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Kohler - Family Planning
- 1. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Costs and Benefits of Expanding Sexual Reproductive Health Services in Haiti Hans-Peter Kohler Haiti Priorise, May 2017
- 2. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions POPULATION Hans-Peter Kohler challenge paper
- 3. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Demographic Transition: Population Quality and Quantity Late Stages in Demographic Transition and Population Quantity LowMedium Much of East Asia High Most OECD countries High Fertility, High Population Growth Potential "Demographic Dividend" Post-Transition Older Population Structure PopulationQuality (Health,Nutrition, Education) Much of Sub- Saharan Africa Much of South Asia Haiti Most of Latin America, Caribbean and parts of South-East Asia Source: Modified from Behrman and Kohler (2014). Population Quantity, Quality, and Mobility. Allen et al (ed.) Towards a Better Global Economy: Policy Implications for Global Citizens in the 21st Century. Oxford University Press
- 4. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Sexual and Reproductive Healthin Haiti Haiti’s total fertility rate (TFR) remains the highest in the Latin America and Caribbean region, despite having decreased from 4.8 in 1994 to below 3 in 2015 Haiti’s modern contraceptive prevalence rate (MCPR) has increased substantially from 13.2 percent in 1994 to 31.3 percent in 2012, it remains the lowest in the LAC region. Unmet need for family planning thus remains at one of the highest levels in the world, with more than 35% being classified as having unmet need for family planning: 20% have a need for limiting births, and 16% for spacing births. High infant mortality rate of 59 deaths/1,000 live births more than three times the level prevailing in the LAC 2010 earthquake reduced contraceptive use, and significantly increased women’s unmet need for family planning
- 5. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Sexual and Reproductive Healthin Haiti Haiti’s total fertility rate (TFR) remains the highest in the Latin America and Caribbean region, despite having decreased from 4.8 in 1994 to below 3 in 2015 Haiti’s modern contraceptive prevalence rate (MCPR) has increased substantially from 13.2 percent in 1994 to 31.3 percent in 2012, it remains the lowest in the LAC region. Unmet need for family planning thus remains at one of the highest levels in the world, with more than 35% being classified as having unmet need for family planning: 20% have a need for limiting births, and 16% for spacing births. High infant mortality rate of 59 deaths/1,000 live births more than three times the level prevailing in the LAC 2010 earthquake reduced contraceptive use, and significantly increased women’s unmet need for family planning
- 6. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Sexual and Reproductive Healthin Haiti Haiti’s total fertility rate (TFR) remains the highest in the Latin America and Caribbean region, despite having decreased from 4.8 in 1994 to below 3 in 2015 Haiti’s modern contraceptive prevalence rate (MCPR) has increased substantially from 13.2 percent in 1994 to 31.3 percent in 2012, it remains the lowest in the LAC region. Unmet need for family planning thus remains at one of the highest levels in the world, with more than 35% being classified as having unmet need for family planning: 20% have a need for limiting births, and 16% for spacing births. High infant mortality rate of 59 deaths/1,000 live births more than three times the level prevailing in the LAC 2010 earthquake reduced contraceptive use, and significantly increased women’s unmet need for family planning
- 7. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Declines in Fertility Population Growth, Demographic Dividends and Economic Development Role of Family Planning (FP) Programs
- 8. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Declines in Fertility Shifts in demand for children Shifts in female bargaining power about reproductive decisions Reduced costs of fertility regulation Diffusion of knowledge and norms, media influences, social interactions Population Growth, Demographic Dividends and Economic Development Role of Family Planning (FP) Programs
- 9. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Declines in Fertility Population Growth, Demographic Dividends and Economic Development Heated controversies: malthusian (–), neo-malthusian (–) and revisionist (+/–) perspectives Recent debates: Demographic dividends: Changes in age structure during demographic transition propel economic development Unified growth theory: Demographic transition and economic development are inherently interrelated Role of Family Planning (FP) Programs
- 10. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Declines in Fertility Population Growth, Demographic Dividends and Economic Development Role of Family Planning (FP) Programs Family planning provide information about contraception, as well as contraceptives themselves and related reproductive health services Primary policy option for influencing population growth and related health concerns Often focus on “unmet need” for family planning Key question: Did family planning programs make a significant causal contributions to past fertility declines and related gains in health and/or well-being?
