Contraception and abortion isn’t “just” a women’s issue it’s a development imperative as this extract from Owen Barder’s post on family planning in Ethiopia highlights.
Access to family planning and safe abortion is an important challenge in Ethiopia. With better primary health care and childhood immunization, infant mortality is falling, so families increasingly want to limit the number of children they have. The shift to smaller family sizes is a hugely important driver of development, known as the demographic transition. When a family has two or three children, all of whom are likely to survive, they are able to invest in the children’s nutrition, health and education, in a way that is impossible for most families with nine or ten children. This investment in each person then leads to higher incomes and better standards of living.
The desire to have smaller families is driven by a combination of rising incomes, improved life expectancy, lower infant mortality, better education and increased savings, as well as changing cultural and social norms. It is not clear whether it is possible to influence from the outside the rising demand for smaller families, and I personally have reservations about whether we should attempt to do so. But in Ethiopia, people want smaller families yet cannot access the services they need to achieve this.
Today Ethiopia and Germany have roughly the same number of people (around 82 million). But unless something changes, by 2050 Ethiopia is projected to more than double its population to 174 million, while over the same period Germany’s population is likely to decline to 72 million. The cause is simple: Ethiopia’s total fertility rate of 5.4 is four times greater than Germany’s rate of 1.3.
According to the Guttmacher Institute Ethiopia’s average family size is slowly declining, from 6.4 children per woman in 1990, to 5.9 in 2000, to 5.4 in 2005. Yet this fertility rate is still much higher than the average of four children per woman that people actually want to have. Many Ethiopian families want to reduce the number of children they have, but do not have access to the basic family planning services they need to do so. The study finds that 68% of sexually active women in Ethiopia have unmet need for contraception.
The Guttmacher Institute estimates that would it cost about $180 million a year to provide modern contraception to every Ethiopian woman who wants it (that’s the all in cost, including supplies, logistics, systems, and training). They estimate that there would be direct savings to the health service as a consequence of reduced pregnancies and unsafe abortions which would more than cover the costs.
And the results would be striking. If every woman who wanted to use family planning had access to modern contraception, each year in Ethiopia there would be 1 million fewer unwanted pregnancies, 340 thousand fewer abortions (a reduction of more than 80%), 130,000 fewer infant deaths and 6,500 fewer women dying in childbirth.
These benefits for individuals and families are compelling enough. But there would also be substantial benefits for the economy as a whole. As a rule of thumb a reduction in fertility of one child per family increases annual per capita GDP growth by a quarter of a per cent a year. Hence if Ethiopian women could achieve the reduction in family size they currently want, from 5.4 to 4.0, this would increase growth of GDP per capita by approximately 0.35% a year. Over a decade of sustained access to contraception, the effect would be higher incomes worth approximately the same as a 60% increase in today’s level of foreign aid. And because population growth would be slower, it would achieve the rare double benefit of increasing standards of living while reducing the pressure on natural resources and the environment.
The economic effect of access to family planning could be even greater because it enables a virtuous circle which plays an important part in the development process. As incomes rise, and education and health improve, families tend to want fewer children. For example, in Ethiopia over the next decade incomes per head may rise by more than 50%, which is likely to lead to a further fall in the number of children that Ethiopians want to have. But to meet this desire for smaller families, people need access to family planning. By setting off a virtuous circle of rising income per capita, lower desired family size, greater use of contraception, lower numbers of children, and so rising income per capita, a decade of access to modern family planning could have roughly the same effect on incomes in Ethiopia as the entire international aid programme does today. Owen Barder, Family planning in Ethiopia and the new UN strategy, Owen Abroad.
It is a startling revelation that something as simple as basic family planning can have such an impact.