principles population demography moazzam ali 2011

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Principles of Population &

Demography

Moazzam Ali MD, PhD, MPH

Department of Reproductive Health and Research

World Health OrganizationOctober 10, 2011


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Definitions of population & demography and relevantindicators

Why family planning is still important

MDG, RH Strategy, UNSG Strategy

Key indicators on family planning Contraceptive Prevalence

Unmet need for FP

Special target populations groups

Need for research in population & family planning


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Population: definition Group of individuals of same species living

in the same geographic area at the same time

A population is often defined by

demographers according to the specific needs

of the research and researcher. Threeprocesses are relevant to demography:

Fertility, Mortality, and Migration


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Population: basic concepts There are only two ways to enter a population by

birth and by in-migration.

There are two ways to leave a population, by

death and by out-migration.

For example, the population of interest may be thatof students attending a specific university during aspecific year. In this situation, the students are born(i.e., enter) into the population when they enroll, andthey die (i.e., leave) when they graduate


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Trends in global population growth

1st Billion: 1804

2nd Billion: 1927 (123 years)

3rd Billion: 1960 (33 years)

4th Billion: 1974 (14 years)

5th

Billion: 1987 (13 years)6th Billion: 1999 (12 years)




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Projecting future

populations Human Population since

1980 is J-shaped curve

Population is increasinghowever growth rate (r) has

started to decline

Projections for 2050 (2007)

Low = 7.7 billion

High = 10.6 billion

Most likely = 9.1 billion


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Reaching the 7 billion mark

World Population to surpass 7 Billion in 2011 and

will reach seven billion on 31

st

October, a milestonethat offers unprecedented challenges and

opportunities to all of humanity, according to

UNFPA


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World population distribution: global overview
http://upload.wikimedia.org/wikipedia/commons/b/b1/World_population.PNG


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http://upload.wikimedia.org/wikipedia/commons/2/2e/World_Population_by_Continent_and_10_Most_Populated_Countries.png


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Population density Population density

The number of individuals of a species per unit

area or volume at a given time Ovals below have same population, and different

densities


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Population density of countries


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Effects of overpopulation

Some of the global effects of overpopulation

include:

Ultimate shortages of energy sources and othernatural resources,

Famine

Serious communicable diseases in dense populations

Shortage of arable land (where food crops will grow) Little surplus food

Mass extinctions of plants and animals as habitat isused for farming and human settlements

War over scarce resources such as land area.


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Effects of overpopulation

High birth rates

Lower life expectancies

Lower levels of literacy

Child poverty

Higher rates of unemployment, especially in urban

Poor diet with ill health and diet-deficiency diseases (e.g.rickets)

Low per capita GDP Increasingly unhygienic conditions

Government stretched economically

Increased crime rates resulting from people stealing resourcesto survive


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Demography: historical perspective

Demography is the study of human population dynamics.

Achille Guillard first used the title on his book:

"Elements de Statistique Humaine ou Demographie Comparee".

Two Greek roots:

demos (people)

graphy (branch of knowledge regarding a particular science in thiscase, human populations).

Guillard then defined demography as: the mathematical knowledge ofpopulations, their general movements, and their physical, civil, intellectualand moral state (Guillard 1855:xxvi).


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Today demography encompass

the determinants and consequences of population changeand is concerned with virtually everything that influences orcan be influenced by:

Population Size

Population growth or decline

Population processes (levels and trends in mortality, fertilityand migration that are determining population size andchange).

Population characteristics (education, religion, or ethnicity)

Population structure (how many by age)


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Population pyramid: age structure

The number and proportion of people at each age in

a population


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Demographics of specific countries


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Demographic stages

Pre-industrial Stage

Birth and death rates high

Modest population growth

Transitional Stage

Lowered death rate

Rapid population growth

Industrial Stage

Birth rate decline

Population growth slow

Post Industrial Stage

Low birth and death rates

Population growth very slow


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Demographic stages


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Demographic indicators

Because demography is interested in changes inhuman populations, demographers focus on specificindicators of change.

Two of the most important indicators are birth anddeath rates, which are also referred to asfertility andmortality.

Additionally, demographers are interested inmigration trends or the movement of people fromone location to another.


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Fertility and fecundity

Fertility, in demography, refers to the ability of females toproduce healthy offspring in abundance. Fecundity is thepotential reproductive capacity of a female. Some of the morecommon demographic measures used in relation to fertility

and/or fecundity include:

Crude birth rate

General fertility rate

Age-specific fertility rate

Total fertility rate

Gross reproduction rate

Net reproduction rate


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Replacement level fertility

It refers to the number of children that a woman (ormonogamous couple) must have in order to replace theexisting population. Replacement level fertility is generallyset at 2.1 children in a woman's lifetime (this number varies

by geographic region given different mortality rates).

