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Family planning, poverty and
Economic Development
Presented by:
SHIKHA BASNET
MPH-2021
SPH & CM
Total Slides: 71
Introduction
• Family planning is defined as “the ability of individuals and couples to anticipate
and attain their desired number of children and the spacing and timing of their
births. It is achieved through use of contraceptive methods and the treatment of
involuntary infertility”
-WHO
• Family planning refers to supplies and services which enable individuals and
couples to attain and plan for their desired number of children, and the spacing and
timing of births.
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Introduction (2)
• Supplies include modern contraceptive methods and services include health care,
counselling and information and education related to sexual and reproductive
health.
• The ability of individuals to determine their family size and the timing and spacing
of their children has resulted in significant improvements in health and in social
and economic well-being.
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Introduction (3)
• Family planning could prevent up to one-third of all maternal deaths by
allowing women to delay motherhood, space births, avoid unintended
pregnancies, and unsafely performed abortions, and stop childbearing when
they have reached their desired family size.
• Pregnancy and childbirth in adolescence can have long-lasting impact on
the social and economic well-being and are among the leading causes of
death among women aged 15-19 years (World Health Organization, 2018).
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Introduction (4)
• Contraceptive information and services are fundamental to the health and human
rights of all individuals.
• Family planning is often characterized as a key investment because it provides a
lifetime of benefits to users and their families and communities.
• At the individual level, there are benefits in infant, child and maternal health
outcomes (SDG 3), improved educational outcomes (SDG 4), gender equality and
women’s empowerment (SDG 5) and equal access to the labor market, social
protection and the political process (SDGs 5, 8, and 16).
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Introduction (5)
• The Family Planning Sustainable Development Goals model demonstrated that
improvements in socioeconomic status along with investments in family planning
maximize long-term progress towards reducing poverty and food insecurity and
increasing income.
• These analyses have helped to build the economic case for investment in family
planning and have shown the relevance of family planning for achieving the
Sustainable Development Goals.
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https://www.usaid.gov/global-health/health-areas/family-planning#dataSources
The cost of family planning services
• Each dollar invested in family planning brings multiple benefits in terms of births
averted and lives saved, making family planning an extremely cost-effective
health intervention.
• International studies have repeatedly confirmed that family planning ranks among
the most cost-effective of all health services, along with other basic and preventive
health measures such as vaccinating children and preventing HIV/AIDS.
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The cost of family planning services
• The average cost per year for contraceptive supplies is estimated to be about
US$1.55, based on the existing mix of contraceptive methods used in developing
countries.
• Program costs are higher, however, because they include health personnel and the
cost of running facilities and outreach programs.
• Program costs vary across regions and range on average from $2 to $35 per year
of protection per person, depending on the mode of service delivery, such as social
marketing, clinics, or community-based distribution.
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The cost of family planning services
• However, because many existing programs are underutilized, researchers believe
that the average cost for an additional contraceptive user may be closer to the
average cost of the commodity—an average of US$1.55 per new user.
• At an average supply cost of US$1.55 per user annually, it offers a safe,
affordable, and effective way for governments to reduce maternal and child illness
and deaths, as well as reduce national health expenditures on reproductive and
children’s health problems.
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Family Planning
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Global Scenario (1)
• Expanding access to contraception is an essential component of achieving
universal access to sexual and reproductive health-care services, as called
for in the 2030 Agenda for Sustainable Development.
• In 2020, among 1.9 billion women of reproductive age (15-49 years), 1.1
billion women are considered to have a need for family planning, meaning
that they desire to limit or delay childbearing.
• Of these women, 851 million are using a modern method of contraception
and 85 million are using a traditional method.
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Global Scenario (2)
• An additional 172 million women are using no method at all, despite their desire
to avoid pregnancy, and thus are considered to have an unmet need for family
planning.
• Most women who use contraception rely on modern methods, but the specific
contraceptive methods used vary by region.
• Still, nearly 1 in 10 women of reproductive age worldwide have an unmet need
for family planning: they want to avoid or postpone pregnancy but are not using
any form of contraception.
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Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning Indicators 2020.
Global Scenario (3)
• Between 2000 and 2020, the contraceptive prevalence rate (percentage of women
aged 15-49 who use any contraceptive method) increased from 47.7 to 49.0
percent.
• Whereas contraceptive use is currently lowest in sub-Saharan Africa, at 27.8
percent, this level is projected to increase over the next decade to 32.9 per cent.
• The proportion of women who have their need for family planning satisfied with
modern methods (SDG indicator 3.7.1) has increased from 74 to 76 per cent from
2000 to 2019.
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South East Asia
• Central and Southern Asia has seen the largest decline in the number of women
with unmet need since 2000.
• Globally, the number of women aged 15-19 years who had unmet need for family
planning decreased from 17 million in 2000 to 14 million in 2020.
• The large decline in unmet need among adolescent girls and young women in
Central and Southern Asia from over 6 million women in 2000 to 2.6 million in
2020 was the primary reason for the decrease at the global level.
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Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning indicators 2020.
South East Asia (2)
• The COVID-19 pandemic is the greatest global public health crisis in a century.
Women’s ability to use contraception has also been impacted by COVID-19
pandemic.
• It has disrupted the global supply chain, which has led to reduced production,
distribution and availability of contraceptive commodities, resulting in shortages.
• In India, it has been reported that nearly 900,000 accredited community health
workers, who used to work on reproductive health and distribution of family
planning, were diverted to the country’s COVID-19 response.
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South East Asia (3)
• Barriers to service utilization also exist on the demand side, with some individuals
avoiding family planning clinics due to restrictions on movement and/or a
(legitimate) fear of contracting the virus during visits to healthcare providers or
pharmacies (UN Women, 2020).
• Furthermore, during lockdowns, there appears to have been a rise in the rate of
intimate-partner violence, which may include sexual coercion and sexual assault,
potentially increasing the need for emergency contraception.
