Population chatter for clearer and broader thinking about fertility
DOI:
https://doi.org/10.55016/ojs/jcph.vi.80229Keywords:
fertility, contraception, vulnerability, MalawiAbstract
This paper examines reproductive vulnerability in Balaka, Malawi by prioritizing population chatter – how ordinary people perceive, narrate, and debate the fertility, mortality, and migration conditions around them. The authors, a cultural anthropologist and a demographer, discuss the translation of the concept of vulnerability in Malawi, identify the common metaphors and predicaments used to express it, and identify articulations of vulnerability in everyday conversation that show how young adults perceive and cope with vulnerabilities during an especially eventful stage of life. Drawing upon 600 pages of ethnographic fieldnotes written in 2015, the analysis is organized around the following question: What we would know about sexual and reproductive health if we privileged ordinary women’s exchanges with one another in everyday conversation over the entrenched measures (i.e., ideal family size, desired time to next birth, unmet need, contraceptive discontinuation rates) that have come to define sample surveys? Results are organized around three key themes: 1) the moral nature of population chatter; 2) widespread discontent with the predominant contraceptive method; and 3) food insecurity as a vulnerability that has relevance for contraceptive behaviors.
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Ali, M. M., Cleland, J. G., Shah, I. H., & World Health Organization (2012) Causes and consequences of contraceptive discontinuation: Evidence from 60 demographic and health surveys. World Health Organization. https://iris.who.int/handle/10665/75429
Alvergne, A., Stevens, R., & Gurmu, E. (2017) Side effects and the need for secrecy: Characterising discontinuation of modern contraception and its causes in Ethiopia using mixed methods. Contraception and Reproductive Medicine, 2(24), 1–16. DOI: https://doi.org/10.1186/s40834-017-0052-7
Bahamondes, L., & Peloggia, A. (2019) Modern contraceptives in sub-Saharan African countries. The Lancet Global Health, 7(7), e819–e820. https://doi.org/10.1016/S2214-109X(19)30199-8 DOI: https://doi.org/10.1016/S2214-109X(19)30199-8
Bamji, M. S. (1985) Oral contraceptives and nutrition interaction. ICMR Bulletin, 15(7), 85–89.
Bledsoe, C. H. (2002) Contingent lives. University of Chicago Press. DOI: https://doi.org/10.7208/chicago/9780226058504.001.0001
Coale, A. J. (1973) The demographic transition reconsidered. In Proceedings of the International Population Conference, Liege (pp. 53–72). International Union for the Scientific Study of Population.
Coombs, L. C. (1974) The measurement of family size preferences and subsequent fertility. Demography, 11(4), 587–611. https://doi.org/10.2307/2060472 DOI: https://doi.org/10.2307/2060472
Davis, K. (1987) The world’s most expensive survey. Sociological Forum, 2(4), 829–834. DOI: https://doi.org/10.1007/BF01124386
Gebrslasie, K. Z., Berhe, G., Taddese, H., Weldemariam, S., Gebre, G., Amano, A., … & Haile, E. (2023) One-year discontinuation among users of the contraceptive pill and injection in South East Tigray region, Ethiopia. PLOS ONE, 18(5), e0285085. https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0285085 DOI: https://doi.org/10.1371/journal.pone.0285085
Giorgio, M., Sully, E., & Chiu, D. W. (2021) An assessment of third‐party reporting of close ties to measure sensitive behaviors: The confidante method to measure abortion incidence in Ethiopia and Uganda. Studies in Family Planning, 52(4), 513–538. https://doi.org/10.1111/sifp.12180 DOI: https://doi.org/10.1111/sifp.12180
Gribaldo, A., Judd, M. D., & Kertzer, D. I. (2009) An “imperfect” contraceptive society: Fertility and contraception in Italy. Population and Development Review, 35(3), 551–584. https://doi.org/10.1111/j.1728-4457.2009.00296.x DOI: https://doi.org/10.1111/j.1728-4457.2009.00296.x
Haakenstad, A., Angelino, O., Irvine, C.M.S., Bhutta, Z.A., Bienhoff, K., Bintz, C., … & Lozano, R. (2022) Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: A systematic analysis for the Global Burden of Disease Study 2019. The Lancet, 400(10348), 295–327. DOI: 10.1016/S0140-6736(22)00936-9 DOI: https://doi.org/10.1016/S0140-6736(22)00936-9
