Family Planning and the Millennium Development Goals

Ward CatesFHI 360

September, 2013

Global FP Perceptions – Findings from Gates Survey ‘09

• Global FP is not an end in itself

• FP is a broad range of RH services, not just contraception

• FP is one of various means to improve health and quality of life

• Providing evidence of FP impact on health and development goals is crucial

Millennium Development Goals:What Are They?

• 2000-2015 targets for development

• Commitments by 181 UN nations

• Priorities for global funders

• Opportunities for multinational organizations

Millennium Development Goals

1. End Poverty and Hunger2. Universal Education

3. Gender Equality

4. Child Health

5. Maternal Health

6. Combat HIV/AIDS

7. Environmental Sustainability

8. Global Partnerships

FP and MDGs

FP

End Hungerand Poverty

FP Generates Wealth

• Per capita GNP associated with prevalence of modern contraceptive methods

• Women’s weekly income directly associated with lower number of pregnancies

Modern Methods GNP

– South Korea

– Jamaica

– Mali

70%

58%

5%

9,700

1,510

250

Source: FHI Women’s Studies Project, PRB Fact Sheet

Smaller Family Size Contributed to “Asian Miracle,” 1960-2005

Ch

ild

ren

per

wo

man

GN

I per c

apita

Source: World Bank (2006)

FP Reduces Hunger

Source: Brown (2009)

Undernourished Total Population World Grain Stocks

775

980

1200

2.6

3.1

3.7

108

62

N/P

1997 2007 2017

Million Billion Days

FP and MDGs

FP

End Hungerand Poverty Increase

Education

FP Prolongs Education

• Pregnancy a major obstacle to school attendance– High levels of pregnancy in youth– < half African girls complete primary school

• Population growth puts pressure on limited school infrastructure

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

FP Empowers Women

• Women who use FP more likely to be employed than non-users (Indonesia, Zimbabwe, Bolivia)

• Long-acting/permanent contraceptive methods associated with greater likelihood of working for pay (Brazil, Indonesia)

• Improves partner relations, family well-being, and community involvement (Philippines)

• Unplanned pregnancies interrupt work and career plans (Egypt)

Source: FHI Women’s Studies Project

Empowering Women

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

FP Saves Infants

• Spacing planned births and limiting unintended births increases child survival

• Currently, 2.7 M infant deaths are averted globally each year by preventing unintended pregnancies

Source: DHS

Child Mortality by Birth Interval

0

0.5

1

1.5

2

2.5

3

3.5

<18 18-23 24-29 30-35 36-41 42-47 48-53 54-59 60+

Birth Interval (Months)

Rel

ativ

e R

isk

Ch

ild

Mo

rtal

ity

Source: DHS; Rutstein (2005)

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

Improve MaternalHealth

FP Improves Maternal Health

• Unintended pregnancies affect women’s health– Risks of terminating pregnancy – unsafe

abortion– Risks of continuing pregnancy – maternal

mortality

• 70% of global maternal deaths could be averted if FP needs met

FP Reduces Abortion

0

100

200

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Modern contraception

Russia (1988-1998)

Abortion47

178

Source: Westoff (2005)

Rel

ati

ve

Co

ntr

ace

pti

ve a

nd

Ab

ort

ion

Pre

vale

nce

FP Reduces Maternal Mortality

COUNTRY Contraceptive Prevalence*

Lifetime probability of

maternal death (1/X)

US 73% 2,500

South Africa 55% 120

Namibia 43% 54

Malawi 26% 7

* Percent of married women ages 15-49 using modern method

Source: WHO (2004)

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

Improve MaternalHealth

DecreaseHIV/AIDS

FP Prevents HIV

Prevention of HIV in women, especially young women

Prevention of unintended pregnancies in HIV-infected women

Prevention of transmission from an HIV-infected woman to her infant

Support for mother and family

Phase 1 Phase 2 Phase 3 Phase 4

4 Phase Approach to Perinatal HIV Prevention

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

Improve MaternalHealth

DecreaseHIV/AIDS

Save theEnvironment

FP Protects the Environment

• Rapidly growing population exacerbates environmental degradation

• Slower population growth places less stress on limited natural resources, including fresh water and arable land

• Preventing unintended pregnancy is the factor in population growth most amenable to intervention

Source: PRB, 2009

FP and MDGs

FP

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

Improve MaternalHealth

DecreaseHIV/AIDS

Save theEnvironment

Support Global

Partnerships

FP Promotes Partnerships

• Four decades of global investment in FP programs has contributed strong collaboration among:– International agencies – Governmental ministries– Multinational organizations– Local NGOs/community groups

FP and MDGs in Science

SRH and HIV: Key Linkages

Key Linkages

Learn HIV status

Promote safer sex

Optimize connection between HIV/AIDS and STI services

Integrate HIV/AIDS with maternal and infant health

HIV/AIDS

• Prevention

• Treatment

• Care

• Support

SRH• Family Planning

• Maternal & infant care

• Management of sexually transmitted infections

• Management of other SRH

problems

Source: WHO/UNAIDS, IPPF/UNFPA (2005)

FP Integration in Multiple Development Sectors

Beyond the MDGs

• Enhance National Security

• Defuse Explosive Societies

• Optimize Financial Resources

The New Population BombChanging Demographic Composition and Distribution

• Shift in “demographic weight” from higher to lower-resource countries

• Aging of higher-resource countries

• Youth bulge in lower-resource countries

• Urbanization of lower-resource countries

Source: Goldstone (2010)

FP Stabilizes Societies

“High birth rates...produced a common problem ― a large, steadily increasing population of young men without any reasonable expectation of suitable or steady employment ― a sure prescription for social turbulence.”

Source: The 9/11 Commission Report (2004)

Proportion of Youth Aged<25, by Region

Source: UN (2007)

0

25

50

75

100

Africa LatinAmerica

East Asia SouthAsia

MiddleEast

NorthAmerica

Europe

0-14 15-24

The “Youth Bulge” Impact

• Disproportionate levels of young adults associated with political volatility and violence

• Countries with youthful age structure slow to become stable democracies ─ Middle East, Africa

• Democratic countries with high proportion of youth are less stable ─ Latin/South America

Source: Cincotta (2009)

FP Saves Dollars

• Preventing unintended pregnancies is less expensive than treating maternal/ infant complications of pregnancy

• Longer acting contraceptive methods are the most cost-effective

• Up to $31 can be saved for every dollar spent on FP (UNFPA)

Family Planning and MDGs: Cost Savings in Zambia

0

20

40

60

80

100

120

Source: USAID-Zambia (2008)

Education $37 M

Immunization$17 M

Water Sanitation$17 M

Maternal Health$37 M

Malaria $4 M

Total Savings: $111 M

Family Planning$27 M

Total Costs: $27 M

FP and MDGs

FP

• FP affects all 8 MDGs• FP is one of multiple interventions to improve health and development

End Hungerand Poverty Increase

Education

EmpowerWomen

Improve InfantHealth

Improve MaternalHealth

Support Global

Partnerships

Save theEnvironment

DecreaseHIV/AIDS

Conclusion

• Investing in global FP programs will help achieve all 8 MDGs

• Strengthening global FP programs contributes to integrated, multisectoral development

• Investing in global FP programs will optimize financial resources