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South East Asia (4)
• In April 2020, UNFPA projected that 47 million women in 114 LMICs Globally
may be unable to use modern contraceptives if the average lockdown persists for 6
months with high levels of COVID-19 related disruptions to health services, and
that an additional 2 million women would be unable to use modern contraceptives
for every 3 months the lockdown continues.
• This translates into an estimated 7 million unintended pregnancies if the lockdown
lasts for 6 months with major health service disruptions due to COVID-19.
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Scenario of Nepal (1)
• Family planning (FP) is one of the important components of Nepal’s national
health system.
• The aim of National FP program is to ensure individuals and couples fulfil their
reproductive needs and rights by using quality FP methods voluntarily based on
informed choices.
• Government of Nepal (GoN) is committed to equitable and right based access to
voluntary, quality FP services based for all individuals with special focus on hard
to reach communities such as adolescents, migrants, slum dwellers, sexual
minorities and other vulnerable groups ensuring no one is left behind.
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Scenario of Nepal (2)
• To achieve this, GoN is committed and striving:
 to strengthen policies and strategies related FP within the new federal context,
 mobilize resources,
 improve enabling environment to engage effectively with supporting partners,
 promote public-private partnerships, and
 involve non-health sectors.
• FP has been enshrined as a fundamental right in the constitution, and included in
the basic health service package under the Public Health Act 2018, thus paving a
way towards universal health coverage.
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Scenario of Nepal (3)
• FP is an essential health care services of Nepal Health Sector Program II
(2010‐2015), National Family Planning Costed Implementation Plan 2015‐ 2021,
Nepal Health Sector Strategy 2015‐2020 (NHSS) and the Government of Nepal’s
commitments to FP2020.
• FP information, education and services are provided through the government,
social marketing, NGOs and the private sector (including commercial sectors).
• In public health system, short acting reversible contraceptive methods are
provided through PHCCs, health posts, Urban Health Units (UHC), Community
Health Units (CHU), PHC-ORCs.
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Scenario of Nepal (4)
• FCHVs provide information and education to women and couple at community
and distribute male condoms and resupply OCPs.
• Access to LARC services in remote area is provided through satellite clinics,
extended visiting service providers and mobile camps.
• A sterilization service is provided at static sites or through scheduled seasonal and
mobile outreach services.
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Scenario of Nepal (5)
• FP services are also provided through private and commercial outlets such as
NGO run clinic/center, private clinics, pharmacies, hospitals including academic
hospitals.
• The total fertility rate (TFR) of women aged 15-49 declined from 4.1 children per
women in 2000 to 2.3 in 2016 and has declined to 2.0 in 2019 and mCPR was
39% in 2019.
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Source: DoHS, Annual Report 2076/77 (2019/20)
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Source: DoHS, Annual Report 2076/77 (2019/20)
SDG Target
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Target and Indicators 2020 status Source 2030
3.7.1 Proportion of women of reproductive age (aged 15-
49 years) who have their need for family planning
satisfied with modern methods
61.9 NMICS 80
a. Contraceptive prevalence rate (modern methods) (%) 44.2 NMICS 60
b. Total Fertility Rate (TFR) (births per women aged 15-
49 years)
2.0 NMICS 2.1
c. Adolescent birth rate (aged 10-14 years, aged 15-19
years) per 1,000 women in that age group
63 NMICS 30
Major activities (1)
Provision of regular comprehensive FP service including post-partum and post
abortion FP services
Provision of long acting reversible services, Permanent FP Methods or Voluntary
Surgical Contraception (VSC)
FP strengthening program through the use of decision-making tool (DMT)and
WHO medical eligibility for contraceptive (MEC) wheel
Micro planning for addressing unmet need of FP in hard to reach and underserved
communities
Provision of RANM and VSP service to increase FP service use
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Major activities (2)
Integration of FP and immunization service
Satellite clinic services for long acting reversible contraceptives
Contraceptive update for Obstetrician/Gynecologist, nurses & concerned key
players
Interaction program on FP and RH including ASRH with pharmacist and
marginalized communities
Community interaction with satisfied clients for promoting permanent method and
IUCD
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Why are people still reluctant in using FP?
 limited choice and access to contraception
 a fear or experience of side-effects
 cultural or religious opposition
 poor quality of available services
 gender-based barriers.
 Lack of youth-friendly services
 Lack of awareness of family planning
services among hard-to-reach populations
 migration
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Source: https://dhsprogram.com/pubs/pdf/FR336/FR336.pdf
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Poverty
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Introduction
• Poverty is a state or condition in which a person or community lacks the financial
resources and essentials for a minimum standard of living.
• Poverty means that the income level from employment is so low that basic human
needs can't be met.
• A person surviving on less than $1.90 a day lives in extreme poverty, as defined
by the World Bank.
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Causes of Poverty
 Inequality and marginalization
 Conflict
 Hunger, Malnutrition, and
Stunting
 Poor health care systems
 Little or no access to clean
water, sanitation and hygiene
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 Climate change
Lack of education
Poor public works and
infrastructure
 Lack of government support
Lack of jobs or livelihoods
 Lack of reserves
Source: https://reliefweb.int/report/world/11-top-causes-global-poverty
Approach to measure Poverty
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Source: https://ophi.org.uk/wp-content/uploads/GMPI_2018_2ed_web.pdf
• The global Multidimensional
poverty index (MPI) is
composed of three dimensions
(health, education, and living
standards) and 10 indicators.
• Each dimension is equally
weighted, and each indicator
within a dimension is also
equally weighted.
• A person is identified as
multidimensionally poor if they
are deprived in at least one
third of the weighted indicators.
Global Scenario
• More than 736 million people or one out of every ten people on the planet
currently live below this poverty threshold, and children, a highly vulnerable
segment of society, account for more than half of the world’s poorest citizens.
