Researchers

How to Attain Population Sustainability

Childhood diarrhoeal deaths in seven low- and middle-income countries
Schwarm said that even if the state's fastest growth is in the past, California has plenty to lure the best and brightest. Would you like to get pregnant in the next year? These conclusions are further developed below. However, there is also a gap in funding and research to engage men, which not only makes overall family planning objectives more elusive, but puts even greater stress and pressure on women to shoulder the burden of contraception on their own. Unsaturated fats may be further classified as monounsaturated one double-bond or polyunsaturated many double-bonds. One in a million:

Voluntary Family Planning

Data sources and methods

All people in the working-age population who, during the reference week, were without a paid job, available for work, and had either actively sought work in the past four weeks or had a new job to start within the next four weeks.

Number of unemployed people expressed as a percentage of the labour force. Usually resident, non-institutionalised, civilian population of New Zealand aged 15 years and over.

Sum of those unemployed, underemployed, and in the potential labour force. Number of underutilised people expressed as a proportion of those in the extended labour force.

People who are in part-time employment who would like to, and are available to, work more hours. People who are not actively seeking work but are available and wanting a job, and people who are actively seeking but not currently available for work, but will be available in the next four weeks. Seasonal adjustment removes the seasonal component present when dealing with quarterly data and makes the underlying behaviour of the series more apparent. A redesigned HLFS was implemented from the June quarter and will enable more accurate reporting of underutilisation statistics in line with International Labour Organisation recommendations.

In June there were , New Zealanders who were officially unemployed 4. Seasonally adjusted quarterly unemployment numbers and rates, New Zealand March to June Unemployment rates, in absolute terms, differ by age, with the highest rates consistently observed for young people aged 15—19 years. From to unemployment rates for 15—19 year olds rose more steeply and peaked higher than unemployment rates for other age groups, and have remained much higher than rates for other age groups Figure The underutilisation rate includes persons underemployed and in the potential labour force, as well as those unemployed.

In June there were , New Zealanders seeking additional hours of work, actively seeking work but not available in the next week, or available but not actively seeking work.

The underutilisation rate increased following the global financial crisis and remains high Figure Analysis by Statistics New Zealand showed that from — unemployment and underutilisation data followed similar patterns over time with the underutilisation rate much higher than the unemployment rate.

These 15—19 and 20—24 year old age groups had both the highest numbers and rates of underemployment, unemployment, potential labour force, and underutilisation. Unemployment rates by selected age groups, New Zealand — Quarterly unemployment rates by ethnicity, New Zealand March —June Quarterly underutilisation by extended labour force status, New Zealand March to June Children in New Zealand households where the main income is from an income support benefit are more likely than other children to live in income-poor households and to experience material deprivation.

Government policies in areas such as access to and value of income support benefits have a substantial effect on household incomes for families dependent on benefit payments. The following section uses data from the Ministry of Social Development to review the proportion of children who are reliant on a recipient of a benefit.

Number of children aged 0—17 years who were reliant on a recipient of a benefit. All figures refer to the number of children reliant on a recipient of a benefit at the end of June and provide no information on the number receiving assistance at other times of the year. Figures refer to the number of children not the number of benefit recipients; in a household with more than one child each will be included in the count.

Welfare reform in July introduced three new benefits Jobseeker Support, Sole Parent Support, and Supported Living Payment , which replaced many of the previously existing benefits, and changed the obligations to be met by recipients of a benefit. The welfare reform changes have been described at https: The benefits prior to the June reform are not directly comparable with the benefits as at June Prior to , "Other benefits" included: To be eligible for a benefit, clients must have insufficient income from all sources to support themselves and any dependents, and meet specific eligibility criteria.

Information about current eligibility criteria for benefits can be found at http: Children aged 0—17 years who were reliant on a recipient of a benefit recipient, New Zealand as at end of June — For 15—17 year olds the percentage of children reliant on a recipient of sole parent support was lower than the percentage of children reliant on recipients of jobseeker support Figure Children aged 0—17 years who were reliant on a recipient of a benefit, by age and benefit type, New Zealand as at end of June Social inequities are responsible for a high proportion of death and illness among children in both poor and rich countries.

Health effects of poverty arise from complex interactions between social and environmental factors such as education, poor quality housing and household crowding. This section of the Child Poverty Monitor brings together data from several sources, each giving valuable insights into factors in the health, education, housing and social sectors that relate to the conditions in which children are born, live and grow, which affect their capacity to develop and thrive. The health-related factors infant mortality, medical conditions with a social gradient, assault, neglect and maltreatment are considered in detail along with housing and education.

Household crowding is included in this report because it has been linked to several health conditions including communicable diseases such as gastroenteritis, hepatitis A and B, and respiratory infections.

The infant mortality rate reflects the effects of economic and social environments on the health of mothers and newborns and can be read as an indicator of national commitment to universal maternal and child health, particularly for poor and marginalised families. In all developed countries, the rates of death in the first year of life infant mortality rates have been reduced to fewer than 10 infant deaths per thousand live births.

The infant mortality rate for New Zealand was similar to that of the United States, higher than Australia and more than twice the rates in Slovenia, Iceland and Japan Figure International comparison of infant mortality rates, Death of a live born infant prior to days of life includes neonates.

