Presentation on theme: "Laneta Dorflinger, PhD Lafayette College October 20, 2011"— Presentation transcript:
1Laneta Dorflinger, PhD Lafayette College October 20, 2011 Reproductive Science: Expanding Choice, Empowering Women, Securing the FutureLaneta Dorflinger, PhDLafayette CollegeOctober 20, 2011
2Expanding access to contraception The Need is Urgent…The Time is Right World Population to reach 10 billion by 2100 if Fertility in all Countries Converges to Replacement LevelUNITED NATIONS, 3MAY, 2011 – The current world population of close to 7 billion is projected to reach 10.1 billion in the next ninety years, reaching 9.3 billion by the middle of this century, according to the medium variant of the 2010 Revision of World Population ProspectsOn May 3 of this year, the UN released the latest revision to their regularly updated World Population Prospects. The new projections are a wake-up call for many governments around the world regarding the need to fulfill the demand for contraception.I should point out that this projection is what is termed the MIDDLE VARIANT projection, and is based on their medium projection of fertility (the average number of births a woman will have in her lifetime). However, if the average fertility globally is a modest 0.5 birth higher, then the population could reach 10.6 billion by 2050, and 15.8 by This is more than a doubling of the number of people today and is just a staggering thought.Throughout the 2000s, there were two reports predicting a peak in the low 9 billions, followed by a decline. However, the fertility declines that had been expected didn’t materialize as rapidly as projected. Growth in Africa remains so high that the population there could more than triple in this century, rising from today’s one billion to 3.6 billion, according to the report— a sobering forecast for a continent already struggling to provide food and water for its people, along with many other challenges, not the least of which is stability.
3Of the nearly 7 billion people in the world today 1.4 billion (20%) are living on less than US$1.25 a day48% live on less that $2 per day2.6 billion (37%) have no access to toilets, latrines or other forms of improved sanitationOver 33 million are living with HIVAverage per capita health care expenditures in sub-Saharan Africa < $100Setting the stage, I want to remind you that: Bullets In countries such as Madagascar, Malawi, Rwanda = 90% live on less than $2. In India, about ¾ live on less than $2 per day.While the US spent $2.6 trillion on health care in 2010, or about $8,700 per capita, the ave per capita in SSA was under $100.Sub-Saharan Africa figures cover the provision of health services (preventive and curative), family planning activities, nutrition activities, and emergency aid designated for healthToday, I hope to convince you that ensuring access to contraception, and expanding choice of affordable, highly effective, and easy to use family planning methods, is truly critical to the ultimate condition of the World.Source: Millennium Development Goals and PBR 2011 Population Datasheet
4Ensuring access - Expanding choice I’ve spent my career working to help improve women’s health, and in particular to expand access to family planning in the developing world. In developing countries, millions of women and couples want to prevent pregnancy but don’t have access to modern contraception. This impacts their health, their educational opportunities, their ability to provide for their families, and indeed the overall health of their families. And as I will review, it impacts many other “things” that we should all be concerned about including the environment and the ability to feed populations, and global stability generally.Despite an economic crisis in this country, spending on global reproductive health is not only the right thing to do, it is critical to our national interest. We all have an important part to play.
5Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
6Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
7Total Fertility Rate (TFR) Total fertility rates and modern contraceptive method prevalenceTotal Fertility Rate (TFR)Modern Contraceptive Prevalence (CPR)Total fertility rate is: the average number of children that would be born to a woman over her lifetime if (1) she were to experience the exact current age-specific fertility rates thru her lifetime, and (2) she were to survive from 15 through her reproductive life.Replacement rates: roughly 2.1 births (affected by mortality); however, globally, the TFR at replacement is 2.33 children per woman (2003 estimate). At this rate, the global population growth would trend towards zero.Modern contraceptive prevalence rate is: Percentage of women between who are practicing contraception (or whose partners are using contraception).Highest fertility rates and lowest modern contraceptive prevalence rates are found in Africa and South/Western Asia.Highest numbers of women needing family planning services are in South/Western Asia.Source: PRB 2010 World Population Data Sheet
8Contraceptive use and method by region Percentage of married women Any MethodAny Modern Method*Total Fertility RateWorld62.756.12.5North America188.8.131.52LAC67.02.2East Asia82.881.31.5South Asia53.945.82.7Sub-Saharan Africa28.615.75.2This table is adapted from the World Contraceptive Use Poster which is put out every one to two years by the United Nations Population Fund and the 2011 World Population Factsheet from PRB. The distribution of contraception use clearly varies.PURPOSE OF SHOWING NUMBERS WILL BE CLEAR ON NEXT SLIDE: To achieve replacement level fertility, modern CPR needs to be in the range of 70%.As you can see on the first line – world wide 63 percent of married women report using any method of contraception – this percentage includes traditional methods, withdrawal, abstinence and fertility awareness methods, or natural family planning.* Modern methods include male/female sterilization, pills, IUD, injectable, implants, condoms, female barriers, EC
9Contraceptive Use and Unmet Need in Africa Most unintended pregnancies result from not using a modern contraceptive.•148 million women in Sub-Saharan Africa and South Asia want to avoid pregnancy but use no method or a traditional one.•Unmet need for modern methods varies by women’s personal characteristics, life stages and living situations.Remind them of the population growth projectionsCourtesy of Scott Radloff, USAID, 2011
10Unmet need of 215 million in developing countries translates to: 53 million unintended pregnancies, leading to:24 million abortions150,000 pregnancy-related deaths [1/2 in Africa]640,000 newborn deaths600,000 orphansSource: Guttmacher Policy Review, Summer 2008, Vol 11, Number 3
11Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
12Measuring maternal mortality Total number of deathsWhile pregnant or within 42 days of termination, due to complications of pregnancy or childbirthMaternal mortality ratioNumber of maternal deaths during a given time per 100,000 live birthsIndicator of the quality of the health care systemMaternal mortality rateNumber of maternal deaths during a given time per 100,000 WRAInfluenced by prevalence of pregnancy and risk of dying from a pregnancyLifetime risk of deathProbability that at 15 year old will die in her lifetime of maternal causesInfluenced by number of pregnancies, spacing of pregnancies, and the quality of the health care systemA woman’s lifetime risk of maternal death is a function of many factors including the number of children, the spacing of these births and the conditions related to giving birth.
13Maternal mortality ratio for 181 countries, 2008 Figure 3Mention ranking of the US in most recent Save the Children reportRemember, MMR is the number of maternal deaths during a given time per 100,000 live birthsWith the exception of South Africa, across SSA, the MMR is over 300.Source: Hogan et al. The Lancet 2010; 375:
14Lifetime risk of maternal death RegionLifetime risk of maternal death (1 in X)World Total140Developed4,300Developing120South Asia110Sub-Saharan Africa31Middle East/N Africa190Source: Trends in Maternal Mortality WHO, UNICEF, UNFPA and The World Bank.
