Achieving the Achieving the Millennium Millennium

Development GoalsDevelopment GoalsThe contribution of family The contribution of family

planningplanning

Achieving the Achieving the Millennium Millennium

Development GoalsDevelopment GoalsThe contribution of family The contribution of family

planningplanning

Scott Moreland, Constella FuturesSandra Talbird, University of North Carolina, Chapel Hill

Countries ModeledCountries Modeled

The number of women of reproductive The number of women of reproductive age is large and growing.age is large and growing.

Projected women of reproductive age in Mali

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

Projected women of reproductive age in Nigeria

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

Source: SPECTRUM 2.38 Projections

The number of pregnancies will The number of pregnancies will continue to increase each year.continue to increase each year.

Pregnancies in Nigeria

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Pregnancies in Mali

0200,000400,000600,000800,000

1,000,0001,200,0001,400,000

Source: SPECTRUM 2.38 Projections

A significant percentage of these A significant percentage of these pregnancies are unintended or pregnancies are unintended or mistimed.mistimed.

Mistimed21%

Intended69%

Unintended10%

Mistimed27%

Intended62%Unintended

11%

Source: SPECTRUM 2.38 Projections

Total pregnancies

Nigeria 2003 Mali 2001

Many women want to space or limit Many women want to space or limit their births but do not use family their births but do not use family planning.planning.

Number of women using or wanting to use family planning

826,465179,260718,331

2,609,196

1,115,071

630,729625,558

3,499,636

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

Nigeria Madagascar Mali Ghana

Users Unmet Need

Source: DHS Users defined as married women of reproductive age (MWRA) currently using contraception Unmet need represents those who want to use family planning but are not currently doing so

Traditional Modern

NigeriaNigeria 35%35% 65%65%

MaliMali 30%30% 70%70%

GhanaGhana 26%26% 74%74%

MadagascarMadagascar 32%32% 68%68%

Percentage distribution of users by type of family planning method used

Use of less effective, traditional contraceptive methods is high.

Source: DHS, married women (Nigeria 2003, Mali 2001, Ghana 2003, Madagascar 2003/2004)

Meeting the unmet need for family Meeting the unmet need for family planning will increase the percentage planning will increase the percentage of women using family planning.of women using family planning.

CPR in Nigeria

05

101520253035

%

CPR in Mali

05

10152025303540

2001

2003

2005

2007

2009

2011

2013

2015

2017

2019

%

Source: Nigeria DHS 2003, Mali DHS 2001, married women

The The numbernumber of women using family of women using family planning will increase when unmet planning will increase when unmet need is met.need is met.

FP users in Nigeria

0

3,000,000

6,000,000

9,000,000

12,000,000

Need Met Base

FP users in Mali

0

500,000

1,000,000

1,500,000

2,000,000

Need Met Base

Source: SPECTRUM 2.38 Projections

Meeting the unmet need for family Meeting the unmet need for family planning will reduce unintended planning will reduce unintended pregnancies…pregnancies…

0500,000

1,000,0001,500,0002,000,0002,500,0003,000,0003,500,000

2005 2007 2009 2011 2013 2015

Unintended pregnancies in Nigeria

Need Met Base

0

100,000

200,000

300,000

400,000

500,000

2005 2007 2009 2011 2013 2015

Unintended pregnancies in Mali

Need Met Base

Source: SPECTRUM 2.38 Projections

……as well as reduce the number of as well as reduce the number of abortions.abortions.

0

300,000

600,000

900,000

1,200,000

2005 2007 2009 2011 2013 2015

Abortions in Nigeria

Need Met Base

0

50,000

100,000

150,000

200,000

2005 2007 2009 2011 2013 2015

Abortions in Mali

Need Met Base

Source: Henshaw et al., 1999, and SPECTRUM 2.38 Projections

……and therefore reduce the number of and therefore reduce the number of unintended births.unintended births.