Health Policy Plus and Ministry of Health Malawi (2022) Malawi FP2020 Assessment: Summary Report. Palladium, Health Policy Plus. http://www.healthpolicyplus.com/ns/pubs/18671-19157_FPAssessmentSummaryReport.pdf
Higgins, J. A., & Hirsch, J. S. (2007) The pleasure deficit: Revisiting the “sexuality connection” in reproductive health. Perspectives on Sexual and Reproductive Health, 39(4), 240–247. doi: 10.1363/3924007 DOI: https://doi.org/10.1363/3924007
Higgins, J. A., & Hirsch, J. S. (2008) Pleasure, power, and inequality: Incorporating sexuality into research on contraceptive use. American Journal of Public Health, 98(10), 1803–1813. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2007.115790 DOI: https://doi.org/10.2105/AJPH.2007.115790
Ibrahim, P. M., & Samwel, E. L. (2023) Prevalence of heavy menstrual bleeding and its associated factors among women attending Kilimanjaro Christian Medical Centre in Northern Eastern, Tanzania: A cross-sectional study. The East African Health Research Journal, 7(1), 1–6. DOI: https://doi.org/10.24248/eahrj.v7i1.702
John, N. A., Babalola, S., & Chipeta, E. (2015) Sexual pleasure, partner dynamics and contraceptive use in Malawi. International Perspectives on Sexual and Reproductive Health, 41(2), 99–107. https://doi.org/10.1363/4109915 DOI: https://doi.org/10.1363/4109915
Johnson-Hanks, J., Bachrach, C. A., Morgan, S. P., & Kohler, H.-P. (2011) The theory of conjunctural action. In Understanding Family Change and Variation (pp. 1–22). Springer Netherlands. DOI: https://doi.org/10.1007/978-94-007-1945-3_1
Kreager, P. (2006) Migration, social structure and old-age support networks: A comparison of three Indonesian communities. Ageing and Society, 26(1), 37–60. doi:10.1017/S0144686X05004411 DOI: https://doi.org/10.1017/S0144686X05004411
Lakoff, G., & Johnson, M. (2003 [1980]) Metaphors we live by. University of Chicago Press. https://doi.org/10.7208/chicago/9780226470993.001.0001 DOI: https://doi.org/10.7208/chicago/9780226470993.001.0001
Lethaby, A., Wise, M. R., Weterings, M. A., Bofill Rodriguez, M., & Brown, J. (2019) Combined hormonal contraceptives for heavy menstrual bleeding. The Cochrane Database of Systematic Reviews, 2(2), CD000154. https://doi.org/10.1002/14651858.CD000154.pub3 DOI: https://doi.org/10.1002/14651858.CD000154.pub3
Magalona, C. S. (2024). Contraceptive-induced side effects: The role of experience, management, and information on contraceptive use dynamics in Kenya [Doctoral Dissertation]. Johns Hopkins University.
MDHS (2016) Malawi Demographic and Health Survey. ORC Macro, MEASURE DHS. https://dhsprogram.com/pubs/pdf/FR319/FR319.pdf
MDHS (2024) Malawi Demographic and Health Survey. ORC Macro, MEASURE DHS. https://cms.nsomalawi.mw/api/download/487/2024-MDHS-KIR--Final.pdf
Modesto, W., Bahamondes, M. V., & Bahamondes, L. (2014) A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives. Human Reproduction, 29(7), 1393–1399. https://doi.org/10.1093/humrep/deu089 DOI: https://doi.org/10.1093/humrep/deu089
Moroole, M. A., Materechera, S. A., Otang-Mbeng, W., & Aremu, A. O. (2020) African indigenous contraception: A review. African Journal of Reproductive Health, 24(4), 173–184.
Moroole, M. A., Materechera, S. A., Otang-Mbeng, W., & Aremu, O. A. (2019) Medicinal plants used for contraception in South Africa: A review. Journal of Ethnopharmacology, 235, 19–27. https://doi.org/10.1016/j.jep.2019.02.002 DOI: https://doi.org/10.1016/j.jep.2019.02.002
Owolabi, O. O., Giorgio, M., Leong, E., & Sully, E. (2023) The confidante method to measure abortion: Implementing a standardized comparative analysis approach across seven contexts. Population Health Metrics, 21(1), 9. https://doi.org/10.1186/s12963-023-00310-0 DOI: https://doi.org/10.1186/s12963-023-00310-0
Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013) Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 17(13), 1804–1813.
Parkin, D. J. (1986) Toward an apprehension of fear. In D. L. Scrunton (Ed.), Sociophobics: The anthropology of fear (pp. 158–172). Westview Press.