15Maternal Mortality Worldwide, 2008 Estimated numbers: 342,900Down from 526,300 in 1980More than 60% of all deaths occur in just 6 countriesIndiaNigeriaPakistanAfghanistanEthiopiaDRCRoss and Blanc estimate that about 50% of the reduction of MMR between has been due to contraception.Source: Hogan et al. The Lancet 2010; 375:
16World’s worst airline disaster Tenerife, Canary Islands on March 27,1977Two Boeing 747’s collided on the runway in fog583 deadSlide courtesy of Dr. David Grimes
17Annual global maternal mortality 939 Boeing 777’s fully loaded with women aged 15-45or….More than two planes per daySlide courtesy of Dr. David Grimes
18Maternal morbidityDisabilities are estimated to be 20 times more frequent than maternal deathsThe ratio of “near misses” ranges from 1:5 to 1:118Source: Lewis. Br Med Bull 2003;67:27
19Primary health center and “Zambulance” Suburban area of Lusaka, Zambia Life is different for women in most of the developing world than it is for most women in the US. This primary health center is in a suburban area of the nation’s capital. The Zambulance is used to bring high-risk women in labor into the health post for delivery.Courtesy of Dr. Cindy Geary, FHI 360
20Family Planning Reduces Maternal Mortality COUNTRYContraceptive Prevalence*Lifetime probability of maternal death (1/X)US73%2,100India49%140Malawi38%36Nigeria9%23The number of maternal deaths is influenced by the probability of becoming pregnant and the risk of death while pregnantProbability of becoming pregnant is influenced by a number of factors, importantly effective use of contraception* Percent of married women ages using modern methodSource: PRB World Population Datasheet, 2011 and Save the Children State of the World’s Mothers, 2011CSIS Renewing US Global Leadership in RH, 2/5/09FP MDGs Overview, March 1020
21Unsafe AbortionAbout 15% of maternal deaths are related to unsafe abortionAn estimated 50,000 to 60,000 women die each year from unsafe abortionAlmost all of these deaths occur in developing countriesAlmost all are preventableMany pregnancies end in abortion…In developing countries, about 15% of maternal deaths are related to unsafe abortion.This is one of the hugely controversial areas in my field – the issue of abortion and the linking of family planning methods to abortion.Grimes. Lancet 2006;368:1908
22Increased use of modern contraceptive methods reduces rates of abortion The frequent conservative concern that increased access to contraceptive technology will increase abortions is unfounded and counter to the evidence.Slide courtesy of Scott Radloff, USAID, 2011
23Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
24Millennium Development Goals Goals to end poverty and inequalityTargets for global developmentCommitments by 189 countriesPriorities for fundingOpportunities for multinational organizationsThe eight Millennium Development Goals (MDGs) – which range from halving extreme poverty to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015 – form a blueprint agreed to by all the world’s countries and all the world’s leading development institutions. They have galvanized unprecedented efforts to meet the needs of the world’s poorest.
25Millennium Development Goals – by 2015 End Poverty and HungerUniversal EducationGender EqualityChild HealthMaternal HealthReduce maternal mortality by three-fourthsAchieve universal access to reproductive healthCombat HIV/AIDSEnvironmental SustainabilityGlobal PartnershipFor example:Halve the % who live on less than $1 per dayReduce by 2/3 the under-five mortality rateFP MDGs Overview, March 10
26Family Planning Prolongs Education Pregnancy a major obstacle to universal education for womenHigh levels of pregnancy in youthFewer than half of African girls complete primary schoolPopulation growth puts pressure on limited education infrastructureGirls suffer disproportionately
27Teenage Pregnancy and Motherhood (Percent with children or currently pregnant) CountryAge16171819Kenya 20089.416.526.236.2Malawi 201012.621.743.463.5Uganda 20068.525.541.058.6Nigeria 200813.024.235.738.4India 2005/066.412.524.0Bangladesh 200718.633.442.558.5More than half the adolescents in many countries in sub-Saharan Africa have a child. Teenage childbearing interrupts education, as well as long-term social and economic mobility. These young mothers are denied the opportunity to pursue basic and advanced educational goals. Children born to very young mothers are normally predisposed to higher risks of illness and death. Adolescent mothers are more likely to have complications during pregnancy.Women with less education are more likely to have children at a young age.Source: Demographic and Health Surveys (DHS), Macro