Deaths of live born infants prior to days of life per 1, live births. Sudden unexpected death in infancy SUDI: Death of a live born infant prior to days of life, where the cause of death was sudden infant death syndrome SIDS , accidental suffocation or strangulation in bed, inhalation of gastric contents or food, or ill-defined or unspecified causes. Sudden infant death syndrome SIDS: Cause of death is the main underlying cause of death.

Refer to Appendix 2 for relevant codes. Infant mortality rates fell overall from to , with the majority of the decrease occurring between and and a more gradual decline from to Infant mortality rates were stable from — Between and there were inequities in infant mortality rates by socio-economic deprivation, maternal age, ethnicity and gender as shown in Table 5.

The mortality rate for infants born in areas with the highest scores on the NZDep index of deprivation deciles 9—10 was almost three times higher than the mortality rate for infants born in areas with the lowest NZDep scores deciles 1—2. The mortality rates for infants born to mothers younger than 20 years and aged 20—24 years were 2—3 times higher than the mortality rate for infants born to mothers aged 30—34 years.

Most infant deaths occurred in the first 28 days of life, and were caused by serious issues occurring around the time around birth such as congenital anomalies, extreme prematurity and other perinatal conditions.

Sudden unexpected death in infancy SUDI was the most common cause of death for infants aged from 28 days old Table 6. Infant mortality rates in New Zealand, total — and by prioritised ethnicity — Infant deaths by demographic factors, New Zealand — National Mortality Collection; Denominator: Birth Registration Dataset; Rate ratios are unadjusted.

Infant mortality by main underlying cause of death, New Zealand — Sudden unexpected death in infancy; SIDS: Sudden infant death syndrome. These are deaths that occur suddenly and unexpectedly in the first year of life, usually in otherwise healthy infants, and often during sleep. Collectively these challenges were likely barriers to being able to provide a safe sleep environment for baby or to access appropriate supports. From to there was a statistically significant fall in the SUDI rate.

Between and there were inequities in SUDI rates by socioeconomic deprivation, maternal age, ethnicity, gestational age at birth and gender as shown in Table 7. The SUDI rate for infants living in areas with the highest scores on the NZDep index of deprivation deciles 9—10 was more than seven times higher than infant mortality rates for infants in areas with the lowest NZDep scores deciles 1—2.

The SUDI rate for infants born to mothers aged under 20 years was almost eight times higher than the rate for infants born to mothers aged 30 years or older, and for infants born to mothers aged 20—25 years the SUDI rate was five times the rate for infants born to mothers aged 30 years or older.

National Mortality Collection, Denominator: The New Zealand Child and Youth Epidemiology Service has identified a number of medical conditions and modes of injury where rates of death or hospitalisation are more than one and a half times higher for children living in areas with the highest NZDep index of deprivation scores deciles 9—10 compared with children living in areas with the lowest NZDep scores deciles 1—2 and conditions where there are strong social gradients on the basis of ethnicity see Appendix 3.

These medical conditions and modes of injury are said to have a social gradient. This section reviews deaths and hospitalisations from medical conditions and injuries with a social gradient, including sudden unexpected death in infancy SUDI , using information from the National Mortality Collection and the National Minimum Dataset. National Mortality Collection; Hospitalisations: Deaths excluding neonates with a medical condition or injury with a social gradient as the main underlying cause of death.

Acute and arranged hospitalisations excluding neonates and waiting list cases with a medical condition with a social gradient as the primary diagnosis and hospitalisations with a primary diagnosis of injury with a social gradient excluding neonates and ED cases.

Medical conditions with a social gradient: Acute bronchiolitis; acute lower respiratory infection unspecified; acute upper respiratory infections; asthma and wheeze; bronchiectasis; croup, laryngitis, tracheitis, epiglottitis; dermatitis and eczema; epilepsy or status epilepticus; febrile convulsions; gastroenteritis; inguinal hernia; meningitis; meningococcal disease; nutritional deficiencies or anaemias; osteomyelitis; otitis media; pneumonia; rheumatic fever or rheumatic heart disease; skin infections; tuberculosis; urinary tract infection; vaccine preventable diseases; viral infection of unspecified site for codes see Appendix 2.

Injuries with a social gradient: External cause is land transport crashes road traffic; non-traffic ; falls; mechanical forces inanimate; animate ; thermal injury; poisoning; and drowning or submersion for codes see Appendix 2.

SUDI rates are traditionally calculated per 1, live births, however in this section of the report the denominator used was children aged 0—14 year olds, so that the relative contribution SUDI makes to mortality in this age group is more readily appreciated. In the five years from — there were deaths of 0—14 year olds as a result of conditions with a social gradient. Drowning and off-road transport injuries were also frequent causes of death from injuries with a social gradient Table 8.

From to there was an overall marked fall in mortality rates for sudden unexpected death in infancy and deaths from injuries with a social gradient, with a less marked fall in the deaths from medical conditions with a social gradient Figure Deaths from conditions with a social gradient in 0—14 year olds excluding neonates , by main underlying cause of death, New Zealand, — National Mortality Collection neonates removed ; Denominator: Deaths from conditions with a social gradient in 0—14 year olds excluding neonates , New Zealand, — There was significant disparity in death rates from conditions with a social gradient by ethnicity, particularly for medical conditions.

