World Development Report 1984

FIGURE 8.2 upper Egypt want no more children but are not
Fertility in relation to income: selected developing using contraception, and that more than half of
countries in the Middle East and North Africa, 1972 these women would like to use a method. In Jen-
douba, Tunisia, 46 percent of women who were
Total fertility rate not using contraception wanted no more children,
8 and 22 percent said that they would like to space
the next birth. When women in Marrakech,
Jordan Algeria Morocco, were offered supplies of oral contraceptives
through home visits, the rate of contraceptive
7 use rose from 18 to 43 percent. In the Sfax region of
Tunisia, household distribution increased the rate
\ 1972 from 7 to 18 percent.
6 \\ Tunisia * 1982 Continued progress in reducing fertility in these
countries will depend both on better family planning
services and on measures to improve the sta-
Norm for 92 developing tus of women.
countries, 1972 * Family planning programs. Access to services in
5 / rural areas is still restricted. The Tunisian program
has had difficulty reaching a dispersed rural popu-
Egypt lation, which includes half of the married women
of reproductive age. Services in Morocco and
4 *Turkey Egypt rely heavily on physicians and are clinic-
based with little outreach. In Egypt only physi-
Norm for 98 developing countries,1982 cians may prescribe the pill and insert the IUD.
The few outreach workers in place are not permit-
0 $1000 $2000 $30 ted to distribute contraceptives and are supposed
Income per capita(1980dollars) to motivate only women who already have three
children. In Morocco, nurses were only recently
authorized to insert IUDs, and nonclinical distribution
of the pill is still frowned upon. Yet experience
in South and East Asia as well as in Latin America
Despite these achievements, population growth indicates that carefully trained paramedical
remains rapid and acceptance of family planning fieldworkers can deliver many methods and
slow. Total fertility, although reduced, is still 4 to 5 increase contraceptive prevalence dramatically.
in Egypt, Tunisia, and Turkey, and about 6 in Use of the media to promote family planning and
Morocco. In Egypt and Tunisia, an increase in the small families has been limited in Morocco: not
proportion of women of childbearing age has kept until 1982 were the Ministry of Public Health and
the birth rate high. Mortality has declined, and the the private family planning association permitted
rate of population growth has changed little. Pop- to broadcast family planning messages and show
ulation pressure has been eased in both countries films.
by emigration, but poor economic conditions in The limited range of contraceptives available
Europe have reduced emigration from Tunisia and in Egypt and Morocco also restricts their use.
caused many emigrants to return. The rate of con- Although the IUD and condoms are theoretically'
traceptive use has remained at about 25 percent in available, both programs favor the pill. Only one-
Egypt for several years; increases have been slow quarter of outlets in Egypt are staffed or suppliedin
Turkey and Morocco. The number of new accep- to provide IUD insertions. Only one brand of pill is
tors of family planning has barely risen in Tunisia offered. Sterilization is legal but not promoted by
for about five years. the official program; abortion is prohibited. In con-
There is ample evidence of unmet need for fam- trast, the Tunisian program has made the pill, IUD,
ily planning services. Low and high estimates in female sterilization, and abortion (in the first three
Egypt ranged from 12 to 22 percent of married months of pregnancy) more widely available.
women of childbearing age in 1980. In certain areas * The status of women. Increasing the number of
unmet need is even higher. One study found that educated women could do much to reduce fertility
82 percent of married women in rural areas of in the region. Enrollment rates for girls in 1980
168