28Family planning enhances gender equity and empowers women Women who use FP more likely to be employed than non-users (Indonesia, Zimbabwe, Bolivia)Unplanned pregnancies interrupt work and career plans (Egypt)Long-acting/permanent contraceptive methods associated with greater likelihood of working for pay (Brazil, Indonesia)Girls in larger families were less likely to attend school than girls from households with smaller families (Ghana)Sources: Woman’s Studies Project; UNFPA, 2003
29Family Planning Saves Infants Maternal death increases risk of newborn infant deathCurrently, 2.7 million infant deaths are averted globally each year by preventing unintended pregnanciesSpacing planned births and limiting unintended births increases child survivalSource: Demographic and Health Surveys
30Child Mortality by Birth Interval Relative Risk Child MortalityAdd WHO statement from Gates presentationDuration of Preceding Birth Interval (Months)Source: DHS; Rutstein S. (2005)
31Family Planning Prevents HIV 4 Phase Approach to Perinatal HIV PreventionFour-phased approach to preventing perinatal HIV transmissionPrevention of HIV in women, especially young womenPrevention of unintended pregnancies in HIV-infected womenPrevention of transmission from an HIV-infected woman to her infantSupport for mother and familyPhase 1Phase 2Phase 3Phase 4CSIS Renewing US Global Leadership in RH, 2/5/09FP MDGs Overview, March 1031
32Unintended pregnancies among women with HIV in Africa 51% of pregnancies are unintended among women with HIV in Cote d’Ivoire74% of pregnancies are unintended among women in an ART treatment program in Rwanda84% of pregnancies are unintended among women using PMTCT services in South AfricaMany programs that provide services to HIV positive individuals, are “overwhelmed” with providing general services and are unable to provide FP. FP/HIV integration research…Sources: Rochat et al., JAMA 2006:295:1376-8;Desgrées-du-Loû et al., Int J STD AIDS 2002;13: ;Bangendanye, et al., Presented November 2007.FP MDGs Overview, March 10
33Family planning protects the environment Rapidly growing populationchallenges constrained resources (arable land, clean water)exacerbates environmental degradationexacerbates food insecuritiesPreventing unintended pregnancy is the factor in population growth most amenable to interventionSource: Population Reference Bureau, 2009FP MDGs Overview, March 10CSIS Renewing US Global Leadership in RH, 2/5/0933
34Family Planning Critical to Achieving MDGs Reduced child mortalityImproved maternal healthGender equityUniversal primary educationCombatting HIV/AIDSEnvironmental sustainabilitySexualandreproductivehealthEradication of povertyTo conclude, this is a wonderful visual of how reproductive health, particularly family planning, forms the roots and trunk of the tree that are critical to the success of all the Millennium Development Goals to improve lives worldwide.Global partnership for developmentCourtesy of Jeff Spieler, USAID. Adapted from HRP/RHR/WHO
35Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomics realities of expanding access and choice
36Source: Adapted from WHO 2006 Current contraceptive methods and typical effectivenessMore effectiveHow to make your method most effectiveLess than 1 pregnancy per 100 women in one yearVasectomyFemale SterilizationImplantAfter procedure, little or nothing to do or rememberVasectomy: Use another method for first 3 monthsIUDInjections: Get repeat injections on timeLAM (for 6 months): Breastfeed often, day and nightPills: Take a pill each dayPatch, ring: Keep in place, change on timeLAMInjectablesPillsPatchRingMale CondomsFemale CondomsCondoms, diaphragm, sponge, withdrawal: Use correctly every time you have sex.SpongeDiaphragmWithdrawalSome years ago, Markus Steiner – a colleague from FHI 360 – conducted research to better understand how individuals understand the effectiveness of various contraceptive options. The goal of this work was to improve how service providers counsel users with regard to effectiveness. He and others then worked with the World Health Organization to develop this pictorial presentation that has become a centerpiece of counseling materials in many developing country programs.Fertility-Awareness Based MethodsSpermicide: Use correctly every time you have sexFertility-awareness based methods: Abstain or use condoms on fertile days.SpermicideLess effectiveAbout 25 pregnancies per 100 women in one yearSource: Adapted from WHO 2006