Analysis by NZDep confirmed the social gradient for the selected medical conditions and injuries Figure Figure 36 and other similar figures compare the rates in different population groups with the reference REF population group. An unadjusted rate ratio of one indicates no difference between two groups.

A rate ratio of two indicates that the health condition occurs twice as often in the specified group compared with the reference group. The error bars indicate the level of uncertainty in the ratio. In the five years from — there were , hospitalisations of 0—14 year olds for medical conditions with a social gradient and 44, such hospitalisations for injuries with a social gradient. The most common primary diagnoses for hospitalisations for medical conditions with a social gradient were respiratory and communicable diseases such as asthma, bronchiolitis and gastroenteritis.

The hospitalisation rate of 0—14 year olds for medical conditions with a social gradient rose overall from to ; the rise was most marked from to From to hospitalisation rates for selected respiratory and communicable diseases with a social gradient were highest for the youngest children and declined steeply with increasing age Figure There was significant ethnic disparity in hospitalisation rates for medical conditions and injuries with a social gradient.

Hospitalisation rates for conditions with a social gradient were slightly higher for male 0—14 year olds compared with female 0—14 year olds. National Minimum Dataset neonates removed ; Denominator: Statistics NZ estimated population. Hospitalisations for conditions with a social gradient in 0—14 year olds excluding neonates , New Zealand — Hospitalisations for selected conditions with a social gradient in 0—14 year olds by age, New Zealand — Hospitalisation for medical conditions and injuries with a social gradient, comparison by demographic factors, New Zealand — Child maltreatment is a serious public health issue that is recognised internationally.

The following section reviews deaths and hospitalisations of New Zealand 0—14 year olds that involved injuries due to assault, neglect or maltreatment, using data from the National Minimum Dataset and the National Mortality Collection.

Hospitalisations for injuries arising from the assault, neglect, or maltreatment of 0—14 year olds. From — there were children aged 0—14 years who died from injuries arising from assault, neglect, or maltreatment, a stable rate of around nine deaths per million children per year. Lower rates in —03, —13 and were not statistically different from the rates in other years Figure Data from future years are required to determine whether this is the start of a new trend or year-to-year statistical variation.

In the five-years from — there were 28 deaths of 0—14 year olds as a result of assault, neglect or maltreatment. Sixteen of these deaths were of female and 12 were of male children. Sixteen deaths occurred in the first year of life, seven deaths were of 1—4 year olds and five were of 5—14 year olds. There was an overall fall in both the number and rate of hospitalisations for injuries arising from assault, neglect or maltreatment of New Zealand children aged 0—14 years from to Figure In the five years from — there were hospitalisations of 0—14 year olds for injuries arising from assault, neglect or maltreatment.

The most common primary diagnoses for these hospitalisations included traumatic subdural haemorrhage in 0—4 year olds, and head injuries at all ages 0—14 years Table Age-specific hospitalisation rates for injuries arising from assault, neglect or maltreatment were highest in the first year of life Figure There was a clear social gradient with increasing hospitalisation rates for children living in areas with higher scores on the NZDep index of deprivation.

Hospitalisation rates were eight times higher for children who lived in areas with the highest NZDep scores compared with children living in areas with the lowest scores. Hospitalisations due to injuries arising from the assault, neglect, or maltreatment of 0—14 year olds, New Zealand — Hospitalisations due to injuries arising from assault, neglect, or maltreatment of 0—14 year olds by age and gender, New Zealand — Nature of injuries arising from injuries arising from the assault, neglect, or maltreatment of hospitalised 0—14 year olds, by age group, New Zealand — Hospitalisations for injuries arising from assault, neglect, or maltreatment of 0—14 year olds, comparison by demographic factors, New Zealand — Addressing quality and affordability of housing is arguably the most important action to mitigate the effects of child poverty in New Zealand.

Put up with feeling cold as a result of being forced to keep costs down to pay for other basics. Statistics New Zealand People who owned their home, partly owned their home, or held it in a family trust.

People who did not own their home, did not have it in a family trust, and were making rent payments to a private person, trust, or business. People who did not own their home, did not have it in a family trust, and were making rent payments to Housing New Zealand Corporation, local authority or city council, or other state-owned corporation or state-owned enterprise, or government department or ministry. Housing costs include all mortgage outgoings principal and interest together with rent and rates for all household members.

Repairs, maintenance and dwelling insurance are not included. Any housing-related cash assistance from the government is included in household income. Variations in housing costs do not necessarily correspond to similar variations in housing quality.

This is because many older individuals live in good accommodation with relatively low housing costs, for example, those living in mortgage-free homes, whereas many in an earlier part of the life cycle have a similar standard of accommodation but relatively high accommodation costs.

The NZHES data give a sense of the scale of the issue but are not sufficiently robust for a time series. The NZHES-based crowding rates are derived from a sample not from the total population and are somewhat lower than the Census rates.

Material Wellbeing Index MWI quintiles are calculated by ranking all people by the MWI score of their households and then dividing them into five equal groups quintiles.

The MWI quintiles are population-based measures. Home ownership is a significant part of family wealth in New Zealand and enables one generation to pass resources on to the next generation. From to the proportion of people living in owner occupied dwellings fell with a rise in the proportion of people in rental accommodation. Among people living in rented accommodation, those who have a private sector landlord increased at each Census from to , while at the same time there was a decrease in the percentage of people living in rented accommodation managed by Housing New Zealand Corporation or other social sector housing.

