Fertility

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POP 105: Fertility and Reproduction
Week 9: Gender Inequality
Religion and Fertility
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Gender Roles and Norms
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Gender Roles and Norms
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Gender Roles and Norms (UNFPA Study on Mali)
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Other Measures of Gender Inequality
• Income Differences
• Occupational Status
• Educational Differences
• Power strucuture
5
Gender Equality and Fertility
Gender and gender equity represent an important challenge
for fertility research. Gender shapes reproductive
strategies, be it through mate choice and parental
investment (Trivers 1972), power relations within the
household (Folbre 1983), or more general notions of
gender ideology (Philipov 2008).
6
Differing views exist as to whether increased gender
equity will make people wish for more or fewer
children.
Historically, traditional family arrangements have
correlated with higher numbers of children.
During the first demographic transition to smaller
families women became much more equal with
men.
7
The second demographic transition witnessed even
smaller family sizes while recent years have seen a
recuperation of fertility in the most developed
societies, which also score high in gender equity
(Myrskylä, Kohler, and Billari 2009).
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Several studies predict that fertility will increase as
gender equity within families advances.
For instance, influential articles by Peter McDonald
(2000a and 2000b) proposed that the imbalance
between high gender equity in institutions such as
education and market employment and lower
level of equity in family life have contributed to
low fertility in advanced countries.
9
Once the ‘gender revolution’ is completed fertility should rise
(Brewster, and Kavee 1996).
This may indeed be one explanation for the recent reversal in
fertility decline (Myrskylä, Kohler, and Billari 2009).
However, the actual impact of family gender equity and
egalitarian values on fertility is unclear, although it is crucial
for understanding demographic prospects and “the male
role in Europe” in the 21st century (Puur et al. 2008).
10
Egalitarian women can reasonably be expected to
opt for either ‘no families’ or ‘new families’
(Goldsheider and Waite 1991).
If their double burden is alleviated – due to work
and family reconciliation policies or due to men
acquiring a larger share of household tasks – a
positive influence of gender equality on women’s
childbearing prospects can be presumed.
11
But why should gender egalitarian attitudes increase
men’s fertility aspirations, since equality means
more, not less domestic work for them?
Both indirect and direct explanations have been
suggested. If egalitarian men are more willing to
share domestic and childcare tasks, this may
increase their partners’ desire to have children.
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Egalitarian men may also attach more importance and
meaning to family life and fatherhood than traditional men
do.
Hence, ‘doing family’ or strong family orientation of egalitarian
men could compensate for the costs of domestic and caring
responsibilities and increase men’s fertility intentions.
However, not all egalitarian men are highly family‐oriented,
while men with traditional gender attitudes may also
prioritize family life.
13
Attitudes to gender equality in low fertility societies
have been claimed to correlate with higher
numbers of children, both on the social and
individual level, but the existing evidence is
somewhat contradictory.
The impact of gender equality typically varies by sex
and parity, depending on the national and social
context and on measurements of gender equality.
14
Kaufman (2000), in analyzing the 1987/1998 and
1992/1994 waves of the United States National
Survey of Families and Households, found that
while egalitarian women are less likely to intend
or actually have a child than traditional women,
for men the opposite is the case.
15
Studies derived from the Population Policy Acceptance
Study (PPAS) conducted in fourteen European countries
between 2000‐2003 concluded that men with more
egalitarian attitudes toward gender equity have higher
fertility intentions.
Puur et al. (2008:1898) found that “egalitarian attitudes
tend to be associated with higher fertility intentions” as
well as with higher realized fertility in all studied eight
countries (Austria, Estonia, East and West Germany, Italy,
Lithuania, the Netherlands, and Poland).
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In a more in‐depth regional analysis of the PPAS data
for Austria, Tazi‐Preve et al. (2004) found that a
traditional division of household labour clearly
diminished people’s wish to have a(nother) baby,
with the inverse being the case in more
egalitarian partnerships.
17
On the other hand, using panel data from Gender
and Generations Survey (GGS) in Hungary, Spéder
and Kapitány (2009) found that traditional gender
role orientation significantly correlated with
having a second and third child among both men
and women, while no relation was found between
egalitarian attitudes and having the first child.
18
Finally, a crucial reason for conflicting evidence is due to
different measures of gender equity (Goldsheider, Oláh,
and Puur 2010).
It is not clear what aspect of gender relations is the most
critical considering fertility behaviour, or how societal
context shapes the association.
While some measures of gender equity are related to fertility
in some societies, other aspects of gender relations may be
more relevant in others. Also the formulations of survey
questions vary (Westoff and Higgins 2009:72.)
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• Lower age at marriage
• Limited role in decision making
• Higher prevalence of unwanted children
• Limited choice for contraceptive use
• Effect of patriarchal society
• Higher gender equality means lower education for women; which
increases fertility
• Higher gender inequality means lower employment rate for women;
which increase fertility
• Higher gender equality means lower income for women; which leads
