailable. We conducted a representative survey of 2,078 households measuring standard reproductive health indicators. We also interviewed local women, community leaders, and clinicians about access to reproductive services. In the survey, over half of all women reported an unmet need for spacing or limiting births. Interviews revealed that Idjwi’s extremely high fertility is associated with a weak health care system, poor funding, deteriorating infrastructure, and discrimination and violence against women. Modeling proximate determinants of fertility, we predicted that an increase in contraceptive prevalence (from 1% to 30%) could reduce TFR on Idjwi to 6 children per women, the average desired number. To improve the status of women and curb unsustainable population growth, we recommend: adding family planning services at health centers, reaching out to women during regular medical and maternal health visits, pursuing a community health worker program, promoting extended periods of breastfeeding, and implementing programs to end gender-based violence. Lessons from Idjwi may be applied to other densely populated, low-income settings with high fertility.
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    Modelling Strategic Interventions in a Population with a Total Fertility Rate of 8.3: A Cross-Sectional Study of Idjwi Island, DRC
    (BioMed Central, 2012) Thomson, Dana R.; Hadley, Michael; Greenough, Paul Gregg; Castro, Marcia
    Background: Idjwi, 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. Methods: At 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. Results: Over 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%. Conclusions: To 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.