UN Population Division, Department of Economic and Social Affairs,
with support from the UN Population Fund (UNFPA)
|
| UN Population Division, Department of Economic and Social Affairs, with support from the UN Population Fund (UNFPA) |
|
Population Network News
No. 1, October, 1992
Part IV
Demographic and Health Survey Results: Dominican Republic
---------------------------------------------------------
The TFR in the Dominican Republic fell from 4.3 in the period 1980-82
to 3.3 in the period 1988-1991, according to the 1991 Demographic and
Health Survey. This TFR is right in line with the average for Latin
America, as shown in a recent PRB (Population Reference Bureau)
publication (see the citation on page 10). Both level of education and
location of residence are strongly correlated with fertility -- women
with higher or university education have a TFR one-half that of
uneducated women(2.5 and 5.2 children per woman, respectively).
Similarly, rural women have, on average, higher fertility (TFR of 4.4)
than those living in urban areas, where the TFR is 2.8. Fertility also
shows great variation among the regions of the DR.
Levels of contraceptive use are correspondingly high, with 56 percent of
women in union using a contraceptive method at the time of the survey, a
level close to the regional average. The most popular method is
sterilization (adopted by 39 percent of women in union), followed by the
pill (used by 10 percent), the IUD, and other modern or traditional
methods.
Publications of Note
---------------------
Jose Garcia-Nunez, Improving Family Planning Evaluation, A Step-by-Step
Guide for Managers and Evaluators, a publication of Pathfinder
International (Hartford, CT: Kumarian Press, May 1992). Targeted
principally to family planning program managers, this reference manual
aims to provide practical analytical tools, and includes sample workplans
and charts, as well as explanations of statistical analysis and data
collection techniques.
H. Yuan Tien, et al., "China's Demographic Dilemmas, "Population
Bulletin, Vol. 47, No. 1 (Washington, D.C.:Population Reference Bureau,
Inc., June 1992). Detailing the history and results of China's
"strategic demographic initiatives (SDI)", this Bulletin examines both
the extent to which China has managed to control population growth, and
the demographic challenges that remain in the form of rapid urbanization,
an ageing population, and the impact of population momentum on the labor
force, education and health systems, and the environment.
Population Crisis Committee, Access To Affordable Contraception, Report
on World Progress Towards Population Stabilization, (Washington, D.C.:
Population Crisis Committee, July 1992). Based on data from a Population
Council survey, this report calculates the yearly cost of private sector
contraceptives in 110 countries as a percentage of annual GNP per capita,
by method. For example, the cost of one year's supply of condoms
bought in the private sector in Burundi would cost almost 50% of the
average annual income. The report also estimates the percentage of
couples with access to free or low cost contraception through the public
sector, which in Burundi ranges from 10 to 60%, depending on the region.
Copies of this progress report are available from PCC.
Oral Contraceptives and Neoplasia, A Report of a WHO Scientific Group,
WHO Technical Report Series No. 817 (Geneva, Switzerland: World Health
Organization, 1992). This booklet summarizes the results of an extensive
review of the major studies of the possible links between use of oral
contraceptives and cancer, including its own multi-center research study.
The report confirms the general safety of oral contraceptives with
respect to various cancer risks, except for the usual contra indicated
groups. The Group also reviewed research findings from developing
countries, and found that there appears to be no significant difference
in the medical evidence between industrialized and developing countries.
In conclusion, "the Scientific Group recommends no changes to family
planning policies concerning the use of oral contraceptives."
Karen G. Foreit, Private Sector Approaches to Effective Family Planning,
WPS940, August 1992. As part of the PPAS review of effective family
planning program approaches,this paper investigates experience with and
prospects for increased private sector involvement in providing family
planning. Foreit looks at why the private sector should be involved, how
the private sector should be defined, what the experience has been to
date, what might be expected in the future, and what steps donors should
take to encourage the private sector.
Rodolfo A. Bulatao and Eduard Bos, Projecting the Demographic Impact of
AIDS, WPS941, August 1992. While the debate continues over how to most
accurately measure the demographic impact of AIDS, this paper puts forth
a simple model for investigating the effects of the AIDS pandemic in
Africa. After setting forth the model and its assumption, the authors
apply it to Zaire. Using this simplified model, the implications for
Zaire are serious: tens of thousands of deaths in five years; hundreds of
thousands after 20 years.