37Pregnancy risk and continuation rates for select contraceptive methods at one year Perfect UseTypical UseNo method85Male condom218Pill, Patch, Ring0.39Depo-Provera0.26Copper-IUD0.60.8MirenaImplanon0.05Female sterilization0.5Male sterilization0.100.15For the quantitative in the audience, this is another way of looking at effectiveness data (that used by FDA)Contraceptive effectiveness is a measure of the success of typical use of a method. It incorporates efficacy – how well a method works when used consistently and correctly – and other factors such as compliance with use.While PERFECT USE is similar for all but the condom, typical use is much higher for the user-dependent methods.PERFECT use failure rates: Low for all methods, even for the condom.TYPICAL USE failure: Quite high for user-dependent methods.Source: Trussell, Contraception 2011; 83:
38Pregnancy risk and continuation rates for select contraceptive methods at one year Perfect UseTypical UsePercent ContinuingNo method85Male condom21843Pill, Patch, Ring0.3967Depo-Provera0.2656Copper-IUD0.60.878Mirena IUS80Implanon (implant)0.0584Female sterilization0.5100Male sterilization0.100.15Another challenge with user-dependent methods relates to continuation rates which also have an overall impact on pregnancies – highlighted in Yellow.Source: Trussell, Contraception 2011; 83:
39Benefits of Implants vs. Shorter-acting Methods If 20% of OC or injectable users in Africa switched to implants -- over next 5 years, it would avert:1.8 million unplanned pregnancies576,000 abortions10,000 maternal deathsAs I just mentioned, long-acting methods, including implants, are more effective in practice than shorter acting methods, including oral contraceptives and injectables, because compliance and continuation rates are higher. As this slide illustrates, widespread use of implants could significantly reduce the numbers of unintended pregnancies, abortions, and maternal deaths in Africa. A similar impact would be seen with IUD use.Source for quote on slide: Hubacher, D, Mavranezouli, I, McGinn, E. Unintended pregnancy in sub-Saharan Africa: Magnitude of the problem and potential role of contraceptive implants to alleviate it. Contraception :Grimes, D. Forgettable contraception. Contraception. 2009;80(6):497-9.The impact would be even more dramatic adding new usersSimilar impact with a shift to IUDs.Hubacher, Mavranezouli, and McGinn, Contraception 2008
40Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
41Why do we need more technology? Existing methods do not meet the needs of allSome are difficult to use consistently and correctlyHigh typical use failure ratesHigh discontinuationSide effects or fear of side effectsChanging needs and desires over reproductive lifespanMissing a spectrum of male methodsMany people say that our greatest challenge is to get out the technologies that we already have. That is indeed partially true, as my previous slide suggests. However, existing methods clearly do not meet the needs of all women or couples. Each of the available methods, in and of themselves, have advantages and disadvantages.Some methods are hard to use consistently and correctly, and that leads to high typical use failure rates.Most existing methods have side effects - These side effects may be acceptable or tolerable to some women and unacceptable for others. Data from many studies, and from DHS surveys, clearly document the fact that 25 to 50%, and even more, of women discontinue use of their chosen contraceptive within the first year. Side effects or fear of side effects is typically most common reason.In addition, there is a dramatic change in the needs and desires of women over their reproductive lives. For example, the needs and optimal choices of young women in their teens or early 20s are very different from the needs of a woman wanting to limit her childbearing in her 30s or 40s.
42Target qualities for new contraceptive methods Highly effective in typical useForgiving of misuseUser-independentSafe and AcceptableMinimal side effects orHave “desirable” side effects (e.g. amenorrhea)Convenient and easy to useUse in chronic disease statesProvide additional health benefitsVery low costPotential for wide availabilityProvided by low level health care providers or be provider independentWhat should be the target qualities of new methods? First, in addressing the shortcomings of some existing methods, a new method would ideally be highly effective in typical use.It goes without saying that a method should be safe and acceptable.Increasingly, there are many women with chronic disease states that make them poor candidates for some methods, e.g. estrogen-containing oral contraceptives. Some attention should be paid to developing new methods that would be safe and broaden choice for these women.Additional health benefits – could advance health causes and also make new methods more appealing to potential users.