• Nearly two out of five of 2020’s new global poor are in South Asia. At the same
time, it is the most vulnerable that have been hit hardest by the crisis.
• Multidimensional poverty is found in all developing regions of the world, but it is
particularly acute in Sub-Saharan Africa and South Asia.
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Global scenario (2)
• These two regions account together for 83% of all multidimensionally poor people
in the world, more than 1.1 billion.
• Global extreme poverty rose in 2020 for the first time in over 20 years as the
disruption of the COVID-19 pandemic compounded the forces of conflict and
climate change, which were already slowing poverty reduction progress.
• About 120 million additional people are living in poverty as a result of the
pandemic, with the total expected to rise to about 150 million by the end of 2021.
4/6/2022 39
Global Scenario (3)
• Even the pre-COVID-19 scenario is well short of the 3% target for 2030. In order
to reach this target, each economy, starting in 2021, would have to grow at a much
higher rate than their annual historical growth rates.
• In a world without the COVID-19 pandemic, the required annual growth rate to
reach the World Bank’s 2030 goal was 7%; with COVID-19, the required growth
rates have been pushed even higher, between 8% and 8.5%.
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Source: https://ourworldindata.org/extreme-poverty
Poverty in Nepal
• 17.4 percent or almost 5 million of the population of 28.6 million are poor in
2019 and this has reduced strongly since the 2014 level of 30.1 percent.
• Thus, in 2019, Nepal was on track to reach its national target
of 11.5 percent incidence of MPI by 2024.
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Source: NEPAL'S MULTIDIMENSIONAL POVERTY INDEX 2021
Poverty in Nepal (2)
• Across indicators, the highest number of people are deprived in housing materials,
clean cooking fuel, years of schooling, assets, and nutrition. Considering the
indicator weights, years of schooling and nutritional deprivations contribute most
to ongoing multidimensional poverty in Nepal.
• By 2030, the aim to reduce proportion of population living below national poverty
line by age and sex is by 4.9% which was 16.7% in 2019.
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Source: National Family Planning Costed Implementation Plan 2015-2020
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Source: Calculations based on data from NMICS (2019).
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 The finding reveals that poverty can be
alleviated by improving the quality of
economic growth for the entire
community, increasing HDI through the
average length of education and life
expectancy, and job creation by
investment.
 Other factors include national budget
expenditures related to direct government
budget increase of expenditures for
infrastructure and improvement of family
planning programs, and provision of free
health care.
Family Planning, Poverty and
Economic Development
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Family planning Poverty
Economic
Development
Increase
Decrease
How does family planning help in economic
development? (1)
• Family planning plays a catalytic role in improving the health and well-being of
women and children, while at the same time influencing other areas of human
development, including gender equality.
• In particular, family planning is a crucial and cost-effective step towards poverty
reduction and economic development.
4/6/2022 49
How does family planning help in economic
development? (2)
• Access to sexual and reproductive health, including family planning, can affect
population dynamics through voluntary fertility reduction and reductions in infant
and maternal mortality.
• Complications from pregnancy and birth not only threaten the health and lives of
women and children, they can also have economic consequences for families.
4/6/2022 50
How does family planning help in
economic development? (3)
• In many countries, maternal health care is not free and can be extremely expensive
for poor households.
• On the other hand, when family planning services are accessible and affordable,
they can have positive, long-term effects on the lives of women, girls and families.
• For instance, sexually active adolescent girls who use contraception are less likely
to drop out of school due to pregnancy than their peers who do not use
contraception.
4/6/2022 51
How does family planning help in
economic development? (4)
• In addition, girls who delay their first birth until later in life are better able to take
advantage of training and education, which is a deterrent to household poverty.
• Healthy women are also more productive in the workforce and stand to earn more
throughout their lives than women who suffer ill health.
• Overall, studies find that women and couples who can decide on the number,
spacing and timing of their children are better able to save resources, increase their
household income, invest in their existing children, and better plan their lives
4/6/2022 52
How does family planning help in
economic development? (5)
• Unsustainable population growth can also limit the government’s ability to
productively invest.
• Governments faced with rapid population growth are forced to redirect resources
away from investment towards providing healthcare for mothers and newborns
and dealing with the significant complications associated with pregnancy and
childbirth.
4/6/2022 53
How does family planning help in
economic development? (6)
• Health is not the only area in which population growth drains government
resources.
• At projected rates of population growth, many developing country governments
will have to provide food, water, housing, sanitation and other basic services to
populations that will have doubled or even tripled in size by 2050.
4/6/2022 54
How does family planning help in
economic development? (7)
• However, if fertility rates decline, these things will not be such a drain on
government resources and a large working-age population and fewer dependents
should lead to increased savings at both household and state levels.
• This period is known as the “demographic dividend” and if governments use this
opportunity to invest these savings in their people it can have tremendous poverty
alleviation effects.
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How does family planning help in
economic development? (8)
• In recent decades, countries with lower fertility and slower population growth
have experienced higher productivity, more savings and more effective
investments.
• Globally, there is a correlation between the prevalence of modern contraceptive
methods and per capita gross domestic product (GDP).
4/6/2022 56
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Economic Benefits of Family planning (1)
• Fertility decline produces a temporary boost to economic growth as the proportion
of the population of working age rises.
• Countries with high birth rates typically have very young populations. For
example, in several West and Central African countries where women on average
bear about seven children over their lifetime, half the population is under age
fifteen.
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Economic Benefits of Family planning (2)
• Fewer births lead to a decline in the proportion of the population under age fifteen.
This trend has beneficial macroeconomic effects because it reduces the size of the
dependent population relative to the size of the economically productive group
(fifteen to sixty-four).
• There are fewer young mouths to feed and children to educate but more people to
earn wages that can support improvements in the quality of life for the young and
the very old.
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Economic Benefits of Family planning (3)
• More workers per capita directly raises per capita income and frees up resources
for investment in health, education, and other development sectors, thus further
contributing to economic growth.
