What Will Happen If Family Planning Services Was Taken Away

• Journal List
• Philos Trans R Soc Lond B Biol Sci
• v.364(1532); 2009 Oct 27
• PMC2781837

Philos Trans R Soc Lond B Biol Sci. 2009 Oct 27; 364(1532): 3093–3099.

Making family planning accessible in resource-poor settings

Abstract

It is imperative to brand family unit planning more than accessible in low resource settings. The poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet demand for contraception. It is also in the low resource settings where maternal and child mortality is the highest. Family planning can contribute to improvements in maternal and child health, particularly in low resource settings where overall access to health services is limited. Iv disquisitional steps should be taken to increase access to family planning in resource-poor settings: (i) increase cognition about the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (three) ensure supply of contraceptives by making family planning a permanent line item in healthcare organisation's budgets and (iv) have immediate action to remove barriers hindering access to family unit planning methods. In Africa, there are more women with an unmet need for family planning than women currently using modern methods. Making family planning accessible in low resources settings will help subtract the existing inequities in achieving desired fertility at individual and country level. In addition, information technology could help wearisome population growth inside a human rights framework. The United nations Population Division projections for the year 2050 vary betwixt a loftier of 10.vi and a low of 7.4 billion. Given that most of the growth is expected to come up from today's resource-poor settings, like shooting fish in a barrel access to family planning could make a difference of billions in the world in 2050.

Keywords: family planning, fertility regulation, resources-poor settings, unmet need, access to services, contraception

ane. Introduction

Family planning programmes in resource-poor settings are usually delicate, show signs of poor performance and are both dependent on international funding and constrained by existing policies or lack thereof. However, it is exactly in those settings where family unit planning programmes are most needed if countries aim to reduce inequalities in health, reduce maternal and child mortality rates, alleviate poverty and foster economical development.

Voluntary family planning is an effective way of controlling fertility within a human rights framework past giving couples the ability to have their desired family size (Prata 2007). In the 1993 World Evolution Report entitled 'Investing in Health', the World Bank considered family planning a highly toll-effective public health intervention (World Depository financial institution 1993). As Cleland et al. (2006) write, 'The promotion and availability of family planning in resource-poor settings represents ane of the most significant public health success stories of the past century… . Family planning is unique among health interventions in the breadth of its benefits—family unit planning decreases maternal and child mortality, empowers women, reduces poverty and it lessens stress on the natural and political environment'.

In many resource-poor settings, the growing unmet need for contraception is astounding. Couples who wish to have fewer children are unable to determine the size of their families as family planning funding continues to become scarce and existing programmes and services fail to encounter the concerns and desires of their users. It is important to emphasize not telling women how many children they should take, merely underscore that they accept a right and the freedom to choose how to control their own fertility. To control fertility effectively, women and couples need to accept access to correct information almost contraceptive methods and be able to beget the method of their option. The cease result at the family level will positively bear on the health of women and children, easing pressure on family resource and increasing a family's chances to escape the trap of poverty (Cleland et al. 2006).

The poorest economic quintiles in resource-poor settings are often more likely to turn to the private sector than to government services, which oftentimes fail to achieve those in greatest need (Prata et al. 2005). In this newspaper, I am including not only the work of public, private and faith-based wellness facilities simply social marketing, output-based assistance and franchized service providers who come across the demand for family planning information and services.

The study by the U.k.'due south All Party Parliamentary Group on Population, Evolution and Reproductive Health entitled Return of the population growth gene: its touch on upon the millennium development goals shows conspicuously that poverty and socioeconomic disparities are closely linked to unchecked population growth. The poorest of the poor tend to have not only the everyman contraceptive prevalence, just the highest total fertility rate (TFR) and the highest unmet need for family unit planning (Prata 2006, 2007). Population growth also remains a meaning issue with respect to increasing levels of education or improving the income gap. The 'Return of the population growth gene' study analysis shows that, every bit a result of rapid population growth, the developing world must train 2 1000000 additional teachers every year to keep instruction levels at where they are today—with no level of comeback. With increasing population levels, however, even this will non be enough.

