Tawanda Musarurwa
CHECK POINT DESK
TWO scenarios paint a picture of Zimbabwe’s evolving reproductive landscape.
In Harare, a woman welcomes her second child five years after her first, exactly as planned. Meanwhile, in rural Murewa, a young mother, not yet ready for another baby, secretly takes oral contraceptives, fearing her husband’s disapproval.
Despite their different circumstances and locations, both women are quietly exercising control over their reproductive choices.
Their experiences reflect broader demographic shifts happening across Zimbabwe.
A comparative analysis of the 2015 and 2023/2024 Zimbabwe Demographic and Health Surveys (ZDHSs), conducted nearly a decade apart, reveals more than just changing population figures.
It highlights evolving social behaviours, improvements in health systems and persistent inequalities.
Zimbabwe’s fertility rate has dropped by 30 percent, from 5,6 children per woman in 1982 to 3,9 in 2024.
However, the decline over the past decade has been subtle, moving from four in 2015 to just 3,9 in 2024. This marginal change may quietly signal a broader transition.
Is Zimbabwe laying the groundwork for a demographic dividend?
To understand the full picture, it is necessary to examine five key areas from the 2015 and 2023/2024 ZDHSs: fertility, mortality, family planning, HIV prevalence and education.
Fertility: A plateau or turning point?
One of the clearest indicators of demographic transition is the total fertility rate (TFR) — the average number of children a woman is expected to have during her reproductive years.
In 2015, it stood at four children per woman. By the 2023/2024 ZDHS, it had only declined slightly to 3,9.
On the surface, this might appear stagnant. However, a key shift has occurred: birth intervals have lengthened, from 43,7 months in 2015 to 47,4 months in 2024.
This suggests that, while the overall number of children per woman has not changed much, women are spacing births more, a sign of greater reproductive control.
The age at first birth has remained at 20,1 years.
Teenage pregnancies have modestly declined, with the share of girls aged 15 to 19 who had begun childbearing dropping from 22 percent to 21 percent.
This is probably due to various legislative interventions outlawing child marriages in the country.
Regional and urban-rural divides still shape the landscape.
Rural women have, on average, 1,5 more children than urban women (4,6 versus 3,1). Yet the deeper shift may lie in what women want and are increasingly achieving.
Both surveys show a narrowing gap between desired and actual fertility, especially among more educated and wealthier women.
By 2015, this gap had shrunk to 0,6 children in rural areas and 0,3 in urban areas, suggesting that women’s reproductive intentions are aligning more closely with outcomes.
This alignment could lead to further, albeit gradual, fertility decline.
According to the United Nations’ World Fertility 2024 report, Zimbabwe is among 63 countries projected to reach low fertility after 2054 — still far from completing the “fertility transition”.
Fertility transition refers to the shift from high to low fertility rates that typically occurs as a country develops economically and socially.
Globally, the fertility rate fell from about five in the 1960s to 3,3 in 1990 and now sits at 2,2 — just below the replacement rate of 2,1.
By 2050, it is expected to drop to 2,1 and continue down to 1,8 by 2100.
The replacement rate maintains a stable population in most developed countries.
While Zimbabwe remains among higher-birth-rate nations, global trends point downwards.
The World Fertility 2024 report highlights a strong link between high fertility and low income, limited female education and poor access to birth control.
Zimbabwe’s 2024 fertility rate of 3,9 is below the Sub-Saharan African average of 4,3, but still well above the global average of 2,2.
Mortality: Uneven progress
Under-5 mortality is generally believed to offer an insight into a country’s public health system. In 2015, Zimbabwe’s under-5 mortality rate was 69 deaths per 1 000 live births. By 2023/2024, it remained unchanged.
However, infant mortality saw an increase, rising from 50 to 56 per 1 000 live births.
Infant mortality refers to deaths of infants before their first birthday, while under-5 mortality includes deaths of children under the age of five.
More mothers are now giving birth in health facilities, up from 78 percent in 2015 to 88 percent — meaning more women receive antenatal care and more children are vaccinated against measles and
polio.
But neonatal mortality rose from 32 to 37 per 1 000 live births (the highest ever recorded in the ZDHS), indicating that a growing share of infant deaths occur in the first month of life.
These trends show Zimbabwe is still far from meeting Sustainable Development Goal (SDG) 3.2: reducing neonatal mortality to 12 and under-5 mortality to 25 per 1 000 live births by 2030.
Still, there are gains.
With medical facilities being stocked and established throughout the country, easy health access is gradually increasing.
In the past year, 68 percent of women received a postnatal check within two days of delivery, up from 57 percent in 2015 and just 28 percent in the period between 2010 and 2011.
However, urban-rural disparities persist.
Under-5 mortality in the previous year was 66 in urban areas and 71 in rural areas. But in 2015, the gap was wider — 60 versus 92.
Education remains a strong determinant, according to the study.
It was revealed that a decade back, women with more than secondary education had the lowest under-5 mortality, just 26 per 1 000 live births, nearly four times lower than among those with only primary education.