• Women who have access to family planning services can pursue higher education
that helps women to stay in the workforce and earn higher wages.
• In addition, the private, for-profit sector may find that providing employees with
family planning services can lower medical costs of pregnancy and maternity
leave, lower employee turnover and increase productivity and profit.
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Economic Benefits of Family planning (4)
• At the family level, wanted children bring joy and social and economic benefits to
their parents while unwanted births unnecessarily raise family expenses for food,
clothes, shelter, schooling, and health care as well as time devoted to childcare and
rearing.
• This strengthens their economic security and well-being and that of their families.
Cumulatively, this contributes to development progress and poverty reduction.
4/6/2022 61
Challenges of Family Planning
• Inefficient public procurement system, which creates delays for contraceptive
procurement leading to frequent stock outs.
• Issues with quality of data: accuracy, adequacy, and time.
• Quality of FP counseling services remains an issue
• Lack of skilled health workers to provide quality FP
• High rate of spousal separation due to migration.
4/6/2022 62
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Priority actions for Family planning
services (1)
• Advocate for family planning at all levels of government and with donor agencies
to ensure that family planning is included in budgeting and planning.
• Reform service delivery to ensure that the health systems supporting family
planning function well and provide quality care.
• Create demand for family planning services through information, education, and
behavior change communication programs.
4/6/2022 64
Priority actions for Family planning
services (2)
• Involve communities and community leaders, particularly in rural areas where the
majority of the population lives.
• Reach out to underserved groups, especially adolescents, men, and the poorest
segments of society.
• Partner with the private sector to increase the reach of family planning services
and foster long-term sustainability.
4/6/2022 65
Priority actions for Family planning
services (3)
• Improve health system mechanisms for procurement and supply-chain to ensure
regular availability of commodities at service delivery points.
• Expand LARC service sites and also training sites on quality FP (including in
counseling)
• Integration of family planning with maternal and child health services.
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C
O
N
C
L
U
S
I
O
N
4/6/2022 67
References
Program, I., Butler, A. and Clayton, E., 2021. Overview of Family Planning in the United States.
[online] Ncbi.nlm.nih.gov. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK215219/>
Who.int. 2021. Contraception. [online] Available at: <https://www.who.int/health-
topics/contraception
 Countdown2030europe.org. 2021. [online] Available at:
<https://www.countdown2030europe.org/storage/app/media/IPPF_FactSheet-5_poverty.pdf
Who.int. 2021. Family planning/contraception methods. [online] Available at:
<https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
Un.org. 2021. [online] Available at:
<https://www.un.org/en/development/desa/population/publications/pdf/family/fam
Investopedia. 2021. Poverty. [online] Available at:
<https://www.investopedia.com/terms/p/poverty.asp>
4/6/2022 68
References
 2021. [online] Available at: <https://www.worldbank.org/en/topic/poverty/overview>
Ophi.org.uk. 2021. Global Multidimensional Poverty Index | OPHI. [online] Available at:
<https://ophi.org.uk/multidimensional-poverty-index/>
PRB. 2021. ENGAGE Snapshot: Family Planning Leads to Poverty Reduction. [online] Available
at: <https://www.prb.org/resources/engage-snapshot-family-planning-leads-to-poverty-reduction/>
2021. [online] Available at:
<https://www.un.org/development/desa/dpad/wpcontent/uploads/sites/45/WESP2021_CH3_SA.pd
f>
Dhsprogram.com. 2021. [online] Available at:
<https://dhsprogram.com/pubs/pdf/FA119/FA119.pdf>
2021. [online] Available at:
<https://asiapacific.unfpa.org/sites/default/files/pubpdf/210112_unfpa_impact_of_covid19_on_hu
man_fertility_sp.pdf>
4/6/2022 69
References
Un.org. 2021. [online] Available at:
<https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/docu
ments/2020/Sep/unpd_2020_worldfamilyplanning_highlights.pdf>
2021. [online] Available at:
<https://nepal.unfpa.org/sites/default/files/pubpdf/FP%20Costed%20Implementation%20Plan.pdf>
Usaid.gov. 2021. Family Planning and Reproductive Health. [online] Available at:
<https://www.usaid.gov/global-health/health-areas/family-planning#dataSources>
PRB. 2021. Family Planning Saves Lives. [online] Available at:
<https://www.prb.org/resources/family-planning-saves-lives/>
Unfpa.org. 2021. Population and poverty. [online] Available at:
<https://www.unfpa.org/resources/population-and-poverty>
2021. [online] Available at:
<https://populationmatters.org/sites/default/files/poverty_reduction.pdf>
4/6/2022 70
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Family planning, Poverty and Economic development

  • 1. Family planning, poverty and Economic Development Presented by: SHIKHA BASNET MPH-2021 SPH & CM Total Slides: 71
  • 2. Introduction • Family planning is defined as “the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility” -WHO • Family planning refers to supplies and services which enable individuals and couples to attain and plan for their desired number of children, and the spacing and timing of births. 4/6/2022 2
  • 3. Introduction (2) • Supplies include modern contraceptive methods and services include health care, counselling and information and education related to sexual and reproductive health. • The ability of individuals to determine their family size and the timing and spacing of their children has resulted in significant improvements in health and in social and economic well-being. 4/6/2022 3
  • 4. Introduction (3) • Family planning could prevent up to one-third of all maternal deaths by allowing women to delay motherhood, space births, avoid unintended pregnancies, and unsafely performed abortions, and stop childbearing when they have reached their desired family size. • Pregnancy and childbirth in adolescence can have long-lasting impact on the social and economic well-being and are among the leading causes of death among women aged 15-19 years (World Health Organization, 2018). 4/6/2022 4
