1. 06_PVL_UK_APPG_Jun1 Population Growth, MDGs and Sexual and Reproductive Health Parliamentary Hearings UK All Party Parliamentary Group on Population, Development and Reproductive Health Paul F.A. Van Look, MD, PhD, FRCOG Department of Reproductive Health and Research World Health Organization London, 19 June 2006

2. 06_PVL_UK_APPG_Jun2 Outline Potential impact of (rapid) population growth on human development – The ultimate aim of the MDGs Role of sexual and reproductive health – Source – Consequence Access to sexual and reproductive health care and selected MDGs of (rapid) population growth

3. 06_PVL_UK_APPG_Jun3 Population growth/ discussions From 1950s to date – world's population tripled Malthus – to proportion the population to food, since the food cannot be proportioned to population Critiques – he failed to foresee the potential technological improvements that increase food production Neo-Malthusians – suggested policy actions in addition to provision of family planning

4. 06_PVL_UK_APPG_Jun4 Demographic transition Developed countries – completed, population sizes hardly changing Developing countries – mixed stages – Rapid falls in fertility, birth rates declined – India, Thailand, Bangladesh Unequal fertility – Fertility is still high in the least-developed countries

5. 06_PVL_UK_APPG_Jun5 Total fertility rate – number of children per woman (1990-2000) Below replacement level (2.1) in more developed countries Majority of developing countries are in transition to low fertility 50 countries (mostly in sub- Saharan Africa) – total fertility > 5 children per woman – They are also a long way off reaching the MDGs Source: UN Population Division, 2003

6. 06_PVL_UK_APPG_Jun6 Contraceptive met need* * currently married, sexually active women Source: UN Population Division

7. 06_PVL_UK_APPG_Jun7 Major consequences – effect of population growth on economic growth and development Diverse evidence – both negative and positive effects – Direction and size of the effect varies according to which stage of the demographic transition the country is in and its economic/political context – Positive effect of declining fertility on economic growth – greater in poorer countries and those with initial higher fertility levels (Eastwood and Lipton 2001) – Economic growth is driven by adequate human capital (educated, skilled, healthy population) (Strulik 2005, Barro 2001, Rosenzweig 1990)

8. 06_PVL_UK_APPG_Jun8 Major consequences – dynamics of rapid population growth/ effects on human capital Migration → rapid urbanisation Typical age structure – 40% of the population under age 15 Increasing inequalities (poorer people tend to have more children) Increased needs Schooling Employment Sexual and reproductive health – in case of unmet need for family planning, high fertility persists Challenges to build human capital

9. 06_PVL_UK_APPG_Jun9 The role of sexual and reproductive health Source of population growth – high fertility in least developed countries – unequal distribution of fertility (fertility differentials between rich and poor) in middle income countries – due to socio-economic and cultural factors as well as unmet need for family planning Sexual and reproductive health services should be able to respond when high fertility is due to limited availability/provision of family planning or information about them

10. 06_PVL_UK_APPG_Jun10 The role of sexual and reproductive health Consequences of population growth – age structure, migration, increased inequalities The needs of increasing number of people at reproductive ages should be met to better build human capital – Family planning needs – Consequences of unsafe sex (second leading risk factor to health) – sexually transmitted infections (STI), HIV/AIDS – Pregnancy-related morbidity/mortality

11. 06_PVL_UK_APPG_Jun11 Sexual and reproductive health and selected MDGs MDG 3 – achieve gender equality – Women's ability to control their fertility is not by itself sufficient to gaining their full empowerment and achieving gender equality, but it is the first and most important step (Oppenheim 2005)

12. 06_PVL_UK_APPG_Jun12 Sexual and reproductive health and selected MDGs MDG 4 – reduce child mortality – Better care for women during pregnancy and at the time of delivery has a positive impact on newborn health – thus contributing to achieving goal 4 (Darmstadt 2005, Feresu 2005)

13. 06_PVL_UK_APPG_Jun13 Sexual and reproductive health and selected MDGs MDG 5 – improve maternal health – All components of sexual and reproductive health directly impact reaching goal 5 Family planning (at least a quarter of maternal deaths could be avoided if women were able to avoid unplanned pregnancies – Freedman 2005 ) Prevention and treatment of complications during pregnancy/delivery/postpartum, including complications of unsafe abortion Prevention and treatment of STIs including HIV/AIDS

14. 06_PVL_UK_APPG_Jun14 Sexual and reproductive health and selected MDGs MDG 6 – combat HIV/AIDS – Presence of a sexually transmitted infection increases acquisition of HIV (Cohen 1997, Robinson 1997) – Small reductions in maternal HIV prevalence or in unintended pregnancy are more effective in reducing new HIV cases among infants than prevention of transmission of virus from mother to infants by using antiretroviral drugs (Sweat 2004) – Family planning services in sub-Saharan Africa might be preventing more HIV infections of infants than prevention of transmission of virus from mother to infants (Reynolds 2005 )

15. 06_PVL_UK_APPG_Jun15 Conclusion Population growth is still a problem where socio- economic development is also limited – High fertility in least developed countries – Higher fertility in poorer segments of middle-income countries Consequences of rapid population growth could restrain building human capital Focus on sexual and reproductive health is crucial in addressing both the sources and human capital implications of population growth – achieving development Access to sexual and reproductive health care is a major contributor to achievement of gender- and health-related MDGs