FAMILY PLANNING TRENDS IN SUB SAHARAN AFRICA: PROGRESS, PROSPECTS AND LESSONS LEARNED Mona Sharan, Saifuddin Ahmed, John May & Agnes Soucat
Background : Sub Saharan Africa Highest TFR (5.1) compared to South Asia (2.8) and LAC (2.2) Lowest CPR (22%) compared to South Asia (53%) and East Asia (77%) Cultural acceptance of family planning lower than other regions Perception of little or no fertility decline across the region Emerging evidence of fertility transitions in some parts of the region but no regional analysis
Methodology Analysis of Demographic and Health Surveys from 45 countries ti Countries with more than one survey between 1986 to 2009 included d World Development Indicators,United Nations, World Bank health h systems study data Descriptive analysis of family planning and fertility indicators Trends in contraceptive use, fertility, unmet need and method mix over ~ 20 year period
CONTRACEPTIVE PREVALENCE RATES Somalia Chad Guinea Angola Niger Eritrea Democratic Republic of the Congo Benin Sierra Leone Guinea-Bissau Mali Côte d'ivoire Mauritania Burundi Central African Republic Nigeria Senegal Liberia Togo Gabon Mozambique Cameroon Congo Gambia Burkina Faso Ethiopia Ghana Madagascar Djibouti Uganda Comoros Rwanda Zambia Sao Tome and Principe Kenya Lesotho Malawi Mauritius Botswana Swaziland Namibia Zimbabwe South Africa 1.2 1.7 4 4.5 5 5.1 5.8 5.9 6 6.1 6.3 8 8 8.5 8.6 9.1 10 10.3 11.1 11.8 11.8 12 12.7 12.7 13.3 13.7 16.6 16.7 17.1 17.9 19.3 26.1 26.5 27.4 31.5 35.2 38.4 39.3 42.1 46.8 53.5 57.9 60.3 Many countries in SSA achieve high CPR 0 10 20 30 40 50 CPR East Africa Middle Africa West Africa Southern Africa
CPR TRENDS Angola Benin Botswana Burkina Faso Burundi Cameroon Central African Republic Chad 0 20 40 60 0 20 40 60 Comoros Côte d'ivoire Democratic Republic of the Congo Djibouti Eritrea Ethiopia Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali 0 60 0 20 40 60 Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Senegal 40 60 0 20 40 Sierra Leone Somalia South Africa Swaziland Togo Uganda Zambia Zimbabwe 0 20 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 Year East Africa Middle Africa West Africa Southern Africa Steep increases in some countries, stagnation in others
TOTAL FERTILITY RATES Benin Burkina Faso Cameroon Chad Côte d'ivoire 4 5 6 7 Eritrea Ethiopia Ghana Guinea Kenya 4 5 6 7 Total Fertility Rate 4 5 6 7 Liberia Madagascar Malawi Mali Mozambique Namibia Niger Nigeria Rwanda Senegal 6 7 4 5 6 7 Tanzania Togo Uganda Zambia Zimbabwe 4 5 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Year East Africa Central Africa Southern Africa West Africa Source: Demographic and Health Surveys, various years Drop in TFR in many countries, stagnation after 2000
CPR vs. UNMET NEED Benin Burkina Faso Cameroon Chad Cote d'ivoire 0 25 50 0 25 50 Eritrea Ethiopia Ghana Guinea Kenya Madagascar Malawi Mali Mozambique Namibia 0 25 50 Percent 0 25 50 Niger Nigeria Rwanda Senegal Tanzania 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Uganda Zambia Zimbabwe 0 25 50 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Year Modern contraceptive ti prevalence rate Unmet need Source: Demographic and Health Surveys, various years Converging and diverging gaps between CPR and Unmet need
ACTUAL vs. WANTED TFR Benin Burkina Faso Cameroon Chad Côte d'ivoire 2 4 6 8 Eritrea Ethiopia Ghana Guinea Kenya 8 2 4 6 8 Liberia Madagascar Malawi Mali Mozambique 6 8 TFR 2 4 6 Namibia Niger Nigeria Rwanda Senegal 6 8 2 4 6 Tanzania Togo Uganda Zambia Zimbabwe 2 4 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 1990 1995 2000 2005 2010 Year Actual TFR Wanted TFR Converging and diverging gaps between actual and wanted TFR