A large office of the burden of disease linked to maternal health which poor countries are facing today is also cogitating of undesired fertility. It is unjust that women are dying simply because of unmet demand for contraception and yet this remains to be the case. Cleland et al. (2006) estimate that promotion of family unit planning in loftier fertility countries has the potential to avoid 32 per cent of all maternal deaths and nearly ten per cent of babyhood deaths. Information technology is estimated that 25 per cent of HIV-positive women accept an unmet need for family unit planning. Unfortunately, even though contraception is also more cost-effective than Niverapine to forestall mother-to-child-manual (Reynolds et al. 2006), family planning is often not an integral part of HIV prevention programmes.

Health disparities are increasing over fourth dimension and this in turn poses a pregnant problem for speedily growing populations living on extremely deficient resource (Ezeh et al. 2009). Low resources settings are already suffering from h2o scarcity, food shortages and inadequate sanitation. Furthermore, internal conflict and/or civil unrest that affects poor countries has often also been a direct consequence of desperation over the need for resources such as arable state that continue to remain at crisis levels (Thayer 2009). Until family unit planning is made accessible to address the large burden of unmet need for contraception, countries will be unable to provide their citizens with even their basic human needs.

In this newspaper, I propose four critical steps that can help increase access to family unit planning in low resource settings, especially those in sub-Saharan Africa. In support of the proposed solutions, I present evidence on current status and recent trends in family planning in poor countries. I debate that family planning services are greatly needed and hash out the health and socioeconomic benefits at individual, family and community levels.

ii. Greater accessibility to family planning

To address the effect of high fertility in low resources settings, it is imperative that family unit planning is made accessible to all. Given the electric current socioeconomic and demographic indicators in poor countries and the slow progress in the concluding decade, four critical steps should be undertaken: (i) increase knowledge nigh the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (3) ensure supply of contraceptives past making family planning a permanent line particular in healthcare system'southward budgets and (iv) take firsthand action to remove barriers hindering admission to family planning methods.

(a) Use of family planning methods

Sub-Saharan Africa has the lowest family planning use in the developing world. The utilise of modern methods by married women is higher in Latin America (63%), followed by Asia (48% excluding China) and sub-Saharan Africa (eighteen%). The current contraceptive level in sub-Saharan Africa represents a small-scale increment from 13 per cent registered around the belatedly 1990s to the beginning of 2000 (Population Reference Bureau 2002; Population Reference Bureau 2008). Co-ordinate to contempo available data from 31 countries with Demographic and Health Surveys (DHS), on boilerplate xxx per cent of women in sub-Saharan Africa have an unmet need for modernistic family unit planning methods. Nineteen of the 31 countries accept a reported unmet demand for family unit planning upwards to 49 per cent. On average, sub-Saharan Africa has not seen a reduction in the unmet need for family planning in the concluding decade. As a outcome, at that place are more women (25 meg) with an unmet need for family unit planning than women currently using modern methods (18 one thousand thousand) (Westoff 2006; Population Reference Bureau 2008).

Directly associated to this depression family planning utilise and high unmet need is very high fertility and rapid population growth. In sub-Saharan Africa, the TFR is v.5, considerably college than the TFR of Latin America (2.5) and Asia (ii.4 excluding China). Fifteen of the 31 sub-Saharan African countries with a recent DHS have TFRs that exceed half dozen.0 (Population Reference Agency 2007). This level is essentially unchanged from the late 1990s, when the region's overall TFR was five.half dozen (Population Reference Bureau 2002). It is estimated that in 2008 sub-Saharan Africa's population was 828 meg and is expected to increase by nearly a billion people (1761 million) by 2050 (United nations Population Segmentation 2007).

The use of family planning methods is inherently related to correct noesis and access to available methods. Correct knowledge should include how the various methods work, family planning methods' safety and side effects, and address the issues of misinformation.

