African Population and Health Research Center (APHRC)Improving the wellbeing of Africans through policy-relevant research on population and health

111

The Contribution of Family Planning to Maternal

Health and Socio-Economic Development in the

Eastern Africa region

-Alex Ezeh PhD and Blessing Mberu PhD

The 4th Eastern Africa Reproductive Health Network Meeting on Repositioning Family Planning/Reproductive Health in Eastern

Africa Region, April 28, 2011, Kampala, Uganda.

2

Outline

Population and fertility trends in Africa

Implications of rapid population growth

African maternal health and socio-economic

outcomes profile

Priorities in addressing population growth in

Africa

The role of family planning programs in

improving maternal health

Conclusion

Population Trends - Africa

Currently:

• 31 of 34 countries with TFR of 5+ are in SSA

• About 14m unintended pregnancies occur each year

• While >2/3 of women use FP in all regions, only ¼ do so

in Africa

• At least 25% of women 15-49 have unmet need for FP

• Stall in fertility transition casts doubt on medium variant

projections for Africa

Over the next 40 years:

• Africa’s population will double from 1 to 2 billion

• Africa will account for 22% of world population, up from

15% in 2010

4

Fertility Patterns Globally

7-8 Children

6-7 Children5-6 Children4-5 Children3-4 Children2-3 Children1-2 Children0-1 Children

Trends in TFR – 4 Eastern African Countries

0

2

4

6

8

10

70-74 75-79 80-84 85-89 90-94 95-99 00-07

Kenya Tanzania

Uganda Zimbabwe

6

Implications of Rapid Population Growth

Implications for Future Population Trends

• Example: Kenya, Tanzania, Ugandan and Zimbabwe

Implications for economic growth

• Example: Botswana and Zambia

Implications for levels and gender parity in

school enrolment

• Example: Sub-Saharan Africa

Changes in Future Population Projections before and after the Stall in Fertility Decline

6

3338

42

51

8

38

47

58

81

5

26

35

44

65

3

12 14 1518

6

36 36

46

85

8

39

49

60

85

5

29

40

54

93

3

13 15 1619

0

20

40

60

80

100

120

1950

2005

2015

2025

2050

1950

2005

2015

2025

2050

1950

2005

2015

2025

2050

1950

2005

2015

2025

2050

Kenya Tanzania Uganda Zimbabwe

1998 Projections 2006 Revision

8

Trends in Fertility & Population Growth

Rates, Botswana and Zambia: 1960-2008

6.6 6.66.2

4.7

3.4

2.9

2.3

3.1

3.6

3

1.71.5

7.027.4

7.2

6.56.2

5.8

2.93.3 3.3

32.6 2.5

0

1

2

3

4

5

6

7

8

1960 1970 1980 1990 2000 2008

Botswana TFR

Botswana Pop. Growth Rate

Zambia TFR

Zambia Pop. Growth Rate

9

Trends in GDP Per Capita, Botswana and Zambia: 1960-2008

0

1000

2000

3000

4000

5000

6000

7000

8000

1960 1970 1980 1990 2000 2008

Botswana Zambia

10

Female Gap in Primary Enrolment by Population Growth Rate, SSA: 1990-2009

0

5

10

15

20

25

30

1990-94 1995-99 2000-04 2005-09

<2 2.0 - 2.99 3+

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Africa’s Maternal Health Profile 1

MDG 5: Reduce the maternal mortality by 75% between

1990 and 2015

50% of global maternal deaths occur in Africa

In SSA, a woman has a 1 in 16 chance of dying in

pregnancy or childbirth; 100 times more than elsewhere;

>1000 times than in Sweden!

Key causes of maternal deaths are known & preventable:

• Hemorrhage (25%)

• Infection (15%)

• Complications of unsafe abortion (13%)

• Hypertensive disorders in pregnancy (Eclampsia) (12%),

• Obstructed labor (8%),

• Other direct causes (8%), and Indirect causes (20%).

