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
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 & 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