to higher fertility
22
In population sciences religion has been found to be
associated with a wide range of behavioural
processes such as variations in marital stability,
divorce, the of choice of conjugal partner, timing of
sexual debut, contraceptive use, attitudes towards
the family and marriage, likelihood of cohabitation,
completed family size, spacing of childbearing, and
abortion (Adsera 2006; Hayford and Morgan 2008; McQuillan 2004; Newman and
Hugo 2006), as well as health and mortality differentials
(House, Landis and Umberson 1988; Pescosolido and Giorgianna 1989). 23
Among the reasons underlying the relevance of religion for
explaining differences in fertility investigators have
emphasized the importance of sociopolitical context.
For instance, Day (1968) observed that in countries where
Catholics constitute the dominant population their fertility
rates were generally in line with other populations,
whereas in situations where Catholics represented a
substantial minority group, their fertility was significantly
above average.
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A similar argument was posed by Kennedy (1973) to
describe the higher fertility of Catholics in
Northern Ireland, where the group is minority, as
compared to Catholics in the Republic, where
they are the majority population.
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These observations are consistent with van Heek’s
(1956) formulation of the particularized ideology
explanation.
Van Heek argues that Catholicism serves to raise
fertility above that of the majority population
only in sociopolitical contexts where Catholics
form a disadvantaged minority group because in
such contexts the teachings of the Church
prohibiting birth control tends to be followed
more devoutly by Catholics, thus explaining their
higher birth rates.
26
Goldscheider and Uhlenberg (1969) argue that
disadvantaged groups would consciously limit fertility
if three preconditions prevail: (1) the group shares a
history of prejudice and discrimination; (2) the group
seeks socioeconomic assimilation with the larger
society; and (3) the group possesses no particularized
ideology emphasizing large families or that prohibits
the use of birth control.
27
In the North American context, such as the
Hutterites and the Mormons (Heaton and Goodman 1985; Lehr
and Katz 2012), most religious minority groups do not
possess such ideologies, and consequently have
birth rates that are more or less in line with the
general population (Goldscheider and Uhlenberg 1969).
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Indeed, over time, with the increasing secularization of
society, the fertility rates of most religious and ethnic
groups in North America have been converging, a trend
consistent with expectations inherent in the demographic
transition theory
A clear example of this is the virtual disappearance of the
Catholic/Protestant fertility differential after the 1960s in
the United States (Westoff and Jones 1979) and Canada, especially
among younger generations of women (Balakrishnan, Krotki and
Lapierre‐Adamczyk 2003). 29
How does religion influence fertility?
KEVIN MCQUILLAN (2004). When Does Religion Influence
Fertility? POPULATION AND DEVELOPMENT REVIEW
30(1): 25–56
• Religion and values
• The role of religious institutions
• Religious Identity
30
Example of the relationship between Religion and Fertility
K. Moulasha and G. Rama Rao. (1999). Religion‐Specific
Differentials in Fertility and Family Planning. Economic and Political
Weekly, 34(42/43):47‐3051
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Definition of reproductive health
Reproductive health is a state of complete physical,
mental and social well‐being, and not merely the
absence of reproductive disease or infirmity.
Reproductive health deals with the reproductive
processes, functions and system at all stages of
life.
37
ICPD definition of reproductive health
• The International Conference on Population and
Development Programme (ICPD) of Action states that
"reproductive health ... Implies that people are able to
have a satisfying and safe sex life and that they have
the capability to reproduce and the freedom to
decide if, when and how often to do so.
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ICPD definition of reproductive health (cont’d):
Implicit in this last condition are the right of men and
women to be informed and to have  access to safe,
effective, affordable and acceptable methods of
family planning of their choice, as well as other
methods of their choice for regulation of fertility
which are not against the law,
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and the right of access to appropriate health care
services that will enable women to go safely
through pregnancy and childbirth and provide
couples with the best chance of having a healthy
infant. ...
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Reproductive health includes sexual health, the
purpose of which is the enhancement of life and
personal relations, and not merely counseling and
care related to reproduction and sexually
transmitted diseases."
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Importance of reproductive health
• Reproductive health is a crucial part of general
health and a central feature of human
development.
• It is a reflection of health during childhood, and
crucial during adolescence and adulthood, sets
the stage for health beyond the reproductive
years for both women and men, and affects the
health of the next generation.
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Importance of reproductive health
• The health of the newborn is largely a function of
the mother's health and nutrition status and of
her access to health care.
• Reproductive health is a universal concern, but is
of special importance for women particularly
during the reproductive years.
• Although most reproductive health problems
arise during the reproductive years, in old age
general health continues to reflect earlier
reproductive life events.
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Importance of reproductive health (cont’d):
• Men too have reproductive health concerns and
needs though their general health is affected by