Household tenure by ethnicity, individuals in households, New Zealand Census — Total number of people in households. People who did not own their home, did not have it in a family trust, and were making rent payments. Ethnicity is total response. Rates of mobility are higher for households who rent which can have negative consequences for children in relation to schooling and social interaction.

Child poverty rates show a clear gradient across different tenure types. The cost of housing is relatively high in New Zealand. Individuals aged 0—17 years are more likely than 45—64 year olds and older to live in households with high OTIs. Between and there was an increase in the percentage of individuals living in households with high OTIs across all age groups Figure Housing costs as a proportion of income, accommodation supplement recipients, by household type, New Zealand Household crowding is clearly linked with poorer health outcomes, particularly for children, and there is also some evidence for poorer mental health, educational and social outcomes.

The highest rates of crowding were seen for 0—17 year olds living in Housing New Zealand Corporation HCNZ homes; rates of crowding for 0—17 year olds living in HNZC and private rental homes were higher than rates for their peers in owner-occupied households Figure Household crowding by household tenure and composition, New Zealand — The physical quality of housing is associated with individual and family well-being and the positive health outcomes that accrue from investing in good quality housing.

On average, in the — NZHES years, almost half of the households experiencing major problems with dampness, mould or heating lived in private rental housing, and one-fifth lived in social sector housing.

Problems with dampness, mould, heating, problems keeping homes warm in winter, and frequently putting up with being cold to reduce costs and pay for other basics were more prevalent in households with the lowest incomes after housing costs AHC, Figure Housing quality problems, by household tenure and composition, individuals in households, New Zealand — average.

Major problem with damp and mould in previous 12 months. Major problem with heating or keeping home warm in winter. Housing quality problems, by household income quintile after housing costs and composition, individuals in households, New Zealand — average.

Put up with cold: Housing quality problems, by household material wellbeing index MWI quintile and composition, individuals in households, New Zealand — average. The socioeconomic context in which children and young people live has a significant impact on their educational performance. The following section presents Ministry of Education data to summarise key measures for educational attainment of school leavers from There are three levels depending on the difficulty of the standards achieved.

At each level, students must achieve a certain number of credits, with credits being able to be gained over more than one year. All schools are assigned a decile ranking based on the socioeconomic status of the areas they serve. These rankings are based on census data from families with school age children in the areas from which the school draws its students.

Census variables used in the ranking procedure include equivalent household income, parent's occupation and educational qualifications, household crowding and income support payments. Decile ratings are used by the Ministry of Education to allocate targeted funding, as well as for analytical purposes.

These data follow a new definition of school leavers from the Ministry of Education's ENROL system utilised from onwards so comparison with previous years is not possible. New Zealand has continued to see an increasing percentage of students leaving school with qualifications.

The proportion of school-leavers with NCEA level 1 rose from From — there were improvements in educational outcomes across all ethnic groups, with persisting inequity between ethnic groups. School socioeconomic deciles were used by the Ministry of Education in the time period of this report for funding purposes. Ranking of deciles is in the opposite direction to that of the NZDep index of deprivation used with health data in this report. Highest educational attainment of school leavers, New Zealand — Educational attainment of school leavers by ethnicity, New Zealand — Educational attainment of school leavers by school socioeconomic quintile, New Zealand This appendix outlines the main New Zealand data sources for non-income measures NIMs that are used in this report to monitor material hardship or material wellbeing.

Table 12 is modified from Perry 6 and provides a brief overview of the deprivation and material wellbeing indices used in his report and in other Ministry of Social Development MSD research. National and international material deprivation and material wellbeing indices. A 13 item material deprivation index used by European researchers for some time and formally adopted by the EU in May to replace EU The short-form SF version uses 25 items.

Unlike indices above, NZDep is not a household- or family-based index. It is based on information from households within a small area, using Census items as described in Appendix 3. The following are the sources of current non-income measures data reported in New Zealand: The Living Standards Surveys LSS , undertaken nationally by the Ministry of Social Development and collected information from 5, households on their material circumstances including ownership and quality of household durables, and their ability to keep the house warm, pay the bills, have broken down appliances repaired and pursue hobbies and other interests.

From to there were 25 items and from to there were 29 items. In six further items were added. The initial SoFIE sample in —03 included around 11, households. Economising not at all, a little, a lot — to keep down costs to help in paying for other basic items: Housing problems no problem, minor problem, major problem: For MWI, score as 2, 1 and 0 respectively. When buying, or thinking about buying, clothes or shoes for yourself, how much do you usually feel limited by the money available?

Received help in the form of food, clothes or money from a welfare or community organisation such as a church or food bank. Economising not at all, a little, a lot — to keep down costs to help in paying for other basic items. About how much money, on average, do you have each week for spending on things for yourself without consulting anyone else? The Material Wellbeing Index MWI was developed by Ministry of Social Development and gathers data across the wellbeing spectrum from low to high, with information not only on "enforced lacks" but also "freedoms enjoyed".

The range of items included provides differing degrees of hardship which allows for finer nuances within material hardship and how it is experienced by different people. This is working on a spectrum from lower to higher levels of hardship. For further detail see Perry The NZ index of deprivation NZDep was first created using information from the census, and has been updated following each census.

