UNFPAState of World Population 2004
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State of World Population
Population and Poverty
Population and the Environment
Migration and Urbanization
Gender Equality and Women's Empowerment
Reproductive Health and Family Planning
Maternal Health
Preventing HIV/AIDS
Adolescents and Young People
Reproductive Health for Communities in Crisis
Action Priorities
Sources for Boxes
Graphs and Tables


Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11


1. Singh, S., et al. 2004. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. Washington, D.C., and New York: The Alan Guttmacher Institute and UNFPA.

2. UNFPA. 2004a. Investing in People: National Progress in Implementing the ICPD Programme of Action. New York: UNFPA; and WHO. 2003. Reproductive Health: Draft Strategy to Accelerate Progress towards the Attainment of International Development Goals and Targets (EB113/15 Add.1). Geneva: WHO.

3. United Nations. 2004. Review and Appraisal of the Progress made in Achieving the Goals and Objectives of the Programme of Action of the International Conference on Population and Development: Report of the Secretary-General (E/CN.9/2004/3). New York: United Nations.

4. In Bangladesh, prevalence increased by 1.8 percentage points overall but 3 quintiles—to the largest extent in the poorest quintile—experienced decreases in desires satisfied by modern method use.

5. Details about the calculations, and an extended discussion of the reliability, validity and implications of the concept, can be found in: Casterline, J. B., and S. W. Sinding. 2000. “Unmet Need for Family Planning in Developing Countries and Implications for Population Policy.” Population and Development Review 26(4): 691-723.

6. United Nations. 1995. Population and Development, vol. 1: Programme of Action adopted at the International Conference on Population and Development: Cairo: 5-13 September 1994, paragraph 7.16. New York: Department of Economic and Social Information and Policy Analysis, United Nations.

7. United Nations. 1999. Key Actions for the Further Implementation of the Programme of Action of the International Conference on Population and Development(A/S-21/5/Add.1), paragraph 58. New York: United Nations.

8. Reports of total and wanted fertility in most recent surveys obtained from: Demographic and Health Surveys’ StatCompiler. Web site: www.orcmacro.org, accessed 8 March 2004.

9. The dynamics of this relationship, and the corresponding impact on recourse to abortion are analyzed in: Bongaarts, J. 1997. Trends in Unwanted Childbearing in the Developing World. Policy Research Division Working Paper. No. 98. New York: The Population Council; and Bongaarts, J., and C. F. Westoff. 2000. “The Potential Role of Contraception in Reducing Abortion.” Studies in Family Planning 31(3): 193-202.

10. Singh, S., et al. 2004.

11. Modern contraceptive techniques include male and female sterilization, oral contraceptives, implants and injections and barrier methods (male and female condoms and diaphragms). Traditional methods include periodic abstinence, withdrawal and lactational amenorrhea (extended breast-feeding).

12. Adding those using traditional methods into those with unmet need for modern methods, fully 63 per cent of sub-Saharan women and couples have unmet limiting and spacing desires.

13 This can include shortages of support for and supply of temporary methods for birth spacing, the need to address cultural sensitivities (e.g., bleeding or spotting side effects where blood taboos are prevalent).

14. Rudy, S., et al. 2003. “Improving Client-Provider Interaction.” Population Reports. Series Q. No. 1. Baltimore, Maryland: The INFO Project, Center for Communication Programs, the Johns Hopkins Bloomberg School of Public Health. Web site: http://www.infoforhealth.org/ pr/q01/q01.pdf, last accessed 27 April 2004.

15. See the discussion of Youth Friendly Services in: UNFPA. 2003. The State of World Population 2003: Making 1 Billion Count: Investments in Adolescents’ Health and Rights. New York: UNFPA.