reproductive health to a lesser extent than is the
case for women.
• However, men have particular roles and
responsibilities in terms of women's reproductive
health because of their decision‐making powers in
reproductive health matters.
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• At each stage of life individual needs differ.
However, there is a cumulative effect across the
life course events at each phase having important
implications for future well‐being.
• Failure to deal with reproductive health problems
at any stage in life sets the scene for later health
and developmental problems.
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• Because reproductive health is such an important
component of general health it is a prerequisite
for social, economic and human development.
• The highest attainable level of health is not only a
fundamental human right for all, it is also a social
and economic imperative because human energy
and creativity are the driving forces of
development.
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• Such energy and creativity cannot be generated
by sick, tired people, and consequently a healthy
and active population becomes a prerequisite of
social and economic development.
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In‐depth meaning of reproductive health
• Reproductive health does not start out from a list
of diseases or problems ‐ sexually transmitted
diseases, maternal mortality ‐ or from a list of
programmes ‐ maternal and child health, safe
motherhood, family planning.
• Reproductive health instead must be understood
in the context of relationships: fulfillment and
risk; the opportunity to have a desired child or
alternatively, to avoid unwanted or unsafe
pregnancy.
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Reproductive health contributes enormously to
physical and psychosocial comfort and closeness,
and to personal and social maturation.
Poor reproductive health is frequently associated
with disease, abuse, exploitation, unwanted
pregnancy, and death.
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The most significant achievement of the Cairo
Conference in 1994 was to place Reproductive health
at the centre of development efforts.
The aim of interventions is to
• enhance reproductive health
• promote reproductive rights
• empowerment of women
• involvement of women and young people in
development
• reaching out to the poor, the marginalized and
• assuming greater responsibility for reproductive
health on the part of men.
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How the concept of reproductive health differs
from existing family planning and maternal and
child health programmes?
Programmes dealing with various components of
reproductive health exist in some form almost
everywhere.
But they have usually been delivered in a separate
way, unconnected to programmes dealing with
closely interdependent topics.
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For example, the objectives, design and evaluation
of family planning programmes were largely
driven by a demographic imperative, without due
consideration to related health issues such as
maternal health or STD prevention and
management.
Evaluation was largely in terms of quantity rather
than quality ‐ numbers of contraceptive acceptors
as opposed to the ability and opportunity to make
informed decisions about reproductive health
issues.
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In general, such programmes exclusively targeted
women, taking little account of the social, cultural
and intimate realities of their reproductive lives
and decision‐making powers.
They tended to serve only married people,
excluding, in particular, young people.
Services were rarely designed to serve men even
though they have reproductive health concerns of
their own, particularly with regard to sexually
transmitted diseases.
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Moreover, the involvement of men in reproductive
health is important because they have an
important role to play as family decision‐makers
with regard to family size, family planning and use
of health services.
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A reproductive health approach would differ from a
narrow family planning approach in several ways.
It would aim to build upon what exists and at the
same time to modify current narrow, vertical
programmes to ones in which every opportunity
is taken to offer women and men a full range of
reproductive health services in a linked way.
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The underlying assumption is that people with a
need in one particular area ‐ say treatment of a
sexually transmitted diseases ‐ also have needs in
other areas ‐ family planning or antenatal/
postpartum care.
Such programmes would recognize that dealing with
one aspect of reproductive health can have
synergistic effects in dealing with others.
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For example, management of infertility is difficult
and expensive but it can be largely prevented
through appropriate care during and after
delivery and prevention and management of
STDs.
Promotion of breast‐feeding has an impact on
reproductive health in many ways ‐ it helps
prevent certain postpartum problems, delays the
return to fertility, may help prevent ovarian and
breast cancer, and improves neonatal health.
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Another important difference between existing
programmes and those developed to respond to
the new concept of reproductive health is the way
in which people ‐ particularly women and young
people who are the most affected by reproductive
health concerns ‐ are involved in programme
development, implementation and evaluation.
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When women become more involved in
programmes it becomes clearer that they have
health concerns beyond motherhood and also
that dealing with reproductive health involves a
profound rethinking of the behavioural, social,
gender and cultural dimensions of decision‐
making which affect women's reproductive lives.
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What reproductive health services include