It is a small area index of deprivation, and is used as a proxy for socioeconomic status. The main concept underpinning small area indices of deprivation is that the socioeconomic environment in which a person lives can confer risks or benefits which may be independent of their own social position within a community.

The latest index, NZDep, combines nine variables from the census to reflect eight dimensions of material and social deprivation Table Each variable represents a standardised proportion of people living in an area who lack a defined material or social resource. These are combined to give a score representing the average degree of deprivation experienced by people in that area. While this may be less of a problem for very affluent or very deprived neighbourhoods, in average areas, aggregate measures may be much less predictive of individual socioeconomic status.

The Child Poverty Monitor presents information derived from several national administrative datasets. These are described briefly below, and limitations and issues to be aware of when interpreting results drawn from these sources are outlined.

The National Mortality Collection is a dataset managed by the Ministry of Health which contains information on the underlying cause, or causes, of death along with basic demographic data for all deaths registered in New Zealand since Fetal and infant death data are a subset of the Mortality Collection, with cases in this subset having additional information on factors such as birth weight and gestational age.

It is used for policy formation, performance monitoring, and research purposes, providing key information about the delivery of hospital inpatient and day patient health services both nationally and on a provider basis. It is also used for funding purposes.

Information in the NMDS includes principal and additional diagnoses, procedures, external causes of injury, length of stay and sub-specialty codes; and demographic information such as age, ethnicity and usual area of residence. Data have been submitted by public hospitals electronically since the original NMDS was implemented in , with additional data dating back to also included.

The private hospital discharge information for publicly funded events has been collected since The current NMDS was introduced in Since all NZ hospitals and delivering midwives have been required to notify the Department of Internal Affairs within five working days of the birth of a live or stillborn baby. This applies to stillborn babies born at or more than 20 weeks gestation, or those weighing g or more; prior to , only stillborn babies reaching more than 28 weeks of gestation required birth notification.

In addition, parents must jointly complete a birth registration form as soon as reasonable practicable after the birth, and within two years of delivery, which duplicates the above information with the exception of birth weight and gestational age. Once both forms are received by Internal Affairs the information is merged into a single entry.

This two-stage process it is thought to capture There are limitations when using any of these datasets. The following are of particular relevance to this report. The quality of data submitted to the administrative national datasets may vary.

While the data for the National Mortality Collection and the Birth Registration Dataset are coded by single agencies, the clinical information held in the NMDS is entered by health providers before being collated by the Ministry of Health.

In a review of the quality of coding in the data submitted to the NMDS, 2, events were audited over ten sites during a three month period. Changes in the coding systems used over time may result in irregularities in time series analyses. Back and forward mapping between the two systems is possible using predefined algorithms, 45 and for most conditions there is a good correspondence between ICD-9 and ICDAM codes.

Care should still be taken when interpreting time series analyses which include data from both time periods as some conditions may not be directly comparable between the two coding systems. Inconsistent recording of ED cases has resulted from differing definitions of the time spent in the ED, and at what point this time constitutes an admission. This is important in paediatrics where hospitalisations for acute onset infectious and respiratory diseases in young children especially are mainly of short duration.

In addition, there are regional differences in treatment processes for paediatric emergency cases. This report includes all ED day cases in its analyses of hospitalisations for medical conditions. This approach differs from that commonly used by the Ministry of Health when analysing NMDS hospital discharge data, which the Ministry of Health uses to minimise the impact of the inconsistent reporting of ED cases.

However, as noted above, the treatment of children in acute cases differs from that of adults, and the inclusion of ED day cases is justified when considering hospitalisations for medical conditions, despite inconsistencies in the dataset. There were inconsistencies in the manner in which ethnicity information in New Zealand was collected prior to This report presents ethnic-specific analyses for onwards and, unless otherwise specified, prioritised ethnic group has been used to ensure that each health event is only counted once.

The data selected are mainly from population surveys or routine administrative datasets that provide complete population coverage. A social gradient occurs when hospitalisation or death rates are different for children living in areas with different scores on an NZDep index of deprivation.

This occurs for example, where the rates of a condition are higher for children living in areas with high deprivation index scores compared with rates for children living in areas with low scores. From the 40 most frequent causes of hospital admission in children aged 0—14 years, conditions exhibiting a social gradient were selected. Hospitalisations of neonates infants aged less than 28 days were excluded on the basis that these admissions are likely to reflect issues arising prior to, or at the time of birth.

For medical conditions, only acute and arranged hospital admissions were included as waiting list admissions are likely to reflect service capacity rather than the burden of health need. All injury cases with an emergency department specialty code on discharge were excluded as a result of inconsistent uploading of emergency department cases across district health boards.

This differential filtering means that it is not possible to accurately compare hospitalisations with a social gradient between the medical condition and injury categories.

Differences in how communities use emergency departments versus primary care for minor medical conditions may also have accounted for some of the social gradients seen. As the number of deaths from a particular condition was insufficient to calculate reliable rate ratios for many of the socioeconomic categories, deaths occurring as a result of conditions identified as having a social gradient in hospitalisation data were categorised as deaths with a social gradient with the addition of deaths from drowning and sudden unexpected death in infancy SUDI.

