Achieving the Achieving the Millennium Millennium Development Goals Development Goals The contribution of family The contribution of family planning planning
Jan 15, 2016
Achieving the Achieving the Millennium Millennium
Development GoalsDevelopment GoalsThe contribution of family The contribution of family
planningplanning
Achieving the Achieving the Millennium Millennium
Development GoalsDevelopment GoalsThe contribution of family The contribution of family
planningplanning
Scott Moreland, Constella FuturesSandra Talbird, University of North Carolina, Chapel Hill
Countries ModeledCountries Modeled
The number of women of reproductive The number of women of reproductive age is large and growing.age is large and growing.
Projected women of reproductive age in Mali
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
Projected women of reproductive age in Nigeria
0
10,000,000
20,000,000
30,000,000
40,000,000
50,000,000
Source: SPECTRUM 2.38 Projections
The number of pregnancies will The number of pregnancies will continue to increase each year.continue to increase each year.
Pregnancies in Nigeria
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Pregnancies in Mali
0200,000400,000600,000800,000
1,000,0001,200,0001,400,000
Source: SPECTRUM 2.38 Projections
A significant percentage of these A significant percentage of these pregnancies are unintended or pregnancies are unintended or mistimed.mistimed.
Mistimed21%
Intended69%
Unintended10%
Mistimed27%
Intended62%Unintended
11%
Source: SPECTRUM 2.38 Projections
Total pregnancies
Nigeria 2003 Mali 2001
Many women want to space or limit Many women want to space or limit their births but do not use family their births but do not use family planning.planning.
Number of women using or wanting to use family planning
826,465179,260718,331
2,609,196
1,115,071
630,729625,558
3,499,636
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
Nigeria Madagascar Mali Ghana
Users Unmet Need
Source: DHS Users defined as married women of reproductive age (MWRA) currently using contraception Unmet need represents those who want to use family planning but are not currently doing so
Traditional Modern
NigeriaNigeria 35%35% 65%65%
MaliMali 30%30% 70%70%
GhanaGhana 26%26% 74%74%
MadagascarMadagascar 32%32% 68%68%
Percentage distribution of users by type of family planning method used
Use of less effective, traditional contraceptive methods is high.
Source: DHS, married women (Nigeria 2003, Mali 2001, Ghana 2003, Madagascar 2003/2004)
Meeting the unmet need for family Meeting the unmet need for family planning will increase the percentage planning will increase the percentage of women using family planning.of women using family planning.
CPR in Nigeria
05
101520253035
%
CPR in Mali
05
10152025303540
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
%
Source: Nigeria DHS 2003, Mali DHS 2001, married women
The The numbernumber of women using family of women using family planning will increase when unmet planning will increase when unmet need is met.need is met.
FP users in Nigeria
0
3,000,000
6,000,000
9,000,000
12,000,000
Need Met Base
FP users in Mali
0
500,000
1,000,000
1,500,000
2,000,000
Need Met Base
Source: SPECTRUM 2.38 Projections
Meeting the unmet need for family Meeting the unmet need for family planning will reduce unintended planning will reduce unintended pregnancies…pregnancies…
0500,000
1,000,0001,500,0002,000,0002,500,0003,000,0003,500,000
2005 2007 2009 2011 2013 2015
Unintended pregnancies in Nigeria
Need Met Base
0
100,000
200,000
300,000
400,000
500,000
2005 2007 2009 2011 2013 2015
Unintended pregnancies in Mali
Need Met Base
Source: SPECTRUM 2.38 Projections
……as well as reduce the number of as well as reduce the number of abortions.abortions.
0
300,000
600,000
900,000
1,200,000
2005 2007 2009 2011 2013 2015
Abortions in Nigeria
Need Met Base
0
50,000
100,000
150,000
200,000
2005 2007 2009 2011 2013 2015
Abortions in Mali
Need Met Base
Source: Henshaw et al., 1999, and SPECTRUM 2.38 Projections
……and therefore reduce the number of and therefore reduce the number of unintended births.unintended births.
