World Development Report 1984

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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. <strong>World</strong> 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
TABLE 7.6 Fertility targets and estimates of population program expenditures, 1980 and 2000 Expenditures Fertility targets Total Total Contraceptive (millions of fertility prevalence Percapita constant Region and scenario Year rate (percent) (constant 1980 dollars) 1980 dollars) All developing countries Current estimate 1980 4.36 39 0.62 2,016 With unmet need filled 1980 3.54 52 0.90 2,961 Under standard decline 2000 3.30 58 1.14 5,569 Under rapid decline 2000 2.32 72 1.66 7,591 Sub-Saharan Africaa Current estimate 1980 6.59 11 0.29 112 With unmet need filled 1980 6.03 20 0.76 297 Under standard decline 2000 5.81 24 1.07 791 Under rapid decline 2000 2.69 73 3.72 2,353 Middle East and North Africa Current estimate 1980 5.70 24 0.66 142 With unmet need filled 1980 4.98 35 1.04 222 Under standard decline 2000 3.73 59 1.94 726 Under rapid decline 2000 2.39 74 2.43 812 South Asiab Current estimate 1980 5.22 20 0.35 315 With unmet need filled 1980 4.15 38 0.77 688 Under standard decline 2000 3.43 51 1.10 1,517 Under rapid decline 2000 2.42 67 1.50 1,873 East Asia Current estimate 1980 3.02 61 0.87 1,238 With unmet need filled 1980 2.27 72 1.04 1,480 Under standard decline 2000 2.28 75 1.09 2,022 Under rapid decline 2000 2.16 74 1.08 2,015 Latin America and Caribbean Current estimate 1980 4.28 40 0.59 209 With unmet need filled 1980 3.53 51 0.77 274 Under standard decline 2000 2.80 63 0.95 513 Under rapid decline 2000 2.17 72 1.07 538 Note: The fertility targets and per capita expenditure figures are population-weighted means. Because of lack of data on contraceptive prevalence for many countries, regional estimates include country rates which were estimated based on various social and economic data. a. Includes Republic of South Africa. b. Includes Afghanistan. Souirce: Bulatao, <strong>1984</strong>a. other development programs. For example, a fam- services on a larger, national scale. In areas where ily planning program requires a system for obtain- health services are scant or nonexistent, a family ing, storing, and distributing contraceptives. If a planning program will be extremely difficult to program attempts to provide a mix of methods, implement. this system can become complicated; it may The personnel requirements for an extensive require more than one distribution network-com- family planning program are not large in relation mercial, clinical, and nonclinical. Where overall to the supply of educated people. Desirable ratios government administration is weak, roads are are about 1 fieldworker to 300 families, and 1 poor, and communications slow, even the best-run supervisor for every 8 fieldworkers. For Upper programs will appear inefficient and incapable of Volta, a country with extremely low literacy, a prosustained expansion. These limits may not be evi- gram could be fully staffed at these ratios by about dent in small pilot projects, but they can become a tenth of a single year's primary and secondary important when an attempt is made to extend school graduates. The conclusion becomes less 153
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Public Disclosure Authorized Public
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Oxford University Press NEW YORK OX
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labor markets. And they have a vest
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8 The policy agenda 155 Population
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Boxes 1.1 The arithmetic of populat
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Glossary Demographic terms informat
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I I
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countries regain their momentum of
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4 Box 1.1 The arithmetic of populat
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example. Between 1955 and 1980 inco
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ment-all the more so if human skill
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etween 1 and 2 percent-moderate com
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FIGURE 2.1 directions-with a lag in
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14 Distribution of product among se
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TABLE 2.2 Rates of growth in the re
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export restraints and orderly marke
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Box 2.2 Comparisons between the 193
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TABLE 2.6 indebtedness is denominat
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TABLE 2.7 Change in export prices a
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Burundi, Guinea, Mali, Malawi, and
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TABLE 2.9 Exports from developing c
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of rapid and painful adjustment for
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In many countries internal adjustme
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3 Prospects for sustained growth Wi
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TABLE 3.2 Growth of GDP per capita,
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TABLE 3.4 Current account balance a
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over time. The main focus of indust
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TABLE 3.6 Growth of trade in develo
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Box 3.3 Delinking from the world ec
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nal surplus. The resulting rise in
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Because the public sector in low-in
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developing-country creditworthiness
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themselves and, by caring for young
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fertility in a changing world is a
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nize contraceptive services. As wil
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Economic transformation: Europe, Ja
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scious control of family size, prob
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Box 4.3 The European fertility tran
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FIGURE 4.2 Birth and death rates an
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Box 4.4 Alternative measures of fer
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largest city in 1950, will not even
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FIGURE 4.4 Fertility in relation to
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government goal is a nationwide rat
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North America's population in 2000
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IBox 4.6 Three views of population
