Population and the MDGs UK Parliamentary Hearings Report Martha M. Campbell, PhD School of Public Health University of California, Berkeley & Venture Strategies for Health and Development www.venturestrategies venturestrategies.org December 9, 2007 Arusha,, Tanzania
United Nations Millennium Development Goals (MDGs( MDGs) 1. Poverty and hunger 2. Education 3. Gender equality 4. Child mortality 5. Maternal health 6. HIV/AIDS and other diseases 7. Environment
Two central questions 1. Is population a problem? 2. What reduces fertility?
MDG 1 - Eradicate Extreme Poverty and Hunger Target : Reduce the number living in extreme poverty (under $1 a day) by half by 2015
Sub-Saharan Africa: Rising numbers of people living in extreme poverty 800 in millions Total population in Total population in Sub-Saharan Africa Sub-Saharan (millions) Africa (millions) 600 686.2 100% Population in Sub- Saharan Africa in poverty (millions) 400 200 517.3 100% 230.7 (44.6%) 87.7 more 318.4 (46.4%) (Percentage of population in poverty) 0 1990 2001 1 2 Changes in poverty* levels (1990-2001) *Poverty is defined as people living on or less than $1 per day. Data source: UN Status Division MDG website, UN Population Division Data
MDG 2 Access to Education
MDG 2 Access to Education 2 million more teachers needed each year just to stand still
MDG 4-4 Reduce child mortality
3.5 Infant Mortality MDG 4 Child Mortality 3.0 2.5 Adj. Relative Odds Ratio 2.0 1.5 1.0 0.5 0.0 < 18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60 + Duration of Preceding Birth Interval (months)
Parliamentary report s conclusion The Millennium Development Goals are difficult or impossible to achieve with the current levels of population growth in the least developed countries and regions. Recognized large unmet need for family planning and called for expanded support for availability, commodities.
Barriers to fertility regulation Prices are too high. Outlets are unreachable. Medical rules make getting contraception difficult. Misinformation the dangers of contraception. Community workers are not permitted to provide contraceptives. Method choices are limited Government health services are inadequate. Pills are on prescription for reasons not evidence-based. EC using existing birth control pills: No one has bothered to inform most women. Commodities. Safe abortion is hard for poor women to obtain. Advertising about family planning isn t t allowed. Religions constrain providers. Mothers-in in-law are in charge. Young brides lack power. Unmarried young females are excluded from services.
The absence of any We cannot find any country that has risen out of poverty while maintaining high fertility. We cannot find any country that has achieved replacement level fertility without widespread use of abortion.
Policy challenges Second question needs to be addressed Factors with greater influence on fertility decline (or timing thereof) may not be easily quantified; may be exhibited only by clues Disconnect between successful programs and dominant theory Disconnect between concept of couples decisions and barriers standing between women and realistic options about their childbearing
Mistaken assumption that decision-making about family size is like buying a major appliance. However # sexual intercourse = (hundreds or thousands) X (# desired pregnancies)
To buy a refrigerator: Go to the store and order a fridge. If buying a refrigerator were actually like human reproduction, we would have to call the store several times a week and tell them NOT to send a fridge. If we fail to do this persistently and perfectly
the doorbell rings
there are consequences.
The missing factor: With frequent sexual intercourse, in the absence of modern contraceptive methods used consistently and perfectly, it is extremely difficult to control family size. Ergo: The dominant economic model does not fit the biology of human reproduction.