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