Incorrect cognition can be addressed in the information education and communication campaigns past using simple, single messages that empower women and families such as 'Family Planning is Safe' or 'Family unit Planning is Rubber and Works'. A study of 8 developing countries showed that 50–seventy per cent of women idea the use of oral contraceptive pills was a considerable health risk, fifty-fifty though in a low-resource setting, having a baby tin be upwardly to one thousand times as dangerous every bit taking oral contraceptives (Grubb 1987). Family planning programmes should take main responsibleness for disseminating accurate information and correcting misinformation. A couple'due south acceptance of modern methods is all too ofttimes limited because they practice not know how modern methods work or they recollect methods have an agin influence on their ability to conceive afterwards.

(b) Family planning must be affordable

The need for making family planning more accessible is also compelling from the standpoint of alleviating the burden of poverty. 7 of every 10 sub-Saharan Africans alive in poverty (less than US$ii per twenty-four hour period), with four of every x sub-Saharan Africans living in extreme poverty (less than US$1 per day) (Chen & Ravallion 2007). Examples of sub-Saharan African countries where the vast bulk of people live in poverty include Republic of uganda with 97 per cent, Nigeria with 91 per cent and Zambia with 87 per cent (World Bank 2005).

Poverty is likely to increase markedly in absolute terms in the side by side few decades in sub-Saharan Africa, because past 2050 the population of about every country in Western, Eastern, and Heart Africa will exist double the 2000 level (Un Population Partition 2008). For example, Uganda'southward population volition take more than tripled, from 25 million (32 million in 2008) to 93 million in 2050, and Nigeria's population will take grown by an boosted 164 1000000 people to 289 million. Thus, if poverty rates do not decline, in 2050 over 350 million people—more than the entire population of the USA today—volition be living in poverty in these ii countries alone, with more than 280 meg of them living in extreme poverty. This compares to 135 meg living in poverty between 1999 and 2003 in these 2 countries.

The implications of such loftier levels of population growth, coupled with the even more rapid urban growth, are stark. Three of every iv urban dwellers in sub-Saharan Africa today already live in slum weather. Hundreds of millions more people—more than 1.25 billion people overall—will be living in poverty in 2050, and sub-Saharan African countries will thus accept fifty-fifty greater difficulty elevating their level of socioeconomic development and maintaining their often-tenuous political stability.

Given the current and ascension levels of people living in poverty, it cannot be expected that consumers volition pay the increasing costs of family planning services. The poor are very sensitive to price changes and the results could be a turn down in contraceptive utilise (Prata et al. 2001). Sub-Saharan Africa poses the greatest threat with 77 per cent of its population in 2002 unable to pay for the toll of the commodities (Prata 2006) (tabular array 1).

Table one.

Fertility indicators for selected sub-Saharan African countries. Respective national DHS terminal reports. CPR data refer to women anile 15–19 who are currently married or in wedlock and are currently using a modern contraceptive method. FP, family planning.

country	TFR	wanted fertility charge per unit	met need for FP (modern method CPR)	unmet need for FP
Ghana
2003	4.iv	three.7	18.7	34
1998	iv.6	iii.seven	13.3	24.3
1993	5.5	4.ii	ten.1	38.six
1988	half-dozen.4	5.3	5.2
Republic of kenya
2003	4.9	iii.6	31.5	24.5
1998	4.seven	3.v	31.5	23.nine
1993	5.4	3.4	27.3	36.4
1989	6.vii	4.4	17.ix
Malawi
2004	6	4.ix	28.i	27.6
2000	6.3	five.two	26.1	29.7
1992	half dozen.7	v.vii	vii.4	36.3
Nigeria
2003	5.7	5.iii	eight.2	16.9
1999	5.2	iv.eight	8.half-dozen	17.5
1990	half-dozen	v.eight	3.5	twenty.viii
Senegal
2005	v.3	iv.5	ten.3	31.half dozen
1997	5.vii	4.6	8.1	32.6
1992–1993	6	5.i	4.8	27.9
Tanzania
2004	v.7	4.9	20	21.viii
1999	5.half-dozen	four.eight	16.9	21.8
1996	5.8	5.1	13.3	23.nine
1992	6.2	5.vi	6.half dozen	30.1
Uganda
2006	6.7	5.i	17.9	40.6
2000–2001	vi.9	5.three	18.2	34.6
1995	half dozen.9	five.6	7.8	29
1988	7.5	half dozen.4	2.5	53.7

