The ability to control fertility is a woman’s most essential tool...
to influence the quality of her own life and the life of her child/ren. By giving women the freedom to determine if, when and how many children they will have, contraception enables women to improve their health, education and employment status and invest more in their children. Nations benefit too when women are healthy and engaged in paid work, and when families can invest more in education. But of the estimated 1.8 billion women aged between 15 and 49 in the world, more than 40% may not currently be protected by contraception. Without this protection, many of these women and girls are routinely exposed to the many risks of unprotected sex, including the health, education and economic risks associated with pregnancy and high fertility rates.
As most of these unprotected women live in just ten high population countries, including India, China, the United States of America, Pakistan, Nigeria, Indonesia, Brazil, Bangladesh, Mexico and Ethiopia, their ability to control their own fertility has implications for global economic and social development. And even more importantly in the countries with extremely low (<20%) contraceptive use and high fertility rates (more than 5 children per woman), including Niger, Mali, Somalia, Chad, Burundi, Nigeria, Angola, the Democratic Republic of Congo and Uganda, increasing contraceptive use could yield major national and regional development returns, including increased economic growth, reductions in poverty and inequality, and improvements in maternal and child health and education. Further, due to the “youth bulge” in many of these countries and rising populations of young men with limited opportunities, increasing contraceptive use could also deliver a long-term “peace and security dividend”.
In recognition of the economic and social costs of high fertility to individual women, their families and nations, countries should institute a new measure of women’s freedom to pursue their full potentials - the Child Dependency Ratio - the ratio of dependent children (<14 years) to women of working age (15 to 49 years). They should seek to achieve a Child Dependency Ratio of <1 by 2020 and <0.8 by 2030. This would assist both high population countries with low contraceptive coverage and above average Child Dependency Ratios (e.g. India, Pakistan, Nigeria, Indonesia, Bangladesh, and Ethiopia) and smaller population countries struggling with extremely high fertility rates and low health, education and labor market outcomes for women and girls (e.g. Niger, Mali, Somalia, Chad, Burundi, Angola, the Democratic Republic of Congo and Uganda), to accelerate fertility rate declines.
The United Nations, its agencies and development partners should include the Child Dependency Ratio as a specific indicator in the Sustainable Development Goals, alongside the more traditional indicators of contraceptive prevalence, unmet need for modern contraception, and the fertility rate. The UN should also ensure that all of its member states and agencies understand that fertility control is central to women’s freedom to lead healthy, productive lives and to the economic and social development of nations, especially lower income nations with very high fertility and early marriage rates and very low levels of educational attainment among women and girls. The ultimate goal of the new Child Dependency Ratio is to accelerate the rate of progress in reducing the fertility rate to the levels required for achievement of the Sustainable Development Goals.