The precise configuration of reproductive health
needs and concerns, and the programmes and
policies to address them, will vary from country to
country and will depend on an assessment of
each country's situation and the availability of
appropriate interventions.
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Globally, reproductive health interventions are most
likely to include attention to the issues of
• family planning,
• STD prevention and management
• prevention of maternal and perinatal mortality
• Prevention of morbidity
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Reproductive health should also address issues such as
• harmful practices
• unwanted pregnancy
• unsafe abortion
• reproductive tract infections including sexually
transmitted diseases and HIV/AIDS
• gender‐based violence
• infertility
• Malnutrition
• anaemia
• reproductive tract cancers
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Appropriate services must be accessible and include
• Information
• Education
• Counseling
• Prevention
• detection and management of health problems
• care and rehabilitation. 63
Reproductive health strategies should be founded
first and foremost on the health of individuals and
families.
In the operationalization of the strategies all
reproductive health services must assume their
responsibility to offer accessible and quality care,
while ensuring respect for the individual, freedom
of choice, informed consent, confidentiality and
privacy in all reproductive matters.
They should focus special attention on meeting the
reproductive health needs of adolescents.
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Factors affecting reproductive health
Reproductive health affects, and is affected by, the
broader context of people's lives, including their
• economic circumstances
• Education
• Employment
• living conditions
• family environment
• social and gender relationships
• traditional and legal structures within which they
live
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Factors affecting reproductive health
Sexual and reproductive behaviours are governed by
complex biological, cultural and psychosocial
factors.
Therefore, the attainment of reproductive health is
not limited to interventions by the health sector
alone.
Nonetheless, most reproductive health problems
cannot be significantly addressed in the absence
of health services and medical knowledge and
skills.
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The status of girls and women in society, and how
they are treated or mistreated, is a crucial
determinant of their reproductive health.
Educational opportunities for girls and women
powerfully affect their status and the control they
have over their own lives and their health and
fertility.
The empowerment of women is therefore an
essential element for health.
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Who is most affected by reproductive health problems
Women bear by far the greatest burden of
reproductive health problems.
Women are at risk of complications from pregnancy
and childbirth; they also face risks in preventing
unwanted pregnancy, suffer the complications of
unsafe abortion, bear most of the burden of
contraception, and are more exposed to
contracting, and suffering the complications of
reproductive tract infections, particularly sexually
transmitted diseases (STDs)
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Who is most affected by reproductive health problems
Among women of reproductive age, 36% of all
healthy years of life lost is due to reproductive
health problems such as unregulated fertility,
maternal mortality and morbidity and sexually
transmitted diseases including HIV/AIDS.
By contrast, the equivalent figure for men is 12%.
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Biological factors alone do not explain women's
disparate burden.
Their social, economic and political disadvantages have
a detrimental impact on their reproductive health.
Young people of both sexes, are also particularly
vulnerable to reproductive health problems because
of a lack of information and access to services.
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How countries can identify reproductive health
needs and assess priorities
A number of countries have expressed the desire to
move forward with a new and comprehensive
approach to reproductive health.
A systematic review of reproductive health needs at
country level should focus on the importance of
adding innovative and participatory approaches
to more familiar epidemiological methodologies
in which the process tends to be directed by
experts and framed by biomedical approaches
and indicators.
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The identification of reproductive health needs, the
determination of priorities and the development
of programmatic responses to those needs should
be conducted through an inclusive process,
soliciting the perspectives of a range of groups
concerned with reproductive health including, for
example, women's health advocates, youth
groups, health care providers at the periphery as
well as at the central level, health planners,
researchers, and non‐governmental organizations.
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In the context of the new approach to reproductive
health it is necessary to ensure that assessment
and prioritization reflect people's concerns as
agreed at national and local levels and not the
priorities of agencies or donors.
It is important to avoid duplication and to develop
tools that are appropriate for countries
themselves.
However, it is important to ensure compatibility and
consistency among the various instruments
currently available.
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Similar considerations apply to the selection of
priorities for action in reproductive health.
Criteria for identification of priority problems should
include not only importance ‐ prevalence,
severity, public concern, government
commitment, impact on family, community and
development ‐ but also the feasibility of
addressing them ‐ known interventions, cost‐
effectiveness, availability of financing, human
resources and adequate equipment and supplies.
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Human resources for reproductive health