0

300,000

600,000

900,000

1,200,000

1,500,000

1,800,000

2005 2007 2009 2011 2013 2015

Unintended births in Nigeria

Need Met Base

0

50,000

100,000

150,000

200,000

250,000

300,000

2005 2007 2009 2011 2013 2015

Unintended births in Mali

Need Met Base

Source: Calculated by authors based on unintended pregnancies, abortions, and spontaneous abortions

1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development

Reducing unmet need for family Reducing unmet need for family planning can help countries to meet planning can help countries to meet the MDGs by reducing the cost of the MDGs by reducing the cost of achieving the goals.achieving the goals.

Liz Gilbert, the David & Lucile Liz Gilbert, the David & Lucile Packard FoundationPackard Foundation Chamberlain Diala, JHU/CCPChamberlain Diala, JHU/CCP Chamberlain Diala, JHU/CCPChamberlain Diala, JHU/CCP

Focus on 5 Millennium Development Focus on 5 Millennium Development GoalsGoals

Achieve universal primary educationAchieve universal primary education Reduce child mortalityReduce child mortality Improve maternal healthImprove maternal health Combat HIV/AIDS, malaria and other Combat HIV/AIDS, malaria and other

diseasesdiseases Ensure environmental sustainabilityEnsure environmental sustainability

Calculating savings in the costs of Calculating savings in the costs of meeting the MDGs due to meeting the MDGs due to increased contraceptive useincreased contraceptive use

1.1. Project the population with constant FP Project the population with constant FP use and with unmet need fulfilleduse and with unmet need fulfilled

2.2. Calculate the costs of meeting the Calculate the costs of meeting the MDGs for each projectionMDGs for each projection

3.3. Compare the cost projections and Compare the cost projections and calculate the differencecalculate the difference

Contraceptive prevalence rate Contraceptive prevalence rate assumptions used to calculate assumptions used to calculate population scenariospopulation scenarios

Source: MEASURE DHS, Stat Compiler* Represents all women, not only married women

Current CPRCPR + Unmet

Need Annual %

Increase 2015Annual %

Increase 2020Burkina Faso 2003 13.8 42.6 2.4 1.7Cameroon 2004 26.0 46.2 1.8 1.3Chad 1996/97 4.1 13.8 0.5 0.4Ethiopia 2005 14.7 43.3 2.9 1.9Ghana 2003 25.2 59.2 2.8 2.0Guinea  1999 6.2 30.4 1.5 1.2Kenya 2003 39.3 63.8 2.0 1.4Madagascar 2003/2004 27.1 50.7 2.0 1.4Mali 2001 8.1 36.6 2.0 1.5Niger 1998 8.2 24.8 1.0 0.8Nigeria 2003 12.6 29.5 1.4 1.0Rwanda 2000* 7.4 25.1 1.5 1.0Senegal 1997 12.9 47.7 1.9 1.5Tanzania 1999 25.4 47.2 1.4 1.0Uganda 2000/01 22.8 57.4 2.3 1.7Zambia 2001/02 34.2 61.6 2.0 1.4

Unit costs applied to population Unit costs applied to population projections for each of the MDGsprojections for each of the MDGs

Sector Parameter Unit Cost(US$)

Family Planning Cost per couple-year of protection

$11.2

Education Cost per pupil $30-$75

Immunization Cost per fully immunized child

$17.0

Maternal Health Cost per birth $28.2-$37.3

Water/Sanitation Cost per beneficiary

$4.6

Malaria - ITN Cost per treated-net-year

$4.4

Achieve universal primary education

Ensure that by 2015, children everywhere, boys and girls alike, will be able to complete the course of primary schooling.

