Currently, about one in seven (15%) of the world’s people live in Africa. By 2050, it will be closer to 1 in 4 (24%). Most of this growth will occur in sub-Saharan Africa, due to a current annual increase in population of 2.6%. Population growth is high because the average woman in sub-Saharan Africa has more than five children.
Fertility Rate, 2009 or Latest Available Data
Source: (World Bank 2011)
With reductions in overall mortality rates through improvements in sanitation, immunisation, and improved access to modern health care, death rates have dropped. Yet birth rates have remained high, resulting in high population growth, with a large proportion of children dependent upon working-age adults. In 39 African countries, 40% or more of the population is under 15 years of age.
Birth rates in Africa are high in large part due to low use of family planning; 29% of African women who are married or in union use contraception, compared with an average of 61% worldwide. 11 African countries have contraceptive prevalence rates of 10% or less, meaning that fewer than 1 in 10 women of childbearing age who are in union use family planning.
Contraceptive Prevalence, 2009 or Latest Available Data
Source: (World Bank 2011)
Many women in Africa who do not want any more children, or who want to delay their next pregnancy, are not using contraception. This unmet need for contraception is often due to a poorly funded and supplied health system, a lack of information and access to health care, and the disagreement of her male partner, family, and/or religious or cultural leaders. In addition to the availability of contraceptives, social norms such as age at marriage, desired family size and gender norms also contribute to a woman’s ability to access and use contraceptives, and her ultimate fertility behaviour. Women's empowerment and decision-making in many African countries is limited — for example, 47% of Ugandan men indicate that family size is primarily their decision.
Low contraceptive prevalence and high unmet need in Africa not only contribute to high fertility, but also to high maternal mortality. On average, countries with higher family planning use have lower rates of maternal mortality. Recent estimates of maternal mortality show that African countries have some of the highest maternal mortality ratios globally - in the Central African Republic, there are an estimated 1,570 maternal deaths per 100,000 live births.
Maternal Mortality Ratio Per 100,000 Livebirths, 2008
Source: (Hogan et al. 2010:11)
Addressing the unmet need for family planning can contribute directly to reducing maternal and child mortality. This is because the use of family planning services helps to reduce the number of high-risk pregnancies that result in high levels of mortality. Addressing unmet need in ten African countries would avert 94,307 maternal deaths and more than 5 million child deaths by 2015.
Countries with Higher Family Planning Use Have Lower Maternal Mortality
Source: (United Nations Population Division 2011) and (ORC Macro 2011)
In addition to maternal risks, gender inequalities also increase women’s vulnerability to HIV/AIDS. Young women have higher rates of infection than young men. For example, in South Africa, the prevalence of HIV among young women in the 20-24 age group is 21% while the prevalence of young men in their same group is 7% — a three-fold difference.
High fertility and large, growing numbers of young people put high pressure on social service provisions - for health care, education, the transportation sector, and infrastructure in general. Fulfilling women’s unmet need for family planning results in cost savings over time in other development sectors. Research has found that every dollar invested in family planning in Zambia and Kenya will result in a cost saving of four dollars in other priority development areas such as education, immunisation, water and sanitation, maternal health and malaria.
Most African countries have policies that address high rates of fertility and accompanying health and population issues, but for a variety of reasons, these policies remain under-funded and often under-implemented.
In addition to pledging to meet the global reproductive health targets of the Millennium Development Goals (MDGs) and ICPD, Africa has its own regional commitments, including pledges to provide universal access to sexual and reproductive health in all African countries by 2015 and to commit 15% of annual budgets (excluding external financing) to the health sector. After ten years, only South Africa and Tanzania have met their promise.
The real costs of financing a health system are at least $60 per capita per year, with the most basic interventions for public health costing $34 per capita. Meeting the MDGs and the goals to combat HIV/AIDS costs up to $150 per capita. The median level of real per capita government spending from domestic resources on health in Africa is now $12.20, with a range of the lowest spending per capita at $0.47 and the greatest at $ 316. The governments of 33 African countries currently spend less than $33 per capita on health. Official development aid (ODA) to Africa for health currently averages $13 per person in recipient countries, but with high variations between countries -12 countries received less than $5 per person while another received $115 per person.
Total Expenditure on Health Per Capita at Purchasing Power Parity, 2009
Source: (WHO 2011b)
It is clear that the current spending levels of African and donor governments are not enough to meet the needs of women to safely plan their families, much less achieve all of the MDGs. Ensuring universal access to family planning as part of a broader programme to guarantee reproductive health and rights is clearly a much-needed step towards addressing some of Africa’s health and gender challenges.
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