The operationalization of the new concept of
reproductive health will mean changes in skills,
knowledge, attitudes and management.
People will have to work together in new ways.
Health care providers will have to collaborate with
others, including NGOs, women's health
advocates, and young people.
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Human resources for reproductive health
Managerial and administrative changes will also be
needed because integrated services can impose,
at least initially, greater burdens on already over‐
stretched staff and require attention to planning
and logistics in order to ensure availability and
continuity of services.
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Training for reproductive health workers will need to
focus on improving both technical and
interpersonal skills.
Additional training, particularly in counseling skills
and in ways of reaching out to under‐served
groups will be essential elements of such training.
The back‐up and support of functioning referral
systems will be essential elements if the full range
of reproductive health concerns is to be
adequately addressed.
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Monitoring and evaluation
Monitoring and evaluation of reproductive health
takes place at two levels ‐ the country and the
global level.
Globally, the international community has already
defined a number of indicators relevant to
reproductive health, including:
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Maternal mortality
• % pregnant women who have at least one
antenatal visit
• % of pregnant women who have a trained
attendant at delivery
• % of pregnant women immunized against tetanus
contraceptive prevalence rate
• % of infants weighing less than 2500 g at birth (a
newborn indicator that reflects maternal
reproductive health)
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WHO is working on additional indicators for global
monitoring in reproductive health, including
indicators on
• incidence and prevalence of sexually transmitted
diseases
• quality of family planning services
• access to and quality of maternal health services
• prevalence of female genital mutilation
• prevalence and nature of obstetric and
gynaecological morbidities
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Reproductive health indicators should cover not only
quantitative indicators such as those listed above,
but also some qualitative indicators, such as
• women's satisfaction with services
• perceptions of quality
• maternal discomfort and dissatisfaction
• perceived reproductive morbidities
• opportunities for choice and
• enabling environments.
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Data collection should be seen as a means towards
an end rather than an end in itself.
It will, therefore, be necessary to focus increasingly
on performance‐based measures such as
maternal audit, surveillance and other process
measures.
Such programme indicators should be useful for
policy‐making and be generated through data
collection procedures that are useful for
programme management at the level at which the
data are collected.
82
All data collection efforts should be sustainable by
the national authorities and able to take into
account new developments in terms of strategic
thinking and implementation.
In addition, all indicators should be valid, objectively
measurable and reliable.
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KEY ACTIONS TO IMPROVE REPRODUCTIVE HEALTH
1. Advocate for the concept of reproductive and sexual
health
2. Promote multi‐sectoral action
3. Stimulate adherence to essential principles
4. Foster national ownership
5. Ensure consistency and complementarily
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KEY ACTIONS TO IMPROVE REPRODUCTIVE HEALTH
6. Coordinate agency, regional, bilateral and NGO
activities
7. Assist in the identification of reproductive health
needs
8. Support national planning
9. Promote integrated approaches
10. Support monitoring and evaluation
85
1. Advocate for the concept of reproductive and sexual health
• The new system can promote recognition of the concept of reproductive
health as central to general health and human development. This implies
the integration of reproductive health and reproductive rights into all
related development priorities and programmes. Resident Coordinators
should be aware that reproductive health is a dynamic and continuously
evolving concept. Therefore, information sharing and collaboration will
be needed to ensure that the approaches developed and implemented
are based on the most recent and relevant information available and on
the evolving experiences of those working in the field. The Country
Strategy Note should be used as a vehicle to promulgate this vision more
widely.
86
2. Promote multi‐sectoral action
Reproductive health is a health issue but encompasses more than
biomedical aspects and goes beyond the health sector. The
determinants of reproductive ill‐health lie in poverty, gender and
other forms of inequity, social injustice, marginalization and
development failures. All sectors affect and are affected by
reproductive health. The Resident Coordinator system can
advocate that all agencies and all sectors have roles and
responsibilities in promoting reproductive health.
One of the key actions needed to improve reproductive health is the
empowerment of women especially through education. The UN
Resident Coordinator system can mobilize increased energies and
resources for women's education both in‐school and out‐of‐school
(youth groups, workplaces, adult literacy and income generation
groups etc.).
87
3. Stimulate adherence to essential principles
The Resident Coordinator system can disseminate the underlying
principles which must serve as a guide to action in reproductive
health. These are the guiding principles of human rights,
equality and gender equity, and placing people at the centre of
development efforts. Operational principles for the
implementation of reproductive health policies and
programmes include participatory processes, involvement of
multiple perspectives and multi‐sectoral action. The Resident
Coordinator system is well‐placed to ensure the involvement of