The electric current costs of family planning commodities should be examined critically and prices should be adjusted making affordability and necessary subsidies a primary business organisation. The poorest quintile of the population suffers from the highest unmet demand for family planning and shoulders the largest burden of maternal and child mortality. To reduce rising inequalities that identify a high brunt on society as a whole, family planning methods must exist supplied to the poor at a cost they tin afford. The overall, long-term burden for whatsoever land is ultimately higher if a large proportion of the poor cannot afford to make up one's mind the size of their own families. Therefore, it is important to ensure that contraception is genuinely affordable to the poorest families.

(c) Importance of a steady supply of contraceptives

Trends in modern contraceptive use in resources-poor settings seem to be associated with the level of international community's support for family unit planning and local resources, thus affecting the footstep of fertility turn down in such settings. For instance, in sub-Saharan Africa, many countries experienced substantial gains in contraceptive prevalence rates (CPR) in the 1980s and 1990s, followed by a macerated or stalled progress in the 2000s (figure 1). In the 1990s, modern method utilize almost quadrupled in Republic of malaŵi, substantially increasing in all wealth quintiles, despite the widespread poverty, and more than doubled in Tanzania and Uganda. However, subsequent increases were more small in Malawi, Senegal and Tanzania, and the ascension in CPR that ceased altogether in Kenya, Uganda and Nigeria has notwithstanding to achieve double-digit levels of modern contraceptive use.

Modern contraceptive employ in Ghana, Kenya, Malawi, Nigeria, Senegal, Tanzania, Uganada and Republic of zambia, 1989–2006. Filled triangle, Ghana; filled diamond, Kenya; filled foursquare, Malawi; open up circle, Nigeria; plus, Senegal; filled circle, Tanzania; open triangle, Uganada; star, Zambia.

The solid declines in TFR that accompanied the increased modern methods in the 1980s and 1990s, of 0.6 births per woman or more from DHS to the next DHS, have subsequently diminished in Republic of ghana, Malawi and Republic of uganda and ceased in Republic of kenya, Nigeria and Tanzania, with TFRs remaining at quite loftier levels. Notwithstanding, every bit seen in tabular array one, all seven countries have higher full fertility than wanted fertility, which, along with their high unmet need for family planning suggests missed programmatic opportunity. These results could too be showing programmatic challenges in these countries due to lack of steady funding for family unit planning, the effects of healthcare workforce dynamics and/or health sector reform and decentralization.

It is well known that Africa suffers more than than 24 per cent of the global burden of disease withal it has only 3 per cent of the world's health workers and less than 1 per cent of the world's financial resources, even with loans and grants from abroad (Globe Health Arrangement 2006). Although international population assist, much of which went to sub-Saharan Africa, more than doubled worldwide from 2001 to 2004, increasing from $two.5 billion to $five.6 billion, this was largely due to increased funding for HIV/AIDS prevention, treatment and care programmes. The share of international population assistance devoted to family unit planning declined from thirty per cent in 2001 to less than 10 per cent in 2004 (Ethelston et al. 2004; Leahy 2007), which represents a decline in both absolute and per capita terms (Speidal 2009). Although donors often have shifted their priorities and resources to other health problems and other development sectors, in pursuit of the UN millennium evolution goals (MDGs), 'the MDGs are difficult or impossible to achieve with electric current levels of population growth in the to the lowest degree developed countries and regions, unless attention is paid to the population growth gene' (All Party Parliamentary Group 2007)—an upshot that can exist dealt with if family planning is fabricated easily bachelor.