  • 5. Introduction (4) • Contraceptive information and services are fundamental to the health and human rights of all individuals. • Family planning is often characterized as a key investment because it provides a lifetime of benefits to users and their families and communities. • At the individual level, there are benefits in infant, child and maternal health outcomes (SDG 3), improved educational outcomes (SDG 4), gender equality and women’s empowerment (SDG 5) and equal access to the labor market, social protection and the political process (SDGs 5, 8, and 16). 4/6/2022 5
  • 6. Introduction (5) • The Family Planning Sustainable Development Goals model demonstrated that improvements in socioeconomic status along with investments in family planning maximize long-term progress towards reducing poverty and food insecurity and increasing income. • These analyses have helped to build the economic case for investment in family planning and have shown the relevance of family planning for achieving the Sustainable Development Goals. 4/6/2022 6
  • 8. The cost of family planning services • Each dollar invested in family planning brings multiple benefits in terms of births averted and lives saved, making family planning an extremely cost-effective health intervention. • International studies have repeatedly confirmed that family planning ranks among the most cost-effective of all health services, along with other basic and preventive health measures such as vaccinating children and preventing HIV/AIDS. 4/6/2022 8
  • 9. The cost of family planning services • The average cost per year for contraceptive supplies is estimated to be about US$1.55, based on the existing mix of contraceptive methods used in developing countries. • Program costs are higher, however, because they include health personnel and the cost of running facilities and outreach programs. • Program costs vary across regions and range on average from $2 to $35 per year of protection per person, depending on the mode of service delivery, such as social marketing, clinics, or community-based distribution. 4/6/2022 9
  • 10. The cost of family planning services • However, because many existing programs are underutilized, researchers believe that the average cost for an additional contraceptive user may be closer to the average cost of the commodity—an average of US$1.55 per new user. • At an average supply cost of US$1.55 per user annually, it offers a safe, affordable, and effective way for governments to reduce maternal and child illness and deaths, as well as reduce national health expenditures on reproductive and children’s health problems. 4/6/2022 10
  • 12. Global Scenario (1) • Expanding access to contraception is an essential component of achieving universal access to sexual and reproductive health-care services, as called for in the 2030 Agenda for Sustainable Development. • In 2020, among 1.9 billion women of reproductive age (15-49 years), 1.1 billion women are considered to have a need for family planning, meaning that they desire to limit or delay childbearing. • Of these women, 851 million are using a modern method of contraception and 85 million are using a traditional method. 4/6/2022 12
  • 13. Global Scenario (2) • An additional 172 million women are using no method at all, despite their desire to avoid pregnancy, and thus are considered to have an unmet need for family planning. • Most women who use contraception rely on modern methods, but the specific contraceptive methods used vary by region. • Still, nearly 1 in 10 women of reproductive age worldwide have an unmet need for family planning: they want to avoid or postpone pregnancy but are not using any form of contraception. 4/6/2022 13
  • 14. 4/6/2022 14 Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning Indicators 2020.
  • 15. Global Scenario (3) • Between 2000 and 2020, the contraceptive prevalence rate (percentage of women aged 15-49 who use any contraceptive method) increased from 47.7 to 49.0 percent. • Whereas contraceptive use is currently lowest in sub-Saharan Africa, at 27.8 percent, this level is projected to increase over the next decade to 32.9 per cent. • The proportion of women who have their need for family planning satisfied with modern methods (SDG indicator 3.7.1) has increased from 74 to 76 per cent from 2000 to 2019. 4/6/2022 15
  • 16. South East Asia • Central and Southern Asia has seen the largest decline in the number of women with unmet need since 2000. • Globally, the number of women aged 15-19 years who had unmet need for family planning decreased from 17 million in 2000 to 14 million in 2020. • The large decline in unmet need among adolescent girls and young women in Central and Southern Asia from over 6 million women in 2000 to 2.6 million in 2020 was the primary reason for the decrease at the global level. 4/6/2022 16
  • 17. 4/6/2022 17 Source: United Nations, Department of Economic and Social Affairs, Population Division. (2020). Estimates and Projections of Family Planning indicators 2020.
  • 18. South East Asia (2) • The COVID-19 pandemic is the greatest global public health crisis in a century. Women’s ability to use contraception has also been impacted by COVID-19 pandemic. • It has disrupted the global supply chain, which has led to reduced production, distribution and availability of contraceptive commodities, resulting in shortages. • In India, it has been reported that nearly 900,000 accredited community health workers, who used to work on reproductive health and distribution of family planning, were diverted to the country’s COVID-19 response. 4/6/2022 18
  • 19. South East Asia (3) • Barriers to service utilization also exist on the demand side, with some individuals avoiding family planning clinics due to restrictions on movement and/or a (legitimate) fear of contracting the virus during visits to healthcare providers or pharmacies (UN Women, 2020). • Furthermore, during lockdowns, there appears to have been a rise in the rate of intimate-partner violence, which may include sexual coercion and sexual assault, potentially increasing the need for emergency contraception. 4/6/2022 19
