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Repositioning Family Planning in Africa
Africa SOTANairobi
June 10-15, 2002
Population Priorities
Maximizing access and quality Contraceptive security Post-abortion care Youth reproductive health Population and environment Family planning and HIV integration Reemphasizing family planning in Africa
Population Increases: 2000 to 2025
Africa Population Pyramid: 2000 and 2005
Source: U.S. Bureau of Census.
MaleMale FemaleFemale
Age group 10 – 19 represents 24% of the total population
TFR Trends: Africa
Source: DHS for years indicated.
2
3
4
5
6
7
8
To
tal
Fe
rtil
ity
Ra
te
ZimbabweGhanaKenya
TFR Trends: All Countries
Source: Demographic and Health Surveys 1978-2000.
2
3
4
5
6
7
8
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Year
Tota
l Fert
ility
Rate
African Non-African
CPR Trends: Africa
* Percent of married women ages 15 to 49 using modern contraception.Source: Demographic and Health Surveys 1978-2000.
Co
ntr
ac
ep
tiv
e P
rev
ale
nc
e R
ate
Zimbabwe
Malawi
Kenya
CPR Trends: All Countries
Percent of married women ages 15 to 49 using modern contraception.Source: Demographic and Health Surveys 1978-2000.
0
10
20
30
40
50
60
70
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001
Year
African Non-African
Contraceptive Prevalence and Adult HIV Prevalence
Source: UNAIDS/WHO; DHS; UN. Hill K, et al. Estimates of maternal mortality for 1995, Bulletin of the World Health Organization 79(3), WHO 2001: 182-193.
5% - 9.9%
10% - 19.9%
1% - 4.9%
Over 20%
Modern Contraceptive Prevalence,
Married Women 15-49
Adult HIV Prevalence
1999
3% - 9.9%
10% - 14.9%
1% - 2.9%
Over 15%
0% - 0.9%
HIV and CPR RelationshipAdult HIV/AIDS Prevalence
CP
R (
mo
de
rn m
eth
od
s)
Botswana*KenyaLesotho*Malawi
Burundi*CAR*Cote d’IvoireEthiopiaMozambique
Higher (>8%) HIV Lower (<8%) HIV
Higher (>20%)
CPR
Lower(<20%)
CPR
NamibiaSouth AfricaSwaziland*Zimbabwe
RwandaTanzaniaUganda Zambia
AngolaBeninBurkina FasoCameroonChad*Comoros*CongoDR Congo
EritreaGabon*Gambia*GhanaGuineaGuinea Bissau*LiberiaMadagascar
MaliMauritania*Niger*NigeriaSenegalSierra Leone*Sudan*Togo
* Denotes countries where USAID does not work.
Lower HIV and Higher CPR
Higher HIV and Higher CPR98 million people
No SSA countries fall in this category
Lower HIV and Lower CPR340 million people
Higher HIV and Lower CPR175 million people
FP Use and Unmet Need
0
10
20
30
40
50
60
70
Perc
ent
Use Unmet Need
Unmet Need for Women:Age 15-19
Source: DHS, 1994-1998. Data re-produced from PRB, 2001.
20
2525
20
32
24
30
22
50
2728
4847
50
4346
40
7
43
50
0
10
20
30
40
50
60Married Unmarried, sexually active
Wo
me
n i
n n
ee
d o
f c
on
tra
ce
pti
on
(%)
* Senegal and Zimbabwe have data only regarding married women using modern methods.
Uganda: Unmet Need By Education
0
10
20
30
40
50
No Education Primary SecondaryWomen's Education
Per
cent
Met NeedUnmet Need
Uganda: Unmet Need by Residence
0
10
20
30
40
50
Urban RuralResidence
Perc
ent
Met Need
Unmet Need
Under Five Mortality:Three year birth intervals, or longer, are associated with the lowest mortality risk for the under five age group
0
0.5
1
1.5
2
2.5
3
<18 18- 23 24- 29 30- 35 36- 41 42- 47 48- 53 54- 59 60+
Duration of Preceeding Birth Interval (months)
Adj'd R
ela
tive
Odds
Rati
o
Source: Shea Rutstein, Effect of Birth Intervals on Mortality and Health: Multivariate Cross-Country Analyses, Presentation to USAID, July 27, 2000.
Maternal Deaths: Short birth intervals <14 months significantly increase the risk of maternal death. (one study, sample - 450,000 women)
0
0.5
1
1.5
2
2.5
3
0-5 6-11 12-17 18-23 24-59 60+
Interpregnancy Interval (months)
Adj.
Rela
tive
Odds
Rati
o
Source: Conde-Agudel and Belizán, Maternal Morbidity and Mortality Associated with Interpregnancy Inteval: Cross Sectional Study, British Medical Journal, 18 November 2000.
Summary
High fertility, but glimmers of hope High population growth overall, slowed
somewhat by HIV and in some countries will reverse
Low contraceptive use, under 20% in most countries
High unmet need, over 20% in most countries resulting in
Unwanted, mistimed pregnancies & abortion Child health impacts Maternal health impacts
Challenge
Maintain priority in face of HIV
Large cohorts entering reproductive age
Resource crunch due to AIDS crisis
Opportunities
High unmet need Successful models Capitalize on synergy with
HIV (social marketing, BCC, youth, policy, etc.)
Repositioning FP in MaliLessons Learned
Need for policy champions Lack of government coordination Contraceptive complacency Need for focused FP intervention Start with FP basics Encouraging NGO results, but high
cost/limited coverage Social marketing success
Repositioning FP in MaliActions
Long-term contraceptive planning Assessment of FP context Advocacy Strengthen national coordination
capacity Relaunch CBD FP a major CSP axis
Repositioning FP in MaliNext Steps
Design of intervention based on findings training service providers equip service delivery points
Operations research IEC strategies Policy dialogue
Repositioning FP in Malawi:History
1964 FP failed to take off 1982 child spacing program launched 1984 USAID provided TA and funding 1992 National Family Welfare Council
est 1993 name changed to FP Council 1999 MOHP takes over FP activities
Repositioning FP in Malawi:Achievements
CPR increases from 7-26% between 92-00 Injectables up from 6-16% between 96-00 Modern method knowledge up to 90% by 96 CBDAs trained and serving communities Contraceptive logistics mgt system Contraceptive supply assured GOM launched RH strategy in 01
Repositioning FP in Malawi:Critical Ingredients for Success
Government commitment and support Training of FP service providers training and retention of CBDAs Availability of contraceptive mix Contraceptive logistics management Proximity of health facilities/outreach Injectables Coordinated donor support