Primary education net enrollment rate

0%

20%

40%

60%

80%

100%

Burkin

a Fa

so

Camer

oon

Chad

Ethiop

ia

Ghana

Guinea

Kenya

Mad

agas

car

Mali

Niger

Nigeria

Rwanda

Seneg

al

Tanza

nia

Ugand

a

Zambia

Current MDG

Millennium Development Goals and Targets

Source: United Nations Statistics Division, 2000

Family planning use reduces the Family planning use reduces the number of school-aged children.number of school-aged children.

Annual number of children to be enrolled in primary education to meet

the MDG in Ghana (2005-2015)

1,000,0001,500,0002,000,0002,500,0003,000,0003,500,0004,000,0004,500,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

# ch

ild

ren

6-1

1 ye

ars

old

Base Need Met

Annual number of children to be enrolled in primary education to

meet the MDG in Mali (2005-2015)

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

# ch

ild

ren

6-1

1 ye

ars

old

Base Need Met

……which reduces the costs of meeting the which reduces the costs of meeting the primary education MDG.primary education MDG.

Cumulative primary education cost savings in Ghana

$0

$10

$20

$30

$40

$50

Mill

ion

s

Cumulative primary education cost savings in Mali

$0

$10

$20

$30

$40

$50

Mil

lion

s

$35.8m $37.8m

Note: Costs discounted by 3 percent

Reduce child Reduce child mortalitymortalityReduce by two thirds, between 1990 and 2015, the under-five mortality rate.

Percentage of children under 1 vaccinated for measles

0%

20%

40%

60%

80%

100%

Burkin

a Fa

so

Camer

oon

Chad

Ethiop

ia

Ghana

Guine

a

Kenya

Mad

agas

car

Mal

i

Niger

Nigeria

Rwanda

Seneg

al

Tanza

nia

Ugand

a

Zambia

Current MDG

Millennium Development Goals and Targets

Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the Fulfilling unmet need reduces the number of children needing number of children needing vaccinations.vaccinations.

Annual number of children needing the measles vaccine to meet the MDG in

Nigeria (2005-2015)

01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,000

# ch

ildre

n u

nd

er 1

yea

rs o

ld

Base Need Met

Annual number of children needing the measles vaccine to meet the MDG in

Madagascar (2005-2015)

0

200,000

400,000

600,000

800,000

1,000,000

# ch

ild

ren

un

der

1 y

ears

old

Base Need Met

Fulfilling unmet need generates cost Fulfilling unmet need generates cost savings by reducing the costs of meeting savings by reducing the costs of meeting the immunization target.the immunization target.

Cumulative measles vaccination cost savings in Nigeria

$0

$15,000,000

$30,000,000

$45,000,000

$60,000,000

Cumulative measles vaccination cost savings in Madagascar

$0

$3,000,000

$6,000,000

$9,000,000

$12,000,000

$15,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

$13 m$52 m

Note: Costs discounted by 3 percent

Fulfilling unmet need reduces the number Fulfilling unmet need reduces the number of child deaths by reducing the number of of child deaths by reducing the number of high-risk births.high-risk births.

Source: Child Survival Model, John Stover, Futures Group

Cumulative child deaths averted due to spacing and limiting births (2005-2015)

199,952

1,080,156

284,576185,960

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

Ghana Madagascar Mali Nigeria

De

ath

s a

ve

rte

d

Improve maternal mortalityReduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.

Maternal mortality ratio (MMR)

0

200

400

600

800

1000

1200

1400

1600

Burkin

a Fa

so

Camer

oon

Chad

Ethiop

ia

Ghana

Guine

a

Kenya

Mad

agas

car

Mal

i

Niger

Nigeria

Rwanda

Seneg

al

Tanza

nia

Ugand

a

Zambia

De

ath

s p

er

10

0,0

00

liv

e b

irth

s

MDG Current

Millennium Development Goals and Targets

Source: United Nations Statistics Division, 2000

Fulfilling unmet need can reduce the Fulfilling unmet need can reduce the number of births over the next 10 number of births over the next 10 years.years.