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Africa’s Maternal Health Profile 2

Key interventions to improve maternal survival

include:

1. Access to family planning and safe abortion

• Recommended by WHO as first step to safe

motherhood

2. Care from skilled health professionals

3. Access to health facilities with Basic Emergency

Obstetric Care (BEmOC, and

4. Good referral systems

Inadequate facilities and trained personnelFew and FarOnly 20% of births occur in hospitals; 30% in clinics, and as much as 50% at home, often without skilled attendants.

Dearth and emigration of skilled personnel Lack of up-to-date equipment and drugs Cost of hospital birth usually high for many High fertility, often unwanted, with attendant health risks

State of Maternal Health Service in Africa

Low Contraceptive use is a key factor:39% of pregnancies in SSA are unintended 30% in West Africa & 59% in Southern Africa

40% of all unwanted pregnancies end in abortion Unsafe abortion accounts for 25-30% of maternal deaths in SSA Strong FP programs reduces maternal deaths through:Reduction in desired family sizeDecline in fertility

FP & State of Maternal Health in Africa

Percentage of married women with unmet need for contraception by

regions, 1990-95, 2000-05 and 2009

Data Source: UN Department of Economic and Social Affairs, Population Division (2011). World Contraceptive Use 2010.

Number of pregnancies, % distribution of all pregnancies and unintended-pregnancy outcomes, 2008

Region

Total no of

pregnancies

(millions)

% distribution of

pregnancies

% of unintended pregnancy

outcomes as a percentage of all

pregnancies

Intended Unintended Birth Abortions Miscarriages

World

LDRs

Africa

Eastern

Northern

Southern

Western

208.2

185.4

49.1

17.4

7.4

2.0

15.5

59

60

61

54

62

41

70

41

40

39

46

38

59

30

16

16

21

25

15

34

16

20

19

13

8

18

20

10

5

5

5

6

5

8

4

Source Singh et al. 2010 Unintended Pregnancy: Worldwide Levels, Trends, and Outcomes.

Studies in Family Planning 2010; 41[4]: 241–250

Priorities in addressing Africa’s Pop Growth

Meet high unmet need for FP

Reduce/eliminate high unwanted fertility

Create demand for small family sizes in selected countries and regions

Strengthen human resources for health and FP services

Address young people’s attitudes to FP and needs

Promote equity in access to FP

Seize new and emerging opportunities• Resurgence of interest on FP

• MDG Target 5b-Universal Access to RH by 2015

Benefits from family planning programs

• 23 million unplanned births

• 22 million abortions

• 7 million miscarriages

• 1.4 million infant deaths

• 142,000 pregnancy-related deaths (53,000 from unsafe abortion)

• 505,000 children from losing their mothers

Providing family planning to all of women with an unmet need would prevent

Source: Guttmacher institute 2008

• Save 750,000 lives annually• 200,000 mothers (69% decline in MM) and • 550,000 newborns (45% decline in NB deaths)

• Reduce unintended pregnancies by 77%• from 17 million to four million annually

• Reduce unsafe abortions from 5.2 million to 1.2 million

• Reduce number of women in need of medical care from unsafe abortion from 2.2M to 500K

Provision of FP & RH Services in SSA would:

Source: Guttmacher institute 2009

Family planning is also a valuable economic investment

1. $1 spent on FP saves $ 2-6 in other development sectors (e.g. educ, health)

2. Fertility decline would reduce pressure on scarce natural resources and boost economic growth (demographic dividend)

3. As women spend less time in childbearing and childcare, they can become wage earners outside the family

4. Family planning programs in the long run would reduce fertility differentials and income inequality

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Conclusion

Continuing high rates of population growth in the poorest countries will make it harder to achieve any of the MDGs

Family planning programs have been shown to reduce fertility even in poor settings

Meeting the current unmet need for FP can halt current rapid population growth rate in SSA

2424

Thank You