Poverty & fertility decline:

evidence & research needs

Population Impacts on Economic Development: Research Conference

London 1st - 3rd November 2006

Susannah MayhewLondon School of Hygiene &

Tropical Medicine

Global Context

Tension between “SRH” and FP MDGs for ‘poverty alleviation’ – ignored

then recognised population/SRH Decline in FP funding and commodities,

especially in Africa Widespread assumption that population

‘problem’ is solved Continuing rapid population growth &

unmet need in Africa

2000 need = 8 billion condoms

2015 need = 18.6 billion condoms

Since 2001 29 LDCs lost all/some USAID condom & contraceptive supplies

Population Trends: no room for complacency

Population Growth by Development Groups, 1950-2050

UN 2004 World Population Projections for 2005-2050

6

7

8

9

10

11

2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

Yemen [37] AngolaRwanda [24] Benin [16]Ethiopia [20] Iraq

Uganda [28] Burundi [22]Nigeria [24] Pakistan [40] Sudan [29]Niger [25] Togo [14] Kenya [23]

Paraguay [21] Senegal [18] SomaliaNicaragua [26] Burkina Faso [13] Madagascar [24]

Honduras Mali [22] Chad [26]Jordan [34] Laos Guatemala [32]

Malawi [17] AfghanistanSierra Leone Syria

Dem Rep Congo Guinea [17]

Mean CP 39%, Mean TFR 4.3

Tunisia [37]

Mozambique [16]Philippines [33]

El Salvador Egypt [24] India [28]

Indonesia [13] AlgeriaIran Ecuador [16]

Brazil [30] Uzbekistan [30]Colombia [20] Kyrgyz Republic [30]Vietnam [16] Bangladesh [16]

Dominican Republic [28]Morocco [17]

Peru [20]

Mean CP 60%, Mean TFR 2.3 Mean CP 47%, Mean TFR 2.8

Korea, Dem Rep Ukraine Kazakhstan [32] Belarus

Thailand [24] Zimbabwe [11]Cuba Sri Lanka [29]

Romania AzerbaijanChina

Mean CP 71%, Mean TFR 1.6 Mean CP 59%, Mean TFR 1.9

Haiti [27]Ghana [14]Nepal [23]

Mean CP 27%, Mean TFR 3.9

Mean CP 46%, Mean TFR 1.6

Myanmar Serbia

Bulgaria

Mean CP 17.3%, Mean TFR 5.4

P

op

ula

tio

n G

ro

wth

Rate

(2005 -

2010)

L

ow

(<

1%

pa)

M

ed

ium

(1%

- 1

.9%

pa)

H

igh

(2

%+

pa)

Zambia [16]Cote d’Ivoire [16]

Cambodia [21]

Papua New Guinea Bolivia [28]Tajikistan

Cameroon [22]Tanzania [17]

Impact of fertility decline on poverty

Strong evidence when fertility declines: Maternal mortality is reduced Child mortality is reduced Enrolment in primary education is increased Gender equality improves

Some evidence when fertility declines: Pressure on marginal lands is decreased Food and water security is enhanced Under/un-employment is reduced Risk of civil/political unrest is decreased

Maternal, neo-natal & child

mortality; gender & education

Lifetime risk of dying from pregnancy, by fertility & MMR

Source: Marston & Cleland 2004:8, recalculated from idea by Royston & Armstrong

If unmet need in Africa was met 33-40%

maternal deaths could be eliminated

Figure 1. Risk of death among under-five children with a preceding birth interval of 36-41 months compared to risk of

death at other birth intervals

317%

126%105%

316%

143%

116%

281%

100%

151%

82%105%

137%140%

0%

100%

200%

300%

<18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Duration of preceding birth interval (months)

Rel

ativ

e ri

sk (

per

cen

t)

