World Development Report 1984

costs per user. Public cost per user varies among cent. For the projections of a "rapid" decline in
countries, as Table 7.4 shows, depending on many fertility, which imply a total fertility rate of 2.4 in
factors, including local salaries and program effi- 2000, contraceptive use would need to reach 72
ciency and quality. percent.
Cost per user tends to be very high in the first How much would this cost? To achieve the
few years of a family planning program; it then standard decline in fertility, and assuming 1980
falls sharply as the rate of contraceptive use rises costs per user, total public spending on population
above 5 percent. At higher rates the cost per user programs would need to reach $5.6 billion (in contends
to stabilize, or perhaps to rise slightly. stant 1980 dollars) by the year 2000-a rise in real
Between 1965 and 1980, while contraceptive use in terms of 5 percent a year. To ensure the rapid
Korea rose from 12 to 30 percent, cost per user decline, spending would need to total $7.6 billion
fluctuated (with little apparent trend) between $7 by 2000, a rise of 7 percent a year in real terms.
and $13 (in constant 1982 dollars). Growth in spending will have to be much
In any country with contraceptive use of at least greater in some regions than in others. Average
5 percent, current cost per user is a conservative real increases in spending of 2.5 percent a year
guide to costs at higher levels of use. Marginal would be enough to meet targets in East Asia as a
costs could rise if new users are in inaccessible whole (though not for individual countries), and 5
rural areas with high delivery costs, though they percent would be enough for Latin America and
could also fall if services are more intensively used. the Caribbean. In South Asia, the Middle East and
North Africa, and sub-Saharan Africa, however,
Fuiture financial requirements population spending would have to grow 8 to 10
percent every year to achieve a standard decline in
What would it cost to satisfy the unmet need for fertility, and in sub-Saharan Africa as much as 16
limiting births? Some idea can be obtained by percent every year to support a rapid decline.
extrapolating levels of unmet need-the propor- Because spending on population currently repretion
of women exposed to the risk of pregnancy sents less than 1 percent of government budgets,
who want no more children-in thirty-five devel- small increases could go a long way toward meetoping
countries in the mid-1970s to cover the ing the requirement for higher spending. The
developing world as a whole. That extrapolation same is true for external assistance. Only about 1
suggests a possible increase in the rate of contra- percent of official aid now goes for population
ceptive use of 13 percentage points. If the public assistance (and only a part of that for family plancost
for each additional user were the same, coun- ning). lncreasing spending by 50 percent could fill
try by country, as the cost per user in 1980, such an "unmet need" today, but larger increases will be
increase would require another $l billion in public needed in the future. In many countries the
spending (see Table 7.6). required increase in public expenditure for family
In the next two decades total spending for family planning would be more than offset by reductions
planning programs will need to increase because in public expenditure in other sectors. With conof
the growing number of women of childbearing stant enrollment rates, rapid fertility decline would
age and the increasing proportion of them who are generate per capita savings in education expendilikely
to want modern contraceptives. World Bank ture in the year 2000 of $1.80 in Egypt, $3.30 inprojections
indicate that the number of married Kenya, $6.00 in Korea, and $6.60 in Zimbabwe.
women of reproductive age in all developing countries
will increase from about 500 million to more Obstacles to program expansion
than 700 million between 1980 and 2000. About 40
percent of these women used contraception in If the financial resources to expand family plan-
1980. ning services were made available, could they be
The 'standard" projections in Chapter 4 imply put to good use? Program expansion may be diffian
average total fertility rate of 3.3 in developing cult for a variety of reasons, including administracountries
in the year 2000. If it is assumed that the tive and logistical obstacles, scarcity of personnel,
fertility effects of later marriage and of shorter and limited demand. These tend to limit the rate at
breastfeeding will largely cancel each other out which a good program can be expanded, but not
and that the abortion rate will stay constant, expansion itself.
achieving this fertility decline will require an The administrative and logistical obstacles
increase in the rate of contraceptive use to 58 per- include many of the same constraints that hamper
152