Change in Age-Specific Fertility RatesOver Time(Births per 1,000 Women)1970-1975 2005-2010Age<strong>World</strong>More DevelopedLess DevelopedLeast Developed45-49 40-4435-3930-3425-2920-2415-19<strong>World</strong>More DevelopedLess DevelopedLeast Developed<strong>World</strong>More DevelopedLess DevelopedLeast Developed<strong>World</strong>More DevelopedLess DevelopedLeast Developed<strong>World</strong>More DevelopedLess DevelopedLeast Developed<strong>World</strong>More DevelopedLess DevelopedLeast Developed<strong>World</strong>More DevelopedLess DevelopedLeast DevelopedSource: United Nations, 2011a.0 50 100 150 200 250 300between 2000 and 2010 in 88 countries thatreceive donor support for contraception (Ross,Weissman and Stover, 2009). Due to earlierhigh fertility, many more people in developingcountries have now reached their reproductiveages, and meeting the contraceptive needs <strong>of</strong>many more women has contributed to only amarginal gain in the percentage covered.Globally, about three <strong>of</strong> every four sexuallyactive women <strong>of</strong> reproductive ages 15 to 49,who are able to become pregnant, but are notpregnant nor wanting to become pregnant,are currently using contraception (Singh andDarroch, <strong>2012</strong>). In every country <strong>of</strong> the world,most women who are educated and well-<strong>of</strong>fuse family planning. In East Asia, 83 per cent<strong>of</strong> married women use contraception (UnitedNations, Department <strong>of</strong> Economic and SocialAffairs, 2011). Conversely, in the poorestregions <strong>of</strong> the world, contraceptive prevalencerates are lowest and have increased most slowly.Contraceptive use among women in sub-SaharanAfrica in 2010 was lower than use amongwomen in other regions in 1990.Family size and contraceptive use changed dramaticallyworldwide in the 1970s, when coupleshad an average <strong>of</strong> five children per family. Todaythey have an average <strong>of</strong> 2.5 (United NationsDepartment <strong>of</strong> Economic and Social Affairs,2010). Increased contraceptive use is largelyresponsible for fertility declines in developingcountries (Singh and Darroch, <strong>2012</strong>). Thoughlevels <strong>of</strong> contraceptive prevalence have stabilizedsince 2000, the desire to have smaller familiesremains strong worldwide and is increasing indeveloping countries.Use varies according to income levelsMost surveys calculate national wealth scoresand disaggregate indicators by wealth quintile,from the poorest 20 per cent <strong>of</strong> the population18 CHAPTER 2: ANALYSING DATA AND TRENDS TO UNDERSTAND THE needs
through the wealthiest 20 per cent. Quintileanalyses <strong>of</strong> population-based surveys can helpidentify inequalities and family planning needswithin countries, especially in combination withdata on urban-rural and other important dimensions<strong>of</strong> access (Health Policy Initiative, TaskOrder 1, 2010).Because poverty takes on specific characteristicswithin a given setting, some researchersnow advocate for separate quintile rankings forurban and rural populations to paint a morecomplete picture <strong>of</strong> inequalities between povertyand wealth in both urban and rural areas.This approach makes it possible to compare thedifferent experiences <strong>of</strong> poor women in urbansettings and relatively wealthy women in ruralcommunities. Research from a 16-country studyacross Africa, Asia, and Latin America and theCaribbean finds strong relationships betweenfamily planning use, socioeconomic status,and place <strong>of</strong> residence (Foreit, Karra andPandit-Rajani, 2010).In countries such as Bangladesh, the prevalence<strong>of</strong> modern contraceptive use is the sameacross wealth quintiles in urban and rural settings:there is a nominal difference betweencontraceptive use among rich and poor in urbancommunities, and between the wealthiest andpoorest within rural settings (Demographicand Health Surveys, 2007). In Bangladesh, theprevalence <strong>of</strong> contraceptive use is greater (by 6per cent) in urban areas. Similar findings, whichsupport pro-rural strategies, have been found inPeru, which would warrant pro-rural programming,as would Bolivia, Ethiopia, Madagascar,Tanzania and Zambia (Health Policy Initiative,Task Order 1, 2010). In some countries, such asNigeria (DHS, 2008), modern contraceptive useincreases with increasing wealth for people wholive in urban and rural areas. The key differenceis the rate <strong>of</strong> change: wealthier people in ruralsettings report higher use <strong>of</strong> contraceptives thanthe urban poor. These results would supportpolicies that focus on reaching the urban poor,especially if similar patterns <strong>of</strong> disparities existamong indicators that measure adverse sexualand reproductive health outcomes.Educational achievement influencesdesired family size, family planning useand fertilityLevel <strong>of</strong> schooling is associated with desiredfamily size, contraceptive use and fertility. Ananalysis <strong>of</strong> 24 sub-Saharan African countriesshowed that the adolescents most likely tobecome mothers are poor, uneducated and livein rural areas (Lloyd, 2009). Birth rates aremore than four times as high among uneducatedadolescent girls ages 15 to 19 as amonggirls who have at least secondary schooling. Asimilar gap exists based on wealth and residence.And in these countries, the gaps are widening:births among adolescent girls between the ages<strong>of</strong> 15 and 19 with no education have increasedtHigh school studentsin Bucharest, Romania,read a leaflet aboutcondoms.©Panos/Peter BarkerTHE STATE OF WORLD POPULATION <strong>2012</strong>19
- Page 6 and 7: OverviewOne hundred seventy-nine go
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CHAPTERFOURThe social and economici
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tCommunityeducation inCaracas, Vene
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Estimates of Total Fertility2010-20
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children, and healthier women also
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empirical evidence supporting this
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tRicardo and Sarain Mexico City say
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to secure the future population’s
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86 CHAPTER 5: THE COSTS AND SAVINGS
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Unintended Pregnancies and outcomes
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tDonor Commitmentspanel at the Lond
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UNFPA supports the Health for All c
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tDr. BabatundeOsotimehin, Executive
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96 CHAPTER 6: MAKING THE RIGHT TO F
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When individuals are able to exerci
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Family planning programmes must ref
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Family planning programmes reinforc
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tPresident of NigeriaGoodluck Jonat
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring Monitoring ICPD ICPD Goa
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Monitoring ICPD Goals Demographic -
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Monitoring ICPD Goals - Selected In
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BibliographyAbbasi-Shavazi, Mohamma
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Delivering a world where every preg