different sectors and the participation of all those concerned
with reproductive health. Where there are major regional,
ethnic, religious or cultural variations within countries, these
must be taken into account in the development of reproductive
health strategies. Where certain groups have difficulties in
making their voices heard, the Resident Coordinator system can
play a role in providing a forum for the exchange of ideas and
experiences.
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4. Foster national ownership
A global reproductive health strategy must be translated into
approaches that are country‐driven. Implementation of
reproductive health programmes is the sovereign right of each
country, in a way that is consistent with national laws and
development priorities, with full respect for religious, cultural and
ethical values and in harmony with universally recognized human
rights. The Resident Coordinator system can ensure that the
development of strategies, policies and programmes is a nationally
owned process and that decisions taken reflect national priorities
and are not dictated by external agencies.
89
5. Ensure consistency and complementarity
Translating the concept of reproductive health into actions means
ensuring a shared understanding of the concept and consistency
and complementarity in the application of approaches. It is
critically important to avoid conflicting messages from UN agencies
to national counterparts. The Resident Coordinator system can
help to ensure consistency and bring together different parties in
order to avoid duplication and make best use of resources. One
practical way of doing this would be the creation in countries of a
database of information from all in‐country agencies on project
design, implementation, monitoring, evaluation, lessons learned
and future programme plans. This could be drawn upon by all
agencies and would help avoid duplication while ensuring greater
information‐sharing and networking among agencies.
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6. Coordinate agency, regional, bilateral and NGO activities
Each agency has specific mandates and comparative advantages which
need to be incorporated into the concept of reproductive health. Some
agencies, including WHO, UNAIDS, UNFPA, UNICEF, and UNHCR are likely
to have a deeper involvement than others in reproductive health issues.
While subscribing to the overall broad concept of reproductive health,
agencies select priorities in a focused way on the basis on capacities and
resources. Resident Coordinators should be well aware of agency
mandates, capacities and resources and be able to assess where there
are gaps and duplications and recommend strategies to overcome them.
Resident Coordinators can promote harmony between the
activities of international agencies, bilateral donors and NGOs
working to support government and regional strategies in
reproductive health. The Resident Coordinator system should
gather and disseminate information about the resources available
at country, regional and global levels, in terms of funding,
knowledge and expertise.
91
7. Assist in the identification of reproductive health needs
The Resident Coordinator system can help countries in the
identification of national reproductive health needs and the
selection of priorities, in the evaluation of current programmatic
responses to the needs identified and in assessing potential for
improvement and avoidance of overlap. The Resident Coordinators
should promote the need for appropriate guidance and training for
all agency, regional and national representatives in the
reproductive health approach.
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8. Support national planning
The resident coordinator system should support national planning
through making the most effective use of specific agency plans and
programmes, making the best use of the comparative advantages
of each agency, and through seeking to achieve an appropriate
balance in the response of country and agency activities and
promoting an incremental improvement in programmes bearing
the overall reproductive health vision in mind. Of particular
importance in the national planning process is the development of
decision‐making tools and the improvement of managerial
capacities. The overall objective is to increase national capacity for
planning and implementation of reproductive health policies and
programmes within national constraints, objectives and
approaches.
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9. Promote integrated approaches
The Resident Coordinator system can ensure integration of all aspects
of reproductive health, especially those delivered in the past
through vertical programmes such as family planning. The Resident
Coordinator can encourage the incorporation into reproductive
health programmes of such concerns as the eradication of harmful
practices affecting women's health, as well as various forms of
violence.
The Resident Coordinator system can integrate follow‐up to the
various international conferences on related issues such as
population, reproductive health and development, including the
World Summit for Children, the United Nations Conference on
Environment and Development, the World Social Summit, the
United Nations Conference on Human Rights and the forthcoming
Fourth World Conference on Women.
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10. Support monitoring and evaluation
The Resident Coordinator system has an important role to play in
monitoring and evaluation. Global monitoring should be limited
and not impose additional burdens on national reporting systems.
The Resident Coordinator should support national capacity‐
building for monitoring progress in country programmes in a way
which is helpful to programme management and useful at the
point of delivery of the intervention.
95
Guidelines on Reproductive Health
• This document has been prepared by the
Secretariat of the United Nations Inter‐Agency
Task Force on the Implementation of the ICPD
Programme of Action. For further information
please contact the United Nations Population
Fund, Task Force on ICPD Implementation, 220
East 42nd Street, New York, NY 10017 USA or
send E‐mail to: pierce@unfpa.org
96