Population Reference Bureau, Fertility & Family Planning in Latin
America: Challenges of the 1990s, A Chartbook (Washington, D.C.:
Population Reference Bureau,Inc., June 1992). This very useful and
well-presented compilation of statistics lays out the past and future
trends of fertility and family planning in Latin America. It documents
the fall in the TFR for Latin America from about 6 in 1960 to under 3.5
in 1990. The challenges of the future also receive attention, including
improving access to under-served groups, expanding method choice, and
increasing funding to meet increasing demands.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID cee19sPfnTO1v07pbjlPBQ)
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Archive PHNFLASH PNN1C Population News
Population Network News
No. 1, October, 1992
Part III
Maternal Mortality in Nigeria
------------------------------
As noted in Africa Health, the Nigerian Minister of Health recently
claimed that fifty percent of maternal mortality in that country is
the result of unsafe abortion. For the full story, see Africa Health,
Vol. 14, No. 3.
AIDS and HIV Update
--------------------
Using the best available date sources, the World Health Organization
(WHO) has released new global and regional estimates on the incidence
of HIV infection and AIDS. A few startling -and saddening-
statistics:
o Between 9 and 11 million adults are estimated to have been
infected with the HIV, of which 1.5 million have developed AIDS;
o In developed countries, men account for a larger proportion
of AIDS cases, while in developing countries the disease affects
men and women in about equal proportions.
o To date, almost one million children have been born HIV-positive
on a global scale. In addition, "90% of all children born to
HIV-infected women are estimated to be in sub-Saharan Africa."
o While the incidence of AIDS in developed countries is expected to
peak in the mid-1990s, developing countries will most likely continue
to see increases in HIV infections and AIDS. So much so that "there
can be no doubt that during the next several decades, AIDS in most
developing countries will become the leading cause of death among
adults in their most productive years, and will also be one of the
leading causes of infant and child mortality in many regions."
Contraceptive Break-Throughs
-----------------------------
o A new once-a-month injectable, Cyclofem, has recently been
developed by WHO's Special Programme of Research, Development, and
Research Training in Human Reproduction. Similar to other injectables,
Cyclofem may be preferred by many women because it is less likely than
Depo-Provera and Noristerat (3-month and 2-month injectables) to
disrupt menstrual cycles and cause other side effects. Mexico and
Indonesia will most likely make Cyclofem available later this year;
Thailand is expected to do so in 1993. The World Bank supports HRP
through a Special Grant Program. The Bank is also supporting the
manufacture of Cyclofem by an NGO for distribution in developing
countries.
o A U.S. Food and Drug Administration (FDA) advisory panel
recommended approval of Depo-Provera in June. Final approval would
both give women in the U.S. access to Depo-Provera, and allow the U.S.
to provide Depo-Provera to women in other countries through A.I.D.'s
population program. The change of mind on Depo was largely due to the
evidence of its safety derived from HRP's international study.
IPPF Report Expands Unmet Need Concept
--------------------------------------
The 1991-1992 annual report of the International Planned Parenthood
Federation includes a special report that expands the concept of unmet
need for family planning (usually defined as women who want to space
or limit births but have no effective means of doing so) to include
women who are currently using a temporary method (pills, IUDs,
injections, condoms, etc.) but are likely to discontinue that use.
Using Demographic and Health survey data for 12 countries, the report
estimates that more than half of the women using these methods are
likely to discontinue use within a year. Reasons for discontinuation
include dissatisfaction related to side effects or a spouse's
disapproval, as well as difficulties in obtaining additional supplies
after the method was first adopted. The calculation adds 111 million
married women in reproductive ages (out of a total of 200 million
users of these methods) to current estimates of unmet need, which
range from 100 to 300 million women, depending on how broad or narrow
a definition one uses.