Family planning
One of Zimbabwe’s quiet success stories has been in family planning.
Ten years ago, total demand among married women stood at 77 percent, with 67 percent using some form of contraception. By 2023/2024, modern contraceptive prevalence among married women had risen modestly to 69 percent.
This has largely been attributed to various awareness programmes led by the Ministry of Health and Child Care and various partners in both urban and rural areas.
Unmet need dropped slightly, from 10 percent in 2015 to 9 percent in 2024. In 2024, at least 7,8 percent of rural women had an unmet need, compared to 5,3 percent of urban women.
In 2015, women with more than secondary education had an unmet need of just 5 percent, compared to 22 percent among those with only primary schooling.
By 2024, that figure remained low at 5,2 percent for highly educated women.
In short, the more educated a woman is, the more likely she is to use contraception and have her needs met.
Yet concerns persist about women’s control over their reproductive choices, as suggested by the portraits of the two Harare and Murewa women.
The 2023/2024 ZDHS shows 90 percent of urban women participate in contraceptive decision-making, compared to 82 percent in rural areas. Still, 4 percent of married women aged 15 to 49 reported pressure from partners or family to become pregnant against their wishes.
Regarding both maternal health and family planning programmes, the United Nations Population Fund (UNFPA) plays an important role in advocating for increased domestic financing.
“On family planning, UNFPA and the Government have a compact of commitment, which requires the Government to procure contraceptives using domestic resources.
‘‘In the last three years, the Government has invested US$4,5 million, with UNFPA contributing US$9 million,” said UNFPA Zimbabwe country representative Miranda Tabifor.
“We also supported the Government to mobilise resources for maternal health programmes such as the Health Resilience Fund.”
HIV: A long decline with complexities
HIV continues to shape Zimbabwe’s public health landscape.
A decade back, prevalence among adults aged 15 to 49 was 13,8 percent (16,7 percent for women and 10,5 percent for men).
By 2023/2024, Zimbabwe had reduced new infections by 75 percent and is on track to meet the 90 percent reduction target by 2030, outperforming the regional average reduction of 59 percent between 2010 and 2023, according to the Joint United Nations Programme on HIV and AIDS (UNAIDS).
However, awareness is slipping.
In 2015, 91 percent of women and 86 percent of men knew that medication could reduce mother-to-child transmission; by 2024, these figures had dropped to 86 percent and 76 percent, respectively.
Young women remain disproportionately affected.
In 2015, 10,3 percent of women aged 20 to 24 were HIV-positive, compared to 3,7 percent of men of the same age, a gap typically linked to biological vulnerability, age-disparate relationships and limited power in negotiating condom use.
This disparity has prompted targeted interventions, including expanded access to pre-exposure prophylaxis (PrEP), which 40 percent of women and 27 percent of men had heard of by 2024.
Another silent shift: the epidemic is ageing.
In 2015, prevalence among men aged 50 to 54 was 28,9 percent — up from 19,5 percent in 2010/2011, compared to 23,2 percent among those aged 45 to 49.
This reflects the success of antiretroviral therapy (ART), with more people living longer with HIV.
Education
In Zimbabwe, education is not just a demographic indicator; it is a demographic driver. The share of women and men with secondary or higher education has risen, helping to explain shifts in fertility and family planning.
According to the latest ZDHS, the median years of schooling increased from 6,5 to 7,5 for females and from 6,7 to 7,7 for males since 2010/2011.
It is noted that 10 years ago, women with secondary education had a total fertility rate of 3,7, compared to 5,2 among those with only primary education and 5,7 among those with no education.
By 2024, the pattern was: women with secondary education had a fertility rate of 3,8, versus 5,1 (primary) and 5 (no education). This reinforces education as a key lever in fertility decline — possibly more influential than geography or income.
But income and location continue to shape educational outcomes.
In 2023/2024, urban women and men were more likely to have completed secondary school, standing at 38 percent and 41 percent, respectively, than their rural counterparts, at 17 percent and 21 percent.
Education also rises with household wealth.
Median years of schooling exceed 10 years for both females and males in the highest wealth group, compared to 6,1 years for females and 6 years for males in the lowest.
An evolving demographic dividend
According to the UNFPA 2017 Zimbabwe Demographic Dividend study, the country’s window to harness its first demographic dividend opened before 1990 and is likely to remain open until 2060.
The study emphasised that to fully capitalise on this opportunity, Zimbabwe needed to “facilitate further demographic transition through enhancing voluntary family planning services and access to effective modern contraception to reduce the relatively high unmet need (10 percent), and curb early marriages and unwanted teenage pregnancies.”
Data from the ZDHS suggest a slow, but meaningful demographic shift.
Fertility patterns are changing — births are more widely spaced, contraceptive use is rising and reproductive choices are increasingly intentional.
Child health is improving, though neonatal mortality and HIV awareness remain areas of concern. Family planning demand is strong and steady.
The dividend window remains open, but only just. Without urgent investments in adolescent health, women’s education and job creation, this demographic opportunity may quietly slip away.