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Reproductive Health of Female Adolescents (15‐19 years)
in Bangladesh
97 98
in Bangladesh
99
in Bangladesh
100
in Bangladesh

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101
in Bangladesh
What is Family Planning?
• Family planning is the voluntary planning and
action taken by individuals to prevent, delay or
achieve a pregnancy.
• Family planning services include counseling and
education, preconception care, screening and
laboratory tests, and all approved
methods of contraception.
102
International Conference on Population and
Development (ICPD), Cairo 1994
A total of 179 governments signed up to the ICPD
Program of Action which aims to
• Provide universal access to family planning and sexual
and reproductive health services and reproductive
rights;
• Deliver gender equality, empowerment of women and
equal access to education for girls;
• Address the individual, social and economic impact of
urbanization and migration;
• Support sustainable development and address
environmental issues associated with population
changes
103
International Conference on Population and
Development (1994), Cairo
ICPD Program of Action stated that, “the aim of family
planning programs must be to enable couples and
individuals to decide freely and responsibly the
number and spacing of their children and to have the
information and means to do so.”
This affirmation marked a paradigm shift in the way
governments and international organizations looked at
development and population issues.
104

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Scope of Family Planning Programs
A broad range of services must be provided to ensure
sexual and reproductive health. Family planning is just
one such service, which should be integrated with:
• primary health care as well as antenatal care, safe
delivery and post‐natal care;
• prevention and appropriate treatment of infertility;
• management of the consequences of unsafe
abortion;
• treatment of reproductive tract infections;
105
Scope of Family Planning Programs
• prevention, care and treatment of sexually
transmitted infections and HIV/AIDS
• information, education and counselling on
reproductive health
• prevention of violence against women
106
Benefits of Family Planning
107
(1) Family planning saves the lives of women,
newborns, children, and teenage girls
• by preventing a high‐risk pregnancy in women with
certain health conditions or characteristics
• by preventing an unplanned pregnancy.
108

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(2) Family planning lowers the number of
unplanned pregnancies and abortions
Each year there are an estimated 80 million
unintended pregnancies, and 42 million of these
pregnancies end in abortion.
The primary reason for abortion is to end an
unplanned pregnancy.
To reduce the number of unintended pregnancies and
thus the number of abortions, women must have
access to contraceptive information and services.
109
(2) Family planning lowers the number of
unplanned pregnancies and abortions
Studies around the world have found that, where
women received high‐quality contraceptive
services, the number of abortions decreased.
These studies demonstrate the essential role of
contraceptive services in reducing abortions.
110
(3) Family planning benefits families and communities
• Researchers have shown that personal savings and
investments increase when working parents have
fewer children.
• Family planning results in smaller, healthier families
that are better able to care for themselves.
• There will be lower demands on clean water,
sanitation, transportation, educational institutions
and other public services.
111
(3) Family planning benefits families and communities
• By embracing family planning programs,
communities strengthen their ability to provide
public services and improve the lives of their
families.
• Family planning is also one of the most cost‐
effective and powerful strategies to empower
women and improve their lives.
• Women who are empowered to make choices about
childbearing are more likely to get better education
and job experience, and are more likely to
contribute to the economic health of their families
and communities.
112

