A new World Bank report titled Population Issues in the 21st Century: The Role of the World Bank, released recently warns that poor countries, wealthy donors, and aid agencies are losing sight of the value of contraception, family planning, and other reproductive health programs so as to boost economic growth, and reduce high birth rates which are strongly linked with endemic poverty, poor education, and high numbers of maternal and infant deaths. 

According to the new report, 35 countries, mostly from Sub-Saharan Africa (SSA), have birth rates of more than five children per mother, and that of the estimated 210 million women who become pregnant every year worldwide, more than 500,000 women die during pregnancy and childbirth.  About one in five of these women from SSA resorts to abortion because of poor access to contraception. The report finds that some 68,000 women die each year as a result of unsafe abortion, 5.3 million suffer temporary or permanent disability, and many end up being ostracized within their own communities. The report says that because fertility rates have declined significantly in most low-and middle-income, countries, outside of Africa, the priorities and attention of donor countries and development agencies have shifted toward other issues, and global funds and initiatives have largely bypassed funding of family planning, with less attention being focused on the consequences of high fertility, even in those countries that are lagging in achieving sustainable population growth.

It is said that poor women endure a disproportionate burden of poor sexual and reproductive health because they run into financial or social barriers getting access to these basic but vital programs. Poor women’s full and equal participation in development depends directly on accessing essential sexual and reproductive health care. The World Bank is considered to be committed to helping these women, along with the UN Population Fund, WHO, and the technical health agencies, in order to make voluntary and informed decisions about fertility. Falling birth rates cannot be achieved through better health programs alone. There is need for improved education for girls, equal economic opportunities for women in society, and fewer  households living below the poverty line. These are considered to be vital parts of a strategy to achieve sustainable reductions in birth rates. The new report says the world is in the middle of major demographic changes. In 1970, Bangladesh had some of the worst social indicators and lowest income of all countries, with a fertility rate of about seven children per woman; now that rate is about three. Similar declines in fertility can be found in countries in East Asia, Latin America, and the Middle East and North Africa. The widespread decline in fertility, coupled with reductions in mortality in most countries, have resulted in changes in the age structure and population growth rates that have far-reaching consequences for sectors such as health, education, labor markets, and social protection.

During the second half of the 20th century, world population more than doubled to reach six billion, an astonishing 3 billion increase in population in just 40 years. Although this rate has now slowed to 1.2 percent a year, an additional 75 million people are being added every year this decade. The world’s population is projected to reach 9.1 billion by 2050, with the majority likely to live in the world’s poorest countries.

The report says that the globe’s highest birth rates are found in Sub-Saharan Africa, where average fertility remains above five children per woman. While demographic patterns are converging in many regions, countries that are lagging in fertility decline and mortality reduction are increasingly different from the rest of the world. It is said that the longer it takes for countries to move to a low-fertility, low-mortality pattern, the greater the danger that high-birth rate countries will continue to experience greater inequalities in education, jobs, life expectancy, and adult prence of HIV/AIDS, than their wealthier counterparts. The World Bank report says that fertility can also affect women’s jobs in the workplace. One cross-national study has suggested that the percentage of women in the labor force is directly related to national birth rates. Changing household behaviors is recognized as vital for increasing the use of family planning programs. Social and cultural factors such as disapproval by family and communities, and men’s roles in deciding family size, can deter women who might otherwise be interested in family planning help, while in some countries, providers and even programs may deny such care to vulnerable groups such as unmarried adolescents.

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