PCC Critique of Family Planning in China and India
---------------------------------------------------
Population Crisis Committee authors Sharon Camp and Shanti Conly have
written two thoughtful and thorough-going reviews of family planning
in China and India. The reports, China's Family Planning Program:
Challenging the Myths and India's Family Planning Challenge: From
Rhetoric to Action sum up PCC's assessment of the two programs. On
China, the report states that "not only are tens of millions of rural
couples still without good access to family planning services, but
those who are reached by government programs may have to deal with
inconsiderate, poorly trained staff under pressure to meet unrealistic
targets." They report that the situation is even worse in India,
where many local family planning staff single-mindedly focus on
sterilization targets. On the positive side, they note renewed
official commitment to improvement of family planning in India, but
caution that implementation remains a challenge. The reports call for
greater concern for women's reproductive health needs, better training
and public education, and a focus on quality.
Family Size and Support of the Elderly in Thailand
----------------------------------------------------
One of the concerns about reducing birth rates in developing countries,
and therefore a potential obstacle to the adoption of family planning, is
the possible erosion of familial care and support of the elderly.
However, a recently published study of this phenomenon in Thailand by
John Knodel, Napaporn Chayovan and Siriwan Siriboon found little evidence
that support for the elderly was adversely affected by smaller family
size. Because the current generation of older people in Thailand
completed their reproductive lives before the onset of rapid fertility
decline in that country, the study is based on the experiences of those
groups. It found little difference in patterns of co-residence with adult
children and other forms of material support between elders who had large
and small families. In fact, adult care givers who grew up in smaller
families were, on average, more likely to be earning higher wages and
thus able to provide more substantial material contributions to their
parents.
Demographic and Health Survey Results: Cameroon
------------------------------------------------
The Cameroon Demographic and Health Survey conducted in 1991 brings some
positive news about population in Cameroon. Fertility has fallen somewhat
in this central African country, with a TFR of 5.9 (down from 6.4 in
1978). For Sub-Saharan Africa as a whole, the TFR is approximately 6.5.
In addition, knowledge about contraception is more widespread than in
other African countries, with more than 70 percent of women indicating
that they know of at least one method of family planning, traditional or
modern. Nevertheless, only 50 percent answered that they knew of a place
to get modern methods. The contraceptive prevalence rate (CPR) for
modern methods is estimated at only four percent, and rises to 16 percent
when all methods are included.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID cee19sPfnTO1v07pbjlPBQ)
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archive_replace PHNFLASH PNN1A Population-Related World Bank Work
Population Network News
No. 1, October, 1992
Part I
Bank Projects Under Preparation
--------------------------------
* Iran - Primary Health Care and Family Planning Project (Identification)
A project Identification Mission for the family planning component of
the Iran Primary Health Care and Family Planning Project took place on
July 3 to 17, 1992, with Bassam I. Ramadan and Randy Bulatao
representing the Bank. The team found the Government of Iran to be
highly committed to the family planning project, and desirous of Bank
assistance in the formulation of a sound project design and management
system. During the mission, Messrs. Ramadan and Bulatao were treated to
a World Population Day seminar, where senior government officials and
religious leaders confirmed their commitment to slowing population
growth in Iran. Two themes emerged: the linkages between population
growth and various sectors of the economy; and the importance of
women's education and status for reducing population growth.
The Initial Executive Project Summary allocates a $125 million
IBRD loan to the project. Sub-components of the family planning
effort include: expansion of the contraceptive method mix; developing
a Human Reproduction Center for population and family planning
research and training; strengthening capacities in IEC (Information,
Education, Communication); and strengthening the management of the
program. Project preparation continues, with presentation to the
Board scheduled for June 1993.
* Pakistan - Second Family Health Project (Appraisal)
This project seeks to improve the health status of two provinces,
Balochistan and the Punjab; increase the effectiveness of the health
care network; and build institutional capacity. Within these
objectives, the project targets maternal health services, including
family planning and the provision of contraceptives (the purchase of
which IDA will fund). One important element of this effort is an
increase in the number of female paramedical workers through training
and recruitment, and continuing efforts to train the dais (traditional
midwives).
In Pakistan, the Ministry of Population Welfare (MPW) administers
the Population Program and operates its own clinics and service
delivery system. The MPW remains under considerable federal control,
and its facilities are largely independent of the government health
services system. Consequently, although official government policy
requires the provision of family planning services in all GOP health
facilities, such services are generally not offered. Targets have
been set, and agreed to by the GOP, to increase the provision of these
services in the project provinces to 50 percent by the end of 1994,
and 100 percent by July 1996. Other elements of maternal and child
health will, of course, also be provided. Progress on this front
would bring better maternal health services to a country which
suffers from a maternal mortality rate of 600 per 100,000 live
births, and experiences a population growth rate of 3.1 percent
per annum -- one of the highest in Asia. Total project costs
will be $112.8 million, of which an estimated $47 million will be
from IDA.