  • 20. South East Asia (4) • In April 2020, UNFPA projected that 47 million women in 114 LMICs Globally may be unable to use modern contraceptives if the average lockdown persists for 6 months with high levels of COVID-19 related disruptions to health services, and that an additional 2 million women would be unable to use modern contraceptives for every 3 months the lockdown continues. • This translates into an estimated 7 million unintended pregnancies if the lockdown lasts for 6 months with major health service disruptions due to COVID-19. 4/6/2022 20
  • 21. Scenario of Nepal (1) • Family planning (FP) is one of the important components of Nepal’s national health system. • The aim of National FP program is to ensure individuals and couples fulfil their reproductive needs and rights by using quality FP methods voluntarily based on informed choices. • Government of Nepal (GoN) is committed to equitable and right based access to voluntary, quality FP services based for all individuals with special focus on hard to reach communities such as adolescents, migrants, slum dwellers, sexual minorities and other vulnerable groups ensuring no one is left behind. 4/6/2022 21
  • 22. Scenario of Nepal (2) • To achieve this, GoN is committed and striving:  to strengthen policies and strategies related FP within the new federal context,  mobilize resources,  improve enabling environment to engage effectively with supporting partners,  promote public-private partnerships, and  involve non-health sectors. • FP has been enshrined as a fundamental right in the constitution, and included in the basic health service package under the Public Health Act 2018, thus paving a way towards universal health coverage. 4/6/2022 22
  • 23. Scenario of Nepal (3) • FP is an essential health care services of Nepal Health Sector Program II (2010‐2015), National Family Planning Costed Implementation Plan 2015‐ 2021, Nepal Health Sector Strategy 2015‐2020 (NHSS) and the Government of Nepal’s commitments to FP2020. • FP information, education and services are provided through the government, social marketing, NGOs and the private sector (including commercial sectors). • In public health system, short acting reversible contraceptive methods are provided through PHCCs, health posts, Urban Health Units (UHC), Community Health Units (CHU), PHC-ORCs. 4/6/2022 23
  • 24. Scenario of Nepal (4) • FCHVs provide information and education to women and couple at community and distribute male condoms and resupply OCPs. • Access to LARC services in remote area is provided through satellite clinics, extended visiting service providers and mobile camps. • A sterilization service is provided at static sites or through scheduled seasonal and mobile outreach services. 4/6/2022 24
  • 25. Scenario of Nepal (5) • FP services are also provided through private and commercial outlets such as NGO run clinic/center, private clinics, pharmacies, hospitals including academic hospitals. • The total fertility rate (TFR) of women aged 15-49 declined from 4.1 children per women in 2000 to 2.3 in 2016 and has declined to 2.0 in 2019 and mCPR was 39% in 2019. 4/6/2022 25
  • 26. 4/6/2022 26 Source: DoHS, Annual Report 2076/77 (2019/20)
  • 27. 4/6/2022 27 Source: DoHS, Annual Report 2076/77 (2019/20)
  • 28. SDG Target 4/6/2022 28 Target and Indicators 2020 status Source 2030 3.7.1 Proportion of women of reproductive age (aged 15- 49 years) who have their need for family planning satisfied with modern methods 61.9 NMICS 80 a. Contraceptive prevalence rate (modern methods) (%) 44.2 NMICS 60 b. Total Fertility Rate (TFR) (births per women aged 15- 49 years) 2.0 NMICS 2.1 c. Adolescent birth rate (aged 10-14 years, aged 15-19 years) per 1,000 women in that age group 63 NMICS 30
  • 29. Major activities (1) Provision of regular comprehensive FP service including post-partum and post abortion FP services Provision of long acting reversible services, Permanent FP Methods or Voluntary Surgical Contraception (VSC) FP strengthening program through the use of decision-making tool (DMT)and WHO medical eligibility for contraceptive (MEC) wheel Micro planning for addressing unmet need of FP in hard to reach and underserved communities Provision of RANM and VSP service to increase FP service use 4/6/2022 29
  • 30. Major activities (2) Integration of FP and immunization service Satellite clinic services for long acting reversible contraceptives Contraceptive update for Obstetrician/Gynecologist, nurses & concerned key players Interaction program on FP and RH including ASRH with pharmacist and marginalized communities Community interaction with satisfied clients for promoting permanent method and IUCD 4/6/2022 30
  • 31. Why are people still reluctant in using FP?  limited choice and access to contraception  a fear or experience of side-effects  cultural or religious opposition  poor quality of available services  gender-based barriers.  Lack of youth-friendly services  Lack of awareness of family planning services among hard-to-reach populations  migration 4/6/2022 31 Source: https://dhsprogram.com/pubs/pdf/FR336/FR336.pdf
  • 35. Introduction • Poverty is a state or condition in which a person or community lacks the financial resources and essentials for a minimum standard of living. • Poverty means that the income level from employment is so low that basic human needs can't be met. • A person surviving on less than $1.90 a day lives in extreme poverty, as defined by the World Bank. 4/6/2022 35
  • 36. Causes of Poverty  Inequality and marginalization  Conflict  Hunger, Malnutrition, and Stunting  Poor health care systems  Little or no access to clean water, sanitation and hygiene 4/6/2022 36  Climate change Lack of education Poor public works and infrastructure  Lack of government support Lack of jobs or livelihoods  Lack of reserves Source: https://reliefweb.int/report/world/11-top-causes-global-poverty
  • 37. Approach to measure Poverty 4/6/2022 37 Source: https://ophi.org.uk/wp-content/uploads/GMPI_2018_2ed_web.pdf • The global Multidimensional poverty index (MPI) is composed of three dimensions (health, education, and living standards) and 10 indicators. • Each dimension is equally weighted, and each indicator within a dimension is also equally weighted. • A person is identified as multidimensionally poor if they are deprived in at least one third of the weighted indicators.
