  children ▁per ▁woman , ▁decl ining ▁from ▁ 6 . 3 ▁in ▁ 1 9 9 0 . ▁Te en ▁pre gn ancy ▁rates ▁of ▁ 1 4 . 8   percent ▁in ▁ 2 0 1 1 , ▁much ▁higher ▁than ▁the ▁African ▁average , ▁are ▁a ▁contrib uting ▁factor ▁to ▁rapid ▁population ▁growth . ▁In ▁ 2 0 1 0 , ▁the ▁mat ernal ▁mort ality ▁rate ▁was ▁ 4 4 0 ▁per ▁ 1 0 0 , 0 0 0 ▁birth s , ▁compared ▁to ▁ 3 7 3 . 1 ▁in ▁ 2 0 0 8 ▁and ▁ 4 8 4 . 4 ▁in ▁ 1 9 9 0 , ▁indicating ▁a ▁decl ine ▁in ▁per in atal ▁care ▁following ▁the ▁ 2 0 0 9 ▁coup . ▁The ▁infant ▁mort ality ▁rate ▁in ▁ 2 0 1 1 ▁was ▁ 4 1 ▁per ▁ 1 , 0 0 0 ▁birth s , ▁with ▁an ▁under - five ▁mort ality ▁rate ▁at ▁ 6 1 ▁per ▁ 1 , 0 0 0 ▁birth s . ▁Sch ist os om ias is , ▁mal aria , ▁and ▁sex ually ▁transm itted ▁dise ases ▁are ▁common ▁in ▁Mad agas car , ▁although ▁in fection ▁rates ▁of ▁A ID S ▁remain ▁low ▁relative ▁to ▁many ▁countries ▁in ▁main land ▁Africa , ▁at ▁ 0 . 2   percent ▁of ▁the ▁adult ▁population . ▁The ▁mal aria ▁mort ality ▁rate ▁is ▁also ▁among ▁the ▁lowest ▁in ▁Africa ▁at ▁ 8 . 5