0
300,000
600,000
900,000
1,200,000
1,500,000
1,800,000
2005 2007 2009 2011 2013 2015
Unintended births in Nigeria
Need Met Base
0
50,000
100,000
150,000
200,000
250,000
300,000
2005 2007 2009 2011 2013 2015
Unintended births in Mali
Need Met Base
Source: Calculated by authors based on unintended pregnancies, abortions, and spontaneous abortions
1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development
Reducing unmet need for family Reducing unmet need for family planning can help countries to meet planning can help countries to meet the MDGs by reducing the cost of the MDGs by reducing the cost of achieving the goals.achieving the goals.
Liz Gilbert, the David & Lucile Liz Gilbert, the David & Lucile Packard FoundationPackard Foundation Chamberlain Diala, JHU/CCPChamberlain Diala, JHU/CCP Chamberlain Diala, JHU/CCPChamberlain Diala, JHU/CCP
Focus on 5 Millennium Development Focus on 5 Millennium Development GoalsGoals
Achieve universal primary educationAchieve universal primary education Reduce child mortalityReduce child mortality Improve maternal healthImprove maternal health Combat HIV/AIDS, malaria and other Combat HIV/AIDS, malaria and other
diseasesdiseases Ensure environmental sustainabilityEnsure environmental sustainability
Calculating savings in the costs of Calculating savings in the costs of meeting the MDGs due to meeting the MDGs due to increased contraceptive useincreased contraceptive use
1.1. Project the population with constant FP Project the population with constant FP use and with unmet need fulfilleduse and with unmet need fulfilled
2.2. Calculate the costs of meeting the Calculate the costs of meeting the MDGs for each projectionMDGs for each projection
3.3. Compare the cost projections and Compare the cost projections and calculate the differencecalculate the difference
Contraceptive prevalence rate Contraceptive prevalence rate assumptions used to calculate assumptions used to calculate population scenariospopulation scenarios
Source: MEASURE DHS, Stat Compiler* Represents all women, not only married women
Current CPRCPR + Unmet
Need Annual %
Increase 2015Annual %
Increase 2020Burkina Faso 2003 13.8 42.6 2.4 1.7Cameroon 2004 26.0 46.2 1.8 1.3Chad 1996/97 4.1 13.8 0.5 0.4Ethiopia 2005 14.7 43.3 2.9 1.9Ghana 2003 25.2 59.2 2.8 2.0Guinea 1999 6.2 30.4 1.5 1.2Kenya 2003 39.3 63.8 2.0 1.4Madagascar 2003/2004 27.1 50.7 2.0 1.4Mali 2001 8.1 36.6 2.0 1.5Niger 1998 8.2 24.8 1.0 0.8Nigeria 2003 12.6 29.5 1.4 1.0Rwanda 2000* 7.4 25.1 1.5 1.0Senegal 1997 12.9 47.7 1.9 1.5Tanzania 1999 25.4 47.2 1.4 1.0Uganda 2000/01 22.8 57.4 2.3 1.7Zambia 2001/02 34.2 61.6 2.0 1.4
Unit costs applied to population Unit costs applied to population projections for each of the MDGsprojections for each of the MDGs
Sector Parameter Unit Cost(US$)
Family Planning Cost per couple-year of protection
$11.2
Education Cost per pupil $30-$75
Immunization Cost per fully immunized child
$17.0
Maternal Health Cost per birth $28.2-$37.3
Water/Sanitation Cost per beneficiary
$4.6
Malaria - ITN Cost per treated-net-year
$4.4
Achieve universal primary education
Ensure that by 2015, children everywhere, boys and girls alike, will be able to complete the course of primary schooling.
Primary education net enrollment rate
0%
20%
40%
60%
80%
100%
Burkin
a Fa
so
Camer
oon
Chad
Ethiop
ia
Ghana
Guinea
Kenya
Mad
agas
car
Mali
Niger
Nigeria
Rwanda
Seneg
al
Tanza
nia
Ugand
a
Zambia
Current MDG
Millennium Development Goals and Targets
Source: United Nations Statistics Division, 2000
Family planning use reduces the Family planning use reduces the number of school-aged children.number of school-aged children.