  • 38. Global Scenario • More than 736 million people or one out of every ten people on the planet currently live below this poverty threshold, and children, a highly vulnerable segment of society, account for more than half of the world’s poorest citizens. • Nearly two out of five of 2020’s new global poor are in South Asia. At the same time, it is the most vulnerable that have been hit hardest by the crisis. • Multidimensional poverty is found in all developing regions of the world, but it is particularly acute in Sub-Saharan Africa and South Asia. 4/6/2022 38
  • 39. Global scenario (2) • These two regions account together for 83% of all multidimensionally poor people in the world, more than 1.1 billion. • Global extreme poverty rose in 2020 for the first time in over 20 years as the disruption of the COVID-19 pandemic compounded the forces of conflict and climate change, which were already slowing poverty reduction progress. • About 120 million additional people are living in poverty as a result of the pandemic, with the total expected to rise to about 150 million by the end of 2021. 4/6/2022 39
  • 40. Global Scenario (3) • Even the pre-COVID-19 scenario is well short of the 3% target for 2030. In order to reach this target, each economy, starting in 2021, would have to grow at a much higher rate than their annual historical growth rates. • In a world without the COVID-19 pandemic, the required annual growth rate to reach the World Bank’s 2030 goal was 7%; with COVID-19, the required growth rates have been pushed even higher, between 8% and 8.5%. 4/6/2022 40
  • 42. Poverty in Nepal • 17.4 percent or almost 5 million of the population of 28.6 million are poor in 2019 and this has reduced strongly since the 2014 level of 30.1 percent. • Thus, in 2019, Nepal was on track to reach its national target of 11.5 percent incidence of MPI by 2024. 4/6/2022 42 Source: NEPAL'S MULTIDIMENSIONAL POVERTY INDEX 2021
  • 43. Poverty in Nepal (2) • Across indicators, the highest number of people are deprived in housing materials, clean cooking fuel, years of schooling, assets, and nutrition. Considering the indicator weights, years of schooling and nutritional deprivations contribute most to ongoing multidimensional poverty in Nepal. • By 2030, the aim to reduce proportion of population living below national poverty line by age and sex is by 4.9% which was 16.7% in 2019. 4/6/2022 43
  • 44. 4/6/2022 44 Source: National Family Planning Costed Implementation Plan 2015-2020
  • 45. 4/6/2022 45 Source: Calculations based on data from NMICS (2019).
  • 47. 4/6/2022 47  The finding reveals that poverty can be alleviated by improving the quality of economic growth for the entire community, increasing HDI through the average length of education and life expectancy, and job creation by investment.  Other factors include national budget expenditures related to direct government budget increase of expenditures for infrastructure and improvement of family planning programs, and provision of free health care.
  • 48. Family Planning, Poverty and Economic Development 4/6/2022 48 Family planning Poverty Economic Development Increase Decrease
  • 49. How does family planning help in economic development? (1) • Family planning plays a catalytic role in improving the health and well-being of women and children, while at the same time influencing other areas of human development, including gender equality. • In particular, family planning is a crucial and cost-effective step towards poverty reduction and economic development. 4/6/2022 49
  • 50. How does family planning help in economic development? (2) • Access to sexual and reproductive health, including family planning, can affect population dynamics through voluntary fertility reduction and reductions in infant and maternal mortality. • Complications from pregnancy and birth not only threaten the health and lives of women and children, they can also have economic consequences for families. 4/6/2022 50
  • 51. How does family planning help in economic development? (3) • In many countries, maternal health care is not free and can be extremely expensive for poor households. • On the other hand, when family planning services are accessible and affordable, they can have positive, long-term effects on the lives of women, girls and families. • For instance, sexually active adolescent girls who use contraception are less likely to drop out of school due to pregnancy than their peers who do not use contraception. 4/6/2022 51
  • 52. How does family planning help in economic development? (4) • In addition, girls who delay their first birth until later in life are better able to take advantage of training and education, which is a deterrent to household poverty. • Healthy women are also more productive in the workforce and stand to earn more throughout their lives than women who suffer ill health. • Overall, studies find that women and couples who can decide on the number, spacing and timing of their children are better able to save resources, increase their household income, invest in their existing children, and better plan their lives 4/6/2022 52
  • 53. How does family planning help in economic development? (5) • Unsustainable population growth can also limit the government’s ability to productively invest. • Governments faced with rapid population growth are forced to redirect resources away from investment towards providing healthcare for mothers and newborns and dealing with the significant complications associated with pregnancy and childbirth. 4/6/2022 53
  • 54. How does family planning help in economic development? (6) • Health is not the only area in which population growth drains government resources. • At projected rates of population growth, many developing country governments will have to provide food, water, housing, sanitation and other basic services to populations that will have doubled or even tripled in size by 2050. 4/6/2022 54
  • 55. How does family planning help in economic development? (7) • However, if fertility rates decline, these things will not be such a drain on government resources and a large working-age population and fewer dependents should lead to increased savings at both household and state levels. • This period is known as the “demographic dividend” and if governments use this opportunity to invest these savings in their people it can have tremendous poverty alleviation effects. 4/6/2022 55
  • 56. How does family planning help in economic development? (8) • In recent decades, countries with lower fertility and slower population growth have experienced higher productivity, more savings and more effective investments. • Globally, there is a correlation between the prevalence of modern contraceptive methods and per capita gross domestic product (GDP). 4/6/2022 56
  • 58. Economic Benefits of Family planning (1) • Fertility decline produces a temporary boost to economic growth as the proportion of the population of working age rises. • Countries with high birth rates typically have very young populations. For example, in several West and Central African countries where women on average bear about seven children over their lifetime, half the population is under age fifteen. 4/6/2022 58
  • 59. Economic Benefits of Family planning (2) • Fewer births lead to a decline in the proportion of the population under age fifteen. This trend has beneficial macroeconomic effects because it reduces the size of the dependent population relative to the size of the economically productive group (fifteen to sixty-four). • There are fewer young mouths to feed and children to educate but more people to earn wages that can support improvements in the quality of life for the young and the very old. 4/6/2022 59