*Uganda Second Health and AIDS Project (Identification)
The country of Uganda suffers from high rates of HIV/AIDS infection,
infant mortality, and rapid population growth (3.3%p.a.), coupled with
relatively few resources to devote to the health care system. To
address these problems, the GOU and the World Bank are preparing a
Second Health and AIDS Project to follow the First Health Project,
which is currently ongoing. Three components are envisioned for the
project: strengthening district and national primary health care
delivery,including essential assistance to the war-ravaged areas of
the North and Northeast; AIDS control; and population. Within a focus
on safe motherhood, child spacing and child care programs, the
population component will also seek to increase the availability of
contraceptives (especially condoms), target young adults (particularly
adolescent girls), and strengthen the capacity to make and implement
population policy. Total costs for the proposed project are estimated
at $75 million, $50 million of which will be financed by IDA.
Co-financing is expected from WHO, UNDP, UNICEF, and USAID. The
project preparation mission will take place this fall.
* Philippines - Women's Health and Safe Motherhood Project
(Preparation)
A preparation mission to the Philippines in July was made to lay
the groundwork for the Women's Health and Safe Motherhood project.
This project has evolved from discussions with the Government in
support of the shift from the National Family Planning Program's long
standing goal of fertility reduction to a focus on family planning as
a major reproductive health intervention. As such, family planning
would be one of the key interventions in the adoption of a
"birth-based" approach to provision of women's health services; under
this approach, maternal and child health services would be targeted to
newly pregnant women. These women and their children would then be
followed through the reproductive cycle, thus focussing on the
most vulnerable. The proposed project would support the services
that comprise this birth-based approach. The new Secretary of
Health expressed a high level of political commitment by the new
Government to women's health issues, and the desire of the DOH to
move rapidly on project preparation. The project is expected to
have three main components:
o a service delivery component, including family
planning;services for safe pregnancy and birth (focused on
gynecological and obstetrical complications and emergencies); and
other priority women's health interventions, including sexually
transmitted disease control and counselling services;
o an institutional development component to strengthen the
core DOH units managing these services, and to promote
collaboration between the DOH, local government units, NGOs and
local communities to improve access; and
o efforts to test new ways to deliver women's health services
and measure their impact on health status. During the recent
mission, the team gathered information on maternal health and
reproductive health care in the Philippines. Information on
these topics is limited and further research and baseline date
will be needed for project design. The DHS (Demographic & Health
Survey) survey scheduled for next spring (the first Philippines
DHS) should provide additional information, as should a Safe
Motherhood Conference tentatively scheduled for next May. The
mission learned that there is increasing evidence of rising levels
of hospital admissions due to unsafe abortion and of increased
adolescent fertility. Since abortion is illegal in the Philippines
and the national family planning program targets married couples,
creative thinking will be needed as to how to provide health
support in these socially sensitive areas.
Bank Sector Work
-----------------
* Philippines - Family Planning Program (grey cover)
The Bank sector report New Directions in the Philippines Family
Planning Program (Oct. 1991) provided an analytic base for the recent
shift in the Philippines National Family Planning Program from a goal
of fertility reduction to a focus on family planning as a major
reproductive health intervention. For the report, analysis by
demographer John Casterline of Brown University (USA) found that the
new health-oriented family planning strategy had the potential to
yield significant health and demographic results. Looking at unmet
need for family planning on the basis of both health (age, parity and
spacing) and fertility preference criteria, the report found extensive
overlap in the two potential client groups, indicating a high degree
of client receptivity if the family planning program stressed
reproductive health concerns. Most importantly, the analysis noted
that if pregnancy were avoided by women under the age of 20, over 35,
with 4 or more children, and less than 15 months post-partum, both the
infant and child mortality rates would decline by almost 25 per
cent and the number of infant and child deaths would decline by
35 to 50 percent.