Neonatal Mortality Infant Mortality

Under-Five Mortality Perinatal Mortality

Source: USAID, 2002.Birth Spacing: Research Update: p.1

1mil deaths of children under 5 could be averted

if all birth intervals were above 2 years

Solutions for reducing maternal, neo-natal & child mortality

Reduce the total number of pregnancies (and therefore the lifetime risk of dying)

Prevent unwanted & high-risk pregnancies Promote post-partum contraception Offer alternatives to unsafe abortion

healthier, better educated children are less drain on economies & more economically productive; reduced human & social costs

Enhancing education & gender equality

Delay age at marriage (legislation) & first birth (FP)

Increase access to services (especially for adolescents: married & unmarried)

Policies to support female education & employment

Fewer, spaced births enhance opportunities for education, especially of girls … development benefits

Poverty, food/water security, employment &

unrest

Poverty & hunger

“One of the ‘bright spots’ in development is that faster fertility

decline can speed-up poverty reduction”

Professor Michael Lipton, University of Sussex

Depends on achieving & capitalising on

‘population dividend’

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

12.5 10 7.5 5 2.5 0 2.5 5 7.5 10 12.5

Population in %

Source: World Population Prospects, 1998

Rep. Korea 1990

Male and Female Population by Age

The ‘Population Dividend’ for Korea

Can Africa achieve a ‘population dividend’?

Figure 4: Kenya: Trends in Total Fertility Rate and Contraceptive use in Married Women

Fertility Rate

Contraceptive Use

0

1

2

3

4

5

6

7

8

9

10

1975 1980 1985 1990 1995 2000 2005

Year

Ferti

lity

Ra

te

0%

5%

10%

15%

20%

25%

30%

35%

Co

ntr

acep

tiv

e U

se

USAID FP & AIDS Funding 1995-2006

0

20

40

60

80

100

120

1995 2006

US

$ m

il

AIDS FP

Strong FP programmes Delay age of marriage Education, especially for women Support of religious & community leaders

for FP

Economic Commission for Africa, 2002

Achieving the Dividend through policies & programmes

Can Africa capitalise on a ‘population dividend’?

Job Opportunities (incl. women) Asia’s ‘green revolution’ possible in Africa? Need strong pro-employment policies Attract foreign investment

Multiple stresses in a diverse continent AIDS Conflict Pressures on land and water

Poverty & pressure on fertile land & water

In sub-Saharan Africa: 33 countries will double

in 50 years 21countries have

unmet contraceptive needs of >20%

28 countries rank in the lowest category of the Human Development Index

19 rapidly growing African countries: already lack fertile land, water, resources = humanitarian crises without massive and immediate fertility declines. (Alexandratos 2005)

Niger, Mali, Burkina Faso, Somalia, Uganda will treble in size

Population (2005) 14 million

Total Fertility Rate 7.5

Desired number of children 8.2

% using modern contraception 4.6%

Life expectancy 45.4 years

Infant mortality 145

Adult literacy 16%

% child stunted 38%

HIV prevalence 1.2%

Projected population in 2050 if

(a) Fertility remains constant 80 million

(b) Fertility declines to 3.6 by 2050

50 million

Niger

Research Priorities

thoughts from Anglophone group at the Paris Population & Development meeting

Spring 2006

Research Priorities (1) Understand better the links between

demographic factors & socio-economic progress: Multi-disciplinary scenario building Research sub-national differences Sector specific research Conflict & demographic security Micro-level factors

Research Priorities (2) Research on attitudes to child bearing/

family size and how change can be facilitated Policy analysis Human rights and women’s group Concept of inter-generational custodianship Social protection & reproductive intentions Mass media influences Reproductive choices for single women

Research Priorities (3) Research into programmes & services

Condoms for FP Post-partum contraception Integration of services Mobilising community support New & neglected technologies Contraceptive discontinuation Abortion versus contraception

Policy priorities:

“The lack of investment in family planning is a disaster … It’s time to

wake up and look at the facts”Professor John Cleland, London School of

Hygiene & Tropical Medicine

Reduce Population Growth (long term) Mitigate adverse consequences of rapid

population growth (interim)