The last decades of the last century saw a drastic reduction in the fertility of Peruvian women, as the global fertility rate fell from more than six children per woman in the early 1960s to just under three in 2000.
55-planning-and-fertilization-rate-in-peruHowever, this reduction has strong inequalities between social groups: according to ENDES 2000, the fertility rate in rural areas (4.3) is double that in urban areas. Likewise, the fertility rate among women in the poorest quintile is still 5.3 children per woman, three times higher than among women in the richest quintile.
These changes in fertility patterns are certainly related to the urbanization process and the increase in the educational level of women and their empowerment. Precisely, the differences in these variables by socioeconomic level explain the inequalities observed in fertility patterns. The high cost of raising children means that households with many children invest less in their health and education, in such a way that poverty, high fertility and the deterioration of the local environment interact perniciously to sustain the mechanisms and reproduction of poverty and of gender iniquities.
The present study seeks to analyze the determinants of fertility among Peruvian women, but not only through the number of children they have, but also through the number of years that separate one birth from the next. Furthermore, the patterns of use of modern family planning methods are also characterized and their impact on investment in the human capital of children is evaluated.
A key question is to what extent the increase in spending on family planning programs (PPF) in the past decade contributed to reducing fertility among Peruvian women, especially those with fewer resources. This question is crucial for the redefinition of the priorities of the sector and PPF in particular.
The main data source used in this study is constituted by the National Demographic and Health Surveys (ENDES) that have been applied in Peru four times, over the last 14 years (1986, 1992, 1996 and 2000).
«… The fertility rate in rural areas (4.3) is double that in urban areas. the fertility rate among women in the poorest quintile is still 5.3 children per woman, three times higher than among women in the richest quintile »
With the information provided by these surveys, various econometric estimates were made to analyze the determinants of four variables: use of modern contraceptive methods, number of children, time and spacing between births, and nutritional level of children under five years of age. Given the unavailability of information disaggregated by district on the activities of the PPF, the variable of intensity of the PPF in the different districts and provinces is obtained from the same data from the ENDES, through averages by locality.
Family planning public policy in Peru
Public sector efforts to promote family planning increased significantly during the 1990s. The main mechanism was the subsidized distribution of contraceptive supplies and services; so much so that the executed budget of the MINSA increased gradually, reaching a peak of US $ 21 million in 1997. At the beginning of the decade, foreign cooperation contributed most of the financing. However, in recent years, the contribution of the Public Treasury became the dominant source, without this meaning the loss of importance of the participation of foreign cooperation.
It should be noted that in the past it was very difficult to get the Peruvian State to define a population policy.
In this sense, it was surprising that by 1995, the Peruvian government declared that it assumed more specific and serious objectives with regard to reproductive health policy: increasing timely access to reproductive health and family planning services, for which purpose it was it had to improve coverage and quality of care; achieve an informed demand for reproductive health services and PPFs; and, finally, mobilizing resources to develop local systems of universal access for the promotion, prevention and attention in these fields. The main measure was the free delivery of all modern contraceptive methods, such as injections, condoms, pills and even surgical sterilization.
It should be noted, however, that despite the statement of reproductive health objectives, the majority of agents agree that the implementation of the policies was more consistent with a population control approach to the fight against poverty. This limitation explains the main deficiencies observed during the past decade.
If anything, this new orientation led to a substantial increase in the use of modern contraceptive methods. Indeed, while in 1986 only 4.4% of women of reproductive age reported using some modern method provided by the Government, this proportion rose to 27.7% in 2000.
The following lines will present the results of the econometric analysis on the four variables of interest.
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