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in Honduras (23) and Nicaragua and Guatemala (31), reflecting poor living conditions and high economic and social vulnerability (United Nations 2019a, Mort/7-3).

      – The third group includes four countries, Haiti, Bolivia, Guyana and Suriname, whose female life expectancy at birth is lower than 75 years. These are the poorest countries in Latin America, with many economic and political difficulties, and high social inequality (CEPAL 2019). Infant mortality in Haiti is 64 and in Bolivia it equals 42 deaths of children under the age of 1 per thousand births, which are very high levels (United Nations 2019a, Mort/7-3).

      In 2017, the PAHO declared that in Latin America and the Caribbean, the Millennium Development Goals (MDGs) had all been achieved in 2015, except for MDG5 on maternal mortality. The PAHO is also responsible for monitoring the sustainable development goals (SDGs) in progress, including SDG3 on good health and well-being (PAHO 2017).

       (source: United Nations 2019a, Mort/7-3). For a color version of this figure, see www.iste.co.uk/charbit/demographic.zip

      1.5.2 The period of strong population growth

      A period of strong growth in the Latin American population began in the mid-20th century, following the decline in mortality. Between 1950 and 1970, natural increase rates rose to over 2.5%, reaching 2.75% per year between 1960 and 1965 (Cosio Zavala 1998). This was a consequence of the decrease in mortality, increase in nuptiality and high fertility. Indeed, a Latin American union boom was observed between 1950 and 196019. The percentages of women in union increased, with particularly early unions and universal nuptiality (as was the case of Nicaragua between 1950 and 1960, where 60% of women between 20 and 24 years old were in union, as well as 97% of women aged 50). It was only in the southern countries of South America (Argentina, Chile, Uruguay) that unions came later, although these increased during the period of the union boom (Camisa 1978).

      Fertility in Latin America remained very high before 1965, and all countries showed indicators of between 6 and 7.4 children per woman, with the exception of a few countries with moderate fertility (between three and five children per woman), such as Argentina, Chile, Cuba and Uruguay (United Nations 2019a, Fert/4). High fertility was the result of the association of a lasting marital life, natural fertility in couples (who did not control their births), early and intense nuptiality, the decline in mortality which reduced intrauterine mortality and widowhood (divorce being very rare in those times) and the reduction in the infertility of couples, thanks to medical, nutritional and health progress.

      1.5.3. New reproductive behavior

      After 1965, fertility was quickly transformed in Latin America and the Caribbean. We can identify four fertility transition models, as follows:

      – An accelerated transition that occurred between 1965 and 2015 in Brazil, Colombia, El Salvador, Ecuador, Mexico, Peru, Panama, Dominican Republic and Venezuela. In this group of countries, fertility in 1960–1965 oscillated between 6 and 7.4 children per woman, then between 3.5 and 5 children per woman in 1980–1985, and finally, in 2015–2020, between 1.7 and 2.5 children per woman. In Colombia and Costa Rica, the reduction in the total fertility rate was 46% between 1960 and 1985, and greater than 30% in Brazil, Mexico, Panama and Venezuela (United Nations 2019a, Fert/4).

      – A late and extremely rapid transition that occurred in Bolivia, Guatemala, Haiti, Honduras, Nicaragua and Paraguay. These countries maintained a high fertility level in 1980–1985, with values between five and six children per woman. The decline in fertility after this date reached a reduction equal to or greater than 50%, and fertility in 2015–2020 oscillated between 2.5 and 3 children per woman (United Nations 2019a, Fert/4).

       (source: United Nations 2019a, Fert/4; LAC group and selected countries). For a color version of this figure, see www.iste.co.uk/charbit/demographic.zip

      In 2019, contraceptive prevalence in Latin America and the Caribbean rose to 58% of women aged between 15 and 49 years using contraception methods. Female sterilization predominated, with 16% users for the whole region, 30% in the Dominican Republic and more than 20% in El Salvador, Colombia, Ecuador and Mexico. The pill follows with 15% for the Latin American average, but 30% in Brazil. Sterilization is the first female method in Cuba (25% of users), and 24% of Cubans use the IUD, in a country where many legal abortions occur21 (United Nations 2019b).

      The diffusion of modern contraception methods explained the decrease in fertility in Latin America after 1965, as family planning programs were established in the majority of countries, making it possible to meet the demand for birth control on the part of educated, economically active women living in large cities, with high

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