PLATEAUING CPR: TIPPING POINT PROGRAMMATIC ISSUES.
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Transcript of PLATEAUING CPR: TIPPING POINT PROGRAMMATIC ISSUES.
PLATEAUING CPR: TIPPING PLATEAUING CPR: TIPPING POINTPOINT
PROGRAMMATIC ISSUESPROGRAMMATIC ISSUES
PLATEAUING CPR: THREE STAGESPLATEAUING CPR: THREE STAGES
Beginning of the program Beginning of the program After take offAfter take off After reaching the ceilingAfter reaching the ceiling
MODERN METHOD MODERN METHOD CONTRACEPTIVE PREVALENCE RATE CONTRACEPTIVE PREVALENCE RATE IN EGYPTIN EGYPT
57.656.556.653.9
49.5
45.544.844.3
0
10
20
30
40
50
60
70
1991 1992 1995 1998 2000 2003 2005 2008
Average Annual Increase1991-95: 0.31995-03: 1.42003-08: 0.2
Source: Demographic Health Surveys
MODERN METHOD CONTRACEPTIVE PREVALENCE MODERN METHOD CONTRACEPTIVE PREVALENCE RATE RATE IN IN JORDANJORDAN
26.9
4241.941.239.839.239.838.7
37.7
0
5
10
15
20
25
30
35
40
45
1990 1997 1998 1999 2000 2001 2002 2007 2009
Average Annual Increase
1900-1999: 1.43 1999-2000: 0.22
Source: DHS-1990,1997, 2002,2007,2009; JAFS-1998,1999,2000,2001
MODERN METHOD CONTRACEPTIVE PREVALENCE MODERN METHOD CONTRACEPTIVE PREVALENCE RATE RATE IN IN BANGLADESHBANGLADESH
31.2
36.2
41.543.4
47.3 47.5
0
5
10
15
20
25
30
35
40
45
50
1991 1994 1997 2000 2004 2007
Average Annual Increase1991-2004: 1.242004-2007:0.07
Source: Demographic Health Surveys
QUESTIONS ON PLATEAUINGQUESTIONS ON PLATEAUING
Why do programs plateau?Why do programs plateau? How long do they remain How long do they remain
stagnant? stagnant? What has been done or needs to What has been done or needs to
be done to get out of such be done to get out of such situations? situations?
Is it possible to predict such Is it possible to predict such situations in advance? situations in advance?
REASONS BEHIND SLACKENED PACEREASONS BEHIND SLACKENED PACE
A limited method mixA limited method mix Program management weaknessesProgram management weaknesses Sheer growth of numbersSheer growth of numbers Changing demographic profile within the Changing demographic profile within the
reproductive yearsreproductive years Shift in attention to other programsShift in attention to other programs Diminishing returns at high prevalence ratesDiminishing returns at high prevalence rates
Source: John Ross et al Plateaus during the Rise of Contraceptive Prevalence, IFPP, 2004
COUNTRIES BY PACE OF FERTILITY COUNTRIES BY PACE OF FERTILITY DECLINE IN SUB-SAHARAN AFRICA AND DECLINE IN SUB-SAHARAN AFRICA AND ASIAASIA
Pace of Pace of
DeclineDeclineSub-Saharan AfricaSub-Saharan Africa Asia/North AfricaAsia/North Africa
No No Significant Significant DeclineDecline
CameroonCameroon
(Chad)(Chad)
Cote d’lvoireCote d’lvoire
EthiopiaEthiopia
GhanaGhana
(Guinea)(Guinea)
KenyaKenya
(Mali)(Mali)
MozambiqMozambiqueue
NigeriaNigeria
RwandaRwanda
TanzaniaTanzania
UgandaUganda
ZambiaZambia
ZimbabweZimbabwe
TurkeyTurkey
Significant Significant DeclineDecline
BeninBenin
Burkina FasoBurkina Faso
MadagascarMadagascar
MalawiMalawi
NamibiaNamibia
NigerNiger
SenegalSenegal
BangladesBangladeshh
EgyptEgypt
IndiaIndia
IndonesiaIndonesia
JordanJordan
MoroccoMorocco
NepalNepal
PhilippinPhilippineses
YemenYemen
(Vietnam(Vietnam))
Source: John Bongaarts, Fertility Transition in Developing Countries: Progress or Stagnation? 2008
REASONS FOR THE STALL IN REASONS FOR THE STALL IN FERTILITYFERTILITY
Changes in fertility preferences such as shifts Changes in fertility preferences such as shifts in marriage patterns, timing of initiating child in marriage patterns, timing of initiating child bearingbearing
Shifts in local/national policies, reduced Shifts in local/national policies, reduced budgets or donor supportbudgets or donor support
Increasing unmet need, unwanted child Increasing unmet need, unwanted child bearingbearing
Increasing negative attitudes towards family Increasing negative attitudes towards family planning or methodsplanning or methods
Changes in age structure of population and Changes in age structure of population and migration migration
Source: Ian Askew et al, Pop Council 2009
DECLINE IN TFR IN INDIA AND SELECT DECLINE IN TFR IN INDIA AND SELECT STATESSTATES
2.85
2.25 2.13
4.06 4.0
2.68
1.792.07
3.824.0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
India AP Karnataka UP Bihar
1999 2006
Source: NFHS 1998-99, 2005-06
TFR IN INDIAN STATESTFR IN INDIAN STATES
Source: SRS 2007
PLATEAUING CPR IN INDIAPLATEAUING CPR IN INDIA
Significant proportion of declines in fertility Significant proportion of declines in fertility and increase in CPR have come from select and increase in CPR have come from select statesstates
States that have achieved ceiling levels will States that have achieved ceiling levels will not significantly contribute to increases in not significantly contribute to increases in CPR and fertility declineCPR and fertility decline
States that have experienced plateau in the States that have experienced plateau in the past decade have to contribute to CPR past decade have to contribute to CPR increase significantlyincrease significantly
If not, India will enter into Plateauing phase If not, India will enter into Plateauing phase this decade.this decade.
HOW TO TACKLE PLATEAUS?HOW TO TACKLE PLATEAUS?
11Analyze data sets to understand contributions of Subgroups and prepare strategies
22
33
44
Keep FP program central to development efforts
Introduce new FP technologies if they are not part of current programs
Involve private sector in FP service delivery