Annual number of children to be enrolled in primary education to meet
the MDG in Ghana (2005-2015)
1,000,0001,500,0002,000,0002,500,0003,000,0003,500,0004,000,0004,500,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
# ch
ild
ren
6-1
1 ye
ars
old
Base Need Met
Annual number of children to be enrolled in primary education to
meet the MDG in Mali (2005-2015)
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
3,500,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
# ch
ild
ren
6-1
1 ye
ars
old
Base Need Met
……which reduces the costs of meeting the which reduces the costs of meeting the primary education MDG.primary education MDG.
Cumulative primary education cost savings in Ghana
$0
$10
$20
$30
$40
$50
Mill
ion
s
Cumulative primary education cost savings in Mali
$0
$10
$20
$30
$40
$50
Mil
lion
s
$35.8m $37.8m
Note: Costs discounted by 3 percent
Reduce child Reduce child mortalitymortalityReduce by two thirds, between 1990 and 2015, the under-five mortality rate.
Percentage of children under 1 vaccinated for measles
0%
20%
40%
60%
80%
100%
Burkin
a Fa
so
Camer
oon
Chad
Ethiop
ia
Ghana
Guine
a
Kenya
Mad
agas
car
Mal
i
Niger
Nigeria
Rwanda
Seneg
al
Tanza
nia
Ugand
a
Zambia
Current MDG
Millennium Development Goals and Targets
Source: United Nations Statistics Division, 2000
Fulfilling unmet need reduces the Fulfilling unmet need reduces the number of children needing number of children needing vaccinations.vaccinations.
Annual number of children needing the measles vaccine to meet the MDG in
Nigeria (2005-2015)
01,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,000
# ch
ildre
n u
nd
er 1
yea
rs o
ld
Base Need Met
Annual number of children needing the measles vaccine to meet the MDG in
Madagascar (2005-2015)
0
200,000
400,000
600,000
800,000
1,000,000
# ch
ild
ren
un
der
1 y
ears
old
Base Need Met
Fulfilling unmet need generates cost Fulfilling unmet need generates cost savings by reducing the costs of meeting savings by reducing the costs of meeting the immunization target.the immunization target.
Cumulative measles vaccination cost savings in Nigeria
$0
$15,000,000
$30,000,000
$45,000,000
$60,000,000
Cumulative measles vaccination cost savings in Madagascar
$0
$3,000,000
$6,000,000
$9,000,000
$12,000,000
$15,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
$13 m$52 m
Note: Costs discounted by 3 percent
Fulfilling unmet need reduces the number Fulfilling unmet need reduces the number of child deaths by reducing the number of of child deaths by reducing the number of high-risk births.high-risk births.
Source: Child Survival Model, John Stover, Futures Group
Cumulative child deaths averted due to spacing and limiting births (2005-2015)
199,952
1,080,156
284,576185,960
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
Ghana Madagascar Mali Nigeria
De
ath
s a
ve
rte
d
Improve maternal mortalityReduce by three-quarters, between 1990 and 2015, the maternal mortality ratio.
Maternal mortality ratio (MMR)
0
200
400
600
800
1000
1200
1400
1600
Burkin
a Fa
so
Camer
oon
Chad
Ethiop
ia
Ghana
Guine
a
Kenya
Mad
agas
car
Mal
i
Niger
Nigeria
Rwanda
Seneg
al
Tanza
nia
Ugand
a
Zambia
De
ath
s p
er
10
0,0
00
liv
e b
irth
s
MDG Current
Millennium Development Goals and Targets
Source: United Nations Statistics Division, 2000
Fulfilling unmet need can reduce the Fulfilling unmet need can reduce the number of births over the next 10 number of births over the next 10 years.years.
