Meeting Objectives Present data on the status and trends of FP needs and programs in sub-Saharan...
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Transcript of Meeting Objectives Present data on the status and trends of FP needs and programs in sub-Saharan...
Meeting Objectives Present data on the status and trends of FP needs and
programs in sub-Saharan Africa.
Identify effective strategies to demonstrate the importance of strong FP programs within the context of health and development priorities in SSA.
Identify next steps to effectively mobilize existing resources to strengthen FP programs to address current health and development priorities in SSA.
Status and Trends of Family Planning in Sub-Saharan Africa
USAID Africa Bureau and
Global Bureau for Health
October 30, 2002
FP in Sub-Saharan Africa Task Force
Khadijat Mojidi Nomi Fuchs
Daniel KabiraKatharine KreisDaniel Halperin
Jyoti Schlesinger
Kendra PhillipsAdrienne CoxDana Vogel*
Population of Sub-Saharan Africa by Age and Sex: 2000 and 2005
Source: U.S. Bureau of Census.
MaleMale FemaleFemale
Age group 10 – 19 represents 24% of the total population
Fertility Decline in Selected World Regions, Early 1960s to 2002
6.7
5.8
6.7
6.0
2.7
2.5
2.5
1.6
5.4
3.0
2.74.6
0 1 2 3 4 5 6 7 8
Latin America
Asia
Sub-Saharan Africa
Developingcountries
Developedcountries
WorldEarly 1960s
2002
Children per woman*
* The average total number of children a woman will have given current birth rates.Source: US Bureau of the Census, International Data Base, September 23, 2002.
African Contraceptive Prevalence Rate Compared to Other Regions
Source: Population Reference Bureau, 2002.
Rate of Modern Contraceptive Prevalence among Married Women
13
43
5962
0
10
20
30
40
50
60
70
Sub-Saharan
Africa
North Africa Asia (exc luding
China)
Latin America
Wo
me
n u
sin
g c
on
tra
ce
pti
on
(%
)
Family Planning Data
Population/Family Planning Programs in Africa – 25 Programs
Ongoing Programs West Africa RegionalBenin ProgramDR Congo Burkina FasoEritrea CameroonEthiopia Cote d’IvoireGhana TogoGuineaKenyaLiberiaMadagascarMalawiMaliMozambiqueNigeriaREDSO/ESARwanda SenegalSouth AfricaTanzaniaUgandaZambiaZimbabwe
Strategic Objective in Population and Family Planning
Trends in Contraceptive Prevalence Rates: Select Countries
* Percent of married women ages 15 to 49 using modern contraception.Source: Demographic and Health Surveys 1978-2001.
Wo
me
n u
sin
g c
on
tra
ce
pti
on
(%
)*
Representative Contraceptive Prevalence Rates* (population in millions)
Source: Demographic and Health Surveys, most recent available data. No recent data available for Angola, DR Congo, Lesotho, and Swaziland. Total population, mid-2002. 2002 World Population Data Sheet, PRB, 2002.
* Married women, Modern Methods
Contraceptive Prevalence and Adult HIV Prevalence
Source: Report on the global HIV/AIDS epidemic. UNAIDS, July 2002; 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
2002
3% - 9.9%
10% - 14.9%
1% - 2.9%
Over 15%
0% - 0.9%
3.5
4
4.5
5
5.5
6
6.5
7
7.5
8
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Mali Ghana Kenya Madagascar SenegalTanzania Uganda Zambia Zimbabwe CameroonTogo Nigeria Ethiopia Malawi
Comparison of Total Fertility Rates for Selected African Countries: 1986-2000
Source: DHS for years indicated.
To
tal
Fe
rtil
ity
Ra
te (
ch
ild
ren
/wo
ma
n)
Use and Total Unmet Need* Women 15-49
0
10
20
30
40
50
60
Chad
1996
/97*
*
Niger 1
998
Nigeria
199
9
Benin
199
6
Camer
oon
1998
Ghana
199
8
Mal
i 199
6
Guine
a 19
99
Zambia
199
6
Burkin
a Fa
so 1
998/
99
Cote
d'Ivo
ire 1
998/
99
Togo
1998
Seneg
al 1
997
Liber
ia 19
86
Ethiop
ia 2
000*
*
Zimba
bwe
1999
Ugand
a 20
00/0
1
Kenya
199
8**
Mal
awi 2
000*
*
Use Total Unmet Need
Source: Demographic and Health Surveys.