16. Calculated from data provided by John Ross from the 1999 Family Planning Program Strength survey (See: Ross, J., and J. Stover. 2000. Effort Indices for National Family Planning Programs: 1999 Cycle. Measure Evaluation Working Paper. No. WP-00-20. Chapel Hill, North Carolina: Carolina Population Center, University of North Carolina. See also: Ross, J., J. Stover, and A. Willard. 1999. Profiles for Family Planning and Reproductive Health Programs: 116 Countries, Ch. 5. Glastonbury, Connecticut: The Futures Group International.). This survey has been conducted periodically since 1982. An update is scheduled for late 2004. Data on unmarried women lacking access to contraceptives are less available, but would add significant numbers to this estimate.

17. Bongaarts, J., and S. C. Watkins (1996). “Social Interactions and Contemporary Fertility Transitions. Population and Development Review 22(4): 639-682; and Merrick, T. W. 2002. “Population and Poverty: New Views on an Old Controversy.” International Family Planning Perspectives 28(1): 41-46.

18. Merrick 2002.

19. The term is used here to denote those who are using a method when they wish to avoid a pregnancy. More complete definitions take into account whether or not users have access to a range of choice and have selected a method appropriate to their desires (see: Sinding and Casterline 2000; Jain, A. K. 2001. “Family Planning Programs: Quality of Care.” In: The International Encyclopedia of the Social and Behavioral Sciences, edited by N. J. Smelser and P. B. Baltes. 2001. Amsterdam: Elsevier; and RamaRao, S., and R. Mohanam. 2003. “The Quality of Family Planning Programs: Concepts, Measurements, Interventions, and Effects.” Studies in Family Planning 34[4]: 227-248). An important historical contribution focused on attainment of intentions can be found in: Jain, A., and J. Bruce. 1994. “A Reproductive Health Approach to the Objectives and Assessment of Family Planning Programs.” Pp. 192-208 in: Population Policies Reconsidered: Health, Empowerment, and Rights, edited by G. Sen, A. Germain, and L. Chen. 1994. Cambridge, Massachusetts: Harvard University Press.

20. Merrick, T. 2004. “Maternal- Newborn Health and Poverty.” Draft. Washington, D.C.: The World Bank. Cited in: UNFPA 2004a.

21. UNFPA 2004a.

22. WHO. 1998. Emergency Contraception: A Guide for Service Delivery (WHO/FRH/FPP/98.19). Geneva: Family Planning and Population, Reproductive Health Technical Support, Family and Reproductive Health, WHO.

23. WHO. n.d. “Sexually Transmitted Infections: A Persistent Public Health Burden.” Geneva: Department of Reproductive Health and Research, WHO.

24. WHO 2003.

25. WHO n.d.

26. UNFPA. 2004b. “Sexually Transmitted Infections: Breaking the Cycle of Transmission,” p. 16. Draft. New York: Reproductive Health Branch, Technical Support Division, UNFPA.

27. United Nations 1995, paragraph 7.32.

28. WHO n.d.

29. Coggins, C., and A. Heimburger. 2002. “Sexual Risk, Sexually Transmitted Infections, and Contraceptive Options: Empowering Women in Mexico with Information and Choice,” pp. 274-275. Ch. 15 in: Responding to Cairo: Case Studies of Changing Practice in Reproductive Health and Family Planning, edited by N. Haberland and D. Measham. 2002. New York: The Population Council.

30. WHO n.d.

31. WHO 2003.

32. UNFPA 2004b, pp. 25-26.

33. Ibid., pp. 26-27.

34. UNFPA 2004a, p. 37.

35. Ibid.

36. The World Bank. 2004. World Development Report 2004: Making Services Work for Poor People, pp. 1-5. New York: Oxford University Press.

37. Bruce, J. 1990. “Fundamental Elements of the Quality of Care: A Simple Framework.” Studies in Family Planning 21(2): 61-91.

38. Huezo, C., and S. Diaz. 1993. “Quality of Care in Family Planning: Clients’ Rights and Providers’ Needs.” Advances in Contraception 9(2): 129-139.