Annual number of births in Nigeria (2005-2015)

0

2,000,000

4,000,000

6,000,000

8,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Bir

ths

Base Need Met

Annual number of births in Ghana (2005-2015)

0200,000400,000600,000800,000

1,000,000

Bir

ths

Base Need Met

Reducing the number of births generates Reducing the number of births generates savings for maternal health costs.savings for maternal health costs.

Cumulative maternal healthcare savings in Nigeria

$0$30,000,000$60,000,000$90,000,000

$120,000,000$150,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Cumulative maternal healthcare savings in Ghana

$0

$10,000,000

$20,000,000

$30,000,000

$40,000,000$39 m

$127 m

Note: Costs discounted by 3 percent

Fulfilling unmet need saves lives by Fulfilling unmet need saves lives by reducing the number of maternal reducing the number of maternal deaths.deaths.

Maternal deaths averted by reducing the number of pregnancies (2000-2015)

18,6884,007

2,12018,849

6,8216,512

2,91814,040

1,9873,962

12,7821,151

4,9621,954

16,8774,474

0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000

ZambiaUganda

TanzaniaSenegalRwandaNigeria

NigerMali

MadagascarKenya

GuineaGhana

EthiopiaChad

CameroonBurkina

Ensure Ensure environmental environmental sustainabilitysustainabilityBy 2015, reduce by half the proportion of people without sustainable access to safe drinking water and sanitation.

Percentage of population without access to safe water and sanitation

0

20

40

60

80

100

Burkin

a Fa

so

Camer

oon

Chad

Ethiop

ia

Ghana

Guine

a

Kenya

Mad

agas

car

Mal

i

Niger

Nigeria

Rwanda

Seneg

al

Tanza

nia

Ugand

a

Zambia

% o

f p

op

ula

tio

n

MDG Current

Millennium Development Goals and Targets

Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the Fulfilling unmet need reduces the number of people needing safe water number of people needing safe water and sanitation.and sanitation.

Annual # of new people with access to safe water and sanitation in Nigeria

(2005-2015)

1,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Base Need met

Annual # of new people with access to safe water and sanitation in Ghana

(2005-2015)

0

200,000

400,000

600,000

800,000

1,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Base Need met

The costs of achieving the safe water and The costs of achieving the safe water and sanitation goals are reduced by fulfilling sanitation goals are reduced by fulfilling unmet need.unmet need.

Cumulative cost savings to provide water and sanitation in Nigeria

$0$10,000,000$20,000,000$30,000,000$40,000,000$50,000,000$60,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Cumulative cost savings to provide water and sanitation in Ghana

$0$5,000,000

$10,000,000$15,000,000$20,000,000$25,000,000$54 m

Note: Costs discounted by 3 percent

$21 m

Combat HIV/AIDS, malaria and other diseases

By 2015, halt and begin to reverse the incidence of malaria and other major diseases

Percentage of children under 5 with an insecticide-treated net

0

20

40

60

80

Burkin

a Fa

so

Camer

oon

Chad

Ethiop

ia

Ghana

Guinea

Kenya

Mad

agas

car

Mali

Niger

Nigeria

Rwanda

Seneg

al

Tanza

nia

Ugand

a

Zambia

Current MDG

Millennium Development Goals and Targets

Source: United Nations Statistics Division, 2000

Fulfilling unmet need reduces the number of Fulfilling unmet need reduces the number of mosquito nets needed to reach the Abuja mosquito nets needed to reach the Abuja target of 60% coverage.target of 60% coverage.

Annual number of children under age 5 needing ITNs

in Nigeria (2005-2015)

0

5,000,000

10,000,000

15,000,000

20,000,000

Base Unmet Need

Annual number of children under age 5 needing ITNs

in Ghana (2005-2015)

0500,000

1,000,0001,500,0002,000,0002,500,0003,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Base Unmet Need

Reducing the number of mosquito nets Reducing the number of mosquito nets needed makes reaching the Abuja target needed makes reaching the Abuja target more affordable.more affordable.