*All women 15-49, modern methods.**Currently married women 15-49, modern methods.
Unmet Need for Contraception Among Adolescent Women Ages 15-19, by Marital Status
Source: DHS, 1994-1998. Data re-produced from PRB, 2001.
28
7
50
43
27
50
22
40
30
46
24
43
32
20
50
25
47
25
48
20
0
5
10
15
20
25
30
35
40
45
50
Cote d'Iv
oire
Ghana
Keny
a
Madag
asca
rMali
Mozam
bique
Sene
gal
Tanz
ania
Ugand
a
Zambia
Zimba
bwe
Married 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.
FP Summary Africa’s high fertility will ensure continued rapid growth
throughout most of the region and will surpass 1 billion in 25 years.
Twenty-one of the 25 countries that USAID supports has CPRs of less than 20%--with most under 10%.
High unmet need for family planning among all of reproductive age, especially adolescents who are risk for both pregnancy and HIV.
Data suggests need to revisit USAID programming in responding to country FP and HIV needs.
Maternal and Child Health Data
Western Africa1,040
Eastern Africa1,340
North Africa460
Central Africa 1,020
Southern Africa360
*Maternal deaths per 100,000 live births
Maternal Mortality Ratio*
Source: Kenneth Hill, Carla Abou Zahr, & Tessa Wardlaw: Estimates of maternal mortality for 1995. Bulletin of the World Health Organization, vol.79, no.3, 182-193.
Sub-Saharan Africa 1,100
South Asia 430
East Asia/Pac. 140
LAC 190
DevelopingCountries 440
Maternal Mortality andAdult HIV Prevalence
600 - 1,199
1,200 – 1,799
Less than 600
Over 1,800
Maternal Mortality Ratio(Maternal Deaths
Per 100,000 Live Births)
Source: Report on the global HIV/AIDS epidemic. UNAIDS, July 2002; DHS; UN. Hill K, et al. Estimates of maternal mortality for 1995, Bulletin of the World Health Organization 79(3), WHO 2001: 182-193.
Adult HIV Prevalence
2002
3% - 9.9%
10% - 14.9%
1% - 2.9%
Over 15%
0% - 0.9%
CPR and Maternal Mortality Ratio by Country
55.1
50.4
32
26.1
18.2 16.914.4
8.6 8.2 7.3 6.3 5.7
13.4
1059
867
586
11291198 1188
1841
630576
609
341
1339
1056
0
10
20
30
40
50
60
SouthAfrica1998
Zimbabwe1999
Kenya1999
Malawi2000
Uganda2000/01
Tanzania1999
Zambia1996
Ghana1998
Nigeria1999
Senegal1999
Coted'Ivoire1999
Ethiopia2000
Mali 2001
0
200
400
600
800
1000
1200
1400
1600
1800
2000CPR Maternal Mortality per 100,000 births
Source: Demographic and Health Surveys for CPR. Hill K, et al. Estimates of maternal mortality for 1995, Bulletin of the World Health Organization 79(3), WHO 2001: 182-193.
Pe
rce
nta
ge
of
wo
me
n u
sin
g m
od
ern
me
tho
ds
De
ath
pe
r 1
00
,00
0 b
irth
s
Maternal Mortality Summary
Maternal mortality rates in SSA are unacceptably high, ranging from 341 (South Africa) to 1841 (Ethiopia) per 100,000 women, nearly two to three times that of the rest of the developing world.
Most maternal deaths are due to: Closely-spaced births Complications during delivery and unsafe abortions Inadequate obstetrical care
Family planning could reduce maternal mortality by 20% or more.