In the resource-poor settings common in sub-Saharan Africa, family planning programmes are farther challenged by the unintended consequences of health sector reform and decentralization, which have devolved programmatic authority to lower levels. At that level, family planning programmes accept to compete for the insufficient man and financial resources of other pressing priority health programmes such as malaria, tuberculosis and HIV/AIDS. As a result, the health, social and economic benefits that family unit planning confers on individuals, communities and nations are not as widely appreciated as they should be at the sites where the funding and man resources resource allotment decisions that affect family planning are being fabricated.

The devastating AIDS pandemic in sub-Saharan Africa has not just been diverting programmatic attending and resources, but it has also been affecting the healthcare workforce itself through disability and decease. Reductions in the skilled workforce available to provide family unit planning are farther occurring because of other negative factors: out-migration to more adult countries; low pay, particularly in the public sector; uneven distribution, deployment and apply of existing staff; retirement and diminished programmatic investment in pre-service education (Earth Health Organization 2006).

Thus, contraceptive security is essential. Ensuring a steady flow of family planning commodities should be part of the healthcare systems' responsibleness—information technology cannot let the supply of products, which are so essential to protecting the health of the populations, to get disrupted. Currently, most governments are relying on donors to provide funding for family planning, but donor support has been unsteady and difficult to predict. Outside funding should be sought as a supplement to a healthcare system's commitment but should never be the sole source. A promising new 'south–south' supply of contraceptives is arising and recently the authorities of Peoples Democracy of China has donated contraceptives to Partners in Population and Development for distribution in Africa. Information technology is important to ensure the supply of contraceptives by making family planning a permanent line item in healthcare organisation's budgets.

(d) Remove barriers hindering access to family planning

Programmes committed to reduce unmet need for family planning tin can take concrete steps to remove barriers that hinder access to family planning (Campbell et al. 2006). Legal, facility-based and provider-based barriers must be addressed to improve access. Legal barriers include formal laws and restrictions that deny females of reproductive age piece of cake access to family unit planning services. For example, keeping oral contraceptive pills on prescription disallows the ability to socially market place the pills—an important distribution and financing mechanism in low resource settings. Other restrictions include what level of provider can/should provide certain contraceptive methods. For example, rural women in many part of Africa receive services from community-based distributors (CBDs), but CBDs are simply allowed to distribute pills and condoms. However, it is exactly in rural areas of sub-Saharan Africa that women prefer injectable contraceptives. Depo-provera provision by customs-based workers was used in many parts of Asia and Latin America, and it was recently demonstrated in airplane pilot projects in Uganda, Madagascar and Ethiopia. However, in most of sub-Saharan Africa, Depo-provera provision is restricted to skilled providers, despite the prove showing its condom, feasibility and acceptability at the community level (Stanback et al. 2007). Similarly, the satisfactory provision of IUD insertion by not-physicians has been established since the 1970s (Eren et al. 1983; Farr et al. 1998), merely today these services are provided by and large by physicians and in some places selected mid-level providers such as clinical officers when, in fact, provision of not-surgical long-term methods of contraception should be an integral part of pre-service training for all levels of wellness workers, not just those working on higher level facilities. The reproductive rights of all women of reproductive age, regardless of age, marital status and place of residence, need to be protected and facilitated by non-restrictive laws.

Facility-based barriers are not codified in law, just their de facto practise creates unnecessary barriers to accessing family planning services such as clinics refusing to see adolescent patients or but providing contraceptive services on specific days of the week. In add-on, provision of services of poor quality, including express contraceptive pick and disability to switch methods if unsatisfied with the prescribed one, are all facility restrictions imposed on clients that hinder access. Moreover, to make family planning more accessible, all family unit planning methods except tubal ligation and vasectomy should be provided by community outreach workers whom women trust, outside of a facility.

