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      Family planning in sub-Saharan Africa: progress or stagnation? Translated title: Planning familial en Afrique subsaharienne: progrès ou stagnation ? Translated title: Planificación familiar en el África Subsahariana: ¿progreso o estancamiento?

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      Bulletin of the World Health Organization

      World Health Organization

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          OBJECTIVE: To review progress towards adoption of contraception among married or cohabiting women in western and eastern Africa between 1991 and 2004 by examining subjective need, approval, access and use. METHODS: Indicators of attitudes towards and use of contraception were derived from Demographic and Health Surveys, which are nationally representative and yield internationally comparable data. Trends were examined for 24 countries that had conducted at least two surveys between 1986 and 2007. FINDINGS: In western Africa, the subjective need for contraception remained unchanged; about 46% of married or cohabiting women reported a desire to stop and/or postpone childbearing for at least two years. The percentage of women who approved of contraception rose from 32 to 39 and the percentage with access to contraceptive methods rose from 8 to 29. The proportion of women who were using a modern method when interviewed increased from 7 to 15% (equivalent to an average annual increase of 0.6 percentage points). In eastern African countries, trends were much more favourable, with contraceptive use showing an average annual increase of 1.4 percentage points (from 16% in 1986 to 33% in 2007). CONCLUSION: In western Africa, progress towards adoption of contraception has been dismally slow. Attitudinal resistance remains a barrier and access to contraceptives, though improving, is still shockingly limited. If this situation does not change radically in the short run, the United Nations population projections for this subregion are likely to be exceeded. In eastern Africa, the prospects for a future decline in fertility are much more positive.

          Translated abstract

          OBJECTIF: Observer le progrès de l'adoption de la contraception chez les femmes mariées ou en concubinage en Afrique occidentale et orientale entre 1991 et 2004 en examinant le besoin subjectif, l'acceptation, l'accès et l'utilisation. MÉTHODES: Les indicateurs d'attitude envers la contraception et son utilisation ont été dérivés des enquêtes de démographie et de santé publique qui sont représentatives au niveau national et fournissent des résultats internationalement comparables. Les tendances ont été étudiées pour 24 pays ayant mené au moins deux enquêtes entre 1986 et 2007. RÉSULTATS: En Afrique de l'Ouest, le besoin subjectif de contraception est resté inchangé, environ 46% des femmes mariées ou en concubinage ont indiqué un désir d'arrêter et/ou de retarder une maternité pendant au moins deux ans. Le pourcentage de femmes qui approuvaient la contraception s'est accru de 32 à 39 et le pourcentage de celles qui accédaient aux méthodes contraceptives, de 8 à 29. La proportion de femmes utilisant une méthode moderne au moment de leur interview s'est accrue de 7 à 15% (équivalant à une augmentation annuelle moyenne de 0,6 point de pourcentage). Dans les pays d'Afrique de l'Est, les tendances ont été beaucoup plus favorables, avec une utilisation des contraceptifs en augmentation annuelle moyenne de 1,4 point de pourcentage (de 16% en 1986 à 33% en 2007). CONCLUSION: En Afrique de l'Ouest, le progrès de l'adoption de la contraception a été désastreusement lente. L'attitude de résistance demeure une barrière et l'accès aux contraceptifs, bien qu'en progrès, est toujours terriblement limité. Si cette situation ne change pas radicalement dans le court terme, les estimations des Nations Unies pour la population de cette sous-région seront probablement dépassées. En Afrique de l'Est, les perspectives d'un futur déclin de la fertilité sont beaucoup plus positives.

          Translated abstract

          OBJETIVO: Revisar el progreso hacia la adopción de métodos anticonceptivos en las mujeres casadas o que viven en pareja en África Oriental y Occidental entre los años 1991 y 2004 analizando su necesidad subjetiva, aprobación, acceso y uso. MÉTODOS: Los indicadores de las actitudes hacia la anticoncepción y el uso de los métodos anticonceptivos se extrajeron de las Encuestas Demográficas y de Salud, que son representativas a nivel nacional y generan datos comparables a nivel internacional. Se examinaron las tendencias de 24 países que habían realizado al menos dos encuestas entre los años 1986 y 2007. RESULTADOS: En África Occidental, la necesidad subjetiva de métodos anticonceptivos permaneció invariable; aproximadamente un 46% de las mujeres casadas o que vivían en pareja manifestaron su deseo de detener y/o posponer la maternidad durante al menos dos años. El porcentaje de mujeres que aprobaron la anticoncepción aumentó de 32 a 39 puntos y el porcentaje de acceso a los métodos anticonceptivos se elevó de un 8 a un 29 por ciento. La proporción de mujeres que estaba utilizando un método anticonceptivo moderno cuando se les realizó la entrevista aumentó de un 7 a un 15% (el equivalente a un aumento medio anual de 0,6 puntos porcentuales). En los países de África Oriental las tendencias fueron mucho más favorables: el uso de métodos anticonceptivos experimentó un aumento anual de 1,4 puntos porcentuales (del 16% de 1986 al 33% registrado en 2007). CONCLUSIÓN: El progreso hacia la adopción de métodos anticonceptivos ha sido catastróficamente lento en África Occidental. Las posturas de rechazo siguen siendo una barrera y el acceso a los métodos anticonceptivos, si bien ha mejorado, sigue siendo sorprendentemente limitado. En caso de que esta situación no cambie radicalmente a corto plazo es muy probable que se sobrepasen las proyecciones demográficas de las Naciones Unidas para esta subregión. En África Oriental, las perspectivas de un futuro descenso de la natalidad son mucho más positivas.

