(August 2008) Fertility has declined significantly throughout the developing world, and in Latin America total fertility rates (TFRs) have declined by 50 percent over the last three decades, from 5.0 births per woman in 1970 to only 2.5 today.1 Service providers have achieved many family planning and reproductive health (FP/RH) successes in Latin America, most notably the increase in modern contraceptive prevalence rates to 64.5 percent of sexually active women in 2007.2 These successes have led international health and development agencies to focus their attention on other regions that have yet to show similar improvements in reproductive health.

The successes in Latin America however, mask a great deal of regional variation. In countries such as Bolivia, Guatemala, and Haiti, total fertility rates, a measure of the average number of children a woman will have over her lifetime, are still nearly 4.0 or higher.3 Furthermore, in these countries, between 22 percent and 32 percent of women who do not desire another child or want to space their births still have no access to family planning services.4 Within the Latin American countries that have experienced substantial declines in fertility, there are sub-populations and regional pockets characterized by high fertility and lack of access to FP/RH services. Among those with the most limited access to basic reproductive health services are people living in the poorest and most remote communities—on the frontiers of lowland tropical forests like the Amazon and indigenous people living far beyond forest frontiers.

An analysis by the authors of regional and provincial data from Demographic and Health Surveys (DHS) show continued high fertility in the Amazon regions of several countries including Bolivia, Brazil, Colombia, Ecuador, and Peru (see Table 1). Total fertility rates are in most cases substantially higher than national rates: In Ecuador, fertility is higher in the Amazon than in any other region of the country. These averages mask substantially higher fertility in rural areas of the Amazon, which are almost unrepresented in DHS data. The DHS data for the Brazil North region, for example, contains only 14 rural observations. The DHS data from rural Amazon provinces of Colombia report no data. And fertility surveys from Ecuador do not report disaggregated rural data for the Amazon.

Table 1
Total Fertility Rates (TFR) for Select Areas of the Amazon Latin America

Country/year Provinces/regions in lowland areas TFR
Bolivia, 2003 National 3.8
  Beni/Pando provinces 4.2
Brazil, 1996 National 2.5
  North region 2.7
  Central West region 2.3
Colombia, 2005 National 2.4
  Amazonas province 2.8
  Vaupes province 3.4
  Guania province 2.9
Ecuador, 2004 National 3.3
  Amazon region 4.2
Peru, 2004–06 National 2.4
  Amazon region 3.4

Note: The total fertility rate (TFR) measures the total number of lifetime births a woman would have given current birth rates.
Sources: The TFRs for Bolivia, Brazil, Colombia, and Peru were obtained from Demographic and Health Survey (DHS) reports. The TFRs for Ecuador were obtained from the report for ENDEMAIN—a DHS-type survey conducted periodically by MEASURE and CEPAR.

Data on modern contraceptive prevalence rates for these same regions also reveal low rates of modern contraceptive use (see Table 2). The little rural data available suggest that contraceptive prevalence rates (CPR) among sexually active women of reproductive age are under 50 percent for the majority of the Amazon.

Table 2
Modern Contraceptive Prevalence Rates (CPR) for Select Amazon Tropical Forest Areas of Latin America 

Country/Year Provinces/Regions in Lowland Areas Modern CPR (%)
    Urban Rural
Bolivia, 2003 Beni/Pando provinces 53.9 45.0
Brazil, 1996 North region 69.0 44.4a
  Central West region 80.0 76.4
Colombia, 2005 Amazonas province 55.0b – – – –d
  Vaupes province 57.1b – – – –d
  Guania province 65.3b – – – –d
Ecuador, 2004 Amazon region 65.3c – – – –c
Peru, 2004 06 Amazon region 53.4 33.7

a Rural North Region contains only 14 observations.
b Urban areas only.
c Women in unions. Rural and urban could not be disaggregated for Ecuador Amazon.
d Data not available.
Note: The total fertility rate (TFR) measures the total number of lifetime births a woman would have given current birth rates.
Sources: The CPR for Bolivia, Brazil, and Peru were calculated from Demographic and Health Survey (DHS) data and included women ages 15 to 49 who were currently married or in consensual union, and unmarried sexually active women. CPR for Columbia and Ecuador were obtained from the DHS and ENDEMAIN reports respectively.

Indigenous populations in lowland Latin America tend to be particularly underserved by health providers for many reasons, including cultural barriers, language, and accessibility. Available studies among these indigenous populations indicate TFRs from 7.0 to 8.0.5 Some researchers have argued that fertility rates among these indigenous women remain high because of a strong desire to have large families. However, survey data from indigenous women in the Ecuadorian Amazon contradict this argument, and indicate that approximately 50 percent do not want another child. Yet 98 percent of these women were not using a modern contraceptive method.6 While some might argue that the populations are too small to warrant attention from development agencies, the social and environmental implications of this growth are of great interest to the environmental community.

Conservation, Population, and Indigenous Peoples

Latin American tropical forests, including the Amazon basin, contain the world’s greatest concentration of biodiversity and play a critical role in climate change. More than two decades of conservation efforts have sought to decrease rates of deforestation in Latin American tropical forests. Despite these efforts, estimates of Amazon deforestation from 2002 to 2004 were near their highest levels since monitoring began in 1988, with an average of 2.5 million hectares annually.7 After three years of improvement, recent reports of deforestation during the last months of 2007 and first months of 2008 were the highest ever recorded for the wet season.8 The causes of this deforestation include underlying forces such as crop prices, land and forestry policies that encourage logging, and weak enforcement institutions at the national and global level. These forces drive local-level human activities such as agricultural expansion, timber extraction, and infrastructure growth that directly result in forest loss.9

In response, conservationists are seeking new strategies and new partners to protect the largest remaining tracts of tropical forest. Indigenous lands now encompass the single largest category of protected area in the Amazon, and 20 percent of the Amazon is now under the permanent rights of indigenous people. Indigenous lands are now touted as a critical barrier to future deforestation.10 Many of the largest conservation groups now work with indigenous groups, and international development agencies are beginning to finance conservation projects that work with indigenous groups. Central to the conservation objectives of these programs is the improved well-being of indigenous populations. Thus, indigenous communities and conservation organizations together should assess how demographic change will impact the health and livelihoods of indigenous households and the ecosystems in which they live.

