Country Contexts

Demographic diversity ranges from rapid growth and large youth population in some countries to aging and declining fertility in others. Megatrends are reshaping entire societies through climate change, migration and urbanization. And humanitarian crises from natural disasters to violent conflicts are disrupting lives and livelihoods. These megatrends are testing the capacity of health systems even as demand grows.

Family planning has a role in each context. First, it protects “reproductive intentions” regarding each person’s ideal family size and desire for more children. History has shown that fertility policies designed to increase or lower birth rates are very often ineffective and can undermine women’s rights.

The use of modern contraceptives (prevalence) is lowest in countries where the number of women and girls who want to avoid pregnancy but are not using contraception is highest (unmet need). Maternal death is also high. The Lancet article, Measuring contraceptive method mix, prevalence, and demand satisfied by age and marital status in 204 countries and territories, 1970–2019: a systematic analysis for the Global Burden of Disease Study 2019, provides a comprehensive look at CPR, mCPR, demand satisfied and methods in 204 countries from 1970-2019.

Different contexts call for different responses:

Humanitarian settings

Family planning is an intervention that cuts across sectors and contributes to reaching vulnerable populations with life-saving care that reduces the impact of acute shocks, such as natural disasters and conflicts, as well as chronic stresses, such as political instability and food insecurity. Over 500 women die in pregnancy or childbirth every day in humanitarian and fragile settings. Access to a full range of sexual and reproductive health services, including emergency contraception, are essential components of humanitarian response.

Low-fertility contexts

For regions with low fertility, a successful family planning approach would also include fertility services. According to the latest population estimates, 66% of the world population are living in countries that are below replacement level fertility of 2.1 children per woman. Women and men may have fewer children than they want to have.

A recent UN study says greater gender parity in the labor force would do more to sustain economies in aging, low-fertility societies than setting targets for women to have more children. One step is to expand comprehensive sexuality education (CSE) to protect the right to health and empower individuals to achieve their reproductive health intentions – whether that means larger or smaller families. CSE can address issues of secondary infertility, or age-related infertility, to increase knowledge.

High-fertility contexts

For regions that have very high fertility, make sure there is good access to family planning information and services and a way to procure good quality contraceptives. Sub-Saharan African countries have high fertility rates and large youth populations entering their reproductive years, yet other factors must be recognized, including the rapid decline in mortality as people live longer and healthier lives, individual struggles with infertility, and the momentum of past growth through 2050 even as fertility rates are declining.

Smaller numbers of children per household generally lead to larger investments per child, more freedom for women to enter the formal workforce and more household savings for old age. When this happens, the national economic payoff can be substantial. This is a "demographic dividend."

Hard-to-reach groups

Pockets of disparity may be obscured by national statistics. Look closely at the modern contraceptive prevalence rate and sub-regional data to understand if groups of adolescents and women are being overlooked because of geography (urban/rural) or ethnicity, among other factors. These are people at the center of the principle “leave no one behind."

Exclusionary factors drive discrimination and inequality, creating disadvantages and deepening exclusion. Consider the barriers to access and complex social norms surrounding a variety of intersecting factors:

Low gender equality
Age
Culture, ethnicity, race, language, religion
Income/wealth
Location

Disability
HIV and AIDS status
Migration, asylum, displacement, refugee status
Sexual orientation and gender identity

Population dynamics

Global demographics are changing rapidly: Two-thirds of people are living in low fertility contexts, while eight countries will account for half the projected growth in global population by 2050 (the Democratic Republic of the Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, the Philippines and the United Republic of Tanzania), dramatically reordering the world’s ranking of most populous countries.

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Did you know...

You can view unmet need, demand satisfied, mCPR, and the number of modern method users by country with this interactive map developed by the Track20 Project, which is implemented by Avenir Health. Track20 works directly with governments in participating countries to collect, analyze and use data to monitor progress annually in family planning and to actively use data to improve family planning strategies and plans. Click the image below to view Track 20's interactive map.

The S-Curve: Putting mCPR Growth into Context

Track20's S-Curve visualizes how context informs programming. Historical data shows that modern contraceptive prevalence (mCPR) grows in an S-shaped pattern. This is characterized by slow growth and little annual change when mCPR is low (Stage 1), an opportunity for rapid growth in the middle during the transition from low to high mCPR (Stage 2), and slowing growth as mCPR reaches its maximum (Stage 3). While all countries will go through this general pattern, the duration and speed of growth seen in each stage will vary. Understanding this concept provides countries with a template that can assist in:

Identifying program priorities
Setting realistic targets for growth and contraceptive prevalence goals
Maximizing the potential of obtaining the demographic dividend

Source: Track20

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Watch Pape Amadou Gaye, Founder and President of the Baobab Institute, emphasize the role local leadership plays in sustaining family planning outcomes and support.