Annual number of births in Nigeria (2005-2015)
0
2,000,000
4,000,000
6,000,000
8,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Bir
ths
Base Need Met
Annual number of births in Ghana (2005-2015)
0200,000400,000600,000800,000
1,000,000
Bir
ths
Base Need Met
Reducing the number of births generates Reducing the number of births generates savings for maternal health costs.savings for maternal health costs.
Cumulative maternal healthcare savings in Nigeria
$0$30,000,000$60,000,000$90,000,000
$120,000,000$150,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Cumulative maternal healthcare savings in Ghana
$0
$10,000,000
$20,000,000
$30,000,000
$40,000,000$39 m
$127 m
Note: Costs discounted by 3 percent
Fulfilling unmet need saves lives by Fulfilling unmet need saves lives by reducing the number of maternal reducing the number of maternal deaths.deaths.
Maternal deaths averted by reducing the number of pregnancies (2000-2015)
18,6884,007
2,12018,849
6,8216,512
2,91814,040
1,9873,962
12,7821,151
4,9621,954
16,8774,474
0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000
ZambiaUganda
TanzaniaSenegalRwandaNigeria
NigerMali
MadagascarKenya
GuineaGhana
EthiopiaChad
CameroonBurkina
Ensure Ensure environmental environmental sustainabilitysustainabilityBy 2015, reduce by half the proportion of people without sustainable access to safe drinking water and sanitation.
Percentage of population without access to safe water and sanitation
0
20
40
60
80
100
Burkin
a Fa
so
Camer
oon
Chad
Ethiop
ia
Ghana
Guine
a
Kenya
Mad
agas
car
Mal
i
Niger
Nigeria
Rwanda
Seneg
al
Tanza
nia
Ugand
a
Zambia
% o
f p
op
ula
tio
n
MDG Current
Millennium Development Goals and Targets
Source: United Nations Statistics Division, 2000
Fulfilling unmet need reduces the Fulfilling unmet need reduces the number of people needing safe water number of people needing safe water and sanitation.and sanitation.
Annual # of new people with access to safe water and sanitation in Nigeria
(2005-2015)
1,000,0002,000,0003,000,0004,000,0005,000,0006,000,0007,000,0008,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Base Need met
Annual # of new people with access to safe water and sanitation in Ghana
(2005-2015)
0
200,000
400,000
600,000
800,000
1,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Base Need met
The costs of achieving the safe water and The costs of achieving the safe water and sanitation goals are reduced by fulfilling sanitation goals are reduced by fulfilling unmet need.unmet need.
Cumulative cost savings to provide water and sanitation in Nigeria
$0$10,000,000$20,000,000$30,000,000$40,000,000$50,000,000$60,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Cumulative cost savings to provide water and sanitation in Ghana
$0$5,000,000
$10,000,000$15,000,000$20,000,000$25,000,000$54 m
Note: Costs discounted by 3 percent
$21 m
Combat HIV/AIDS, malaria and other diseases
By 2015, halt and begin to reverse the incidence of malaria and other major diseases
Percentage of children under 5 with an insecticide-treated net
0
20
40
60
80
Burkin
a Fa
so
Camer
oon
Chad
Ethiop
ia
Ghana
Guinea
Kenya
Mad
agas
car
Mali
Niger
Nigeria
Rwanda
Seneg
al
Tanza
nia
Ugand
a
Zambia
Current MDG
Millennium Development Goals and Targets
Source: United Nations Statistics Division, 2000
Fulfilling unmet need reduces the number of Fulfilling unmet need reduces the number of mosquito nets needed to reach the Abuja mosquito nets needed to reach the Abuja target of 60% coverage.target of 60% coverage.
Annual number of children under age 5 needing ITNs
in Nigeria (2005-2015)
0
5,000,000
10,000,000
15,000,000
20,000,000
Base Unmet Need
Annual number of children under age 5 needing ITNs
in Ghana (2005-2015)
0500,000
1,000,0001,500,0002,000,0002,500,0003,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Base Unmet Need
Reducing the number of mosquito nets Reducing the number of mosquito nets needed makes reaching the Abuja target needed makes reaching the Abuja target more affordable.more affordable.