Inferential statistics are used when a researcher wishes to use a sample to draw conclusions about a larger population as a whole for example, weighing a class of year-old boys, in order to estimate the average weight of all year-old boys in New Zealand. The findings obtained from the sample provide an estimate for the population, but will always differ from it to some degree, simply due to chance. Similarly, samples are used when a researcher questions whether the risk of developing a particular condition is different between two groups, and the fit of the estimate obtained from the samples to the actual population needs to be carefully considered.

An example of this would be a study examining whether lung cancer is more common in smokers or non-smokers: Over time, statisticians have developed a range of measures to quantify the uncertainty associated with random sampling error. These measures can assign a level of confidence to estimates and conclusions drawn from samples, allowing researchers to assess, for example, whether the average weight of boys in the sample reflects the true weight of all year-old boys, or the rates of lung cancer in smokers are really different to those in non-smokers.

Two of the most frequently used statistical significance tests are:. The p value from a statistical test measures the probability of finding a difference at least as large as the one observed between groups, if there were no real differences between the groups studied. For example, if statistical testing of the difference in lung cancer rates between smokers and non-smokers resulted in a p value of 0. When sampling from a population a confidence interval is a range of values that contains the measure of interest.

While a confidence interval for the average height of year-old boys could be 20cm to cm, for example, the smaller range of cm to cm is a more informative statistic. When tests of statistical significance have been applied in this report, the statistical significance of the associations presented has been signalled in the text with the words significant, or not significant.

Where the words significant or not significant do not appear in the text, then the associations described do not imply statistical significance or non-significance. In general the data sources used in this report are either population surveys or routine administrative datasets.

Data from national surveys: In population surveys information from a sample has been used to make inferences about the population as a whole. In this context, statistical significance testing is appropriate and, where such information is available in published reports, it has been included in the text accompanying graphs and tables. In a small number of cases, information on statistical significance was not available, and any associations described do not imply statistical significance.

Data from routine administrative data: Administrative datasets, for example the National Mortality Collection, capture information on all of the events occurring in a particular category.

Measures the number of people with the condition of interest in relation to the number of people in the population. It is calculated by dividing the number of people with the condition of interest in a specific time period by the total number of people in the population in the same time period.

Measures the occurrence of an event within a defined age group in relation to the number of people in that group. Age-specific rate is calculated by dividing the number of people with the condition of interest in a specific age group and time period by the total number of people in the population in the same age group and time period. A fair chance for every child: The state of the world's children New York: The agenda for sustainable development.

Children and the Sustainable Development Goals in rich countries Florence: Solutions to child poverty in New Zealand: Office of the Children's Comissioner. Creating a child and youth health monitoring framework to inform health sector prioritisation and planning: Child Indicators Research, The material wellbeing of New Zealand households: Trends and relativities using non-income measures, with international comparisons.

Ministry of Social Development. Household incomes in New Zealand: Trends in indicators of inequality and hardship to Are the outcomes of young adults linked to the family income experienced in childhood?

Social Policy Journal of New Zealand, 22 Carter K, Imlach Gunasekara F. Dynamics of Income and Deprivation in New Zealand, Organisation for Economic Co-operation and Development. Why less inequality benefits all. Education, outreach, and access to services are necessary and are currently being advocated for and offered by Reproductive Health Uganda. However, in Colorado, the Colorado Family Planning Initiative provides low or no cost long-acting reversible contraceptives to low-income women, especially teens.

By doing this, teen pregnancies were nearly cut in half in their state. Family planning is often an overlooked path forward to deal with climate change. It has been shown that regions of high population growth, coupled with a high unmet need for family planning, frequently overlap with regions that are most vulnerable to climate change.

When women's needs for family planning are met, their families are healthier, there is a reduced household demand on resources, and women have more time to devote to climate adaptation-related activities.

Increasingly, though, climate researchers and activists are making the connection. It has been estimated that, just by educating girls and supporting family planning alone, emissions could be reduced by gigatons of CO2-equivalent by Biodiversity can also be impacted by family planning.

Recently the World Wildlife Fund found that the world's forests could lose more than half of their plant species by the end of the century. Indonesia has one of the highest deforestation rates in the world and, although its government has invested in education and awareness of contraceptives, its population is still increasing and is projected to be the world's seventh largest country by Today there are more that 1. New thinking about conservation, climate change, and communities is needed.

One new model known as Population, Health, and Environment PHE is an integrated solution linking family planning, public health and conservation that recognizes the interconnectiveness of people and their local environment. Humanity must stop living beyond the carrying capacity of Earth.

To help in this cause, readers are encouraged to become informed about policies that empower women, call on elected representatives to stop cuts on family planning assistance internationally and locally, urge congressional representatives to co-sponsor the Global Health, Empowerment, and Rights Act and the Women and Climate Change Act of , protest cuts to environmental protections, involve men in family planning programs, and vote.

In many developing countries, it is equally important as family planning, especially in cultures where girls are married as children. Each year, 12 million girls are married before the age of That is about 84 million girls of child-bearing age who are likely to become pregnant, and who many could have been helped by improved education opportunities, such as building schools within walking distance. Some women of Turkana County in Kenya are turning to goat oil as a means of contraception and swear by its effectiveness.

Reasons given for the low usage are: One woman, now 50 years old, never used contraceptives because, as a fifteen year old, her mother-in-law told her if she ever used government family planning methods, she would never have a baby when she was ready. The chemicals in birth control would destroy her womb, she was warned.

