Culturally Rooted Strategies for Fertility Decline in High-Fertility Nations

The World Bank’s Evaluation Insight Note highlights that successful fertility transitions in high-fertility countries require culturally sensitive, gender-informed strategies that integrate both supply- and demand-side interventions. Meaningful community engagement, tailored program design, and addressing gender power dynamics are key to ensuring lasting impact.

A July 2025 Evaluation Insight Note from the World Bank Group’s Independent Evaluation Group (IEG), with contributions from institutions such as the Africa Gender Innovation Lab, Human Development Practice Group, and the Corporate and Human Development division, distills over a decade’s worth of data on fertility transition strategies in high-fertility countries. Despite the global decline in birth rates, from 3.2 to 2.5 births per woman between 1990 and 2019, many Sub-Saharan African nations still face persistently high fertility rates, often exceeding 5 or even 6 births per woman. These demographic patterns pose considerable challenges, including limiting the demographic dividend, worsening maternal mortality, reducing women’s opportunities, and placing enormous stress on social infrastructure.

Demand Meets Supply: The Fertility Equation

The report’s central thesis is clear: successful fertility transitions require a dual-pronged strategy that tackles both supply- and demand-side drivers. On the supply side, health systems must ensure reliable and affordable access to reproductive health services, including contraceptive availability and counseling. The evidence is stark: 37 percent of women of reproductive age in Sub-Saharan Africa who wish to avoid pregnancy do not use modern contraceptives. Supply chain failures, stockouts, and undertrained health staff often undermine the best intentions of policy. But improving access alone is insufficient. On the demand side, social attitudes, misinformation about contraceptive side effects, and low reproductive autonomy among women impede progress. Programs in Uganda, Cameroon, and Chad demonstrated that strategic behavior change campaigns, including radio shows, postnatal counseling, and football-based outreach, can effectively shift perceptions and increase the use of contraceptives.

Culture Matters: Local Norms Can Make or Break a Project

The report highlights that culturally sensitive interventions are far more successful than those that impose external norms. In Burkina Faso, for instance, young women were unable to attend training programs because of restrictions on traveling alone or participating in mixed-gender events. In Peru, female participation in road construction projects led to domestic abuse, as male partners reacted negatively to women’s higher earnings and absence from the home. These examples illustrate how vital it is for development programs to engage with community values, beliefs, and traditional roles. In contrast, successful interventions in Panama, Ethiopia, and Afghanistan demonstrated how adapting programs to local realities, such as enabling women to work from home or training practitioners in indigenous languages, can increase participation. Gender-separate spaces, such as girls-only libraries or women-focused agricultural value chains, proved instrumental in improving outcomes.

Empowerment Through Participation: Listening to Women and Men

One of the most powerful insights from the evaluation is the value of participatory design. Projects that involved women, community members, and religious leaders from the start fared much better than those planned top-down. In Mali and Burkina Faso, community engagement helped shape land rights discussions and vocational programs that genuinely reflected women's aspirations. Conversely, the SWEDD project in Benin faltered by selecting income-generating activities without consulting local communities, making the training less relevant. Importantly, the report also underlines the role of men. In Ethiopia and Mali, male partners were shown to be active supporters of reproductive health when engaged directly. Programs that formed men’s clubs or trained male champions saw ripple effects across communities. Religious leaders also proved vital, initiatives in Afghanistan and Chad that included faith-based messaging around family planning and girls’ education experienced greater cultural acceptance and higher contraceptive uptake.

One Size Does Not Fit All: Tailoring for Real Impact

The IEG report is adamant that projects must avoid treating women and girls as a monolithic group. Diverse needs based on age, ethnicity, education level, geography, and marital status mean that what works for one group may not work for another. For example, a project in Ethiopia failed to boost contraceptive use because it distributed pills and condoms when women preferred injectable options. In Côte d’Ivoire, small adjustments like adding private washing areas and toilets improved the comfort and uptake of reproductive services. Similarly, in Burkina Faso’s Agricultural Productivity and Food Security Project, failure to consult female participants initially led to inappropriate equipment choices. This oversight was corrected in the next phase through the direct involvement of women in decision-making. In Sierra Leone, women’s participation in labor-intensive roadwork was low because no alternatives or childcare options were offered. The takeaway is clear: relevance and effectiveness improve significantly when project design incorporates the preferences and constraints of intended beneficiaries.

Gender Power Dynamics: The Silent Barrier

The report concludes by warning against superficial gender inclusion strategies that fail to address deeper power imbalances. While many projects promote women’s access to credit, land, or employment, they often ignore the issue of agency. In Afghanistan, for instance, 80 percent of loans issued to women were used by their husbands. In Burkina Faso, a mobile-based e-voucher scheme excluded many women simply because they lacked access to cell phones. The report argues that quotas and numeric targets are ineffective unless systemic barriers, such as financial exclusion, domestic power hierarchies, and social norms, are also addressed. Effective programs, like Zambia’s Livestock Development Project, focused on training, access to resources, and targeted support to ensure that women not only participated but benefited meaningfully. Integrating robust gender analysis into project design, as seen in Chad and Yemen, helped uncover hidden constraints and led to more culturally appropriate, context-aware interventions.

Overall, the Evaluation Insight Note makes a strong case for integrated, localized, and gender-informed approaches to reducing fertility in high-fertility countries. It emphasizes that change must be co-created with communities, grounded in gender-sensitive research, and flexible enough to respond to the complexities of culture, identity, and power. As the world seeks to meet the Sustainable Development Goals, this report offers a blueprint for how development programs can more effectively support reproductive health and gender equity in regions where it matters most.