39. John Snow, Inc. 2000. Mainstreaming Quality Improvement in Family Planning and Reproductive Health Service Delivery: Context and Case Studies. Arlington, Virginia: Family Planning Expansion and Technical Support (SEATS II) Project, John Snow, Inc.; Lynam, P., L. M. Rabinowitz, and M. Shobowale. 1993. “Using Self-Assessment to Improve the Quality of Family Planning Clinic Services.” Studies in Family Planning 24(4): 252-260; and Hardee, K., and B. Gould. 1993. “A Process for Service Quality Improvement in Family Planning.” International Family Planning Perspectives 19(4): 147-152.

40. Hardee, K. Forthcoming. “The Intersection of Access, Quality of Care and Gender in Reproductive Health and STI/HIV Services: Evidence from Kenya, India and Guatemala.” Washington, D.C.: Interagency Gender Working Group and the POLICY Project.

41. Mensch, B., M. Arends-Kuenning, and A. Jain. 1996. “The Impact of the Quality of Family Planning Services on Contraceptive Use in Peru.” Studies in Family Planning 27(2): 59-75.

42. Mroz, T. A., et al. 1999. “Quality, Accessibility, and Contraceptive Use in Rural Tanzania.” Demography 36(1): 23-40.

43. Pariani, S., D. M. Heer, and M. D. Van Arsdol, Jr. 1991. “Does Choice Make a Difference to Contraceptive Use: Evidence from East Java.” Studies in Family Planning 22(6): 384-390.

44. Cotton, N., et al. 1992. “Early Discontinuation of Contraceptive Use in Niger and the Gambia.” International Family Planning Perspectives 18(4): 145-149.

45. Quality of care was defined as the fieldworker usually or always being responsive to a client’s questions, appreciating her need for privacy, being perceived as dependable to help with problems, sympathetic to the client’s needs, providing enough information, spending 10 minutes or more with the client during the past visit, and providing a choice of methods.

46. Koenig, M. 2003. The Impact of Quality of Care On Contraceptive Use: Evidence from Longitudinal Data from Rural Bangladesh. Baltimore, Maryland: Department of Population and Family Health Sciences, Bloomberg School of Public Health, Johns Hopkins University.

47. Rudy, S., et al. 2003.

48. John Snow, Inc. 2000; Nguyen, M. T., et al. 1998. “Improving Quality and Use of Family Planning in Three Sites in Vietnam.” Paper presented at the American Public Health Association Annual Meeting, Washington, D.C., 15-19 November 1998; Bradley, J., et al. 1998. Quality of Care in Family Planning Services: An Assessment of Change in Tanzania 1995/6 to 1996/7. New York: AVSC International. All cited in: RamaRao, S., and R. Mohanam. 2003. “The Quality of Family Planning Programs: Concepts, Measurements, Interventions, and Effects.” Studies in Family Planning 34(4): 227-248.

49. RamaRao and Mohanam 2003.

50. Schuler, S. R., L. M. Bates, and M. D. K. Islam. 2002. “Paying for Reproductive Health Services in Bangladesh: Intersections between Cost, Quality and Culture.” Health Policy and Planning 17(3): 273-280.

51. UNFPA. 2004c. “Donor Support for Contraceptives and Condoms for STI/HIV Prevention 2002.” Draft. New York: UNFPA.

52. The average cost per user of contraceptives has been calculated at $1.52 a year. It is assumed that the unavailability of contraceptives would have an adverse impact on women’s reproductive health, even where other reproductive health services exist. To estimate the consequences, we have used the formulas employed in: UNFPA. 1997. Meeting the Goals of the ICPD: Consequences of Resource Shortfalls up to the Year 2000: Report of the Executive Director (DP/FPA/1997/12). New York: UNFPA.

53. UNFPA. 2002. Reproductive Health Essentials: Securing the Supply: Global Strategy for Reproductive Health Commodity Security, Chapter 1. New York: UNFPA.