* Bangladesh - Population and Health Sector Study (green cover)
As a poor, largely rural country with high mortality and asocial
system that keeps women from participating in the public sphere,
Bangladesh should not, under most theories of demand for children, see
a decline in fertility. However, this study documents a significant
decline in fertility between 1975 and 1990, from a TFR of about 7 to
one well below 5. The analysis concludes that this striking decline
in fertility is the result primarily of an increase in contraceptive
use, from about 3 percent in 1971 to 40 percent in 1991. The effects
of other proximate determinants of fertility (age at marriage,
postpartum in fecundability), as well as various social and economic
factors, are examined, but found to be dominated by the increase
in contraception. This report highlights the importance of political
commitment and a comprehensive family planning program in motivating
the behavioral changes that increase contraceptive use: "Fertility
decline in Bangladesh demonstrates that success is possible even in
constrained societal settings. If policies are implemented with
sustained resolve, fertility decline is possible, even in the absence
of rapid economic development and social change."
* Chad - Population Health and Nutrition Sector Report(yellow cover)
Slowing the rapid pace of population growth must be a priority for the
government of Chad if it wishes to improve the health and well-being
of its citizens, who suffer from high rates of maternal and child
mortality and little access to contraceptives, according to this
report. A 1965 law still in effect prohibits the import, distribution
and use of contraceptives. The government acknowledges the need to
liberalize this legislation and is taking steps to design a population
policy and family planning strategy. Among other recommendations, the
report stresses the need for a government coordination body for the
development of a population policy, the preparation of a national
family planning strategy and plan of action, and the use of IEC
campaigns to stimulate demand for family planning.
Bank Projects Approved in FY92
-------------------------------
The Population component in PHN (Population, Health and Nutrition)
accounted for an estimated $103.5 million in loan commitments during
fiscal year 1992. Of the sixteen PHN projects approved, ten included
population lending,with three of those having family planning and population
policy efforts as a primary objective: Niger Population; Mauritania Health
and Population; and India Family Welfare (Urban Slums).
* Niger Population Project
The Niger Population Project is the Bank's first free-standing
population project in the Sahel. The project seeks to decrease
fertility in Niger through a range of efforts, including strengthened
maternal health and family planning services, promotion of women's
status, and support for demographic data collection, policy analysis,
monitoring, and research. This project will utilize innovative means
to expand the use of family planning and decrease Niger's total
fertility rate from its current high level of 7.1 (with an annual
population growth rate of 3.4%). A widespread IEC campaign is
envisioned, utilizing national TV and radio to counter sociocultural
attitudes about fertility control and the status of women that curtail
family planning use. The GON (Government of Niger) will also
establish a Population Fund to finance private sector, NGO,and
community involvement in service delivery and IEC activities.
* Mauritania Health and Population Project
The Mauritania Health and Population Project seeks to improve the
access to and quality of basic health services, integrate family
planning services into public health facilities, and assist in
the articulation and implementation of a population policy. The
Bank's first health and population project in Mauritania, it will
also support efforts to decentralize health services and
strengthen regional capacities for health care delivery, and
promote the status of women. Traditionally a low-density,
nomadic people, Mauritanians have become more sedentary since
independence, and the country's growth rate has climbed to 2.9
percent as fertility remains high (the total fertility rate is
currently 6.5 children)and mortality rates fall. The resulting
increase in urbanization and pressures on the social
infrastructure have led, in part, to the recognition of family
planning as a part of health care for women, and as a way to
control population growth. The GOM (Government of Mauritania)
strategy includes many elements necessary for a successful population
project: maternal and child health promotion, family planning
services, promotion of the status of women, and demographic research
and data collection. The project will also include a migration study,
to better understand the movement and settlement patterns of the
population.
* India Family Welfare (Urban Slums) Project
Following on seven other population projects, the India Family
Welfare (Urban Slums) Project will establish projects directed at
slum areas in eight cities, with a view to nationwide replication.
The project combines standard population project components --
improved access to and quality of family welfare services (including
family planning);IEC campaigns to increase demand for family welfare
services; and institutional support for the management and
administration of Health Departments -- with innovative schemes and
future project preparation. Creche, or day care,programs are
envisioned, as are nutrition interventions,environmental sanitation
projects, and female education and skill training. India Family
Welfare will also build up local capacity in communities and NGOs
through their involvement in service delivery and IEC activities.