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          Most cited references 18

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          Induced abortion: estimated rates and trends worldwide.

          Information on incidence of induced abortion is crucial for identifying policy and programmatic needs aimed at reducing unintended pregnancy. Because unsafe abortion is a cause of maternal morbidity and mortality, measures of its incidence are also important for monitoring progress towards Millennium Development Goal 5. We present new worldwide estimates of abortion rates and trends and discuss their implications for policies and programmes to reduce unintended pregnancy and unsafe abortion and to increase access to safe abortion. The worldwide and regional incidences of safe abortions in 2003 were calculated by use of reports from official national reporting systems, nationally representative surveys, and published studies. Unsafe abortion rates in 2003 were estimated from hospital data, surveys, and other published studies. Demographic techniques were applied to estimate numbers of abortions and to calculate rates and ratios for 2003. UN estimates of female populations and livebirths were the source for denominators for rates and ratios, respectively. Regions are defined according to UN classifications. Trends in abortion rates and incidences between 1995 and 2003 are presented. An estimated 42 million abortions were induced in 2003, compared with 46 million in 1995. The induced abortion rate in 2003 was 29 per 1000 women aged 15-44 years, down from 35 in 1995. Abortion rates were lowest in western Europe (12 per 1000 women). Rates were 17 per 1000 women in northern Europe, 18 per 1000 women in southern Europe, and 21 per 1000 women in northern America (USA and Canada). In 2003, 48% of all abortions worldwide were unsafe, and more than 97% of all unsafe abortions were in developing countries. There were 31 abortions for every 100 livebirths worldwide in 2003, and this ratio was highest in eastern Europe (105 for every 100 livebirths). Overall abortion rates are similar in the developing and developed world, but unsafe abortion is concentrated in developing countries. Ensuring that the need for contraception is met and that all abortions are safe will reduce maternal mortality substantially and protect maternal health.
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            Women's fears and men's anxieties: the impact of family planning on gender relations in northern Ghana.

            The Navrongo experiment, a family planning and health project in northern Ghana, has demonstrated that an appropriately designed, community-based family planning program can produce a change in contraceptive practice that had been considered unattainable in such a setting. Simultaneously, however, evidence suggests that newly introduced family planning services and contraceptive availability can activate tension in gender relations. In this society, where payment of bridewealth signifies a woman's requirement to bear children, there are deeply ingrained expectations about women's reproductive obligations. Physical abuse and reprisals from the extended family pose substantial threats to women; men are anxious that women who practice contraception might be unfaithful. Data from focus-group discussions with men and women are examined in this report and highlight the strains on gender relations resulting from contraceptive use. The measures taken to address this problem and methods of minimizing the risk of adverse social consequences are discussed.
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              Fertility transitions in developing countries: progress or stagnation?

              Over the past quarter-century,fertility has declined rapidly in many developing countries. Projections typically assume that this trend will continue until replacement level is reached. Recent evidence suggests, however, that ongoing fertility declines may have slowed or stalled in a number of countries in transition. This study examines the pace of fertility change in developing countries that have multiple Demographic and Health Surveys to determine whether ongoing transitions are decelerating or stalling. The main findings are that in sub-Saharan African countries, the average pace of decline in fertility was lower around 2000 than in the mid-1990s and that more than half the countries in transition in this region have stalled.

                Author and article information

                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                February 2011
                : 89
                : 2
                : 137-143
                Nairobi orgnameAfrican Institute for Development Policy Kenya
                London orgnameLondon School of Hygiene & Tropical Medicine orgdiv1Department for Population Studies England
                S0042-96862011000200013 S0042-9686(11)08900213

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 7
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