2009 UN policy brief on how to accelerate fertility decline in the least developed countries *
UN Population Division Policy Brief
No. 2009/1 March 2009
What would it take to accelerate fertility decline in the least developed countries?
Fast population growth, fueled by high fertility, hinders the reduction of poverty and the achievement of other internationally agreed development goals. While fertility has declined throughout the developing world since the 1970s, most of the least developed countries still have total fertility levels above 5 children per woman.
Furthermore, universal access to reproductive health, one of the key goals of the Programme of Action adopted by the International Conference on Population and Development (ICPD) in 1994 and reaffirmed by the World Summit in 2005, is still far from being achieved and unmet need for family planning in the least developed countries remains high.
Thus, particularly in the least developed countries, satisfying the unmet demand for modern family planning methods would reduce fertility, moderate population growth and have several beneficial effects on maternal and child health that would contribute to the achievement of other key Millennium Development Goals. Given the synergies between improved access to family planning and other development goals, for every dollar spent in family planning, between 2 and 6 dollars can be saved in interventions aimed at achieving those other goals.
This policy brief provides an overview of fertility trends and changes in selected indicators of reproductive health in the least developed countries and a discussion of the policies that underpin them.
For purposes of this brief, the less developed regions include all the countries and areas of the world except Australia, Canada, Japan, New Zealand, the United States of America and all countries in Europe. The group of least developed countries (LDCs) includes the 49 countries designated as such by the General Assembly. The rest of the countries in the less developed regions, as a group, are designated by the term developing countries.
Fertility trends and contraceptive use in the least developed countries
Because most countries in the less developed regions have experienced major reductions in fertility since 1970, high fertility is concentrated today in few countries and is particularly prevalent among the 49 least developed countries, 31 of which had fertility levels above 5 children per woman around 2005.
Among the rest of the countries in the less developed regions, that is, the developing countries, only Cameroon and Nigeria still have such high fertility levels.
Furthermore, fertility remains high in the least developed countries as a group. Thus, in 2005, women in the least developed countries had, on average, twice as many children as women in developing countries. The majority of least developed countries have long been characterized by high fertility, although in the 1960s and early 1970s, high fertility was common in most countries of the less developed regions.
Yet, even as early as 1970, total fertility in the least developed countries as a group was nearly one child higher than that in the group of developing countries (6.5 vs. 5.6 children per woman). Moreover, whereas fertility declined rapidly in most developing countries, it has declined very slowly in the majority of the least developed countries. Overall, the fertility of developing countries dropped from 5.6 children per woman in 1970 to 3.6 by 1985 and reached 2.8 children per woman by 1995.
In contrast, the fertility of the least developed countries dropped by just 0.4 of a child from 1970 to 1985 (from 6.5 children per woman to 6.1) and was still a high 5.4 children per woman in 1995.
Despite the commitments made by Governments at the time of the 1994 International Conference on Population and Development, fertility in the majority of the least developed countries continued to decline slowly after 1995. Thus, in 27 of the 49 least developed countries, total fertility has dropped by less than one child since 1995 and, in eight, fertility has remained virtually unchanged or has even increased. Only in 14 least developed countries has fertility declined by over one child per woman.
Increases in the use of modern contraceptive methods have contributed significantly to the rapid reduction of fertility achieved by developing countries since 1970. Although modern contraceptive use has increased in several least developed countries, such increases have not been sufficient to meet demand.
In the least developed countries of sub-Saharan Africa, for instance, the level of modern method use has doubled since 1995, rising from 6 per cent to 12 per cent, but the current level would have to triple by 2015 in order to satisfy existing demand.
In 31 of the 49 least developed countries, total fertility exceeds 5 children per women. Only two developing countries, Cameroon and Nigeria, have similarly high fertility levels The persistence of high fertility in the majority of the least developed countries and the slow fertility reductions observed among them are associated with high levels of unmet need for family planning.
It is estimated that, in the least developed countries as a group, 23 per cent of women of reproductive age who are married or in union have an unmet need for family planning. This level compares unfavourably with that estimated for the group of developing countries, where unmet need stands at 9 per cent.
The level of unmet need is particularly high in the least developed countries located in sub-Saharan Africa (27 per cent) and in those with total fertility exceeding 5 children per woman (28 per cent). Furthermore, in half of the 34 least developed countries having the requisite data, at least a quarter of all women of reproductive age who are married or in union have an unmet need for family planning.
Such high levels of unmet need suggest that the reduction of fertility could be accelerated if effective measures were taken to satisfy the unmet demand for family planning.
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