Cumulative savings for reaching the ITN coverage goal in Nigeria
$0$2,000,000
$4,000,000$6,000,000$8,000,000
$10,000,000
$12,000,000$14,000,000
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Met
ric
To
ns
$12.7m
Cumulative savings for reaching the ITN coverage goal in Ghana
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
Met
ric
To
ns $4.2m
Note: Costs discounted by 3 percent
Weighing the Benefits and Costs of Weighing the Benefits and Costs of Meeting the MDGs by Fulfilling Meeting the MDGs by Fulfilling Unmet Need for Family PlanningUnmet Need for Family Planning
The costs savings for the MDGs The costs savings for the MDGs outweigh the costs of reducing unmet outweigh the costs of reducing unmet need.need.
FP CostsFP Costs
(Millions(Millions))
MDG MDG SavingSavingss
B/C B/C RatioRatio
FP Costs FP Costs (Millions(Millions))
MDG MDG SavingSavingss
B/C B/C RatioRatio
Burkina Burkina FasoFaso
$27.5 $80.9 2.95 MaliMali $35.8 $106.4
2.97
CameroonCameroon $14.7 $54.9 3.72 NigerNiger $28.6 $91.9 3.22
ChadChad $4.7 $25.0 5.29 NigeriaNigeria $139.5 $386.6
2.77
EthiopiaEthiopia $102.8 $208.5
2.03 RwandaRwanda $6.1 $28.2 4.59
GhanaGhana $54.0 $120.6
2.23 SenegalSenegal $42.7 $265.6
6.22
GuineaGuinea $20.8 $80.0 3.85 TanzaniaTanzania $71.6 $291.3
4.07
KenyaKenya $71.4 $270.6
3.79 UgandaUganda $97.4 $407.9
4.19
MadagascarMadagascar $25.5 $76.4 3.00 ZambiaZambia $27.2 $111.3
4.09
Fulfilling unmet need leads to health Fulfilling unmet need leads to health benefits as well as cost savings.benefits as well as cost savings.
MaternMaternal al
Deaths Deaths AvertedAverted
Child Child Deaths Deaths AvertedAverted
AbortionAbortions s
AvertedAverted
MaternMaternal al
Deaths Deaths AvertedAverted
Child Child Deaths Deaths AvertedAverted
AbortionAbortions s
AvertedAverted
Burkina Burkina FasoFaso
4,962 240,753 199,603 MaliMali 6,512 284,576 371,372
CameroonCameroon 1,954 96,357 N/A NigerNiger 6,821 280,203 652,384
ChadChad 1,151 56,857 151,557 NigeriaNigeria 18,849 1,080,156
1,207,568
EthiopiaEthiopia 12,782 1,144,767
1,953,170
RwandaRwanda 2,120 72,751 38,554
GhanaGhana 3,962 199,952 430,739 SenegalSenegal 4,007 213,277 406,135
GuineaGuinea 1,987 119,227 212,698 TanzaniTanzaniaa
18,688 495,786 1,065,044
KenyaKenya 14,040 434,306 1,242,254
UgandaUganda 16,877 796,296 1,176,963
MadagascaMadagascarr
2,918 185,960 391,037 ZambiaZambia 4,474 244,241 397,982
Achieving the MDGs will be a major Achieving the MDGs will be a major challenge.challenge.
These goals will be easier and cheaper to These goals will be easier and cheaper to achieve if contraceptive use increases as a achieve if contraceptive use increases as a result of fulfilling unmet need.result of fulfilling unmet need.
The additional costs of reducing unmet The additional costs of reducing unmet need for family planning are offset by need for family planning are offset by substantial MDG cost savings by 2015.substantial MDG cost savings by 2015.
In ConclusionIn Conclusion
Meeting the unmet need for family planning in Africa can help countries reach the MDGs.