- 11. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Role of Family Planning (FP) Programs Key question: Did family planning programs make a significant causal contributions to past fertility declines and related gains in health and/or well-being? Economic literature—until recently—largely skeptical about causal effects of family planning programs Recent evidence from RCTs and careful evaluation studies: FP programs increase uptake of family planning causally reduce fertility through reduced fertility, result in increases in child and maternal health, increased child human capital, and increased female earnings are reinforced by other health programs/interventions Concern: Does evidence generalize to Haiti?
- 12. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Role of Family Planning (FP) Programs Key question: Did family planning programs make a significant causal contributions to past fertility declines and related gains in health and/or well-being? Economic literature—until recently—largely skeptical about causal effects of family planning programs Recent evidence from RCTs and careful evaluation studies: FP programs increase uptake of family planning causally reduce fertility through reduced fertility, result in increases in child and maternal health, increased child human capital, and increased female earnings are reinforced by other health programs/interventions Concern: Does evidence generalize to Haiti?
- 13. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Role of Family Planning (FP) Programs Key question: Did family planning programs make a significant causal contributions to past fertility declines and related gains in health and/or well-being? Economic literature—until recently—largely skeptical about causal effects of family planning programs Recent evidence from RCTs and careful evaluation studies: FP programs increase uptake of family planning causally reduce fertility through reduced fertility, result in increases in child and maternal health, increased child human capital, and increased female earnings are reinforced by other health programs/interventions Concern: Does evidence generalize to Haiti?
- 14. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Declines in Fertility Demographic Dividends and Economic Development Role of Family Planning Programs Benefit-Cost Analyses Conclusions Causes and Consequences of Demographic Transition Role of Family Planning (FP) Programs Key question: Did family planning programs make a significant causal contributions to past fertility declines and related gains in health and/or well-being? Economic literature—until recently—largely skeptical about causal effects of family planning programs Recent evidence from RCTs and careful evaluation studies: FP programs increase uptake of family planning causally reduce fertility through reduced fertility, result in increases in child and maternal health, increased child human capital, and increased female earnings are reinforced by other health programs/interventions Concern: Does evidence generalize to Haiti?
- 15. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Benefit-Cost Analyses for Family Planning Programs an estimated $4.1 billion (Figure includes the costs of contracepti plies ($1.3 billion), health worker and program and systems costs costs, $2.1 billion).The indirect c types of program support, such and training, information and ed planning, construction and main development and maintenance ply systems, and other managem The cost of contraceptives and re by method: Long-acting and per such as the IUD and sterilization up front than short-acting meth protection from pregnancy for m each user, average annual direct IUDs ($0.58), male sterilization ($ sterilization ($1.84). Annual costs NOTES TO FIGURE 2.3 Meeting all women’s needs for modern contraceptives will cost $5.3 billion per year more than is currently spent.2.3 100% of need for modern methods met Improved care for current users Current level of care 1.3 0.7 2.1 $4.1 $5.4 $9.4 1.3 0.7 3.3 2.3 1.2 6.0 Costs in 2014 U.S. dollars (in billions) Program and systems costsHealth worker salariesSupplies FIGURE Source: Singh et al (2014). Adding It Up: The Costs and Benefits of Investing in Family Planning and Maternal and Newborn Health. Guttmacher Institute
- 16. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Benefit-Cost Analyses for Family Planning Programs Benefits included: Improvements in health and reductions in mortality (children and adults) Life-cycle, distributional and intergenerational benefits of family planning programs Gains in economic growth through reduced fertility Benefits excluded: Climate change Political instability and conflict Limitations Strong assumptions, limited empirical evidence, no interactions
- 17. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Benefit-Cost Analyses for Family Planning Programs Benefits included: Improvements in health and reductions in mortality (children and adults) Life-cycle, distributional and intergenerational benefits of family planning programs Gains in economic growth through reduced fertility Benefits excluded: Climate change Political instability and conflict Limitations Strong assumptions, limited empirical evidence, no interactions