43Ratio of Health Provider to Population This slide emphasizes the importance of having new methods that are easy to use by lower level health care providersCourtesy of Scott Radloff, USAID, 2011
44Improving upon existing methods Less expensive (“generic” or “alternative”)Implant systemsLevonorgestrel IUSEasier to use in a compliant wayVaginal ringsEasier to deliver in service settingsPreloaded injectable systems (e.g. Depo SC in Uniject)Biodegradable implantsMultipurpose technologies (Dual protection)
45Sino-implant (II)/Zarin Two thin, flexible silicone rods, each containing 75 mg levonorgestrelThe same amount of active ingredient and mechanism of action as JadelleCurrently labeled for four years of useAvailable with disposable trocarAbout $8 compared with $20-$24 for JadelleSino-implant (II) is a new low-cost, highly effective contraceptive implant. Sino-implant (II) is composed of two thin rods, each containing 75 mg of levonorgestrel, the active ingredient. It is similar to Jadelle, in that it provides the same amount of levonorgestrel and has the same mechanism of action. It is currently labeled for four years of use and is distributed with a CE-marked disposable trocar. The CE mark indicates the trocar meets European quality standards of manufacturing. The disposable trocar eliminates the need for autoclaving and facilitates service delivery in resource poor settings.Almost $7.5 million in cost savings to date for over 500K implants.
46Population Council Nes/EE vaginal ring Mention that vaginal rings are being evaluated as dual protection technologies.Designed to last one year
47Depo-subQ Provera 104 delivery in Uniject For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.For FIGO Faculty Use Only. DO NOT COPY OR DISTRIBUTE.Depo-subQ Provera 104:New formulation for subQ injection30% lower dose (104 mg vs. 150 mg)Approved by USFDA (2005) and EMA/UKUniject:Single dose, prefilled, sterile, non-reusableEasier to use by non-clinical personnel/CHWsCompact; easy to use and storePotential for home- and self-injectionApproval by EMA. LDC registration forthcoming47
49New methods that could be game changers Non-surgical methods of male and female sterilizationReversible male methodsDual protection methods (multipurpose technologies)Highly-effective peri-coital or post-coital methodImmunocontraception (women and men)Methods with non-contraceptive health benefitsA low-cost, non-surgical option for female sterilization would provide an important opportunity for many women who either fear or can’t get access to surgical sterilization. A new approach such as Essure, is too expensive and difficult to deliver to be applicable to most low-resource settings. Chemical/drugs, such as sclerosing agents, may be low cost alternatives.Male methods: Suppress the production of sperm; Physically disrupt sperm transport; Disrupt sperm maturation; Disable sperm function (Will be covered in more detail in another session at this meeting)Peri-coital method: Many women have infrequent sex and feel they don’t want a method that they have to use continuously. Anecdotal information from repeat ECP users that a method a woman could use at the time of coitus - just before or soon after sex – would be desireable. But it must be highly effective!Immunocontraception has been a somewhat controversial area. Much research was funded in the 80s on this approach. I believe that gaps in knowledge about the immune system were limiting. Advances in immunology that have taken place over the last decade may provide a renewed opportunity for thinking in this area. Many targets (both male and female) are already identified. Most experts and women’s rights advocates believe that a permanent immuno-contraceptive approach would provide too great an opportunity for misuse. However, an approach that would require periodic boosters could be exciting.For my last point, imagine you could say to a woman, you can take a pill that would prevent breast cancer, the only side effect is that you won’t get pregnant. This would be true innovation in contraceptive technology. It is this type of long-term dream/vision that at least some research needs to focus on.
