The world's human population will reach a staggering 7 billion on Oct 31, 2011, according to The State of World Population2011
, a report released recently by the UN Population Fund. World population growth has shown some positive demographic trends during the past 60 years, especially the increase in average life expectancy from about 48 years in the early 1950s to 68 years in 2010. But, since 90% of future population growth is projected to occur in the least developed countries, there will be heightened competition for already restricted resources, leading to increased poverty, and reduced access to services such as health care.
Asia will remain the most populous area during the 21st century, but Africa's population will more than treble—from 1 billion in 2011 to about 3·6 billion in 2100. There will be another billion Africans by 2044, even as the fertility rate drops from 4·6 children per woman in 2005—10 to 3 children per woman in 2040—45. Currently, 15% of the world's population lives in Africa, and population growth in sub-Saharan Africa of 2·4% is expected between 2010 and 2015—with Niger's growth rate of 3·5% topping the region. With population growth outpacing economic growth in sub-Saharan Africa, resource issues, such as low agricultural productivity and a vulnerability to climatic shocks, will continue to expose the region to both nutritional and economic uncertainty.
Although the International Monetary Fund forecasts that sub-Saharan Africa's gross domestic product will grow by 5·3% this year and 5·8% in 2012, investment in health is still lagging behind economic growth. Indeed, population growth is an obstacle to development in many countries in sub-Saharan Africa. It is likely that sub-Saharan Africa as a whole will not reach the targets set by the Millennium Development Goals (MDGs), and that further population growth will threaten gains made already. Progress towards MDG 5—to improve maternal health—has made the slowest progress. Several of the other MDGs cannot be achieved without increased progress in promotion of women's reproductive health and protection of maternal and newborn health. Therefore, the need for strengthened reproductive health services, especially family planning, is substantial and urgent.
Although investments in disease-specific programmes and vaccination in developing countries are successful and commendable, access to family planning is often sorely neglected in development priorities. Thousands of women in sub-Saharan Africa are still dying annually from pregnancy-related causes, many of them preventable. In some countries, women lack access to health facilities and midwifery services; in others, cultural forces and gender inequality interfere with a woman's ability to exercise her reproductive rights. In some areas, demand for contraceptives is falling, owing to a combination of economic and social factors.
Stabilisation of population growth, especially in the developing countries of sub-Saharan Africa, requires increased attention to women's health. As noted in The Lancet's 2007 Women Deliver Series
and a report, Adding it up
, from the Guttmacher Institute, the necessary investment in maternal health is a small fraction of world spending, and maternal health interventions are cost-effective for settings in sub-Saharan Africa. Saving one disability adjusted life-year through family planning and maternal and newborn care costs less than US$100, at population level a cost of only $4·50 per head. There is an opportunity for improvements to be made in reproductive health, child health, education, and empowerment of women. These must be based on and reinforce human rights and should include sex education for young people, particularly adolescent girls.
To provide a critical review of the topic, a future Lancet
Series on family planning is being developed. Next month, the International Conference on Family Planning in Dakar, Senegal
, will bring together high-level leaders from Africa and Europe, world-class researchers, and advocates to discuss how to access family planning, especially for 215 million women worldwide who want to avoid or delay pregnancy, but do not use or have access to modern contraception. As 2015 fast approaches, the sexual and reproductive health communities face several challenges including what will replace the MDGs alongside the simultaneous end of the 20-year programme of the Cairo agenda
, which defined the needs of individuals for universal education and sexual reproductive health care and rights as the best road to sustainable development. As we celebrate reaching the milestone of a population of 7 billion people, family planning and maternal health need to become top development priorities in sub-Saharan Africa. This is a necessity for the future prosperity of all.