Cumulative savings for reaching the ITN coverage goal in Nigeria

$0$2,000,000

$4,000,000$6,000,000$8,000,000

$10,000,000

$12,000,000$14,000,000

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Met

ric

To

ns

$12.7m

Cumulative savings for reaching the ITN coverage goal in Ghana

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

Met

ric

To

ns $4.2m

Note: Costs discounted by 3 percent

Weighing the Benefits and Costs of Weighing the Benefits and Costs of Meeting the MDGs by Fulfilling Meeting the MDGs by Fulfilling Unmet Need for Family PlanningUnmet Need for Family Planning

The costs savings for the MDGs The costs savings for the MDGs outweigh the costs of reducing unmet outweigh the costs of reducing unmet need.need.

FP CostsFP Costs

(Millions(Millions))

MDG MDG SavingSavingss

B/C B/C RatioRatio

FP Costs FP Costs (Millions(Millions))

MDG MDG SavingSavingss

B/C B/C RatioRatio

Burkina Burkina FasoFaso

$27.5 $80.9 2.95 MaliMali $35.8 $106.4

2.97

CameroonCameroon $14.7 $54.9 3.72 NigerNiger $28.6 $91.9 3.22

ChadChad $4.7 $25.0 5.29 NigeriaNigeria $139.5 $386.6

2.77

EthiopiaEthiopia $102.8 $208.5

2.03 RwandaRwanda $6.1 $28.2 4.59

GhanaGhana $54.0 $120.6

2.23 SenegalSenegal $42.7 $265.6

6.22

GuineaGuinea $20.8 $80.0 3.85 TanzaniaTanzania $71.6 $291.3

4.07

KenyaKenya $71.4 $270.6

3.79 UgandaUganda $97.4 $407.9

4.19

MadagascarMadagascar $25.5 $76.4 3.00 ZambiaZambia $27.2 $111.3

4.09

Fulfilling unmet need leads to health Fulfilling unmet need leads to health benefits as well as cost savings.benefits as well as cost savings.

MaternMaternal al

Deaths Deaths AvertedAverted

Child Child Deaths Deaths AvertedAverted

AbortionAbortions s

AvertedAverted

MaternMaternal al

Deaths Deaths AvertedAverted

Child Child Deaths Deaths AvertedAverted

AbortionAbortions s

AvertedAverted

Burkina Burkina FasoFaso

4,962 240,753 199,603 MaliMali 6,512 284,576 371,372

CameroonCameroon 1,954 96,357 N/A NigerNiger 6,821 280,203 652,384

ChadChad 1,151 56,857 151,557 NigeriaNigeria 18,849 1,080,156

1,207,568

EthiopiaEthiopia 12,782 1,144,767

1,953,170

RwandaRwanda 2,120 72,751 38,554

GhanaGhana 3,962 199,952 430,739 SenegalSenegal 4,007 213,277 406,135

GuineaGuinea 1,987 119,227 212,698 TanzaniTanzaniaa

18,688 495,786 1,065,044

KenyaKenya 14,040 434,306 1,242,254

UgandaUganda 16,877 796,296 1,176,963

MadagascaMadagascarr

2,918 185,960 391,037 ZambiaZambia 4,474 244,241 397,982

Achieving the MDGs will be a major Achieving the MDGs will be a major challenge.challenge.

These goals will be easier and cheaper to These goals will be easier and cheaper to achieve if contraceptive use increases as a achieve if contraceptive use increases as a result of fulfilling unmet need.result of fulfilling unmet need.

The additional costs of reducing unmet The additional costs of reducing unmet need for family planning are offset by need for family planning are offset by substantial MDG cost savings by 2015.substantial MDG cost savings by 2015.

In ConclusionIn Conclusion

Meeting the unmet need for family planning in Africa can help countries reach the MDGs.