CPR RATE OF CHANGE 0 Rate of % change 1 2 3 Chad India Niger Morocco Vietnam Liberia Senegal Mali Eritrea Guinea Benin Nigeria Azerbaijan Togo Philippines Ghana Rwanda Burkina Faso Yemen Guatemala Georgia Honduras El Salvador Zimbabwe Kenya Uganda Cameroon Bangladesh Pakistan Jordan Haiti Nepal Bolivia Indonesia Ukraine Tanzania Colombia Ecuador Nicaragua Ethiopia Côte d'ivoire Cambodia Dominican Republic Zambia Madagascar Egypt Peru Malawi Brazil Paraguay Namibia Mozambique SSA Asia North Africa/Central Asia Latin America CPR: rate of change in African countries same or higher than other regions
Modern vs. Traditional Methods Benin Burkina Faso Cameroon Chad Cote d'ivoire 0 25 50 0 25 50 Eritrea Ethiopia Ghana Guinea Kenya Percent 0 25 50 Liberia Madagascar Malawi Mali Mozambique Namibia Niger Nigeria Rwanda Senegal 0 25 50 Tanzania Togo Uganda Zambia Zimbabwe 0 25 50 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 Year Modern Methods Traditional Methods Decrease in traditional method use; increase in modern method use
Burden of abortion in low CPR settings Eit Eritrea Ml Malawi Niger Obstetric complication Percent Percent Percent Abortion complications 45.6 24.0 16.0 Obstructed/prolonged labor 18.4 20.6 23.8 Abnormal fetal presentation 10.3 8.1 4.5 Pre eclampsia/eclampsia p 7.7 77 8.0 9.9 99 Premature rupture of 6.5 2.6 membranes Preterm labor 37 3.7 25 2.5 15 1.5 Retained placenta 3.6 2.4 2.8 Antepartum hemorrhage 3.6 3.1 3.7 Postpartum t sepsis 3.3 2.5 2.3 Postpartum hemorrhage 3.1 3.2 2.8 Retained products 3.0 9.1 12.1 Causes of pregnancy complications for hospital admissions in 2007 Sharan et al, Quality of maternal health systems in Eritrea, Malawi & Niger. World Bank 2010
Proportion of obstetric admissions due to abortion complications by age 80 100 72.0 80 100 Percent 40 60 0 20 36.1 45.3 43.8 46.0 50.5 59.3 <20 20-24 25-29 30-34 35-39 40-44 45-49 Age Percent 0 20 40 60 11.7 14.6 16.2 13.2 15.5 24.4 <20 20-24 25-29 30-34 35-39 40-49 Age Eritrea 80 100 Niger Percent 0 20 40 60 21.4 23.0 24.7 25.9 25.6 34.4 <20 20-24 25-29 30-34 35-39 40-49 Age Malawi
CPR and IMR cent) 0 50 e rate (perc 30 40 prevalence 20 3 10 2 ntraceptive co South Africa 1998 Namibia 2006 Madagascar Kenya 2008 2008 Ghana 2008 Gabon 2000 Zimbabwe 1994 Zimbabwe 2005 Kenya 1993 Zambia 2007 Rwanda 2007 Namibia 1992 Tanzania 2004 Cameroon 1991 Uganda 2006 Ghana 1993 Senegal 2005 Benin 2006 Eritrea 2002 Eritrea 1995 Liberia 2007 Senegal 1992 Mauritania 2000 Congo (Brazzaville) 2005 Cameroon 2004 Malawi 2004 Togo 1998 Nigeria 2008 Ethiopia 2005 Niger 2006 Swaziland 2006 Comoros 1996 Burkina Faso Rwanda 20031992 Uganda 1995 Lesotho 2004 Burkina Faso 1993 Mozambique 2003 Congo Democratic Republic 2007 Cote d'ivoire 1994 Benin 1996 CAR 1994 Madagascar 1992 Sierra Guinea Leone 2008 2005 Tanzania 1991 Nigeria 1990 Mali 2006 Guinea 1999 Ethiopia 2000 Chad 1996 Zambia 1992 Cote d'ivoire 1998 Mali 1995 Niger 1992 Malawi 1992 Mozambique 1997 Chad 2004 0 40 60 80 100 120 140 infant deaths per 1,000 live births Strong linear relationship between infant mortality rate and CPR
CPR and GDP 0 Contracep 20 60 8 ence Rate ( 40 6 tive Prevale %) 0 100 0-5 0 5 10 15 Rate of Yearly GDP Changes Strong linear relationship between CPR and economic growth
CONCLUSIONS High level of aggregate fertility but dynamic changes in contraceptive use patterns Reductions and imminent decreases in total fertility rates in parts of Africa Southern Africa making the greatest progress ; West and Central Africa are lagging Recent sharp increases in countries: Ghana, Lesotho, Malawi, Rwanda and Swaziland Stagnation since 2000; impact of shifts in policy and funding environment High levels of abortion burden in low CPR settings shows High levels of abortion burden in low CPR settings shows the latent demand for family planning
Thank you Family Planning Trends in Sub Saharan Saharan Africa: Progress, Prospects and Lessons Learned. In Yes Africa Can: Success Stories from a Dynamic Continent, World Bank, 2011.