1) The population of sub-Saharan Africa is expected to quadruple to 4 billion by 2100, increasing pressure on social and economic resources. Family planning programs have proven effective in reducing fertility and population growth. 2) Family planning programs provide substantial benefits including empowering women, improving health outcomes, reducing environmental impacts, and facilitating economic growth. 3) Despite evidence that investments in family planning yield high returns, such programs receive only 1% of international development assistance. Increased priority and funding for family planning in sub-Saharan Africa is recommended.

1. DEMOGRAPHIC TRENDS IN SUB-SAHARAN AFRICA:
THE ROLE OF FAMILY PLANNING PROGRAMS
John Bongaarts
Population Council

2. 1) Trends in population and contraceptive use
2) Benefits of reduced fertility and population growth
3) Policy options: Family planning programs
Outline

3. 0
2
4
6
8
10
12
Billions
Population trends by world region
Africa
N. America
L. America
Europe
Asia
1950 2000 2050 2100
11.2
World total
7.3

4. 0
1
2
3
4
1950 2000 2050 2100
Billions Population projection Sub-Saharan Africa
4 billion
1 billion
Source: UN 2015

5.  Large investments in education, health, infrastructure
just to keep up with population growth
 Environmental degradation: water, arable land, pollution
 Food insecurity
 Economic stress: low savings, unemployment
 Social/Political instability
Consequences of rapid population growth:

6. 0
1
2
3
4
5
1950 2000 2050 2100
Ratio2015=1
Population size ratio (2015=1)
Senegal
Nigeria
Ethiopia
Indonesia
Bangladesh

7. 0
20
40
60
80
1960 1980 2000 2020 2040
%ofmarriedwomen Contraceptive use trends
Bangladesh
Indonesia
Ethiopia
Senegal
Nigeria

8. 0
20
40
60
80
1960 1980 2000 2020 2040
%ofmarriedwomen Contraceptive use trends
Bangladesh
Indonesia
Ethiopia
Senegal
Nigeria
Family planning
program onset

9. 2) Benefits of reduced fertility and
slower population growth

10.  Women’s empowerment
 Health
 Government
 Economy
 Environment
 Social/Political stability
Benefits for:

11. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
 Greater freedom to
determine the number
and spacing of children
Participate in the formal
labor force

12. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
 Reduced maternal mortality
 Improved infant and child health
 Fewer abortions

13. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
Reduced pressure on
schooling and health care
sectors and on infrastructure

14. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
Demographic Dividend
(Higher growth in GDP/cap)
Decline in fertility raises:
 Relative size of workforce
 Savings rate
 Investment in human capital
 Women’s formal labor force
participation

15. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
 Reduced pressure on natural
resources (water, soil, forest,
agriculture, energy, etc)
 Reduced air, water and soil
pollution

16. Empowerment
Health
Government
Economy
Environment
Social/Political
Benefits
Slower growth of youth
population, lower
unemployment

17. 3) Policy options to reduce fertility:
- Educate girls
- Family planning

18. SDG Target 3.7 :
“By 2030, ensure universal access to
sexual and reproductive health-care
services, including for family planning..”

19. Pregnancies in developing world (2012)
All pregnancies: 190 million
Unplanned 73 million
Abortions 36 million
Births 125 million

20. 0
10
20
30
40
50
60
Eastern Central Southern Western
Percent
% of pregnancies unintended
in Sub-Saharan Africa
Source: Sedgh 2014

21. Family planning programs reduce
unplanned pregnancies by
1) Providing access to contraceptives
2) Removing social/economic/cultural/health
obstacles to contraceptive use
3) Informing couples about benefits of longer birth
intervals and smaller families

22. 0
10
20
30
40
50
1974 1976 1978 1980 1982 1984 1986
ContraceptivePrevalence(%)
Successful FP experiment in Matlab,
Bangladesh
Experimental area
Control area
Source: Cleland et. Al 1994

23. 0
20
40
60
80
1960 1980 2000 2020 2040
%ofmarriedwomen Contraceptive use trends
Bangladesh
Indonesia
Ethiopia
Senegal
Nigeria
Family planning
program onset

24. 0 2 4 6
Indonesia
Philippines
Iran
Jordan
Bangladesh
Pakistan
Kenya
Uganda
Rwanda
Burundi
Births per woman
Natural experiments: Fertility impact
of weak vs strong FP programs
Weak
Strong
Source: Bongaarts et al 2012

25. 0
100
200
300
400
1950 2000 2050 2100
Millions
Population projections
Pakistan
Bangladesh
Source: UN 2015

26. 0
1
2
3
4
5
1950 2000 2050 2100 2150
Billions Alternative projections SS Africa
+0.5 births
Standard
-0.5 births
Source: UN 2015

27. 1) Population size of SS Africa is expected to quadruple
between 2015 and 2100 adding 3 billion
2) Family planning programs have demonstrated
effectiveness in reducing fertility and pop. growth
3) Substantial socioeconomic, health, environmental,
governmental and political benefits from fertility decline
Conclusions

28. Investments in family planning are highly
cost effective
“For every dollar spent in family planning, between 2
and 6 dollars can be saved in interventions aimed at
achieving other development goals”.
(United Nations 2009)
Benefit cost ratios for family planning programs: 90-150
(Copenhagen Consensus Center)

29. 0
50
100
150
200
Billions ODA by sector 2014
Family
Planning
1%
Source: OECD 2016
Education
Health
HIV/RH
Other social
Infrastructure
Production
Multi-sector
Other

30. Reasons for low priority of FP programs
1) Emphasis on health/rights and neglect of
economic benefits
2) AIDS epidemic
3) Opposition from conservative groups
4) Fear of coercion
5) Large fertility declines in Asia and L. America
during 1970s-1990s

31. Make Family Planning programs a development priority
• Engage economic decision makers and a wide
range of stake holders
• Increase investments in FP programs
• FP should be supported publicly by top
government officials
Policy recommendations