1. A Job Half Done: Family planning in the 21 st Century John Cleland London School of Hygiene & Tropical Medicine

3. Fertility Trends, 1950-2005: Selected Developing Regions

5. Estimated Population, 2005 and Projected Population 2050, in millions 20052050Ratio Sub-Saharan Africa75116922.25 North Africa1913121.63 Latin America5617831.39 Asia390552171.34 Northern America3314381.32 Europe7286530.90 World646590761.40 Source : UN Population Proj. 2004

6. Mean Unwanted Fertility Rate by wealth quintiles (n = 19 non-African Countries) PoorestRichest (adapted from Gillespie et al, 2007)

7. African Fertility Trends (Past & Projected)

8. Percentage of currently married women using a modern method of contraception: West Africa PERIOD Country1975- 79 1980- 84 1985- 89 1990 -94 1995- 99 2000+Policy to Reduce Fertility Benin137- Burkina Faso45 9  Chad12- Côte d'Ivoire147  Gabon12- Ghana641013 19  Guinea546  Liberia6  Mali156  Mauritania05- Niger255  Nigeria149 8  Senegal125810  Togo 3 79-

9. Mean desired family sizes among all women (African surveys) PERIOD Country1975-791980-841985-891990-941995-992000+ Benin7.45.54.9 Burkina Faso5.7 5.6 Chad 8.9 Côte d'Ivoire8.45.55.4 Gabon 4.9 Ghana65.34.44.3 4.4 Guinea5.7 5.6 Liberia6 Mali6.96.66.2 Mauritania6.2 Niger8.2 Nigeria8.35.86.1 6.7 Senegal8.36.85.95.3 5.4 Togo 5.3 4.5

11. Niger Population (2005)14 million Total Fertility Rate7.1 births per woman % using modern contraception5% Life expectancy45.4 years Infant mortality81 Adult literacy16% % child stunted38% HIV prevalence0.7% Projected population in 2050 if (a) Fertility remains constant80 million (b) Fertility declines to 3.6 by 205050 million

12. Kenya: Changes in Reproductive Indicators 1977-78198419891993 Mean desired family size7.76.24.73.9 % wanting no more children16%N/A49%52% % contracepting7%17%27%33% Fertility rate87.76.75.4

13. Success in Kenya:1980-95 Strong political support Mobilisation of elite groups Extensive use of mass media Access to FP methods via health facilities, social marketing and community distribution Adequate international funding

14. Trends in total fertility rate and contraceptive use in married Kenyan women

15. KENYA: CAUSES & CONSEQUENCES OF FERTILITY STALL CAUSE(?) Between 1995-2005 USAID’s Annual allocation for family planning fell from $12 million to $9 million while HIV/AIDS allocation rose from $2 to $74 million CONSEQUENCES: % unwanted births rose from 11% (1998) to 21% (2003) and % contraceptive users relying on public sector supplies fell from 68% to 53% KENYA’S PROJECTED POPULATION IN 2050 RAISED FROM 44 TO 83 MILLION

16. DISTRIBUTION OF 76 LOW AND LOWER-MIDDLE INCOME COUNTRIES BY RATE OF POPULATION GROWTH AND UNMET NEED FOR FP Unmet Need Low (<10%) Medium (10-19%) High (20%+) Population Growth High (2%+pa)0626 Medium (1.0-1.9%)61311 Low (<1.0%)653

17. Conclusions High fertility and rapid population growth remains a severe barrier to progress in many – but not all – poor countries Most poor countries already have appropriate population & FP policies BUT they have received far too little encouragement and funding from donor agencies to implement them with commitment. Donors must take much of the blame – Excessive political correctness? Fads and fashions? Renewed emphasis on population stabilisation and FP and respect for reproductive rights are compatible International FP needs a champion

18. What needs to be done? Re-forge link between investment in FP and poverty-reduction that was broken in 1994 at Cairo. Stop cloaking FP in that obfuscating phrase “sexual and reproductive health” Recognise that priorities in poor countries are increasingly divergent – population/fertility is a bigger problem than AIDS in most of Africa but not in Southern Africa.