Other FY92 Population Highlights
--------------------------------
Other PHN projects including lending for population in FY92 were:
in Africa, the Equatorial Guinea Health Improvement Project; in
Latin America Region; the Guyana SIMAP/Health, Nutrition, Water and
Sanitation Project and the Honduras Second Social Investment Fund; and in
Europe & Central Asia Region, the Poland Health Services Development
Project and the Romania Health Rehabilitation Project. The Romanian
project has as one major objective a shift away from abortion to family
planning through contraceptives. Contraception was banned in Romania
from 1966 until 1989. Illegal abortion became the only option for women
desiring to limit fertility, leading to great increases in maternal
mortality. Current policies seek to reverse that trend by making
quality family planning and maternal health services available.
Bank Lending for Population in FY92
-----------------------------------
Population lending commitments for FY92 seem low in comparison to
FY91, when lending for population was an unusually high $351 million.
The FY91 figure, however, is double that of both the previous and
succeeding years, and represents the true outlier. The basic reason
for the FY91 surge in population lending was the acceleration of a
$180 million credit to Bangladesh for the Fourth Population and Health
Project. Approximately $61.5 million of that loan financed population
interventions. The FY92 lending program was not only decreased by
that amount, but also saw two projects scheduled for approval in FY92
move into FY93. Population was not the only sector to experience a
fall in loan allocations in FY92 -- Health, Nutrition, and Education
witnessed similar declines. The good news is that preliminary
estimates of future lending for population in FY93 and FY94 indicate a
continuation of the upward trend begun in FY87.
---------------------------------------------------------------------
PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.
--Boundary (ID cee19sPfnTO1v07pbjlPBQ)
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Archive PHNFLASH PNN1B Conferences/Meetings/Traning
Population Network News
No. 1, October, 1992
Part II
International Conference on Population and Development, 1994
-------------------------------------------------------------
Preparations are underway for the third International Conference on
Population and Development, scheduled to be held in Cairo, Egypt in
September 1994. Within a broad focus on population, sustained economic
growth, and sustainable development, the Conference will target six key
aspects of the population and development equation:
o Population dynamics, including the ageing of populations, and the
inter-relationship between demographic change and socioeconomic
development;
o Population policies and programs;
o The linkages between population,development, and the environment;
o Patterns and determinants of migration, both internal and
international;
o The linkages between women's status, socio economic involvement and
demographic change; and
o Family planning programs, health, and family well-being.
Each of these topics will be the focus of a pre-Conference Expert Group
meeting.
4th Asian and Pacific Population Conference
-------------------------------------------
Maria MacDonald and Badrud Duza represented the Bank at the Fourth Asian
and Pacific Population Conference held in Bali, Indonesia, 19 to 27
August 1992. The meeting,convened by ESCAP with the co-sponsorship of
UNFPA,served as both a regional forum and a preparatory session to the
1994 ICPD. The main theme of the Asian conference was "Population and
sustainable development: goals and strategies into the twenty-first
century." Dignitaries and ministers from all of the countries in the
Asia and Pacific region attended the conference to discuss major issues
facing the area in two forums: a Meeting of Senior Officials and a
Meeting of Ministers. She and Mr. Duza will summarize the discussions at
the next meeting of the Asia Region Population Group on Wednesday, Oct.
14th, 12 - 2 p.m. (a description of the Group follows).
Asia Region Population Group
----------------------------
At high noon on July 8, 1992, the Asia Region Population Group met for
the first time. The Group serves as a flexible forum for "population
people" in the region to exchange experiences and discuss issues relevant
to their work. The Group is designed for easy administration, with
volunteers rotating the responsibilities associated with chairing a
meeting, and members expected to come to only those meetings which they
are interested in and able to attend. A teach meeting topics for the
next session are chosen by the group. Response to the idea has been
positive and widespread, with over a dozen people attending each
session. Recent topics have included lively discussions of the
supervision of Bank population projects and the sector report The
Determinants of Reproductive Change in Bangladesh.