Finally, provider-based barriers prevent women from accessing certain methods of contraception through discouragement or non-prove-based clinical practices that emerge from personal biases and beliefs. Providers have been widely documented to discourage individuals from accessing hormonal methods past insisting on plush and medically unnecessary pelvic examinations, blood tests or making it hard (or impossible) for women to obtain the method of their choice if they are nulliparous, accept recently had an abortion or are of a certain age. Moreover, women using oral contraceptives are often required to visit the provider every month.

Family planning programme planners, particularly in sub-Saharan Africa, could greatly benefit from removing the above-mentioned barriers. They are in a position to demonstrate strong leadership by taking on this of import policy commitment which will pave the way for improved health and prosperity in hereafter generations.

iii. Conclusions

Increasing admission to family planning is an urgent priority for low resources settings. Information technology is both a feasible and achievable intervention that can be implemented immediately. To ensure that populations living in resources-poor settings have the liberty and the choice to control their ain fertility, current family unit planning programmes will do good from focusing on the iv proposed strategies. This requires connected political and programmatic commitment to increase financial and human resources for family planning, from both governments and international strange assistance.

Addressing the fertility and population growth crisis can be done simply when programme planners consider the revitalization of their current family unit planning programme within a human rights framework. Evidence shows that the poorest couples have the highest fertility, the lowest contraceptive utilize and the highest unmet demand for contraception. Making family planning accessible in low resource settings would help decrease the existing inequities in achieving desired fertility, it could increase contraceptive apply, subtract fertility and it could help deadening population growth within a human rights framework. In addition, family planning can contribute to improvements in maternal and child wellness.

Failure to pay concerted attending to making family unit planning attainable in low resources settings will probably result in couples having higher than desired fertility. Continued high fertility will hinder efforts to decrease maternal and infant mortality besides as poverty. Equally a result, evolution goals will become difficult to attain and in some cases impossible.

The health rationale alone is a compelling reason for making family planning more than accessible. Sub-Saharan Africa, for instance, has not experienced a pregnant reduction in maternal mortality (Loma et al. 2007). Two hundred and five million pregnancies occur annually worldwide, 35 per cent of which are unintended and 22 per cent of which end in an induced abortion. Most of these pregnancies (182 1000000) happen in the developing world. Two-thirds of these pregnancies occur among women who are not using any method of contraception, making family planning a pregnant contributor to maternal health (Prata et al. 2009). A sub-Saharan African woman today has a ane in 22 lifetime chance of maternal death, and for every 109 births, a woman dies in pregnancy or childbirth (UNICEF 2009). By contrast, amid the European and other industrialized nations where women accept proficient access to family unit planning services, fewer than 1 in 16 400 will die of complications of pregnancy and childbirth, an well-nigh 750-fold difference (UN Working Group at Women Deliver 2006). In addition to bloodshed, for every woman who dies, approximately xxx women suffer infections, injuries and/or disabilities. Ensuring access to family planning in sub-Saharan Africa could avert thousands of maternal deaths (Prata et al. 2009) and preclude hundreds of thousands of children from losing their mothers every year. When a female parent dies in a low resources setting, the take chances of death in children who survive their female parent's death also rises. Furthermore, family planning prevents more mother-to-child manual of HIV than exercise antiretroviral drugs (Usa AID 2006).

The largest cohorts of young people in sub-Saharan Africa's history are entering and moving through their reproductive years. 40-three per cent of sub-Saharan Africa's population is beneath the age of fifteen (Population Reference Bureau 2007). Given the current population growth rate and the projected rise in female population 15–49 years old, family unit planning programmes volition have to run much faster, merely to keep the current depression modern contraceptive employ. The sure large increase in futurity need and demand for family planning that the incoming young and growing cohorts represent will be intensified further by sub-Saharan Africa's speedily increasing urbanization.