The direct linkages between fertility and deforestation are often thought to be obvious (for example, more people leads to larger farms and thus more deforestation). In reality, however, the relationship between high fertility and land use has not been found to be as clear as is often stated. Research on the causes of tropical deforestation has found population growth to be a consistent underlying factor contributing to deforestation, though this growth is often due to migration and settlement of new colonists rather than high fertility rates.11 A more established link is the cyclical relationship between fertility and poverty, in which high fertility and poor maternal and child health outcomes are both symptoms of poverty and contributors to impoverishment, and affect the way people use, conserve, or overuse resources.

Changes in indigenous livelihoods are already evident at the household level, where increasing wage employment, market-based agriculture, and migration to cities have begun to replace traditional livelihoods of subsistence agriculture, hunting, fishing, and gathering of forest products. Less understood, however, are how demographic changes might affect the communal management groups that have traditionally managed agricultural lands, rivers, and forests. These communal management groups, for example, often make decisions regarding who can hunt, when they can hunt, and what they can hunt on indigenous lands. Now, these groups must confront the added challenges of greater external pressure from the growing population surrounding indigenous lands as well as greater internal pressure from their own growing populations.12

Role of Conservation Organizations

Over the last several years, a few conservation organizations have piloted projects that address the complex links between reproductive health, poverty, and conservation. These projects have adopted an integrated approach to community development that has been termed the Population, Health, and Environment (PHE) approach. The central tenets to this approach are first, that in many remote areas, conservation organizations are among the only institutions providing communities with development assistance; and second, providing men and women with health services and the opportunity to plan their families is beneficial both to the well-being of households and to the long-term sustainability of the forest, fishing, and hunting resources they manage.

The Population Reference Bureau’s PHE Program has been instrumental in developing the PHE approach by providing information to conservation organizations on the links between population, health, and environment, building the capacity of individuals and organizations to work on these cross-cutting issues, and encouraging institutions to form professional networks to share PHE experiences and lessons.

This approach, however, has principally been piloted in Africa and Asia because of the greater need for FP/RH services in these regions and, in part, because of the perception that most Latin American countries no longer need international assistance to provide FP/RH services.13 Furthermore, most Latin American ministries of health are just beginning to develop the capacity to procure and manage supply chains for contraceptives and have yet to focus on distribution of services to remote areas.14 Thus, despite the existence in Latin America of high-priority conservation areas with high unmet need for family planning, there is little indication that the next generation of PHE projects will focus on the unmet need of remote populations in Latin America.

Nonetheless, people in lowland areas of Latin America show an interest in and need for FP/RH services, and conservation organizations are among the few institutions building relationships with indigenous groups. There is, therefore, great opportunity for collaboration between health care providers and conservationists to better the welfare of indigenous peoples, a group typically underrepresented as benefactors of development in the Americas. Responding to this opportunity will require the creativity and commitment of the PHE community and the identification of new priority areas, new partners, and new sources of funding.

Jason Bremner is program director for Population, Health, and Environment at the Population Reference Bureau. Audrey Dorélien was a 2008 Bixby intern at PRB.


  1. United Nations Department of Economic and Social Affairs, World Population Prospects: The 2006 Revision (New York: United Nations, 2007).
  2. United Nations Department of Economic and Social Affairs, World Contraceptive Use 2007 (New York: United Nations, 2007).
  3. United Nations Department of Economic and Social Affairs, World Population Prospects: The 2006 Revision.
  4. United Nations Department of Economic and Social Affairs, World Contraceptive Use 2007.
  5. Kendra McSweeney and Shanha Arps, “A Demographic Turnaround—The Rapid Growth of Indigenous Populations in Lowland Latin America,” Latin American Research Review 40, no. 1 (2005): 3-29.
  6. Jason Bremner et al. “Fertility Beyond the Frontier: Indigenous Women, Fertility, and Reproductive Practices in the Ecuadorian Amazon,” Population Environment (forthcoming).
  7. Instituto Nacional de Pesquisas Espaciais, Annual Estimates of Deforestation 1988-2007, accessed online at www.inpe.br, on June 5, 2008.
  8. Alexei Barrionuevo, “Brazil Rainforest Analysis Sets Off Political Debate,” The New York Times, May 25, 2008.
  9. Helmut J. Geist and Eric Lambin, “Underlying Driving Forces of Tropical Deforestation,” Bioscience 52, no. 2 (2002): 143-50.
  10. Daniel Nepstad et al., “Inhibition of Amazon Deforestation and Fire by Parks and Indigenous Lands,” Conservation Biology 20, no. 1 (2005): 65-73.
  11. Geist and Lambin, “Underlying Driving Forces of Tropical Deforestation.”
  12. Jason Bremner and Flora Lu, “Common Property Among Indigenous Peoples of the Ecuadorian Amazon,” Conservation and Society 4, no. 4 (2006): 499-521.
  13. John Pielmeier et al., Assessment of USAID’s Population and Environment Projects and Programming Options (Washington, DC: United States Agency for International Development, 2007).
  14. Thais Aguilar, Safeguarding the Contraceptive Supply in Latin America in an Era of Donor Phase Out (Washington, DC: Population Reference Bureau, 2006.