A P P E N D I X E : W O R L D B A N K S U P P O R T F O R P O P U L AT I O N
The problems of high fertility and rapid population growth have regained prominence internationally and in the Bank’s population strategy. There is greater recognition that lowering fertility and population growth through demand-side activities alone will take a very long time, while simply providing family planning as part of a package of basic services is unlikely to raise contraceptive prevalence dramatically in high-fertility countries or to lower fertility among the very poor. Both demand- and supply-side activities are important. Universal
Figure E.1: Trends in Modern Contraceptive Use Rates, Case Study Countries
Modern contraception rate in earliest survey
based distributors. Both of these projects included important demand-generation activities. The Madagascar Second Health Program Support Project financed training and contraceptives, with a particular focus on a new, long-duration implantable contraceptive that is easily inserted and especially convenient in rural and remote areas. The number of locations offering family planning services increased by 45 percent from 2003 to 2007, and the contraceptive prevalence rate rose from 9.7 to 24 percent (World Bank 2008e). Unfortunately, the successful investment in pilot family planning activities in Malawi was not replicated nationally, and contraceptive use remains low, with little change (figure E.1). There has been virtually no improvement in Ghana despite support by the Bank and other donors for a health SWAp over the past decade, and there has been modest improvement in Bangladesh, despite the disruption in family planning services by the unpopular and ultimately failed attempt to unify the delivery of health and family planning services.
45 degree line
70 60
Vietnam (1997–2002)
50 Egypt (1995–2005) Bangladesh (1996–2004) Peru (1996–2004)
40 30
Nepal (1996–2006) Malawi (2000–2004)
20
Ghana (1998–2003)
10 Eritrea (1995–2002)
0 0
10
20
30
40
50
60
70
Modern contraception rate in latest survey Source: Nankhuni forthcoming, based on demographic and health survey reports (www.measuredhs.com) Note: Solid circle indicates that the change is statistically significant at 5 or 10 percent level, hollow circle indicates that the change is not statistically significant, and solid triangle indicates that it was not possible to determine statistical significance. Countries below the 45-degree line experienced improvements in uptake of modern contraception rates.
access to reproductive health was added as an MDG in 2007.7 The Bank’s 2007 population strategy (World Bank 2007g) differentiates between reproductive, maternal, and sexual health and the services that address them and factors that affect demographic outcomes. It links population, economic growth, and poverty reduction and advocates targeting assistance to the 35 countries with total fertility rates exceeding 5.0, many of which are also among the poorest countries in the world.
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