Under 5 Mortality andAdult HIV Prevalence
Source: UNAIDS/WHO; U.S. Census Bureau
130-149
150-174
Less than 129
Over 175
Under 5 Mortality(Deaths per 1,000
Live Births)
Adult HIV Prevalence
2002
3% - 9.9%
10% - 14.9%
1% - 2.9%
Over 15%
0% - 0.9%
77.1
216.5
119.4
96.1
233.8
318.2
192.4
131.8
147.4
102.1
166.5
107.3 111.5
188.6
273.8
140.2 142.5151.5
0
50
100
150
200
250
300
350
Ethiopia 2000* Ghana '93,'98 Kenya '93,'98 Malawi '93,'00 Niger '92,'98 Nigeria '90,'99 Senegal'92/93,'99
Uganda '95,'00 Zimbabwe'94,'99
De
ath
s p
er
1,0
00
liv
e b
irth
s
Source: Demographic and Health Surveys of indicated years. UNIICEF for regional U5 mortality rates for 2000.
Under-Five Mortality Rates in Selected African Countries: two points in time
Note: Mortality rates given are for the five-year period prior to the survey. * In Ethiopia’s 2000 survey, the previous period is based on recall.
U5M Regional Averages:
SSA 172
South Asia 101
East Asia/Pac. 44
LAC 38
Dev. Countries 90
177.7166
155
142 142
125.2117
106 10498
52
185.9
102
6859
105102.3 99 95 91
66 64.467
59
0
20
40
60
80
100
120
140
160
180
200
Mal
i 19
96
Ethio
pia 2
000*
Mal
awi 2
000*
Burki
na Fas
o 199
9
Guinea
199
9
Togo 1
998
Uganda
2000
/01
Camer
oon 1
998
Ghana
1998
Niger
ia 1
999
Kenya
199
8
Seneg
al 1
997
Dea
ths
per
1,0
00 i
nfa
nts
un
der
ag
e o
ne
Less than two years At least 2 years
Infant Mortality by Birth IntervalOn average, infants born after short birth intervals are twice as likely to die as those born after intervals of two or more years.
Source: Country DHS Reports.* Figures here are only for a 2 year birth interval instead of a 2-3 year interval.
0 50 100 150 200 250 300
GabonGhanaKenya
South AfricaZimbabweSwaziland
NamibiaBotswana
TogoCameroon
LesothoBurundiNigeria
DR CongoUganda
CARCongo (Brazz.)
BeninCote d'Ioire
TanzaniaEthiopiaZambiaMalawi
RwandaBurkina FasoMozambique
Deaths per 1,000 live births
Without AIDS With AIDS
Under Five Mortality with and without AIDS: 2002
Source: Stanecki, K. The AIDS Pandemic in the 21st Century. Draft report XIV International Conference on AIDS, Barcelona, U.S. Bureau of Census, International Database, July 2002.
Infant and Child Mortality Summary
African children are 3-4 times more likely to die than children in other regions.
Infants are twice as likely to survive if the previous birth interval is at least 2 years. Very few children in SSA are spaced at a birth interval of 3 or more years.
Family planning can make a difference.
HIV and CPR Relationship Data
Spread of HIV over time in sub-Saharan Africa, 1984 to 2002
Source: WHO and UNAIDS June 2002.
Estimated percentage of adults(15–49) infected with HIV
20.0% – 36.0%10.0% – 20.0% 5.0% – 10.0% 1.0% – 5.0% 0.0% – 1.0%1994
1984 1989
2002
Adult HIV Prevalence Rates* (Adult population in millions)
Source: Report on the global HIV/AIDS epidemic, UNAIDS 2002. HIV prevalence data for Gabon, Guinea, Liberia, Mauritania, and Niger is from AIDS in Africa: Country by country, UNAIDS 2000.
* Adult HIV prevalence and population (15-49).
HIV and CPR Relationship
Adult HIV/AIDS Prevalence
CP
R (
mo
de
rn m
eth
od
s)
Botswana*KenyaLesotho*Malawi
Burundi*CAR*Cameroon Cote d’Ivoire
Higher (>8%) HIV Lower (<8%) HIV
Higher (>20%)
CPR
Lower(<20%)
CPR
NamibiaSouth AfricaSwaziland*Zimbabwe
MozambiqueRwanda TanzaniaZambia
AngolaBeninBurkina FasoChad*Comoros*CongoDR CongoEritrea
EthiopiaGabon*Gambia*GhanaGuineaGuinea Bissau*LiberiaMadagascar
MaliMauritania*Niger*NigeriaSenegalSierra Leone*Somalia*Sudan*TogoUganda * Denotes countries where USAID does not work.
