1. Family Planning: The Elevator Speech Global Health Mini-University Scott Radloff Director, Office of Population and Reproductive Health October 8, 2009

2. Objective: Explain to a policy official why family planning programs are important in the span of a short elevator ride.

3. Basic Challenge: Family planning is the solution, or part of the solution, to a panoply of problems.

4. What are the essential messages to include?

5. World Population Growth ←10.8 ←9.2 ←7.8 Source: United Nations Population Division, 2006 Micro & Macro Messages Source: Conde-Agudelo and Belizan, 2000 Maternal Death/Birth Interval

6. More than 380 million women, or nearly 60% of couples in the developing world want to limit or space their births, yet more than 200 million of them do not have access to family planning services (Singh et al., 2003). Enable women/couples to choose the number and spacing of children. #1

7. Very short birth intervals (less than 15 months) are associated with maternal death rates 150% higher than at longer intervals, as well as with various complications of pregnancy (Conde-Agudelo and Belizan, 2000). Reduce mortality/morbidity risk for mothers through healthier timing and spacing of pregnancies #2

8. A child born 3 to 5 years after the birth of its sibling is about 2.5 times more likely to survive than children born at shorter intervals, less likely to be malnourished, and suffer less from stunting (Center for Communication Programs, 2002). Reduce mortality/morbidity risk for children through healthier timing and spacing of pregnancies. #3

9. In Romania, when use of modern contraceptives more than doubled between 1993 and 1999, the abortion rate decreased by 35% and abortion-related maternal mortality dropped by more than 80% (Westoff, 2003) Reduce reliance on abortion. #4

10. A study in Uganda found that HIV incidence rates were 2.3 per 100 person years during pregnancy, 1.3 per 100 years during breastfeeding and 1.1 per 100 person years in non-pregnant and non-lactating women (Gray et al., 2005). At the same level of expenditure, the contraceptive strategy averts 29% more HIV+ births than nevirapine for pevention of mother-to-child transmision of HIV (Reynolds et al., 2006). Reduce HIV/AIDS transmission by reducing unintended pregnancy. #5

11. In Africa, between 8-25% of girls who drop out of school do so because of unintended pregnancy (All Party, 2007). Enable women to complete education and pursue careers. #6

12. Smaller families have more opportunities to increase household savings, to invest more time and resources in each child, and increase each family member’s human capital (UNFPA, 2005). Enhance the ability of families to invest in children. #7

13. A “demographic window” opens when the number of producers in the population grows more rapidly than the number of dependants. The demographic bonus in East Asia is estimated to account for about 1/3 of the region’s unprecedented economic growth during 1965-90 (Bloom and Canning, 2004). Mitigate the impact of population dynamics on: Economic Growth. #8

14. 1.1 billion people lack access to safe drinking water. As population grows, the UN estimates 2/3 of the world’s population will face moderate to high water shortages by 2025 (All Party, 2007). “The goal of achieving food security will be made more difficult if population growth rates cannot be reduced,” concluded a 2005 report by the UN Food and Agriculture Organization (PAI, 2005). Due both to deforestation and human population growth, the current ratio of forests to human beings is less than half what it was in 1960 (PAI, 2000). Mitigate the impact of population dynamics on: Natural Resources. #9

15. Recent studies have shown that a large “youth bulge” – usually defined as a high proportion of 15-to-29 year olds relative to the adult population – is associated with a high risk of outbreak of civil conflict (Cincotta, 2005). Mitigate the impact of population dynamics on: State Stability. #10

16. Why U.S.? –Largest bilateral donor –Technical leadership –Componentry & channels Why Now? –High unmet need –Cost-effectiveness –Momentum + 2

17. messages could be incorporated into an Elevator Speech… …so, which ones to include? 10 + 2

18. Answer may depend on: A. How long is the elevator ride? B. Where is the elevator? C. Who is on the elevator?

19. “Family planning could bring more benefits to more people at less cost than any other single ‘technology’ now available to the human race. But it is not appreciated widely enough that this would still be true even if there were no such thing as a population problem.” (James Grant, UNICEF Annual Report 1992).

20. Pearl in Haiku-form Meet needs of women… good things happen for her, family, others

21. Thank you For your attention and participation!

22. References All Party Parliamentary Group on Population, Development and Reproductive Health (2007). “Return of the Population Growth Factor: Its Impact Upon the Millennium Development Goals.” Bloom, D. and Canning, D. (2004). “Population, Poverty Reduction, and the Cairo Agenda.” Paper prepared for the Seminar on the Relevance of Population Aspects for the Achievement of the Millennium Development Goals (17-19 November 2004). New York: United National, Department of Economic and Social Affairs, Population Division. Center for Communication Programs. (2002). Birth Spacing: Three to Five Saves Lives. Population Reports, XXX (3). Cincotta, Richard. (2005). “Global Security Brief #2: Youth Bulge, Underemployment Raise Risks of Civil Conflict.” Worldwatch Institute. Conde-Agudelo, A., & Belizan, J.M. (2000). “Maternal Morbidity and Mortality Associated with Interpregnancy Interval: Cross sectoral study.” British Medical Journal, 321 (7271), 1255-1259. Gray, Ronald H. et al. (2005). “Increased Risk of Incident HIV During Pregnancy in Rakai, Uganda: a prospective study.” The Lancet, 266: 1182-88. Population Action International (PAI). (2005). “How Population Growth Affects Hunger in the Developing World.” Population Action International (PAI). (2000). “Why Population Growth Matters to the Future of Forests.” Reynolds, Heidi et al. 2006. “The value of contraception to prevent perinatal HIV transmission.” Sexually Transmitted Diseases, Vol. 33, No. 6: 350-356. Singh, S., et al. (2003). Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. New York: The Alan Guttmacher Institute and United Nations Population Fund (UNFPA). UNFPA. (2005). Reducing Poverty and Achieving the Millennium Development Goals: Arguments for Investing in Reproductive Health and Rights – Reference Notes on Population and Poverty Reduction. Westoff, Charles. “A New Approach to Estimating Abortion Rates.” 30 June 2008.