World Bank calls for more family planning

Posted: 11 July 2008

A new World Bank report published for World Population Day (11 July) says that despite a huge increase in contraception globally, 51 million unintended pregnancies in developing countries occur every year to women not using contraception. Another 25 million pregnancies occur because women's contraception fails or they use a contraceptive incorrectly.

Expectant teenage mother, Dominican Republic
Expectant teenage mother, Dominican Republic
An expectant teenage mother watches over her sleeping niece, Dominican Republic. Photo © Carina Wint for UNFPA
According to the new report - Fertility Regulation Behaviours and Their Costs: Contraception and Unintended Pregnancies in Africa and Eastern Europe and Central Asia - 35 poor countries in Sub-Saharan Africa and other regions (Timor-Leste, Afghanistan, Djibouti, and Yemen) have the world's highest fertility rates (more than five children per mother) while also reflecting some of the world's poorest social and economic results, with low levels of education, high death rates, and extreme poverty. Moreover, many poor women turn to abortion as a last-resort means of birth control. Some 68,000 women die each year as a result of unsafe abortion, while another 5.3 million suffer temporary or permanent disability as a result.

The report also says that pregnancies which are less than 15 months spaced apart more than double the risk of the mother dying. Children born 3 years after a previous birth are healthier at birth and more likely to survive. Teenage pregnancies carry a higher risk of obstetric complications such as obstructed labor, eclampsia and fistula formation, and yet teenagers are less likely to receive antenatal or obstetric care, making them twice as likely to die during childbirth as women over the age of 20.

"It's simply tragic that so many leaders in poor countries and their aid donors have allowed reproductive health programmes to fall off the radar, especially at a time when population issues are also front and center of climate change, and the food and fuel crises," says Joy Phumaphi, the World Bank's Vice President for Human Development, and a former Health Minister in Botswana "Giving women access to modern contraception and family planning also helps to boost economic growth while reducing high birth rates so strongly linked with endemic poverty, poor education, and high numbers of maternal and infant deaths."

Poverty linked to poor reproductive health

Fertility levels have been declining steadily over the last three decades with most prominent declines observed between 1985 and 1995; however fertility levels, trends and the pace of decline differ between regions, among countries and within countries. In all regions, particularly in Sub-Saharan Africa, South Asia, and Latin America and the Caribbean, poor women are considerably less likely to use contraception and family planning services than their better-off, city-living counterparts. For example, richer women are more than three times as likely as poorer women to have a doctor or a skilled midwife at their deliveries.

Birth rates have fallen fastest in Asia and have been slowest in Sub-Saharan Africa. With Sub-Sahara Africa's population growing at the rate of 2.5 per cent per year as compared to 1.2 per cent in Latin America and Asia, Africa's population could double in 28 years.

However, significant declines have occurred in the least developed countries as well as in developed countries. For example, in 1970, Bangladesh had some of the worst social indicators and lowest income of all countries, with a total fertility rate of about 7 children per woman, and today the rate is about 3.

Benefits of education

The World Bank report says that high birth rates are closely allied with fragile health, little or no education, and entrenched poverty. Analysis of demographic and health surveys shows that women with secondary or higher education have fewer children than women with primary or no education in all regions.

Educating girls, China. Photo: Don Hinrichsen
Educating girls, China. Photo: Don Hinrichsen
Fewer Chinese girls are dropping out of school© Don Hinrichsen
"Promoting girls' and women's education is just as important in reducing birth rates in the long run as promoting contraception and family planning," says Sadia Chowdhury, a co-author of the new report and Senior Reproductive and Child Health Specialist at the World Bank. "Education becomes a form of social contraception for women. Time and time again we see how women's education provides life-saving knowledge, builds job skills that allow her to join the workforce and marry later in life, gives her the power to say how many children she wants and when, and these are enduring qualities she will hand down to her daughters as well."

Chowdhury says getting an education - even if only at primary school level - is a good predictor of low fertility. The regions with the widest fertility gap between women with secondary education and those who have no education are South Asia, Sub-Saharan Africa, and Latin America and Caribbean.