Her husband, a pastoralist, would leave for long periods, tending to herds and seeking pastures, but when he returned their intimacy would result in a new pregnancy. She gave birth to five children, having one right after the other.

When her husband left, it was her sole responsibility to care for her growing family. With each pregnancy, that burden grew. At the age of 38 she turned to goat cream. One doctor thought that, because the goal oil is not stored correctly, bacteria might grow in it and, when applied, it destroys the fallopian tubes. To prepare the cream, goat milk is put in a gourd and stored untouched for four nights. On the fifth day the cream is boiled and cooled.

The naked woman then puts four drops in her mouth. Swirling the container of cream around her body, she chants "Don't give me a child, shut my womb. The cream is then mixed with donkey feces and stored in the goat's shed untouched for four days. Many men of Turkana are adamantly against birth control and will not allow their wives or partners to use it. Children are seen as a source of wealth, and men want as many children as they can have.

Some Turkana women are forced to go behind their husbands back to use birth control. Public awareness and education were the keys to its early achievement of its goal. Last year a coalition of scientists, economists, policymakers, researchers, and business people published Project Drawdown, a compendium of ways to prevent carbon dioxide from escaping skywards. Drawing from a plethora of peer-reviewed research, the document ranks 80 practical, mitigating measures-along with 20 near-future concepts-that could push back the oncoming storm.

Ranked in order of carbon emissions locked down by , a moderate expansion of solar farms was ranked 8, onshore wind turbines ranked 2, and nuclear power 20 , increasing the number of people on plant-rich diets 4 and using electric vehicles Suprisingly, the top spot went to managing refrigerants like HFCs, which are incredibly effective at trapping heat within our atmosphere. Even more surprising, two lesser-known solutions also made this most practical of lists: Getting more girls into school, and giving them a quality education, has a series of profound, cascading effects: Better educational access and attainment not only equips women with the skills to deal with the antagonizing effects of climate change, but it gives them influence over how their communities militate against it.

Poverty, along with community traditions, tends to hold back girls from education while boys education are prioritized. Then there's family planning. The planet is overpopulated, and the demands of its citizens greatly exceed the natural resources provided by our environment.

As a consequence, the world's population will rise rapidly, consume ever more resources, and power its ambitions using fossil fuels. Carbon dioxide will continue to accumulate in the atmosphere. The education of girls and family planning can be considered as a single issue involving the empowerment of women in communities across the world. Drawdown calculated that, by taking steps toward universal education and investing in family planning in developing nations, the world could eliminate billion tons of emissions by That's roughly 10 years' worth of China's annual emissions as of , and it's all because the world's population won't rise quite so rapidly.

Project Drawdown isn't the only group that has recently tied population growth to climate change. A study published last summer also found that having just one fewer child is a far more effective way for individuals in the developed world to shrink their carbon footprint than, say, recycling or eating less meat.

For women in wealthy countries, these decisions are often freely made, and fertility rates in those countries are already fairly low. In low-income countries, such individual agency - not to mention contraception - is frequently absent, and fertility rates remain high. Just as policymakers, climate advocates, and science communicators should pay attention to Drawdown's findings, individuals should also do what they can to make sure such a solution comes to pass.

Non-government organizations, like Hand In Hand International, Girls Not Brides, and the Malala Fund aren't just uplifting women, but they're helping to save the planet too, and they deserve support.

It's a grim assessment of civilization that, in , humans are still grappling with gender equality. The world would clearly benefit if women were on par with men in every sector of society.

It could result in The return on that investment is incalculable. Ouabain - a plant extract that African warriors and hunters traditionally used as a heart-stopping poison on their arrows, shows promise as a non-hormonal contracetive for men that hinders the sperms' ability to move or swim effectively.

While the birth control pill has been available to women in the United States for nearly six decades-and approved by the US Food and Drugs Administration FDA for contraceptive use since -- an oral contraceptive for men has not yet come to market. The pill has provided women with safe, effective and reversible options for birth control, while options for men have been stuck in a rut.

Men curently have only two forms birth control: Vasectomy is an invasive procedure to do that's also difficult and invasive to reverse.

A male hormonal birth control pill option is in clinical human trials and likely closer to market, but it has potential side effects, such as weight gain, changes in libido, and lower levels of good cholesterol, which could negatively affect the heart health of users.

For nonhormonal contraception methods work, researchers from the University of Minnesota and the University of Kansas have homed in on ouabain: This protein is known to be critical in fertility -- at least in male mice. Ouabain by itself isn't an option as a contraceptive because of the risk of heart damage.

Once bound to those cells, it interferes with the sperms' ability to swim-essential to its role in fertilizing an egg. Ouabain may also offer men a birth control pill option with fewer systemic side effects than hormonal options. This new compound showed no toxicity in rats. The next steps are to test the effectiveness as an actual contraceptive in animals, then human clinical trials within five years.

Reversible, effective male birth control is within sight. Our ongoing research brings us one step closer to expanding the options for male birth control, providing the world's 7. Anti-abortion activists, emboldened by conservatives controlling the White House and Congress, and courts stacked with like-minded judges, are setting their sights on a new target: The elimination of federal funding for family planning services.

