Family Planning Still a Challenge for Many Poor Women

July 17, 2008—Over the last 30 years, birth rates have been falling steadily around the globe, but fertility levels and the pace of decline vary widely among and within countries, says a new World Bank report.

In most of the world today, women on average have three children or less.

However, in 35 of the world's poor countries, birth rates remain high, with an average of more than five children per mother. Thirty-one of these countries are in Sub-Saharan Africa; the rest are Timor-Leste, Afghanistan, Djibouti, and Yemen. The same countries also have low levels of education, high death rates, and extreme poverty.

This year's World Population Day, July 11, reaffirmed the right and ability to plan when to start a family and determine freely and responsibly the number and timing of children.

But for many poor women, obtaining this control to plan their families remains out of reach. Women in developing countries experience 51 million unintended pregnancies each year because of lack of contraception, according to the World Bank report, Fertility Regulation Behaviors and Their Costs.

"Giving women access to modern contraception and family planning also helps to boost economic growth while reducing high birth rates so strongly linked with endemic poverty, poor education, and high numbers of maternal and infant deaths," says Joy Phumaphi, the World Bank's Vice President for Human Development, and a former Health Minister in Botswana.

Education, Economic Opportunity Also Important

In addition to better health programs, Phumaphi says that improving girls' education, giving women equal economic opportunities, and lifting families out of poverty are also important for lowering birth rates.

Getting an education—even if only at primary school level—is a good predictor of low fertility, according to Sadia Chowdhury, a co-author of the report and Senior Reproductive and Child Health Specialist at the World Bank.

"Promoting girls' and women's education is just as important in reducing birth rates in the long run as promoting contraception and family planning," says Chowdhury.

Health and Teenage Pregnancy

Despite carrying a higher risk of pregnancy complications, teenagers are less likely to receive prenatal care, making them twice as likely to die during childbirth as women over the age of 20, according to the report.

The report also says that pregnancies spaced less than 15 months apart more than double the risk of the mother dying. Children born three years after a previous birth are healthier at birth and more likely to survive.