information for practice

The objective of this paper is to discuss some obstacles and opportunities presented by population processes in order to prioritize areas for investment and analytical work as background information for the 2007 HNP Sector Strategy. Within HNP, two areas fall within population: (1) reproductive, maternal, and sexual health issues, and the health services that address them; and (2) levels and trends in births, deaths, and migration that determine population growth and age structure. Many of the aspects of delivery of sexual and reproductive health services are addressed in the overall sector strategy. This paper, therefore, focuses on the determinants and consequences of demographic change, and on policies and interventions that pertain to fertility and family planning. Fertility has declined in most of the low- and middle-income countries, with TFRs converging toward replacement level, except in 35 countries, mainly in Sub-Saharan Africa, where a broad-based decline in fertility has not occurred. As the priorities of donors and development agencies have shifted toward other issues, and global funds and initiatives have largely bypassed funding of family planning, less attention is being focused on the consequences of high fertility. Reproductive health is conspicuously absent from the MDGs, and assistance to countries to meet the demand for family planning and related services is insufficient.