54. See: UNFPA. 2001. Reproductive Health Commodity Security: Partnerships for Change: A Global Call to Action. New York: UNFPA. Web site: www.unfpa.org/upload/lib_pub_file/ 135_filename_rhcstrategy.pdf, last accessed 17 June 2004.

55. WHO and UNFPA. 2002. “Essential Drugs and Other Commodities for Reproductive Health Services.” Draft. Geneva and New York: WHO and UNFPA.

56. United Nations. 2003. World Population Prospects: The 2002 Revision. New York: Population Division, Department Economic and Social Affairs, United Nations; and United Nations. 2002. World Urbanization Prospects: The 2001 Revision. New York: Population Division, Department Economic and Social Affairs, United Nations.

57. Malhotra, A., and R. Mehra. 1999. Fulfilling the Cairo Commitment: Enhancing Women’s Economic and Social Options for Better Reproductive Health. Washington, D.C.: International Center for Research on Women.

58. Greene, M. E., and A. E. Biddlecom. 2000. “Absent and Problematic Men: Demographic Accounts of Male Reproductive Roles.” Population and Development Review 26(1): 81-115.

59. Ezeh, A. C., M. Seroussi, and H. Raggers. 1996. Men’s Fertility, Contraceptive Use, and Reproductive Preferences. Demographic and Health Surveys Comparative Studies. No. 18. Calverton, Maryland: Macro International.

60.Research exploring this topic included: Mason, K. O., and A. M. Taj. 1987. “Differences Between Women’s and Men’s Reproductive Goals in Developing Countries.” Population and Development Review 13(4): 611-638; and Coombs, L. C., and M. C. Chang. 1981. “Do Husbands and Wives Agree: Fertility Attitudes and Later Behaviour.” Population and Environment 4(2): 109-127.

61. The Alan Guttmacher Institute. 2003. In Their Own Right: Addressing the Sexual and Reproductive Health Needs of Men Worldwide. New York: The Alan Guttmacher Institute.

62. Ibid.

63. Examples of this orientation can be found in context-specific programmes and research in Latin America (Loaiza, E. 1998. “Male Fertility, Contraceptive Use, and Reproductive Preferences in Latin America: The DHS Experience.” Paper prepared for the seminar, “Men, Family Formation and Reproduction”, organized by the Committee on Gender and Population of the International Union for the Scientific Study of Population [IUSSP] and the Centro de Estudios de Poblacion [CENEP], Buenos Aires, Argentina, 13-15 May 1998. Liege, Belgium: IUSSP) and in Ghana (Lamptey, P. et al. 1978. “An Evaluation of Male Contraceptive Acceptance in Rural Ghana.” Studies in Family Planning 9(8): 222-226.).

64. Basu, A. M. 1996. “Women’s Education, Marriage And Fertility: Do Men Really Not Matter?” Population and Development Program Working Paper Series. No. 96.03. Ithaca, NewYork: Cornell University; Hull, T. H. 1999. “Men and Family Planning: How Attractive is the Programme of Action?” Paper presented at the Psychosocial Workshop, New York, New York, 23- 24 March 1999; and Hawkes, S. 1998. “Providing Sexual Health Services for Men in Bangladesh.” Sexual Health Exchange 3: 14-15.

65. White, V., M. Greene, and E. Murphy. 2003. “Men and Reproductive Health Programs: Influencing Gender Norms.” Washington, D.C.: The Synergy Project. Available at www.synergyaids.com/ SynergyPublications/Gender_Norms. pdf, accessed 5 March 2004.

66. Rivers, K., and P. Aggleton. 2001. Working with Young Men to Promote Sexual and Reproductive Health. London: Safe Passages to Adulthood, University of London.

67. Brady, M., and A. B. Khan. 2002. Letting Girls Play: The Mathare Youth Sports Association's Football Program for Girls. New York: The Population Council.

68. See: Estudos e Comunicaçao em Sexualidade e Reproducao Humana (ECOS) web site: www.ecos.org.br/, accessed 3 March 2004.

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