World Development Report 1984
World Development Report 1984
World Development Report 1984
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FIGURE 8.2 upper Egypt want no more children but are not<br />
Fertility in relation to income: selected developing using contraception, and that more than half of<br />
countries in the Middle East and North Africa, 1972 these women would like to use a method. In Jen-<br />
douba, Tunisia, 46 percent of women who were<br />
Total fertility rate not using contraception wanted no more children,<br />
8 and 22 percent said that they would like to space<br />
the next birth. When women in Marrakech,<br />
Jordan Algeria Morocco, were offered supplies of oral contraceptives<br />
through home visits, the rate of contraceptive<br />
7 use rose from 18 to 43 percent. In the Sfax region of<br />
Tunisia, household distribution increased the rate<br />
\ 1972 from 7 to 18 percent.<br />
6 \\ Tunisia * 1982 Continued progress in reducing fertility in these<br />
countries will depend both on better family planning<br />
services and on measures to improve the sta-<br />
Norm for 92 developing tus of women.<br />
countries, 1972 * Family planning programs. Access to services in<br />
5 / rural areas is still restricted. The Tunisian program<br />
has had difficulty reaching a dispersed rural popu-<br />
Egypt lation, which includes half of the married women<br />
of reproductive age. Services in Morocco and<br />
4 *Turkey Egypt rely heavily on physicians and are clinic-<br />
based with little outreach. In Egypt only physi-<br />
Norm for 98 developing countries,1982 cians may prescribe the pill and insert the IUD.<br />
The few outreach workers in place are not permit-<br />
0 $1000 $2000 $30 ted to distribute contraceptives and are supposed<br />
Income per capita(1980dollars) to motivate only women who already have three<br />
children. In Morocco, nurses were only recently<br />
authorized to insert IUDs, and nonclinical distribution<br />
of the pill is still frowned upon. Yet experience<br />
in South and East Asia as well as in Latin America<br />
Despite these achievements, population growth indicates that carefully trained paramedical<br />
remains rapid and acceptance of family planning fieldworkers can deliver many methods and<br />
slow. Total fertility, although reduced, is still 4 to 5 increase contraceptive prevalence dramatically.<br />
in Egypt, Tunisia, and Turkey, and about 6 in Use of the media to promote family planning and<br />
Morocco. In Egypt and Tunisia, an increase in the small families has been limited in Morocco: not<br />
proportion of women of childbearing age has kept until 1982 were the Ministry of Public Health and<br />
the birth rate high. Mortality has declined, and the the private family planning association permitted<br />
rate of population growth has changed little. Pop- to broadcast family planning messages and show<br />
ulation pressure has been eased in both countries films.<br />
by emigration, but poor economic conditions in The limited range of contraceptives available<br />
Europe have reduced emigration from Tunisia and in Egypt and Morocco also restricts their use.<br />
caused many emigrants to return. The rate of con- Although the IUD and condoms are theoretically'<br />
traceptive use has remained at about 25 percent in available, both programs favor the pill. Only one-<br />
Egypt for several years; increases have been slow quarter of outlets in Egypt are staffed or suppliedin<br />
Turkey and Morocco. The number of new accep- to provide IUD insertions. Only one brand of pill is<br />
tors of family planning has barely risen in Tunisia offered. Sterilization is legal but not promoted by<br />
for about five years. the official program; abortion is prohibited. In con-<br />
There is ample evidence of unmet need for fam- trast, the Tunisian program has made the pill, IUD,<br />
ily planning services. Low and high estimates in female sterilization, and abortion (in the first three<br />
Egypt ranged from 12 to 22 percent of married months of pregnancy) more widely available.<br />
women of childbearing age in 1980. In certain areas * The status of women. Increasing the number of<br />
unmet need is even higher. One study found that educated women could do much to reduce fertility<br />
82 percent of married women in rural areas of in the region. Enrollment rates for girls in 1980<br />
168