International Commission on Population
--------------------------------------
Modeled on the Bruntland Commission that played a key agenda-setting role
in the lead-up to the United Nations Conference on Environment and
Development (UNCED) earlier this year, a new International Commission on
Population has been formed to "develop and disseminate a fresh vision of
international population matters" as the global community prepares for
the 1994 International Conference on Population and Development in Cairo.
The Commission will be comprised of 15-20 members, all prominent figures
from both the developing and industrialized world. Mrs. Maria de Lourdes
Pintasilgo, former Prime Minister of Portugal, has agreed to serve as its
chairman. The Commission will have a staff of several professionals with
expertise in the areas to be addressed, which include the concerns of the
international women's health movement about fertility regulation policies
and better understanding of the complex linkages between population,
economic development, the environment and human welfare. A number of
donor agencies, including the Bank, have pledged financial support for
the Commission, whose secretariat will be housed at UNESCO
headquarters in Paris starting in October. Recruitment of staff
and naming of Commissioners is expected to occur during the final
quarter of 1992. PPAS will keep you posted about further
developments.
Evaluating Evaluation
----------------------
New ideas about how to evaluate the impact of population projects
were tossed around at a September 11 expert meeting organized by the
USAID-funded Evaluation Project and hosted by the Rockefeller Foundation
in New York. The World Bank was represented by Tom Merrick and Randy
Bulatao. The following elements of the family planning program
evaluation puzzle were discussed:
o Better indicators of outcomes such as increased access to
contraception, better quality of care, and wide diffusion of knowledge of
contraception are needed. These outcomes can take the shape of
immediate outputs, which can be linked directly to project activities, or
intermediate and final outputs, which depend on these activities but also
reflect the contribution of many factors beyond the control of the
project. In addition, programs with health and human rights objectives
need to pay attention to additional outcomes.
o Measures of process are needed to determine whether programs are
actually putting services in place. Measures of costs, which have not
received sufficient attention, must also be included.
o Evaluations are incomplete without attention to the climate of
demand for contraception.
o The definition of need for contraception must be agreed upon. Some
participants suggested that more attention be paid to single women and
adolescents in assessing need, as well as to abortion as an indicator of
need. Others proposed breaking down unmet need by cause: lack of
information,lack of services, or insufficient motivation.
o In conducting evaluations, experiments or large-scale pilot projects
can be of immense value in developing and testing program approaches in
specific cultures, as demonstrated by the Matlab project in Bangladesh.
Also, existing household surveys can be fine-tuned to provide indicators
that are more revealing of program performance. The participants agreed
that we must apply whatever indicators exist, even if they still require
refinement, because immediate application will focus the attention of
managers and eventually contribute to improving the indicators.
Population Training
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During 1991, two training courses in population were organized for Bank
staff: one was a one-week workshop entitled "Population Skills
Enhancement" and provided a basic overview of population and family
planning issues; the other was a three-day seminar called "Population
Issues for Economists" and covered demographic trends and their
implications for economic and social development. Based on experience
and feedback from these two courses, PPAS is planning a training program
for FY 1993. We plan to modify your program in two important ways:
first, we will break the seminars up into a series of one-day modules
requiring a smaller time investment, which we hope will increase
enrollment; and second, we want to focus the content of the modules on
specific operational questions and other issues on which staff express
interest or concern. Our tentative plans call for a series of seminars
on topics including the following:
o measuring unmet need and demand for family planning and how
to use DHS data to identify under-served groups;
o estimating the costs of service delivery and costing out alternative
service delivery strategies;
o case studies and approaches to cost recovery in family planning and
reproductive health services;
o identifying information, education and communication needs and
designing IEC components for projects;
o identifying training needs and designing training components;
o evaluation of family planning program outcomes and incorporating
evaluation indicators and measurement in project design;
o the status of our knowledge about the economic and social
consequences of population growth and how that knowledge base can be used
to inform policy dialogue, sector work and project design.
The timing of seminars on particular topics will depend on how quickly
our work program can delivery useful material on each: for example, work
is progressing on evaluation indicators, but we may not be ready to
deliver a course until late FY93. We would appreciate comments on the
proposed strategy, on the topics and their priority, and any other ideas
about training.
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PNN is a quarterly round-up of news and information relevant to Bank
staff working in the population field. It is produced by the
Population, Policy and Advisory Service (PPAS) and edited by Chantal
Worzala.