1. PLATEAUING CPR: TIPPING POINT PROGRAMMATIC ISSUES

2. PLATEAUING CPR: THREE STAGES Beginning of the program Beginning of the program After take off After take off After reaching the ceiling After reaching the ceiling

3. MODERN METHOD CONTRACEPTIVE PREVALENCE RATE IN EGYPT Average Annual Increase 1991-95: 0.3 1995-03: 1.4 2003-08: 0.2 Source: Demographic Health Surveys

4. MODERN METHOD CONTRACEPTIVE PREVALENCE RATE IN JORDAN Source: DHS-1990,1997, 2002,2007,2009; JAFS-1998,1999,2000,2001

5. MODERN METHOD CONTRACEPTIVE PREVALENCE RATE IN BANGLADESH Average Annual Increase 1991-2004: 1.24 2004-2007:0.07 Source: Demographic Health Surveys

6. QUESTIONS ON PLATEAUING Why do programs plateau? Why do programs plateau? How long do they remain stagnant? How long do they remain stagnant? What has been done or needs to be done to get out of such situations? What has been done or needs to be done to get out of such situations? Is it possible to predict such situations in advance? Is it possible to predict such situations in advance?

7. REASONS BEHIND SLACKENED PACE A limited method mix A limited method mix Program management weaknesses Program management weaknesses Sheer growth of numbers Sheer growth of numbers Changing demographic profile within the reproductive years Changing demographic profile within the reproductive years Shift in attention to other programs Shift in attention to other programs Diminishing returns at high prevalence rates Diminishing returns at high prevalence rates Source: John Ross et al Plateaus during the Rise of Contraceptive Prevalence, IFPP, 2004

8. COUNTRIES BY PACE OF FERTILITY DECLINE IN SUB-SAHARAN AFRICA AND ASIA Pace of Decline Sub-Saharan Africa Asia/North Africa No Significant Decline Cameroon(Chad) Cote d’lvoire EthiopiaGhana(Guinea)Kenya(Mali)MozambiqueNigeriaRwandaTanzaniaUgandaZambiaZimbabweTurkey Significant Decline Benin Burkina Faso MadagascarMalawiNamibiaNigerSenegalBangladeshEgyptIndiaIndonesiaJordanMoroccoNepalPhilippinesYemen(Vietnam) Source: John Bongaarts, Fertility Transition in Developing Countries: Progress or Stagnation? 2008

9. REASONS FOR THE STALL IN FERTILITY Changes in fertility preferences such as shifts in marriage patterns, timing of initiating child bearing Changes in fertility preferences such as shifts in marriage patterns, timing of initiating child bearing Shifts in local/national policies, reduced budgets or donor support Shifts in local/national policies, reduced budgets or donor support Increasing unmet need, unwanted child bearing Increasing unmet need, unwanted child bearing Increasing negative attitudes towards family planning or methods Increasing negative attitudes towards family planning or methods Changes in age structure of population and migration Changes in age structure of population and migration Source: Ian Askew et al, Pop Council 2009

10. Can Plateauing be anticipated? Case of India

11. MODERN METHOD CPR IN INDIA AND SELECT STATES Source: NHFS 1993, 2006

12. DECLINE IN TFR IN INDIA AND SELECT STATES Source: NFHS 1998-99, 2005-06

13. TFR IN INDIAN STATES Source: SRS 2007

14. PLATEAUING CPR IN INDIA Significant proportion of declines in fertility and increase in CPR have come from select states Significant proportion of declines in fertility and increase in CPR have come from select states States that have achieved ceiling levels will not significantly contribute to increases in CPR and fertility decline States that have achieved ceiling levels will not significantly contribute to increases in CPR and fertility decline States that have experienced plateau in the past decade have to contribute to CPR increase significantly States that have experienced plateau in the past decade have to contribute to CPR increase significantly If not, India will enter into Plateauing phase this decade. If not, India will enter into Plateauing phase this decade.

15. HOW TO TACKLE PLATEAUS? 1 Analyze data sets to understand contributions of Subgroups and prepare strategies 2 3 4 Keep FP program central to development efforts Introduce new FP technologies if they are not part of current programs Involve private sector in FP service delivery