Repositioning Family Planning in Africa

Africa SOTANairobi

June 10-15, 2002

Population Priorities

Maximizing access and quality Contraceptive security Post-abortion care Youth reproductive health Population and environment Family planning and HIV integration Reemphasizing family planning in Africa

Population Increases: 2000 to 2025

Africa Population Pyramid: 2000 and 2005

Source: U.S. Bureau of Census.

MaleMale FemaleFemale

Age group 10 – 19 represents 24% of the total population

TFR Trends: Africa

Source: DHS for years indicated.

2

3

4

5

6

7

8

To

tal

Fe

rtil

ity

Ra

te

ZimbabweGhanaKenya

TFR Trends: All Countries

Source: Demographic and Health Surveys 1978-2000.

2

3

4

5

6

7

8

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Year

Tota

l Fert

ility

Rate

African Non-African

CPR Trends: Africa

* Percent of married women ages 15 to 49 using modern contraception.Source: Demographic and Health Surveys 1978-2000.

Co

ntr

ac

ep

tiv

e P

rev

ale

nc

e R

ate

Zimbabwe

Malawi

Kenya

CPR Trends: All Countries

Percent of married women ages 15 to 49 using modern contraception.Source: Demographic and Health Surveys 1978-2000.

0

10

20

30

40

50

60

70

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Year

African Non-African

Contraceptive Prevalence and Adult HIV Prevalence

Source: UNAIDS/WHO; DHS; UN. Hill K, et al. Estimates of maternal mortality for 1995, Bulletin of the World Health Organization 79(3), WHO 2001: 182-193.

5% - 9.9%

10% - 19.9%

1% - 4.9%

Over 20%

Modern Contraceptive Prevalence,

Married Women 15-49

Adult HIV Prevalence

1999

3% - 9.9%

10% - 14.9%

1% - 2.9%

Over 15%

0% - 0.9%

HIV and CPR RelationshipAdult HIV/AIDS Prevalence

CP

R (

mo

de

rn m

eth

od

s)

Botswana*KenyaLesotho*Malawi

Burundi*CAR*Cote d’IvoireEthiopiaMozambique

Higher (>8%) HIV Lower (<8%) HIV

Higher (>20%)

CPR

Lower(<20%)

CPR

NamibiaSouth AfricaSwaziland*Zimbabwe

RwandaTanzaniaUganda Zambia

AngolaBeninBurkina FasoCameroonChad*Comoros*CongoDR Congo

EritreaGabon*Gambia*GhanaGuineaGuinea Bissau*LiberiaMadagascar

MaliMauritania*Niger*NigeriaSenegalSierra Leone*Sudan*Togo

* Denotes countries where USAID does not work.

Lower HIV and Higher CPR

Higher HIV and Higher CPR98 million people

No SSA countries fall in this category

Lower HIV and Lower CPR340 million people

Higher HIV and Lower CPR175 million people

FP Use and Unmet Need

0

10

20

30

40

50

60

70

Perc

ent

Use Unmet Need

Unmet Need for Women:Age 15-19

Source: DHS, 1994-1998. Data re-produced from PRB, 2001.

20

2525

20

32

24

30

22

50

2728

4847

50

4346

40

7

43

50

0

10

20

30

40

50

60Married Unmarried, sexually active

Wo

me

n i

n n

ee

d o

f c

on

tra

ce

pti

on

(%)

* Senegal and Zimbabwe have data only regarding married women using modern methods.

Uganda: Unmet Need By Education

0

10

20

30

40

50

No Education Primary SecondaryWomen's Education

Per

cent

Met NeedUnmet Need

Uganda: Unmet Need by Residence

0

10

20

30

40

50

Urban RuralResidence

Perc

ent

Met Need

Unmet Need

Under Five Mortality:Three year birth intervals, or longer, are associated with the lowest mortality risk for the under five age group

0

0.5

1

1.5

2

2.5

3

<18 18- 23 24- 29 30- 35 36- 41 42- 47 48- 53 54- 59 60+

Duration of Preceeding Birth Interval (months)

Adj'd R

ela

tive

Odds

Rati

o

Source: Shea Rutstein, Effect of Birth Intervals on Mortality and Health: Multivariate Cross-Country Analyses, Presentation to USAID, July 27, 2000.

Maternal Deaths: Short birth intervals <14 months significantly increase the risk of maternal death. (one study, sample - 450,000 women)

0

0.5

1

1.5

2

2.5

3

0-5 6-11 12-17 18-23 24-59 60+

Interpregnancy Interval (months)

Adj.

Rela

tive

Odds

Rati

o

Source: Conde-Agudel and Belizán, Maternal Morbidity and Mortality Associated with Interpregnancy Inteval: Cross Sectional Study, British Medical Journal, 18 November 2000.

Summary

High fertility, but glimmers of hope High population growth overall, slowed

somewhat by HIV and in some countries will reverse

Low contraceptive use, under 20% in most countries

High unmet need, over 20% in most countries resulting in

Unwanted, mistimed pregnancies & abortion Child health impacts Maternal health impacts

Challenge

Maintain priority in face of HIV

Large cohorts entering reproductive age

Resource crunch due to AIDS crisis

Opportunities

High unmet need Successful models Capitalize on synergy with

HIV (social marketing, BCC, youth, policy, etc.)

Repositioning FP in MaliLessons Learned

Need for policy champions Lack of government coordination Contraceptive complacency Need for focused FP intervention Start with FP basics Encouraging NGO results, but high

cost/limited coverage Social marketing success

Repositioning FP in MaliActions

Long-term contraceptive planning Assessment of FP context Advocacy Strengthen national coordination

capacity Relaunch CBD FP a major CSP axis

Repositioning FP in MaliNext Steps

Design of intervention based on findings training service providers equip service delivery points

Operations research IEC strategies Policy dialogue

Repositioning FP in Malawi:History

1964 FP failed to take off 1982 child spacing program launched 1984 USAID provided TA and funding 1992 National Family Welfare Council

est 1993 name changed to FP Council 1999 MOHP takes over FP activities

Repositioning FP in Malawi:Achievements

CPR increases from 7-26% between 92-00 Injectables up from 6-16% between 96-00 Modern method knowledge up to 90% by 96 CBDAs trained and serving communities Contraceptive logistics mgt system Contraceptive supply assured GOM launched RH strategy in 01

Repositioning FP in Malawi:Critical Ingredients for Success

Government commitment and support Training of FP service providers training and retention of CBDAs Availability of contraceptive mix Contraceptive logistics management Proximity of health facilities/outreach Injectables Coordinated donor support