Rutenberg, N., & Watkins, S. C. (1997) The buzz outside the clinics: Conversations and contraception in Nyanza Province, Kenya. Studies in Family Planning, 28(4), 290–307. https://doi.org/10.2307/2137860 DOI: https://doi.org/10.2307/2137860
Schröder-Butterfill, E., & Marianti, R. (2006) A framework for understanding old-age vulnerabilities. Ageing and Society, 26(1), 9–35. doi:10.1017/S0144686X05004423 DOI: https://doi.org/10.1017/S0144686X05004423
Senderowicz, L., Bullington, B. W., Sawadogo, N., Tumlinson, K., Langer, A., Soura, A., Zabré, P., & Sié, A. (2023) Assessing the suitability of unmet need as a proxy for access to contraception and desire to use it. Studies in Family Planning, 54(1), 231–250. https://doi.org/10.1111/sifp.12233 DOI: https://doi.org/10.1111/sifp.12233
Sinharoy, S. S., Chery, L., Patrick, M., Conrad, A., Ramaswamy, A., Stephen, A., … & Caruso, B. A. (2023) Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: A multinational cross-sectional study. The Lancet Global Health, 11(11), e1775–e1784. https://doi.org/10.1016/S2214-109X(23)00416-3 DOI: https://doi.org/10.1016/S2214-109X(23)00416-3
Sittig, K. R., Weisman, C. S., Lehman, E., & Chuang, C. H. (2020) What women want: Factors impacting contraceptive satisfaction in privately insured women. Women’s Health Issues, 30(2), 93–97. https://doi.org/10.1016/j.whi.2019.11.003 DOI: https://doi.org/10.1016/j.whi.2019.11.003
Spini, D., Bernardi, L., & Oris, M. (2017) Toward a life course framework for studying vulnerability. Research in Human Development, 14(1), 5–25. https://doi.org/10.1080/15427609.2016.1268892 DOI: https://doi.org/10.1080/15427609.2016.1268892
Stevens, R., Machiyama, K., Mavodza, C. V., & Doyle, A. M. (2023) Misconceptions, misinformation, and misperceptions: A case for removing the “mis-” when discussing contraceptive beliefs. Studies in Family Planning, 54(1), 309–321. https://doi.org/10.1111/sifp.12232 DOI: https://doi.org/10.1111/sifp.12232
Stewart, C., Stevens, R., Kennedy, F., Cecula, P., Rueda Carrasco, E., & Hall, J. (2025) Experiences and impacts of side effects among contraceptive users in the UK: Exploring individual narratives of contraceptive side effects. The European Journal of Contraception & Reproductive Health Care, 30(1), 27–32. https://doi.org/10.1080/13625187.2024.2410841 DOI: https://doi.org/10.1080/13625187.2024.2410841
Tavory, I., & Swidler, A. (2009) Condom semiotics: Meaning and condom use in rural Malawi. American Sociological Review, 74(2), 171–189. https://doi.org/10.1177/000312240907400201 DOI: https://doi.org/10.1177/000312240907400201
Trinitapoli, J. (2021) Demography beyond the foot. In L. MacKellar & R. Friedman (Eds.) Essays: Covid-19 and the global demographic research agenda (pp. 68–72). Population Council. DOI: https://doi.org/10.31899/pdr1.1012
Trinitapoli, J. (2023) An epidemic of uncertainty: Navigating HIV and young adulthood in Malawi. University of Chicago Press. DOI: https://doi.org/10.7208/chicago/9780226825700.001.0001
van de Walle, E. (1992) Fertility transition, conscious choice, and numeracy. Demography, 29(4), 487–502. https://doi.org/10.2307/2061848 DOI: https://doi.org/10.2307/2061848
Verheijen, J. (2017) The gendered micropolitics of hiding and disclosing: Assessing the spread and stagnation of information on two new EMTCT policies in a Malawian village. Health Policy and Planning, 32(9), 1309–1315. doi: 10.1093/heapol/czx08 DOI: https://doi.org/10.1093/heapol/czx088
Walters, S. (2021) African population history: Contributions of moral demography. The Journal of African History, 62(2), 183–200. doi:10.1017/S002185372100044X DOI: https://doi.org/10.1017/S002185372100044X
Watkins, S. C. (1993) If all we knew about women was what we read in demography, what would we know? Demography, 30(4), 551–577. https://doi.org/10.2307/2061806 DOI: https://doi.org/10.2307/2061806
Wilson, A. (2013) Folklore, gender, and AIDS in Malawi: No secret under the sun. Palgrave Macmillan. DOI: https://doi.org/10.1057/9781137322456
Yeatman, S., Chilungo, A., Lungu, S., Namadingo, H., & Trinitapoli, J. (2019) Tsogolo la Thanzi: A longitudinal study of young adults living in Malawi’s HIV epidemic. Studies in Family Planning, 50(1), 71–84. https://doi.org/10.1111/sifp.12080 DOI: https://doi.org/10.1111/sifp.12080
Yeatman, S., & Trinitapoli, J. (2011) Best-friend reports: A tool for measuring the prevalence of sensitive behaviors. American Journal of Public Health, 101(9), 1666–1667. doi:10.2105/AJPH.2011.300194 DOI: https://doi.org/10.2105/AJPH.TEST.2011.300194
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