The reason the number is set to 2.1 children per woman isbecause two children are needed to replace the parents and an

additional one-tenth of a child is needed to make up for themortality of children and women who do not reach the end oftheir reproductive years.


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Total fertility rate

The total fertility rate (TFR) of a population is theaverage number of children that would be born to awoman over her lifetime if ;

(1) she were to experience the exact current age-specific fertility rates (ASFRs) through herlifetime, and

(2) she were to survive from birth through the endof her reproductive life. It is obtained bysumming the single-year age-specific rates at agiven time.


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Years TFR Years TFR Years TFR

19501955 4.95 20002005 2.62 20502055 2.15

19551960 4.89 20052010 2.52 20552060 2.12

19601965 4.91 20102015 2.45 20602065 2.11

19651970 4.85 20152020 2.39 20652070 2.09

19701975 4.45 20202025 2.33 20702075 2.08

19751980 3.84 20252030 2.29 20752080 2.06

19801985 3.59 20302035 2.25 20802085 2.05

19851990 3.39 20352040 2.22 20852090 2.04

19901995 3.04 20402045 2.19 20902095 2.04

1995

2000 2.79 2045

2050 2.17 2095

2100 2.03

World historical and predicted total fertility

rates (19502100) UN, 2010


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Trends in TFR 1950-2050
http://localhost/var/www/apps/conversion/tmp/scratch_3//upload.wikimedia.org/wikipedia/commons/b/b2/Trends_in_TFR_1950-2050.png


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Mortality

Mortality refers to the finite nature of humanity: people die.Mortality in demography is interested in the number of deathsin a given time or place or the proportion of deaths in relationto a population. Some of the more common demographic

measures of mortality include:

crude death rate: the annual number of deaths per 1000people

infant mortality rate: the annual number of deaths of

children less than 1 year old per thousand live births life expectancy: the number of years which an individual

at a given age can expect to live at present mortality rates


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Infant mortality rate by region 1950-2050
http://localhost/var/www/apps/conversion/tmp/scratch_3//upload.wikimedia.org/wikipedia/commons/f/fe/Infant_Mortality_Rate_by_Region_1950-2050.png


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Life expectancy at birth by region, 1950-2050
http://localhost/var/www/apps/conversion/tmp/scratch_3//upload.wikimedia.org/wikipedia/commons/2/29/Life_Expectancy_at_Birth_by_Region_1950-2050.png


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Change in population size


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Migration : change in population size


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Why Family Planning is still important ?


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Current situation

on family planning

Constraints:

26 countries have CPRbelow 20%

215 million couples havean unmet need for family

planning

Decreased investment in

contraceptive research anddevelopment by industry,despite increased demand

Active mis - and

disinformation

Opportunities:

MDG 5b: Universal accessto reproductive health

FP and other SRHservices

Renewed interest insupporting family planninginternationally


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MDG 5: improve maternal health

5 A:Reduce by three quarters, between 1990 and 2015, thematernal mortality ratio

5.1 Maternal mortality ratio

5.2 Proportion of births attended by skilled healthpersonnel

5.B: Achieve, by 2015, universal access to reproductivehealth

5.3 Contraceptive prevalence rate5.4 Adolescent birth rate5.5 Antenatal care coverage (at least one visit andat least four visits)

5.6 Unmet need for family planning


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UN Secretary General's Global Strategy for

Women's and Children's Health: 2010

Components

Country-led health plans

Comprehensive, integrated

package of essential interventions

and services Integrated care

Health systems strengthening

Health workforce capacity

building

Coordinated research andinnovation

Role of UN agencies

Define norms, regulations andguidance to underpin efforts

Help countries align their national

practices Work together and with others to

strengthen technical assistance toscale-up

Encourage links between sectorsand integration with other

international efforts

Support systems that trackprogress and identify funding gaps

Generate and synthesize research-derived evidence and provide a

platform for sharing


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Evidence-based packages of interventions to

improve SRH (H4+) and partners

Health System

ComponentsBenefits and potential impact of interventions,

including Family planning

Health system requirements

Service delivery recommendations

Indicators


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Indicators on family planning


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Contraceptive prevalence rate

Contraceptive prevalence is the percentage of

women who are currently using, or whose sexual

partner is currently using, at least one method of

contraception, regardless of the method used.

It is usually reported for married or in union women aged 15 to 49.

A union involves a man and a woman regularly cohabiting in amarriage-like relationship.