Sub-Saharan Africa'south 5 per cent annual urban growth rate is the highest in the world, and twice its overall annual population increment of 2.four per cent, also the world'due south highest (United Nations Population Fund 2007). According to recent estimates by the United Nations Population Division, whereas 28 per cent of sub-Saharan Africans lived in cities in 1990, 37 per cent of them lived in cities in 2006, and this proportion will rising to 48 per cent by 2030 and threescore per cent past 2050 (United Nations Population Partition 2008). The additional pressure for family unit planning that such urbanization will impose may exist inferred from the current urban–rural differentials in CPR that are found in various countries. For example, data from recent DHS surveys testify that some of the lowest differentials are found in Republic of malaŵi (35% modernistic CPR in urban areas versus 27% in rural areas) and Nigeria (fourteen% urban versus 6% rural) and the highest in Republic of zambia (39% urban versus 14% rural) and Uganda (43% urban versus 21% rural).

The United Nations Population Division projections for the year 2050 vary betwixt a loftier of x.6 and a low of 7.four billion. Making family planning easily accessible to all today could make a difference of billions in the earth's population in 2050.

Footnotes

References

• All Party Parliamentary Group on Population Development and Reproductive Health 2007Render of the population growth factor: its affect on the millennium development goals. London: Evolution and Reproductive Health, All Party Parliamentary Group on Population [Google Scholar]
• Campbell M., Sahin-Hodoglugil N. N., Potts Thou.2006Barriers to fertility regulation: a review of the literature. Stud. Fam. Plann. 37, 87–98 (doi:x.1111/j.1728-4465.2006.00088.x) [PubMed] [Google Scholar]
• Chen S., Ravallion Thou.2007Absolute poverty measures for the developing world, 1981–2004 Washington, DC: World Bank, Development Inquiry Grouping [PMC complimentary article] [PubMed] [Google Scholar]
• Cleland J., Bernstein S., Ezeh A., Faundes A., Glasier A., Innis J.2006Family unit planning: the unfinished calendar. Lancet 368, 1810–1827 (doi:10.1016/S0140-6736(06)69480-4) [PubMed] [Google Scholar]
• Eren N., Ramos R., Grayness R. H.1983Physicians vs. auxiliary nurse-midwives equally providers of IUD services: a report in Turkey and the Philippines. Stud. Fam. Plann. fourteen, 43–47 (doi:10.2307/1965401) [PubMed] [Google Scholar]
• Ethelston South., Bechtel A., Chaya N., Gibb Vogel C., Kanter A.2004Progress & promises: trends in international assistance for reproductive health and population Washington, DC: Population Action International [Google Scholar]
• Ezeh A. C., Mberu B. U., Emina J. O.2009Stall in fertility decline in Eastern African countries: regional analysis of patterns, determinants and implications. Phil. Trans. R. Soc. B 364, 2991–3007. (doi:x.1098/rstb.2009.0166) [PMC gratis article] [PubMed] [Google Scholar]
• Farr G., Rivera R., Amatya R.1998Non-doc insertion of IUDs: clinical outcomes amidst TCu380A insertions in three developing-country clinics. Adv. Contracept., Off. J. Soc. Adv. Contracept. 14, 45–57 (doi:ten.1023/A:1006575610716) [PubMed] [Google Scholar]
• Grubb G.1987Women'southward perceptions of the condom of the pill: a survey in eight developing countries. J. Biosoc. Sci. 19, 313–321 (doi:10.1017/S0021932000016965) [PubMed] [Google Scholar]
• Hill Grand., Thomas K., AbouZahr C., Walker N., Say L., Inoue One thousand., Suzuki Eastward. & Maternal Mortality Working Grouping 2007Estimates of maternal mortality worldwide between 1990 and 2005: an assessment of bachelor data. Lancet 370, 1311–1319 (doi:x.1016/S0140-6736(07)61572-4) [PubMed] [Google Scholar]
• Leahy E.2007Update: Trends in international assistance for reproductive wellness and population in 2004 Washington, DC: Population Activeness International [Google Scholar]
• Population Reference Bureau 2002Family unit planning worldwide Washington, DC: Population Reference Bureau [Google Scholar]
