Abstract
CONTEXT: Communities indigenous to the Amazon are among the few remaining worldwide still practicing near-natural fertility, without the use of modern contraceptives. Given the large proportion of women desiring no more births, information on the challenges women there face in limiting fertility would be useful. METHODS: Samples of women of reproductive age from five indigenous ethnic groups in the Northern Ecuadorian Amazon were surveyed in 2001 and 2012. Cross-sectional and longitudinal analyses examined married women's desire for another child at both times and modern contraceptive use in 2012, as well as determinants of a change in women's desire to have more children and of the number of children born during the study period. RESULTS: In 2001, 48% of married women desired another child, 2% used a modern contraceptive and 50% had an unmet need for limiting; in 2012, the proportions were 40%, 19% and 47%, respectively. The total fertility rate was 7.9 births per woman in 2001 and 7.0 births per woman in 2012. Characteristics associated with wanting another child in 2001 and 2012 included parity (odds ratios, 0.6 and 0.4, respectively) and experience of a child death (2.0 each); characteristics associated with contraceptive use in 2012 included desire for another child, experience of a child death and presence of a community health worker (0.3-0.5). Number of children born was positively associated, and the square of the term negatively associated, with no longer wanting more children in 2012 among women who wanted more in 2001 (2.1 and 0.9, respectively). CONCLUSIONS: Indigenous women in the Northern Ecuadorian Amazon appear to be making the transition to lower fertility. Insufficient access to credible information about the safety and efficacy of modern contraceptives, however, may slow the transition.