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08_

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0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

1980 1985 1990 1995 2000 2005 2009

YEAR

CPR

Af rica

Asia

Europe

Latin America

North America

Oceania

Global contraceptive prevalence rate


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CPR Trends - Asia

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1980 1985 1990 1995 2000 2005 2009

Year

CPR

ASIA

Central Asia

Eastern Asia

Southern Asia

South-Eastern Asia

Western Asia

Contraceptive prevalence rate in Asia


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Average number of children per woman

4.9

6.8

5.7 5.6

2.42.7

5

2.5 2.6

1.6

World Africa Asia Latin America

and the

Caribbean

More Developed

Countries

1965-1970 2000-2005

Trends in childbearing, by region

Source: United Nations, World Population Prospects: The 2004 Revision, 2005.


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Diverging trends in fertility reduction

Average number of children per woman5.7

5.25.4

6.46.4

8.5

5.3

3.3

6.2

3.1

2.42.1

4.3

2.5

Egypt India Indonesia Iran Pakistan Turkey Yemen

1970-1975 2000-2005

Source: United Nations, World Population Prospects: The 2004 Revision, 2005.


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Family planning methods, worldwide

Pill

8%IUD

14%

Injectable or

Implant

3%

Male Condom

5%

Female

Sterilization

21%

Not Using

39%

Other Modern

Methods

1%

Traditional

Methods

7%Male

Sterilization

3%

Note: Total exceeds 100 due to rounding.

Source: United Nations Population Division, World Contraceptive Use 2005..


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Family planning methods, Sub-Saharan Africa

Any

Method

19%

No

Method

82%

Married Women 15 to 49 Using

Family Planning, Late 1990s

Rhythm16%

FemaleSterilization

11%

Withdrawal

5%

Other

Traditional

11%

IUD

5%Condom

5% Other

Modern

5%

Injectables

21%

Pill

21%

Source: Population Reference Bureau, Family Planning Worldwide 2002 Data Sheet.

Note: Total exceeds 100 percent due to rounding.


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Defining unmet need for family planning The number of women with unmet need for family planning

Understood by many as

the percentage of women who are not currently using amethod of family planning and want to stop or delay

childbearing

Complete calculation

Is complexIs not widely understood

Is difficult to calculate using data other than

Demographic and Health Surveys (DHS)

Women of reproductive age who are married or in a unionX 100


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Unintended births

Births Reported by Women as Either Unwanted or Wanted Later(Percent)

54

30

44

16

45

22

Cameroon

2004

Kenya

2003

Madagascar

2003/2004

Philippines

2003

Morocco

2003/2004

Columbia

2005

Source: DHS STATcompiler: accessed online at www.measuredhs.com/statcompileron June 14, 2006.
http://www.measuredhs.com/statcompilerhttp://www.measuredhs.com/statcompiler


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Wanted Births, Worldwide

Not Wanted

11%

Wanted

Later16%

Wanted

73%

Recent Births, by

Mothers Attitude,

Late 1990s

Note: Estimates based on approximately 60 percent of births worldwide.

Source: Population Reference Bureau, Family Planning Worldwide 2002 Data Sheet.


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Special groups: lack of Access to family planning

215 million couples worldwide dont have access to familyplanning

Groups without access:

Adolescents Unmarried women

Women postponing their first pregnancy

People with disabilities

Poor, especially people in rural areas and urban slums Migrants

Postpartum women


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Why do we need more research?

High unmet need

High percent of non-use

Existing methods do not meet the needs of all

Some are difficult to use consistently and correctly

High typical use failure rates of temporary methods

Side effects or fear of side effects High discontinuation of temporary methods

Changing needs and desires over reproductive lifespan


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Research prioritization for next decade

Research priorities must be reviewed and

updated periodically to maintain their

relevance in a fair and transparent way.


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CHNRI Prioritization Process:

Setting the agenda

The CHNRI priority settingprocess aims to include notonly research that producesnew knowledge, but also

research that focuses onimplementation of existingknowledge.

The CHNRI process is

systematic. This diagramdetails the process ofprioritization.


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CHNRI process: research prioritizationResearch Question(research papers)

Research Option(Research Project)

Research AvenueResearch Instrument

(list research questionswithin each research option)

(list research options withineach research avenue)

Measuring the unmet needBasic EpidemiologicalResearch

Understanding barriers to use

Evaluating existingcontraceptives

Study the capacity to reduce

obstacles to use ofcontraceptives

Health Policy and

Systems research

Studying capacity to deliverefficacious interventions

Research to improvedeliverability

Research to improveexisting interventions

Research to improve affordability

Research to improvesustainability

Basic researchResearch for developmentof new contraceptivetechnologies Clinical research

Public health research


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Conclusion

Use in reducing MMR is under emphasized.

Potential to reduce poverty and hunger and avert

32% of all maternal deaths and nearly 10% of

childhood deaths.

Fall in total fertility rate from 6 to 3.

Need for political willingness and commitment.

Call for renewed commitment by donors and thepotential of commercial sector through partnerships

should be explored.

principles population demography moazzam ali 2011

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