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TABLE 4.6 Population size and densi
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Box 5.1 Consequences of population
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implied by a simple division of tot
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and on farms. But the evidence on e
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get in GDP. Alternatively, all or p
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youths, who are presumably able to
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saving because they come from the c
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acre increased from 15.4 million to
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food they need. Although the amount
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is so scarce, they can do so only o
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from rural to urban areas mainly re
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other developing countries suggests
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Page 118 and 119: Box 5.7 Coping with rapid fertility
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Page 126 and 127: etter education and health services
Page 128 and 129: TABLE 6.1 Total fertility rates and
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Page 134 and 135: FIGURE 6.6 Fertility dedine within
Page 136 and 137: Box 6.3 Mleasuring the value of chi
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Page 140 and 141: Box 6.4 A deferred incentive scheme
Page 142 and 143: Box"7.1 Family planning for health
Page 144 and 145: FIGURE 71 88 in Romania (1979). Res
Page 146 and 147: 132 Box 7.2 Birth planning technolo
Page 148 and 149: TABLE 7.2 Percentage of married wom
Page 150 and 151: TABLE 7.3 Discontinuation of contra
Page 152 and 153: may be delaying a first pregnancy,
Page 154 and 155: family planning and maternal and ch
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Page 158 and 159: Box 7.6 The impact of service quali
Page 160 and 161: medical examination was not always
Page 162 and 163: measuring social acceptability, or
Page 164 and 165: Box 7.7 Military versus social expe
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Page 170 and 171: TABLE 8.1 Population policy indicat
Page 172 and 173: Box 8.2 China's census: counting a
Page 174 and 175: FAMILY PLANNING. In many countries-
Page 176 and 177: improving the availability of famil
Page 178 and 179: Box 8.4 Africa: how much land, how
Page 180 and 181: Box 8.5 Infertility: a challenge to
Page 182 and 183: FIGURE 8.2 upper Egypt want no more
Page 184 and 185: growth. Fertility has declined in t
Page 186 and 187: Box 8.7 Changing policies and attit
Page 188 and 189: FIGURE 8.6 childbearing age have un
Page 190 and 191: able several types of condoms, pill
Page 192 and 193: housing schemes to parents with onl
Page 194 and 195: and training, data collection and a
Page 196 and 197: 9 Ten years of experience Much that
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Page 200 and 201: Population data supplement The six
Page 202 and 203: Table 4. Factors influencing fertil
Page 204 and 205: 190 Births and total fertility =Ice
Page 206 and 207: Table 1. Population projections Rat
Page 208 and 209: Table 2. Population composition Low
Page 210 and 211: Table 3. Contraceptive use and unme
Page 212 and 213: Table 5. Status of women Number enr
Page 214 and 215: Table 6. Family planning policy _ _
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Bibliographical note This Report ha
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Background papers Note: Source refe
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-1984. "The Malthusian Case: Preind
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I I
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Table 10. Structure of merchandise
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Key In each table, economies are li
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same order is used in all tables. T
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Population I~~~~ - * S: ~ -- ' X -
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Table 1. Basic indicators GNP per c
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Table 2. Growthi of production Aver
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Table 3. Structure of production GD
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Table 4. Growth of consumption-and
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Tadble 5. Structure of demand Distr
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Table 6. Agriculture and food Value
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Table 7. Industr Distribution of ma
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Table 8. Commercial energy Energy c
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Table 9. Growthi of merchandise tra
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Table 12. Origin and destination of
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Table 13. Origin and destination of
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Table 14. Balance of payments and r
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Table 15. Flow of public and public
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Table 16. External public debt and
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Table 17. Terms of public borrowing
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Table 18. Official development assi
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Table 19. Population growth and pro
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Table 20. Demographic and fertility
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Table 21. Labor force Percentage of
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Table 22. Urbanization Urban popula
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Table 23. Indicators related to lif
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Table 24. Health-related indicators
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Table 25. Education Number Number e
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Table 26. Central goverrnment expen
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Table 27. Central government curren
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Table 28. In-come distribution Perc
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Technical notes This edition of the
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difficulties in assigning subsisten
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series in national currencies are a
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Public loans are external obligatio
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estimates, the total fertility rate
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expenditure and current revenue sho
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Bibliography of data sources Nation
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World Development Report 1984

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