Transcript Family Planning Programs for the 21st Century

Family Planning Programs for the
21st Century:
Rationale and Design Reconsidered
Monica Das Gupta
John Bongaarts
John Cleland
Shareen Joshi
Outline of talk
1.
Why discuss family planning, not female education?
2.
Rationale for family planning programs. Review literature on:
a)
b)
c)
3.
The donor retreat & its implications:
a)
b)
c)
4.
The donor retreat
Implications for Sub-Saharan Africa
Implications for women’s health
Designing family planning programs:
a)
b)
5.
Does rapid population growth affect developing countries prospects of
economic growth?
Does rapid population growth affect prospects of sustainable
management of resources?
Are family planning programs effective?
Strengthening the supply of services
Building demand for services
Conclusions
SECTION 1
WHY DISCUSS FAMILY PLANNING, NOT
FEMALE EDUCATION?
Why discuss family planning, not
female education?
• Female education strongly associated with lower
fertility and better outcomes of many kinds
– But well-established in the policy arena,
– Well-recognized private & social returns
• By contrast, family planning relatively neglected by
donors
– Less awareness of its intrinsic benefits & positive
externalities
World Bank (2009) notes its support for population nearly disappeared
Percent of donor expenditures on population
assistance by activity, 1995-2007
80
70
60
50
Family planning services
40
Basic reproductive health services
STD/HIV/AIDS activities
30
20
10
0
1995
1996
1997
1998
1999
2000
Source: UNFPA 2003:Table 5, UNFPA 2009:Table5
2001
2002
2003
2004
2005
2006
2007
SECTION 2
THE RATIONALE FOR FAMILY PLANNING
PROGRAMS: A LITERATURE REVIEW
1a: Does rapid population growth affect
developing countries’ prospects of economic growth?
•
Coale-Hoover ― rapid population growth hinders economic growth
(in poor, agrarian 1950s India):
– Resources diverted from investment in production to meet needs of:
• Growing population
• Rising youth dependency ratios
•
Studies challenging these models ― and rationale for family planning programs
(cross-country regressions 1960s to 1980s)
•
Recent studies indicate:
–
–
–
–
Low dependency ratios: can increase productivity, invest in future growth
Household-level: lower fertility ass with better health, schooling, laborforce participation
Population increases associated with lower growth in per capita income
Rapid population growth can constrain economic growth, especially where policy settings
hinder productivity rise
Throughout, broad consensus that policy & institutional settings are key driver of
economic growth, while population growth rate plays a secondary role.
1b: Does rapid population growth affect
prospects of sustainable management of resources?
• Innovation obviates population pressure on resources:
– Population growth induces innovation
– Innovation makes resource base effectively infinite (Simon)
• Constraints to innovation:
– Where resources are free or under-priced
– Difficulties of managing use of global common property resources
Intensive agriculture has contributed to the
proliferation of dead zones
Source: World Bank (2010a) World Development Report 2010: Map 3.4 (derived from Diaz and Rosenberg 2008).
Required growth in agricultural productivity
250
}
200
Climate change
150
}
Population growth
}
Change in per
capita consumption
100
50
1965
••••
1975
1985
1995
2005
2025
2045
The scenario with climate change
― The "business as usual" scenario without climate change
--- The "business as usual" scenario without climate change
AND NO POPULATION GROWTH AFTER 2005
Source: World Bank (2010a) World Development Report 2010: Figure 3.5 (derived from Lotze-Campen et al 2009). We thank Dr Lotze-Campen for
disaggregating the “business as usual” scenario into two estimates: (1) with population held constant at the 2005 level, and (2) the WDR 2010’s “business as
usual” scenario, which includes anticipated population increase to 9 billion by 2055.
1c: Are family planning programs effective?
• (Pritchett): fp programs little effect on fertility
– Controlling for desired family size
– Mass media found effective at reducing desired family size
– Major component of fp progs
• Randomized evaluation data virtually non-existent
– But many careful studies indicate fp programs reduce fertility
SECTION 3
IMPLICATIONS FOR SUB-SAHARAN
AFRICA
IMPLICATIONS FOR WOMEN’S HEALTH
2b: Implications for Sub-Saharan Africa
Trends in fertility by region, 1960-2010
8
7
Sub-Saharan Africa
Birhs/woman
6
5
Latin America
4
3
Asia
2
1
0
1960
Source: UN 2009
1965
1970
1975
1980
1985
1990
1995
2000
2005
2010
% increase in population aged 0-14, 1970-2005
200
180
160
140
120
100
80
60
40
20
0
Asia
Source: UN 2009
LAC
SSA
Niger
Changes in per capita food
production, 1961-2005
Source: The Royal Society 2009: Figure 1.4
East Asia & Pacific
785
Low income
Sub-Saharan Africa
2000
1996
1992
1988
1984
1980
1976
1972
1968
208
124
1964
900
800
700
600
500
400
300
200
100
0
1960
GDP per capita index, 1960=100
Growth in GDP per capita, 1960-2004
Source: World Bank 2007b: Figure 2.5, derived from the World Bank World Development Indicators database
Note: GDP per capita index 1960=100
Fertility decline helps improve women’s health:
Ratio of Male to Female Mortality, India, 1970-1990
Male / female
ratio in mortality
Reproductive age group (15-44)
1.600000000
male/female mortality
ratio1988-92
1.500000000
1.400000000
1.300000000
1.200000000
1.100000000
1.000000000
0.900000000
0.800000000
male/female mortality
ratio 1970-75
0.700000000
0.600000000
0
1
5
10
15
20
25
30
35
40
45
50
55
60
65
70
Age
Source: Government of India, Sample Registration Bulletin 16(1), June 1982, and SRS Based Abridged Life Tables 1988-92, New Delhi: Registrar-General of India.
SECTION 4
DESIGNING FAMILY PLANNING PROGRAMS
Section 4:
Designing family planning programs
• Strengthening the supply of services
• Strengthening the demand for services
Population projections for sub-Saharan Africa
Maintaining one less birth per woman reduces projected population size in 2050 by half a billion
2
High variant
Difference is one
birth per woman
throughout the
projection period
}
Billions
Low variant
1
0
1950
Source: UN 2009
1970
1990
2010
2030
2050
Section 5:
Conclusions