World Population Prospects and Unmet Need for Family Planning
Over the past 30 years, the use of modern family planning methods has increased dramatically in the developing world, leading to a fall in fertility rates. Yet there are still significant levels of demand for family planning that are unmet. If this unmet need were met, unintended pregnancies would be fewer, women’s health and lives would be improved, and the consequent impact on fertility would result in lower population growth and measured development benefits. This paper estimates what the demographic impact of meeting this unmet need would be for the developing world and the United States, and compares this scenario with three United Nations fertility variants. The United Nations (UN) provides estimates of future fertility trajectories for the countries of the world through 2050.1 These estimates are widely used by researchers, planners, and policy makers and are a widely respected reference source when detailed population projections prepared at the country level are unavailable. The UN estimates are based on projections of fertility derived from past trends, as well as estimates of future life expectancy. We estimate the family planning implications of the three UN projections and compare them with the fourth “unmet need” scenario. We compare the demographic implications of the unmet need scenario with those of the three UN scenarios, as well as the implied family planning costs. To prepare the four projection scenarios, we used the DEMPROJ and FAMPLAN modules of the Spectrum model and applied this to each of the 99 countries we modeled. This approach combines a cohort-component population projection with the proximate determinant model of fertility. For the unmet need scenario, we assumed that the contraceptive prevalence rate (CPR) would increase at a rate that was reasonable, given past trends, until all currently observed unmet need was satisfied. We also developed future projections of the percentage of women who are in union, and the contraceptive method mix. For the UN scenarios, we used the model to estimate the level of CPR that, in conjunction with the other proximate determinants would yield the UN fertility assumptions. Family planning costs were projected for each scenario based on family planning unit costs and the projected number of users. The results for all countries together show that the CPR and total fertility rate (TFR) projections under the unmet need scenario first follow the UN medium scenario, then steadily move toward the UN low scenario in later years. Global population under the unmet need scenario follows a trajectory between that of the UN medium and UN low scenarios, although closer to the UN medium scenario. The 2005 starting population is 4.05 billion, and by 2050, the total population is 5.78 billion, 6.7 billion, and 7.7 billion, respectively, under the UN low, medium, and high scenarios, and 6.3 billion under the unmet need scenario. The cumulative costs of the family planning program for the entire projection period (2005–2050) for the unmet need scenario is slightly less than that estimated for the UN low ($1.116 trillion vs. $1.126 trillion). Costs for the UN medium and high scenarios are estimated to be $1.027 trillion and $948 billion, respectively. For the developing countries that were modeled, the CPR and TFR paths under the unmet need scenarios are very similar to the UN medium scenario in earlier years, and then approach and nearly meet the UN low scenario by the end of the projection period. The unmet need projection of total population is similar to the UN medium total population path, diverging significantly only in the later years. This later divergence reflects the unmet need scenario’s effect on continued decline in TFR in later years, when the TFR declines in the UN scenarios are small. The initial 2005 population in the developing countries is 3.7 billion, with a projected 2050 population of 6 billion for the unmet need scenario, compared with 5.4 billion for the UN low, 6.3 billion for the UN medium, and 7.2 billion for the UN high scenarios. The estimated cumulative cost for the unmet need scenario is $638 billion, which falls between the estimated costs for the UN low scenario of $665 billion and the costs for the UN medium scenario of $603 billion. . Assuming the UN high scenario as a baseline, the additional annual costs to meet unmet need for family planning are estimated to be approximately $3.7 billion per year over the 45-year projection period; $1.4 billion of this would be from the United States, and $2.3 billion from the 99 developing countries.