• Population Reference Bureau 20072007 world population data canvass Washington, DC: Population Reference Bureau [Google Scholar]
• Population Reference Bureau 2008Family unit planning worldwide 2008 information sheet Washington, DC: Population Reference Bureau [Google Scholar]
• Prata N.2006Assistance to international family unit planning programs. UC Davis J. Int. Law Policy 13, 19–33 [Google Scholar]
• Prata Due north.2007The need for family planning. Popul. Environ. 28, 212–222 (doi:10.1007/s11111-007-0042-9) [Google Scholar]
• Prata Due north., Marceau Due south., Walsh J., Townes East., Wade T. How much are consumers willing to pay for family unit planning? Bay Surface area International Group; 2001. [Google Scholar]
• Prata Northward., Montagu D., Jeffrey Due east.2005Individual sector human resources and wellness franchising in Africa. Bull. World Health Organ. 83, 274–279 [PMC free article] [PubMed] [Google Scholar]
• Prata N., Sreenivas A., Vahidnia F., Potts M.2009Saving maternal lives in resource-poor settings: facing reality. Health Policy (Amsterdam, Netherlands) 89, 131–148 [PubMed] [Google Scholar]
• Reynolds H. W., Janowitz B., Homan R., Johnson 50.2006The value of contraception to forestall perinatal HIV manual. Sex activity. Transm. Dis. 33, 350–356 [PubMed] [Google Scholar]
• Speidal J. J.2009Food, water, & population. Presentation at The World in 2050: A Scientific Investigation of the Affect of Global Population Changes on a Divided Planet Berkeley, CA, January 2009 [Google Scholar]
• Stanback J., Mbonye A. M., Bekiita M.2007Contraceptive injections by community wellness workers in Republic of uganda: a nonrandomized customs trial. Bull. World Health Organ. 85, 768–773 (doi:ten.2471/BLT.07.040162) [PMC free article] [PubMed] [Google Scholar]
• Thayer B. A.2009Considering population and war: a critical and neglected aspect of disharmonize studies. Presentation at The World in 2050: A Scientific Investigation of the Bear on of Global Population Changes on a Divided Planet Berkeley, CA, January 2009 [Google Scholar]
• United nations Working Group at Women Deliver 2007Maternal mortality scorecard. Women Deliver, Family Health International; See http://2007.womendeliver.org/publications/Maternal_Mortality_Scorecard.htm [Google Scholar]
• UNICEF 2009The state of the world'south children 2009 New York, NY: UNICEF; See http://www.unicef.org/sowc09/report/report.php [Google Scholar]
• United Nations Population Sectionalisation 2007World population prospects: the 2006 revision population database New York, NY: United Nations Population Division; See http://esa.un.org/unpp/ [Google Scholar]
• United Nations Population Division 2008World urbanization prospects: The 2007 revision population database New York, NY: United nations Population Division; See http://esa.un.org/unup/ [Google Scholar]
• United nations Population Fund 2007Land of world population 2007: unleashing the potential of urban growth New York, NY: United Nations Population Fund; Run into http://www.unfpa.org/swp/2007/english/introduction.html [Google Scholar]
• United states of america Aid 2006Adding family planning to PMTCT sites increases PMTCT benefits Washington, DC: US AID; See www.usaid.gov/our_work/global_health/popular/techareas/repositioning/briefs/adding_fp_pmtct.pdf [Google Scholar]
• Westoff C. F.2006New estimates of unmet need and the demand for family planning Calverton, Doc: Macro International Inc [Google Scholar]
• Globe Bank 1993World development report 1993: investing in wellness New York, NY: Oxford Academy Press [Google Scholar]
• World Bank 2005World development indicators 2005 Washington, DC: World Bank; See http://devdata.worldbank.org/wdi2005/Cover.htm [Google Scholar]
• World Wellness System 2006The world health study 2006: working together for health Geneva, Switzerland: WHO [PubMed] [Google Scholar]

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Articles from Philosophical Transactions of the Royal Society B: Biological Sciences are provided here courtesy of The Royal Society

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781837/

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