- 18. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Benefit-Cost Analyses for Family Planning Programs Benefits included: Improvements in health and reductions in mortality (children and adults) Life-cycle, distributional and intergenerational benefits of family planning programs Gains in economic growth through reduced fertility Benefits excluded: Climate change Political instability and conflict Limitations Strong assumptions, limited empirical evidence, no interactions
- 19. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Benefit-Cost Analyses for Expanding SHR Services Valuation of DALYs Intervention Discount Benefit Cost BCR 1 x GDP per capita 3% 543,593 23,638 23.00 Moderate5% 357,091 20,185 17.69 12% 105,585 12,905 8.18 3 x GDP per capita 3% 556,036 23,638 23.52 Moderate5% 364,157 20,185 18.04 12% 107,346 12,905 8.32 8 x GDP per capita 3% 587,145 23,638 24.84 Moderate5% 381,823 20,185 18.92 12% 111,747 12,905 8.66 Benefits and costs are in million Gourdes Quality of Evidence Fully meet demand for modern contraceptive methods Fully meet demand for modern contraceptive methods Fully meet demand for modern contraceptive methods
- 20. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Costs of Family Planning Programs Benefits of Family Planning Programs Benefit-Cost Ratios: Expanding SHR Services Conclusions Robustness Checks 2 3 5 7 10 15 3 5 710 15 0 50 100 150 200 0 50 100 150 200 Percentage underestimation of costs Percentageoverestimationofbenefits
- 21. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Conclusions The Challenge: Concerns about sexual and reproductive health in Haiti are justified Haiti compares unfavorably in key indicators to other LAC countries Shifting evidence: Family planning programs can provide cost-effective interventions to improve health and well-being Benefits of family planning include: reduced population growth ratse improved child and adult health, human-capital and well-being, especially for women potentially more rapid economic development other benefits such as improved status of women, intergenerational benefits, and potentially climate change Limitations Strong assumptions, limited empirical evidence, no interactions Family planning programs are no substitute to other development policies; if anything, they are a complement Contact: hpkohler@pop.upenn.edu
- 22. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Conclusions The Challenge: Concerns about sexual and reproductive health in Haiti are justified Haiti compares unfavorably in key indicators to other LAC countries Shifting evidence: Family planning programs can provide cost-effective interventions to improve health and well-being Benefits of family planning include: reduced population growth ratse improved child and adult health, human-capital and well-being, especially for women potentially more rapid economic development other benefits such as improved status of women, intergenerational benefits, and potentially climate change Limitations Strong assumptions, limited empirical evidence, no interactions Family planning programs are no substitute to other development policies; if anything, they are a complement Contact: hpkohler@pop.upenn.edu
- 23. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Conclusions The Challenge: Concerns about sexual and reproductive health in Haiti are justified Haiti compares unfavorably in key indicators to other LAC countries Shifting evidence: Family planning programs can provide cost-effective interventions to improve health and well-being Benefits of family planning include: reduced population growth ratse improved child and adult health, human-capital and well-being, especially for women potentially more rapid economic development other benefits such as improved status of women, intergenerational benefits, and potentially climate change Limitations Strong assumptions, limited empirical evidence, no interactions Family planning programs are no substitute to other development policies; if anything, they are a complement Contact: hpkohler@pop.upenn.edu
- 24. Sexual Reproductive Health Services H.-P. Kohler An Unfinished Success Story Sexual and Repro- ductive Health Benefit-Cost Analyses Conclusions Conclusions The Challenge: Concerns about sexual and reproductive health in Haiti are justified Haiti compares unfavorably in key indicators to other LAC countries Shifting evidence: Family planning programs can provide cost-effective interventions to improve health and well-being Benefits of family planning include: reduced population growth ratse improved child and adult health, human-capital and well-being, especially for women potentially more rapid economic development other benefits such as improved status of women, intergenerational benefits, and potentially climate change Limitations Strong assumptions, limited empirical evidence, no interactions Family planning programs are no substitute to other development policies; if anything, they are a complement Contact: hpkohler@pop.upenn.edu