50Presentation OutlineOverview of global fertility and contraceptive useMaternal mortality and morbidityRole of family planning in reducing fertility and maternal deathThe contribution of family planning to achieving the Millennium Development Goals (MDGs)Current contraceptive technologyNeed for new technologiesAreas of research that could fill greatest gapsEconomic realities of expanding access and choice
51Family Planning Saves Dollars Preventing unintended pregnancies is less expensive than treating maternal/ infant complications of pregnancyLonger acting contraceptive methods are the most cost-effectiveEvery $1 spent on family planning can avert $2 to $9 in health costsIn Zambia, for every $1 invested in FP, $4 are saved in other development areasCSIS Renewing US Global Leadership in RH, 2/5/09FP MDGs Overview, March 1051
53US Funding for HIV and Family Planning $ Billions AppropriatedFunding for HIV is essential but this comparison highlights one of the stark realities of international population assistance – that is, the political sensitivity and strong feelings have interfered with common sense with regard to support for FP.Source: CRS (2010)Ted King Lecture, March 201153
54US Humanitarian and development assistance The irony of these figures is that a recent survey showed that most Americans think that we spend about 25% of our budget on foreign assistance. This shows the truth – about 0.5% on all non-defense foreign assistance. And as I said, within this little sliver is the approximately $500 to $600 million devoted to women’s health!Sources: Office of Management and Budget. historical Table outlays by Agency:1962– InterAction. Federal Budget Table - FY 2011 CR extension. (february 15, 2011) interaction-federal-budget-table-2011-cr-extensionSave the Children analysis – 2011Sources: OMB; White House; FY 2011 CR extension
55New commitments World Bank 5-year plan for 58 countries UN Secretary General’s Global Strategy for Women’s and Children’s HealthInternational Alliance for Reproduction, Maternal and Newborn HealthUS, UK, Australia, BMGFPledge of $40 billion ($27 billion new)Reduce unmet need by 100 millionExpand skilled birth attendantsExpand post-natal careIf the currently global financial crisis, who knows what will really happen with new funding!
56Putting costs in perspective Americans spent approximately $6 billion in 2010 on Halloween costumes/candy/decorations (National Retail Foundation, 2011)Estimated $3.5 billion needed to fulfill global unmet need and prevent:53 million unintended pregnancies640,000 newborn deaths150,000 pregnancy-related deaths$5.1 million expenditures on health-related servicesOctober 31, 2011 has been designated “7 Billion Day.” The year before I graduated from Lafayette, the world population reached 4 billion (1974). People were beginning to notice. In October of 1999, just 12 years ago, the population reached 6 billion.So, how much will Americans spend this year, despite the economy, on Halloween? I think we should all celebrate a day that brings joy to kids and chocolates to stomachs, but I would encourage each of you to consider Halloween in a slightly different way this year – because that’s the day that the 7 billionth person will enter this world. Consider being a little more modest and contributing to an organization that helps women and children globally.
57Conclusions Expanding choice of the number and spacing of children Ensuring access to family planning is a critical component to the solution of many of the world’s complex issuesExpanding choice of the number and spacing of childrenImproving the health of womenImproving the health of childrenAddressing multiple challenges of societiesEducation, employment, environment, national and global securityEmpowering womenSecuring the futureAccording to the United Nations, or around October 31st, the world’s 7 billionth person will be born. The year before I graduated from Lafayette, the world population reached 4 billion (1974). People were beginning to notice. In October of 1999, just 12 years ago, the population reached 6 billion. Next week, when many are out trick-or-treating, the world will pass the 7 billion mark…
60According to the United Nations, or around October 31st, the world’s 7 billionth person will be born. The year before I graduated from Lafayette, the world population reached 4 billion (1974). People were beginning to notice. In October of 1999, just 12 years ago, the population reached 6 billion. Next week, when many are out trick-or-treating, the world will pass the 7 billion mark…
61Drivers of Population Growth Unwanted fertilityHigh desired family sizePopulation momentumYear184.108.40.206.8Population size (in billions)457891023619001950200020502100Source: Adapted from Bongaarts (2010)CSIS Renewing US Global Leadership in RH, 2/5/09FP MDGs Overview, March 1061
62Sequential Age Pyramids for Africa Small changes in fertility can have significant population effects over timeSequential Age Pyramids for Africain 1960, 1990, & 2010MaleFemaleNumber for each age group in 1,000Both the total population and youth bulge have grownSource: John May, World Bank* Population growth rates: 2.5% translates to a 28 year doubling time and rapidly expanding demands on food, water, schools, health services, energy, infrastructure, and land. * Dependency Ratio: 78 children per 100 workers, compared to 42 in LAC, 39 in Asia, 25 in MDCs. * Momentum: young age structure ensures continued population growth for generations.