Post on 01-Apr-2015
Family Planning Programs for the 21st Century:
Rationale and Design Reconsidered
Monica Das GuptaJohn Bongaarts
John ClelandShareen Joshi
Outline of talk1. Why discuss family planning, not female education?
2. Rationale for family planning programs. Review literature on:a) Does rapid population growth affect developing countries prospects of
economic growth?b) Does rapid population growth affect prospects of sustainable management of
resources?c) Are family planning programs effective?
3. The donor retreat & its implications:a) The donor retreat b) Implications for Sub-Saharan Africac) Implications for women’s health
4. Designing family planning programs:a) Strengthening the supply of servicesb) Building demand for services
5. 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
externalitiesWorld Bank (2009) notes its support for population nearly disappeared
Percent of donor expenditures on population assistance by activity, 1995-2007
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 20070
10
20
30
40
50
60
70
80
Family planning servicesBasic reproductive health servicesSTD/HIV/AIDS activities
Source: UNFPA 2003:Table 5, UNFPA 2009:Table5
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
1965 1970 1975 1980 1985 1990 1995 2000 2005 2015 2025 2035 2045 205550
100
150
200
250
Climate change
Population growth
Change in percapita consumption
}}}
•••• 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
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 20100
1
2
3
4
5
6
7
8
Birh
s/w
oman
Sub-Saharan Africa
Latin America
Asia
Source: UN 2009
% increase in population aged 0-14, 1970-2005
Asia LAC SSA Niger0
20
40
60
80
100
120
140
160
180
200
Source: UN 2009
Changes in per capita food production, 1961-2005
Source: The Royal Society 2009: Figure 1.4
Growth in GDP per capita, 1960-2004
785
208124
0
100
200
300
400
500
600
700
800
900
1960
1964
1968
1972
1976
1980
1984
1988
1992
1996
2000
GD
P pe
r cap
ita in
dex,
196
0=10
0East Asia & Pacific
Low income
Sub-Saharan Africa
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
0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70
0.600000000000001
0.700000000000001
0.800000000000001
0.900000000000001
1
1.1
1.2
1.3
1.4
1.5
1.6
Age
Male / female ratio in mortality
Source: Government of India, Sample Registration Bulletin 16(1), June 1982, and SRS Based Abridged Life Tables 1988-92, New Delhi: Registrar-General of In -dia.
Reproductive age group (15-44)
male/female mortality ratio 1970-75
male/female mortality ratio1988-92
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
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 20500
1000000
2000000
High variant
Low variant
Difference is onebirth per woman throughout theprojection period}
Source: UN 2009
Section 5: Conclusions