Lower HIV and Higher CPR
Higher HIV and Higher CPR105 million people
No SSA countries fall in this category
Lower HIV and Lower CPR466 million people
Higher HIV and Lower CPR118 million people
HIV and CPR Relationship
Higher HIV/Higher CPR105 million
Higher HIV/Lower CPR118 million
Lower HIV/Lower CPR466 million
Lower HIV/Higher CPRNo SSA countries in this category
Ecological Relationship Between Male Circumcision and Heterosexual HIV Transmission
Sources: Halperin D, Bailey R. “Male circumcision and HIV infection: 10 years and counting.” Lancet 1999; 354:1813-5.
Notes: * Countries excluded from table for following reasons: 1) estimated proportion of men circumcised >20%, <80%; 2) similar risk factors for heterosexual HIV not present; 3) insufficient information; 4) very small countries.
** June 1998 UNAIDS/WHO percent estimates. *** If the predominately non-circumcising region of western Kenya, where seroprevalence is approx. 35%, is excluded, national prevalence would be approx. 8%.
<20% Circ. Seroprevalence** >80% Circ. Seroprevalence**
Zimbabwe 25.84 Kenya 11.64***Botswana 25.10 Congo (Braz.) 7.64Namibia 19.94 Cameroon
4.89Zambia 19.07 Nigeria 4.12Swaziland 18.50 Liberia 3.65Malawi 14.92 Sierra Leone 3.1Rwanda 12.75 Ghana 2.38
Benin 2.06
HIV-1 prevalence in African countries with similar risk factors for heterosexual HIV infection.*
World Population Projections by Region or Country
Source: PRB World Population Data Sheet, 2001.
24
13
21
17
9
12
5
25
16
18
17
9
95
26
20
17
17
974
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Pe
rce
nt
of
wo
rld
po
pu
lati
on
2001 2025 2050
Year
North America
Europe
LAC
India
China
Africa
Other Asia and Oceania
Even with the world’s worst HIV epidemic, the population growth rate in Africa will continue to increase at the most rapid rate.
Summary of HIV and CPR Relationship:
SSA countries with the worst HIV epidemics tend to have higher CPR, lower MMR, and lower TFR.
While AIDS has exploded in some SSA countries, HIV rates in most of Africa have remained at relatively low levels.
Epidemiological data on the male circumcision-HIV relationship suggests there may be limits to the spread of HIV in most West African and some other SSA countries, where male circumcision is widely practiced.
Most SSA countries (584 million people out of 688 million total) have very high FP needs, with CPR usually less than 20%. Of these, 466 million people live in countries with both very low CPR and HIV prevalence less than 8%.
Funding Data
0
100
200
300
400
500
600
1995 1996 1997 1998 1999 2000 2001
Year
Fu
nd
ing
Am
ou
nt
in m
illio
ns
Agency
Africa Bureau
USAID Population Funding Trends
Source: USAID Agency Funding Data, Global Population Office.
USAID PHN Funding Trends: SSAPopulation: 673 million
0
50,000
100,000
150,000
200,000
1995 1996 1997 1998 1999 2000 2001 2002
Year
Fu
nd
ing
Am
ou
nt
($0
00
s)
Health includes: Child Survival, Infectious Disease, Other Health, and Vulnerable Children (FY00-03)
Population
HIV/AIDS
Health
Source: Africa Bureau OYB.
Repositioning Family Planning
Africa’s population will continue to increase, averaging about 2.5% increase per annum.
While TFR has declined rapidly in other regions, fertility in Sub-Saharan Africa lags far behind - double that of Asia and Latin America.
There are 584 million people living in 35 SSA countries with contraceptive prevalence less than 20% (most less than 10%).
While HIV/AIDS has exploded in parts of southern and East Africa, West Africa (except Cote d’Ivoire and Cameroon) still has HIV prevalence of less than 8% (usually less than 5 or lower).
Approaches for Resuscitating FP in Sub-Saharan Africa
Promoting FP in HIV/AIDS Settings Promoting Child Spacing in Pre-natal
Settings Promoting Post Partum FP Addressing Unmet need, especially
youth Promoting Male involvement in FP
Questions and Answers