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(4) Family planning facilitates increased public
spending per person in all sectors
Family planning contributes to achieving Millennium
Development Goals (MDGs): reducing poverty, ensure
reproductive health, universal education, access to
water and sanitation.
Reducing the number of unplanned births and having
smaller families helps to reduce the level of need for
public‐sector spending in health, water, sanitation,
education, and other
social services.
113
FP and MDGs
FP
End Hunger
and Poverty Increase
Education
Empower
Women
Improve
Infant
Health
Improve
Maternal
Health
Decrease
HIV/AIDS
Save the
Environment
Support
Global
Partnerships
(5) Family planning reduces the burden on natural
resources and the environment
• Family planning contributes to better management
and conservation of natural resources and eases
population pressure on local ecosystems by
reducing demand for water, trees, and farmland.
• Smaller families help to protect natural resources
and keep them from being overused and destroyed.
115
Linkages between reproductive health and income
116

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Analyzing Data to Assess the Needs of Family Planning
117
Change in Age‐Specific Fertility Rates Over Time
118
Change in Age‐Specific Fertility Rates Over Time
119
The least educated women have the lowest rates of
contraceptive use in Sub‐Saharan Africa
120

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The poorest women have the lowest rates of
121
The rural women have the lowest rates of
122
Global Contraceptive Use by Method
123
More than half of all reproductive‐age
women in developing countries are in need
of modern contraceptive
124

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32
Women who want to avoid pregnancy but do not use
a modern method account for a disproportionate
majority of unintended pregnancies
125
Sources: Singh S and J Darroch, 2012, and special tabulations of data for Singh S et al., 2009.
What is unmet need of family planning?
Women with unmet need are those who are fecund
and sexually active but are not using any method of
contraception, and report not wanting any more
children or wanting to delay the next child.
The concept of unmet need points to the gap between
women's reproductive intentions and their
contraceptive behaviour.
126
Use and Unmet Need among Adolescents Who
Wish to avoid pregnancy in the developing world
127
Use and Unmet Need among Adolescents Who
Wish to avoid pregnancy in the developing world
128

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129 130
131
Factors Associated with Unmet Need for Family Planning
• Location of residence: rural‐urban
• Religion
• Unemployment Status
• Lack of access to media messages
• Poverty
• Gender Inequality
132

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MPS 502: Fertility and Reproduction
Week 14: Fertility Transition in Bangladesh
133
Seetharam, K. M (2012) Twenty‐five Years of Transition in Asia’s Population and
Development: A Review of Progress and Potential, Asia‐Pacific Population Journal
I
134
Trends in Life Expectancy, 1950‐2015
135
Trends in Total Fertility Rate (TFR)
136

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Trends in Total Fertility Rate (TFR)
137
Age structure transition
138
Age Structure Transition
139
Age Structure Transition
140

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141
Trends of TFR in Sri Lanka
142
Changes in TFR in Sri Lanka and Korea
143
TFR in South Asia
144

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Determinants of decline and subsequent increase in fertility
Trends in Timing of Marriage
145
Trends in Contraceptive Use
146
Kabir and Uddin. (1987). Fertility Transition in Bangladesh :
Trends and determinants, Asia‐Pacific Population Journal, 2(4)
147
Fertility Transition in Bangladesh
148
Year Crude Birth Rate Crude Death Rate
National Rural Urban National Rural Urban
1981 34.6 35.7 24.8 11.5 12.2 7.2
1986 34.4 35.4 25.9 11.9 12.3 8.4
1991 31.7 32.9 23.9 11.0 11.5 7.3
1996 25.6 27.8 19.0 8.2 8.8 6.5
2001 18.9 20.7 13.6 4.8 5.2 4.3
2006 20.6 21.7 17.5 5.6 6.0 4.4
2011 19.2 17.4 20.2 5.5 5.8 4.8
Table 3: Crude Birth Rate (CBR) and Crude Death Rate (CDR) per 1000

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Trends in Age Specific Fertility Rates
149
150
151
Contraceptive Prevalence Rate, 1975‐1985
152

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39
Contraceptive Prevalence Rate, 1990‐2011
153
Adolescent Birth Rate, 10‐19 years
154
Unmet Need for Family Planning
155
I
I
156

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40
I
157
Changing age comnposition
158
Determinants of Fertility Transition in Bangladesh
• Age at Marriage
• Increased female education
• Increased Rate of Female Employment
• Increasing trend of individual income
• Higher Rate of Contraceptive Prevalence
• Percentage of Marriage
• Rate of Abortion
• Increased duration of breast feeding
159
160

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