  • 60. Economic Benefits of Family planning (3) • More workers per capita directly raises per capita income and frees up resources for investment in health, education, and other development sectors, thus further contributing to economic growth. • Women who have access to family planning services can pursue higher education that helps women to stay in the workforce and earn higher wages. • In addition, the private, for-profit sector may find that providing employees with family planning services can lower medical costs of pregnancy and maternity leave, lower employee turnover and increase productivity and profit. 4/6/2022 60
  • 61. Economic Benefits of Family planning (4) • At the family level, wanted children bring joy and social and economic benefits to their parents while unwanted births unnecessarily raise family expenses for food, clothes, shelter, schooling, and health care as well as time devoted to childcare and rearing. • This strengthens their economic security and well-being and that of their families. Cumulatively, this contributes to development progress and poverty reduction. 4/6/2022 61
  • 62. Challenges of Family Planning • Inefficient public procurement system, which creates delays for contraceptive procurement leading to frequent stock outs. • Issues with quality of data: accuracy, adequacy, and time. • Quality of FP counseling services remains an issue • Lack of skilled health workers to provide quality FP • High rate of spousal separation due to migration. 4/6/2022 62
  • 64. Priority actions for Family planning services (1) • Advocate for family planning at all levels of government and with donor agencies to ensure that family planning is included in budgeting and planning. • Reform service delivery to ensure that the health systems supporting family planning function well and provide quality care. • Create demand for family planning services through information, education, and behavior change communication programs. 4/6/2022 64
  • 65. Priority actions for Family planning services (2) • Involve communities and community leaders, particularly in rural areas where the majority of the population lives. • Reach out to underserved groups, especially adolescents, men, and the poorest segments of society. • Partner with the private sector to increase the reach of family planning services and foster long-term sustainability. 4/6/2022 65
  • 66. Priority actions for Family planning services (3) • Improve health system mechanisms for procurement and supply-chain to ensure regular availability of commodities at service delivery points. • Expand LARC service sites and also training sites on quality FP (including in counseling) • Integration of family planning with maternal and child health services. 4/6/2022 66
  • 68. References Program, I., Butler, A. and Clayton, E., 2021. Overview of Family Planning in the United States. [online] Ncbi.nlm.nih.gov. Available at: <https://www.ncbi.nlm.nih.gov/books/NBK215219/> Who.int. 2021. Contraception. [online] Available at: <https://www.who.int/health- topics/contraception  Countdown2030europe.org. 2021. [online] Available at: <https://www.countdown2030europe.org/storage/app/media/IPPF_FactSheet-5_poverty.pdf Who.int. 2021. Family planning/contraception methods. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception Un.org. 2021. [online] Available at: <https://www.un.org/en/development/desa/population/publications/pdf/family/fam Investopedia. 2021. Poverty. [online] Available at: <https://www.investopedia.com/terms/p/poverty.asp> 4/6/2022 68
  • 69. References  2021. [online] Available at: <https://www.worldbank.org/en/topic/poverty/overview> Ophi.org.uk. 2021. Global Multidimensional Poverty Index | OPHI. [online] Available at: <https://ophi.org.uk/multidimensional-poverty-index/> PRB. 2021. ENGAGE Snapshot: Family Planning Leads to Poverty Reduction. [online] Available at: <https://www.prb.org/resources/engage-snapshot-family-planning-leads-to-poverty-reduction/> 2021. [online] Available at: <https://www.un.org/development/desa/dpad/wpcontent/uploads/sites/45/WESP2021_CH3_SA.pd f> Dhsprogram.com. 2021. [online] Available at: <https://dhsprogram.com/pubs/pdf/FA119/FA119.pdf> 2021. [online] Available at: <https://asiapacific.unfpa.org/sites/default/files/pubpdf/210112_unfpa_impact_of_covid19_on_hu man_fertility_sp.pdf> 4/6/2022 69
  • 70. References Un.org. 2021. [online] Available at: <https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/files/docu ments/2020/Sep/unpd_2020_worldfamilyplanning_highlights.pdf> 2021. [online] Available at: <https://nepal.unfpa.org/sites/default/files/pubpdf/FP%20Costed%20Implementation%20Plan.pdf> Usaid.gov. 2021. Family Planning and Reproductive Health. [online] Available at: <https://www.usaid.gov/global-health/health-areas/family-planning#dataSources> PRB. 2021. Family Planning Saves Lives. [online] Available at: <https://www.prb.org/resources/family-planning-saves-lives/> Unfpa.org. 2021. Population and poverty. [online] Available at: <https://www.unfpa.org/resources/population-and-poverty> 2021. [online] Available at: <https://populationmatters.org/sites/default/files/poverty_reduction.pdf> 4/6/2022 70

Editor's Notes

  • #27: The modern contraceptive prevalence rate (mCPR) at national level as well as at provinces (except Karnali and Sudurpaschim) is in decreasing trend. The national mCPR stands at 37% in 2076/77 which was 39% in 2075/76 and 40% in 2074/75 (Figure 4.5.3). Province 2 has the highest mCPR of 44% while Bagmati has the lowest (32%). Three Provinces (Bagmati, Gandaki and Karnali) have mCPR less than national average (39%)
  • #28: Depo (39%) occupies the greatest part of the contraceptive method mix for all method among new acceptors, followed by condom (23%), pills (21%), implant (12%), IUCD (2%), female sterilization (- 2%) and lastly male sterilization (NSV-1%) in 2076/77 (Figure 4.5.10). FP new acceptors (all method) as % of MWRA has decreased at national level and all other provinces except Karnali and Sudurpaschim (Figure 4.5.11)
  • #30: The introduction of RANMs is consistent with Government of Nepal policies around expanding equitable access to and quality of community level health services under the Nepal Health Sector Strategy 2015-2020 (NHSS 2015-20). Such a strategy also contributes to the “Reaching the Unreached Strategy” (RTU 2016-2030). In addition to “reach”, the integrated household and community approach to health service provision offers a significant opportunity to address the multiple barriers contributing to poor health access, particularly among HTR groups.
  • #42: The chart shows the projection made by the development research team at the World Bank. This projection answers the question of what would happen to extreme poverty trends if the economic growth of the past decade (2005–15) continued until 2030:5 The number of people in extreme poverty will stagnate at almost 500 million. This is not because it is not possible to end extreme poverty. In more than half of the countries of the world the share of the population in extreme poverty is now less than 3 percent The number of people in extreme poverty has fallen from nearly 1.9 billion in 1990 to about 650 million in 2018.7 According to the World Bank forecasts 87% of the world’s poorest are expected to live in Sub-Saharan Africa in 2030 if economic growth follows the trajectory over the recent past.