tDonor Commitmentspanel at the LondonSummit on FamilyPlanning.©Russell Watkins/UK Department forInternationalDevelopment2008 to 27 per cent today. In Southeast Asia,the rate rose from 50 per cent to 56 per centover the same period. Between 2008 and <strong>2012</strong>,an average annual increase <strong>of</strong> 1.7 per cent inmodern-method users translated into 42 millionadditional married women using family planning.Singh and Darroch (<strong>2012</strong>), with their newmeasures <strong>of</strong> unmet need, recalibrated to includeestimates <strong>of</strong> sexually active never-marriedwomen, calculate that <strong>of</strong> the 1.52 billion women<strong>of</strong> reproductive age in developing countries, 867million have a need for family planning in <strong>2012</strong>.The needs <strong>of</strong> about three in four <strong>of</strong> thosewomen are being met. The needs <strong>of</strong> one in four<strong>of</strong> them, however, are not.Funding fails to keep pace with needDonor and government support for sexual andreproductive health, especially family planning,has been shrinking at a critical time, whennearly 2 billion young people are entering theirreproductive years. Meanwhile, many developingcountries have not made sexual and reproductivehealth a priority in their health sectors(<strong>Population</strong> Council, 2007; Birungi et al., 2006).At the same time, sexual and reproductive healthhas lost ground to “competing” health issues,such as infectious diseases, because the field hasfailed to persuade power brokers—such as policymakersand donors—to increase funds.The Programme <strong>of</strong> Action <strong>of</strong> the InternationalConference on <strong>Population</strong> and Development,ICPD, called on international donors to coverone-third <strong>of</strong> the costs for sexual and reproductivehealth, including family planning, and developingcountries themselves to contribute two-thirds<strong>of</strong> the total.Both developing countries and donorcountries have fallen short <strong>of</strong> this target. Forexample, to meet the family planning needs<strong>of</strong> current users <strong>of</strong> modern contraception in2010, donors had been expected to contributeabout $1.32 billion but actually contributed$822 million—about one-third less thanthe target amount.The shortfall may be attributed to budget cutsin some donor countries but also to changes inthe way a country decides to allocate resources.The United <strong>State</strong>s, for example, a major contributorto international family planning, has placeda growing number <strong>of</strong> countries on a “graduation”list. As countries “graduate,” they are seen as nolonger requiring the same level <strong>of</strong> support theyonce enjoyed. Countries slated for graduationare those with a total fertility rate <strong>of</strong> 3.0 or lessand a modern contraceptive prevalence rate <strong>of</strong> 55per cent or more (Bertrand, 2011). Countries inLatin America have been especially affected bythe graduation process, since some <strong>of</strong> the region’sministries <strong>of</strong> health have not filled the void asUnited <strong>State</strong>s funding ends or is phased out.90 CHAPTER 5: THE COSTS AND SAVINGS OF UPHOLDING THE RIGHT TO FAMILY PLANNING
Extending access to meetthe unmet needProviding contraceptives to the current 645million users in the developing world costs $4billion a year. Improving the quality <strong>of</strong> theseservices would cost an additional $1.1 billiona year, according to the recent GuttmacherInstitute estimates. Providing modern methods<strong>of</strong> contraception, with improved services, to the222 million women with unmet need wouldraise costs an additional $3 billion a year. Thus,the cost <strong>of</strong> fully meeting the needs <strong>of</strong> all womenin developing countries and improving the quality<strong>of</strong> services would together total $8.1 billion ayear. Meeting all need for modern contraception,coupled with improving the quality <strong>of</strong> services,would raise the average annual cost per userin the developing world from $6.15 to $9.31(Singh and Darroch, <strong>2012</strong>).The cost <strong>of</strong> meeting unmet need is highestin sub-Saharan Africa and the poorest countries<strong>of</strong> other regions where capacities for deliveringservices are weakest. Committing to meeting theunmet need would therefore require a shift inthe allocation <strong>of</strong> donor resources. The 69 poorestcountries now receive about 36 per cent <strong>of</strong>donor resources for family planning. That sharewould need to increase to about 51 per cent.Providing modern contraceptives toall who need them in <strong>2012</strong>would meanincreasing current costs by $4.1 billionDirect costsContraceptive commodities and suppliesHealth worker salariesProgramme and system costs (P&S)U.S. dollars (billions)Current level <strong>of</strong> P&S costAdded P&S cost for current usersP&S for serving women with unmet need10864$4.0BillionTO MEET100%OF THENEED FORMODERNMETHODSWOULDINCREASECOSTS$4.1BILLION$8.1BillionCASE STUDYAccountability in Sierra LeoneCorruption is enormously costly to any healthsystem. Before and after the end <strong>of</strong> Sierra Leone’scivil war, more than 50 per cent <strong>of</strong> drugs andmedical supplies destined for public health facilitieswent unaccounted for (<strong>UNFPA</strong>, 2011a).The supply chain faced a lack <strong>of</strong> transparency,poor record keeping, poor management <strong>of</strong>drugs and theft <strong>of</strong> drugs from the public systemthat were then resold to private pharmacies.20Current level<strong>of</strong> careSource: Singh & Darroch <strong>2012</strong>To meet 100%<strong>of</strong> the need forfamily planningTHE STATE OF WORLD POPULATION <strong>2012</strong>91
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OverviewOne hundred seventy-nine go
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The report is structured to answer
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viiiCHAPTER 1: THE RIGHT TO FAMILY
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“All human beings are born free a
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Treaties, conventions and agreement
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Health: a social and economic right
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“Everyone has the right to educat
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designing and delivering accessible
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use, and reduces unintended pregnan
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16 CHAPTER 2: ANALYSING DATA AND TR
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Change in Age-Specific Fertility Ra
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Sexuality, sexual and gender stereo
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not necessarily associated with a d
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METHOD EFFECTIVENESSMethod, rankedf
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tCouple visiting a ruralfamily plan
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Demand and supply over time5 per ce
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contribute to high unmet need (Sing
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abortions in the region lead to mor
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(as stated in the Convention on the
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arriers prevent individuals from ac
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