1. Poverty & fertility decline: evidence & research needs Population Impacts on Economic Development: Research Conference London 1 st - 3 rd November 2006 Susannah Mayhew London School of Hygiene & Tropical Medicine

2. Global Context  Tension between “SRH” and FP  MDGs for ‘poverty alleviation’ – ignored then recognised population/SRH  Decline in FP funding and commodities, especially in Africa  Widespread assumption that population ‘problem’ is solved  Continuing rapid population growth & unmet need in Africa

3. 2000 need = 8 billion condoms 2015 need = 18.6 billion condoms Since 2001 29 LDCs lost all/some USAID condom & contraceptive supplies

4. Population Trends: no room for complacency Population Growth by Development Groups, 1950-2050 UN 2004 World Population Projections for 2005-2050

6. Impact of fertility decline on poverty  Strong evidence when fertility declines: Maternal mortality is reduced Child mortality is reduced Enrolment in primary education is increased Gender equality improves  Some evidence when fertility declines: Pressure on marginal lands is decreased Food and water security is enhanced Under/un-employment is reduced Risk of civil/political unrest is decreased

7. Maternal, neo-natal & child mortality; gender & education

8. Lifetime risk of dying from pregnancy, by fertility & MMR Source: Marston & Cleland 2004:8, recalculated from idea by Royston & Armstrong If unmet need in Africa was met 33-40% maternal deaths could be eliminated

9. Source: USAID, 2002.Birth Spacing: Research Update: p.1 1mil deaths of children under 5 could be averted if all birth intervals were above 2 years

10. Solutions for reducing maternal, neo-natal & child mortality  Reduce the total number of pregnancies (and therefore the lifetime risk of dying)  Prevent unwanted & high-risk pregnancies  Promote post-partum contraception  Offer alternatives to unsafe abortion  healthier, better educated children are less drain on economies & more economically productive; reduced human & social costs

11. Enhancing education & gender equality  Delay age at marriage (legislation) & first birth (FP)  Increase access to services (especially for adolescents: married & unmarried)  Policies to support female education & employment  Fewer, spaced births enhance opportunities for education, especially of girls … development benefits

12. Poverty, food/water security, employment & unrest

13. Poverty & hunger “ One of the ‘ bright spots ’ in development is that faster fertility decline can speed-up poverty reduction ” Professor Michael Lipton, University of Sussex  Depends on achieving & capitalising on ‘population dividend’

14. The ‘Population Dividend’ for Korea

15. Can Africa achieve a ‘population dividend’?

16.  Strong FP programmes  Delay age of marriage  Education, especially for women  Support of religious & community leaders for FP Economic Commission for Africa, 2002 Achieving the Dividend through policies & programmes

17. Can Africa capitalise on a ‘population dividend’?  Job Opportunities (incl. women) Asia’s ‘green revolution’ possible in Africa? Need strong pro-employment policies Attract foreign investment  Multiple stresses in a diverse continent AIDS Conflict Pressures on land and water

19. Poverty & pressure on fertile land & water In sub-Saharan Africa:  33 countries will double in 50 years  21countries have unmet contraceptive needs of >20%  28 countries rank in the lowest category of the Human Development Index  19 rapidly growing African countries: already lack fertile land, water, resources = humanitarian crises without massive and immediate fertility declines. (Alexandratos 2005) Niger, Mali, Burkina Faso, Somalia, Uganda will treble in size Population (2005)14 million Total Fertility Rate7.5 Desired number of children8.2 % using modern contraception4.6% Life expectancy45.4 years Infant mortality145 Adult literacy16% % child stunted38% HIV prevalence1.2% Projected population in 2050 if (a) Fertility remains constant80 million (b) Fertility declines to 3.6 by 205050 million Niger

20. Research Priorities thoughts from Anglophone group at the Paris Population & Development meeting Spring 2006

21. Research Priorities (1)  Understand better the links between demographic factors & socio-economic progress: Multi-disciplinary scenario building Research sub-national differences Sector specific research Conflict & demographic security Micro-level factors

22. Research Priorities (2)  Research on attitudes to child bearing/ family size and how change can be facilitated Policy analysis Human rights and women’s group Concept of inter-generational custodianship Social protection & reproductive intentions Mass media influences Reproductive choices for single women

23. Research Priorities (3)  Research into programmes & services Condoms for FP Post-partum contraception Integration of services Mobilising community support New & neglected technologies Contraceptive discontinuation Abortion versus contraception

24. Policy priorities: “ The lack of investment in family planning is a disaster … It ’ s time to wake up and look at the facts ” Professor John Cleland, London School of Hygiene & Tropical Medicine  Reduce Population Growth (long term)  Mitigate adverse consequences of rapid population growth (interim)