Three family planning policy options in low resource settings: The case of Niger. Malcolm Potts, Martha Campbell, Virginia Gidi

Transcription

1 Three family planning policy options in low resource settings: The case of Niger Malcolm Potts, Martha Campbell, Virginia Gidi

2 Total fertility rate 7.4 Niger Population growth 3.9% 50% of population < 15 years HIV prevalence 0.7% (adults 15-49) 15% of women have primary education Median age of marriage is under 16 years 25% of women >40yrs have 10+ children Economic growth 2%, GNI per capita US$ 680 Cereal output falling One third to one half of children malnourished

3 Niger Population: TFR vs. Population Niger: 2005 vs m 70 Millions (m) m 59m m (Year) TFR Population

4 Policy Option 1: Do nothing / Free market policy... high fertility primarily reflects desired births and that couples are roughly able to achieve their fertility targets. Lant Pritchett (1994)

5 Policy Option 2: Distant Socio-Economic Levers Socio economic development will drive lower fertility... family planning services should be provided within the context of comprehensive reproductive health programs that [have] enhancing health, not lowering fertility, as their fundamental objective. Hodgson and Watkins (1997)

6 Policy Option 3: Proximate Levers of Strategic Family Planning 6

7 Bixby Forum, January 2009 With over 80 million unintended pregnancies each year, there is already a large unmet need for family planning. Ready access to contraception and safe abortion has decreased family size, even in illiterate communities living on less than a dollar a day.

8 Best Practice: That strategy which shows superior results in a low resource settings where the limitations of budgets and human capital constrained the range and achievable outcomes.

9 Option 1: Why do nothing is wrong 1. Family planning is not a free market Contraception expensive Numerous barriers deny women access to family planning (e.g. conservative medical guidelines) 2. Misinformation abounds 3. Abortion is illegal and unsafe

10 Option 2: Why distant levers don t work Educational system under-resourced and unattainable In the current state of affairs, national human resource training system for the health centre sector is incapable of meeting such expanded needs. The public health training system is already experiencing huge difficulties. - The World Bank, 2005

11 Option 2: Why distant levers don t work The World Health Report 2006: Working Together for Health Worldwide shortage of almost 4.3 million doctors, midwives, nurses and support workers. Human resources for 15.3 million people in Niger: 226 physicians 13 pharmacists 1,128 nurses 334 midwives

12 An impossible equation Economic Growth: 2% Population Growth: 3.9%

13 Option 2: Why distant levers don t work 2005: United Nations World Food Programme warned that approximately 350,000 children under five years-old in the West African state of Niger could be suffering from malnutrition

14 United Nations Environment Programme.. unfortunately, the Sahel is almost inevitably heading towards an environmental disaster. Photo from: IRD. Claire Costis Meeting the first MDG of halving the number of poor and hungry people by 2015 is mission impossible.

15 Why a focus on proximate levers offers hope Maintain current patterns of breastfeeding Community distribution contraceptives (including injectables) Social marketing Clinic services (limited potential) Safe abortion Counter misinformation (radio) Explore ways of raise the age of marriage and to delay childbearing within early marriage

16 October 31, 2009 Edition

17 ..many people in poor counties want fewer children, and family planning helps them get their wish The Economist October 31, 2009

18 Africa's population The baby bonanza Aug 27th 2009 JABI, SOMALIA From: The Economist as people get richer, they have fewer children. 18

19 October 31, 2009 Edition

20 Alternative scenarios for the future course of fertility in Niger

21 Do rich people have less sex? Country GNI PP* Sex/year USA 45, France 33, Hungary 17, Vietnam 2, * Gross National Income/purchasing power parity

22 Is money a contraceptive?

23 Common Sense Couples use Contraception Induced abortion Other variables age marriage, duration breast feeding, sexually transmitted diseases have a measurable impact but they are not major variables

24 When barriers are removed, family size falls Voluntary family planning Voluntary FP 2 per. Mov. Avg. (TFR- Iran) 2 per. Mov. Avg. (TFR- China) One-child policy TFR

25 Alternative scenarios for the future course of fertility in Niger and a comparison to fertility trends in Bangladesh

26 When barriers increase, family size rises Total Fertility Rate Kenya Family planning emphasized Weak family planning Family planning submerged Strong family planning

27 Seemingly small changes can have a catastrophic impact Projected population of Kenya in 2050 (millions) 100 Increase = 30 million Population in the year 2000 = 30 million Projection in 1990 Projection in 2009

28 Alternative Population Projections for Niger

29 Devastation Grows: Hunger and Malnutrition Acute malnutrition affects 21% of all Nigerien children 44% of all children <5 are underweight 32% of entire population is undernourished The population could more than double in the next 40 years