The below video on Family Planning in Malawi put out by the UK Dept for International Development (DFID) * and tweeted today by USAID demonstrates the main issues surrounding fertility in low income countries like Malawi. Economists see access to family planning and contraceptives as a supply and demand issue. On the supply side the question is can women get access to contraceptives are there clinics available. On the demand side do they actually want them notice in the video the clinics also includes education programs for the women about the benefits. In the video one woman also talks about how she asked her husband about getting birth control and then wanted to make sure he wouldn't pressure her for more babies. Intrahousehold issues and women's bargaining power are also key.
Fertility in Malawi has fallen substantially since 1980 when it peaked at 7.5 kids per woman falling to 6 kids per woman today (Gapminder). Nearly in every country over the last 30 years fertility has fallen, some may be surprised that countries like Brazil and India only have 1.8 and 2.6 kids per woman, respectively.
The video also demonstrates another issue as families have fewer kids (quantity is reduced) they can invest more in each one so (quality) increases. One thing I teach my students is that in poorer countries children are in a sense a form of an old age pension or social security (since they will take care of their parents when the parents get older). During the last 30 years child mortality in Malawi has fallen from roughly 1 in 4 kids not making it to age 5 in 1980 to 1 in 9 today. This may also be related to falling birth rates
* in the past my research has received funding from DFID