Poor countries losing out on family planning benefits

Posted: 19 July 2007

A new World Bank report warns that poor countries, wealthy donors, and aid agencies are losing sight of the value of contraception, family planning, and other reproductive health programmes in helping to boost economic growth.

Mother and child, Mali
Mother and child, Mali
Fatoumata, a 15-year-old in Mali, holds her newborn son Moussa. She was 14 when she got married and she has never attended school. Her husband is 27. Photo © Save the Children
The report - Population Issues in the 21st Century: The Role of the World Bank - stresses the urgency of reducing high birth rates which are strongly linked with endemic poverty, poor education, and high numbers of maternal and infant deaths.

According to the new report, 35 countries, mostly in Sub-Saharan Africa, have birth rates of more than five children per mother, and that of the estimated 210 million women who become pregnant every year worldwide, more than 500,000 women die during pregnancy and childbirth, and about one in five of them resorts to abortion because of poor access to contraception.

The report says that some 68,000 women die each year as a result of unsafe abortion, 5.3 million suffer temporary or permanent disability, and many end up being ostracized within their own communities.

Shift of emphasis

The report also says that because fertility rates have declined significantly in most low- and middle-income, countries, outside of Africa, "the priorities of donor countries and development agencies have shifted toward other issues, and global funds and initiatives have largely bypassed funding of family planning, with less attention being focused on the consequences of high fertility, even in those countries that are lagging in achieving sustainable population growth."

A group of women hold their newborns at a family planning clinic in Kampala, Uganda. Photo: 2001 Hugh Rigby/CCP, Courtesy of Photoshare
A group of women hold their newborns at a family planning clinic in Kampala, Uganda. Photo: 2001 Hugh Rigby/CCP, Courtesy of Photoshare
Family planning must have higher priority. Clinic in Kampala, Uganda.© Hugh Rigby/CCP, Courtesy of Photoshare
"Poor women endure a disproportionate burden of poor sexual and reproductive health because they run into financial or social barriers getting access to these basic but vital programs," says Joy Phumaphi, the World Bank's Vice President for Human Development. "Their full and equal participation in development depends directly on accessing essential sexual and reproductive health care. The Bank is committed to helping these women, along with the UN Population Fund, WHO, and the technical health agencies, to make voluntary and informed decisions about fertility."

Phumaphi adds that falling birth rates cannot be achieved through better health programmes alone. She says that improved education for girls, equal economic opportunities for women in society, and fewer households living below the poverty line, are also vital parts of a strategy to achieve sustainable reductions in birth rates.

Major changes

The new report says the world is in the middle of major demographic changes. During recent decades, fertility levels have declined more rapidly - even in some of the poorest countries - than had been expected by most demographers. For example, in 1970, Bangladesh had some of the worst social indicators and lowest income of all countries, with a fertility rate of about seven children per woman; now that rate is about three.

Similar declines in fertility can be found in countries in East Asia, Latin America, and the Middle East and North Africa. The widespread decline in fertility, coupled with reductions in mortality in most countries, have resulted in changes in the age structure and population growth rates that have far-reaching consequences for sectors such as health, education, labour markets, and social protection.

During the second half of the 20th century, world population more than doubled to reach six billion, an astonishing 3 billion increase in population in just 40 years. Although this rate has now slowed to 1.2 per cent a year, an additional 75 million people are being added every year this decade. The world's population is projected to reach 9.1 billion by 2050, with the majority likely to live in the world's poorest countries.

The report says that the globe's highest birth rates are found in Sub-Saharan Africa, where average fertility remains above five children per woman. While demographic patterns are converging in many regions, countries that are lagging in fertility decline and mortality reduction are increasingly different from the rest of the world.

Bibi, a nurse from Surinam.
Bibi, a nurse from Surinam.
Bibi, a nurse from Surinam. Photo © UNFPA
"The longer it takes for countries to move to a low-fertility, low-mortality pattern, the greater the danger that high-birth rate countries will continue to experience greater inequalities in education, jobs, life expectancy, and adult prevalence of HIV/AIDS, than their wealthier counterparts," says Phumaphi.

Similarly, the report says that fertility can also affect women's jobs in the workplace. One cross-national study has suggested that the percentage of women in the labour force is directly related to national birth rates and that, for example, in Bolivia, there were strong links between women using contraception and women jobs outside of the home.

Again, in the Philippines, the average income growth for women with one to three pregnancies was twice that of women who had undergone more than seven pregnancies. Accordingly, the number of children a woman gives birth to affects her subsequent employment and income prospects, with the risk of further driving gender inequalities and perpetuating poverty.

To download the report, go here.