For 45 years, the "pro-life" movement has gathered in Washington around the anniversary of the Supreme Court's Roe v. Wade decision to protest the legalization of most abortions in the US. Recently the Trump administration announced that it was strengthening protections for medical providers whose religious beliefs prompt them to refuse to perform abortions or to offer other contraceptive services. Title X, a provision in the Public Health Service Act of - is federal grant legislation that secures federal funding for family planning services.

It is the only grant legislation approved annually, and is constantly under threat of defunding because of this status. Of the 38 million American women who use contraception, over half - 20 million - rely on publicly funded contraceptive care. But, with the exception of emergency contraception, birth control pills require a doctor's prescription, an associated visit and insurance costs.

The theory supporting threats to Title X is that life begins at the moment egg and sperm meet, which increasing numbers of anti-abortion advocates and lawmakers embrace. They equate highly effective, long-acting reversible contraception LARC like IUDs and contraceptive implants with abortion itself, believing these methods would dislodge a fertilized egg - a view which is not scientifically accurate.

IUDs and implants primarily prevent fertilization, not implantation - there is no zygote, so there is nothing to abort. However, buoyed by the Supreme Court's ruling upholding Hobby Lobby's religious right to deny access to LARCs, and President Trump's seeming eagerness to please his base, anti-abortion advocates are seeking to promote their ideology in a number of ways, including going after Title X funding. Title X in the beginning was championed by both sides of the House - its main sponsor was George H.

Bush and was signed into law by President Nixon. However during Ronald Reagan's presidency, there was more anti-abortion ideology involved in the politics and policies of family planning.

If federal funding is removed, these low-income households would suffer the most, physically and financially. An amendment to the recent tax bill fostered the idea that personhood begins at conception by proposing that unborn children could be beneficiaries of college savings plans. The language was cut before the tax bill passed. Trump has appointed prominent anti-contraception advocates to his Department of Health and Human Services HHS in an attempt to keep a promise to his evangelical followers.

Valerie Huber, an advocate of abstinence over contraception will continue the push to defund Title X. A rider in the House Labor, HHS, Education and Related Agencies spending bill would block Planned Parenthood from any federal money in , and effectively "end the nation's family planning program.

President Trump signed a law last spring allowing states to withhold federal money from organizations that offer abortion services. Many of these organizations also provide important contraceptive services to the poorest in society, services which would also be threatened. Some physicians remember the time before Roe v.

Title X funding is intact - for now. But "the Trump administration in its first year and Congress under its current leadership have very openly hostile views and agendas against reproductive health and rights. The birthrate in China fell last year even though the country has changed its One Child policy to allow two children.

Reasons given for the low birth rate were the trend toward later marriage, the desire for smaller families and concerns about the high cost of raising children. China's policy was changed in in an attempt to increase the size of the younger working population that will eventually have to support their elders. But that appears to have been a one-time increase. Experts have recommended the country increase its retirement age to address an expected labor shortage and declining economic vitality.

One woman, a housewife in Beijing, pointed out that the burden of looking after aging parents is one reason not to have a second child. China enacted its one-child policy in , enforced with fines and in some cases state-mandated abortions. The expected future reduction in the working-age population is exacerbated by a skewed male-female birth ratio resulting from the traditional preference for male offspring. It is my belief that family planning would be far more widely supported if China had not imposed its oppressive policy.

The author, who works for the NGO Marie Stopes, tells us that reproductive rights are not guaranteed anywhere. In urban areas people come to Marie Stopes clinics and in rural or remote settings Marie Stopes take their services to the people. In Papua New Guinea the author has spoken to women who were afraid for their lives because they knew someone who had died during childbirth. One woman had been told by a local health worker she would "probably die" if she became pregnant again.

The author has met men who worried deeply about conflict in their villages as the population grew and land became scarce.

In Cambodia he has met young factory workers who can only afford to keep their children in school as long as they can keep working. In Myanmar he has met aspirational students who are the first in their families to go to university and are not at all ready to get married. The need to control their own fertility, and the challenge to do so, binds this diverse group together. In Australia, senator Cory Bernardi recently introduced a motion intended to undermine abortion rights for Australian women.

His series of proposals covered abortion funding, greater scrutiny of the activist group GetUp, and White Ribbon Australia's support for abortion, including late-term terminations. In the US, employee rights to contraception in their healthcare coverage have been rolled back and support to family planning programs in developing countries slashed.

We need to fight to keep our current rights but should also fight to extend that franchise to others. Family planning is fundamental to both individual empowerment and national development and yet is somehow regularly overlooked by bureaucracies or targeted for elimination by conservative forces. There are million women in the developing world who don't want to have a child right now but don't have access to family planning.

As a result they are less able to control their futures. Their health, education, employment prospects and very standing in society will all be impacted by something Australians so often take for granted - the ability to choose. It is appropriate that we focus on women and girls because of the persistent and debilitating gaps in global access to education, health care, and economic opportunity between the genders.

However, there is also a gap in funding and research to engage men, which not only makes overall family planning objectives more elusive, but puts even greater stress and pressure on women to shoulder the burden of contraception on their own.

The majority of family planning options are designed for women, and options for men are limited to condoms, vasectomies, and the withdrawal method of contraception.

However, World Vasectomy Day has shown that. With 1, vasectomists in plus countries participating, World Vasectomy Day is the largest male-focused family planning event ever, using creative media to dispel vasectomy myths, raise awareness, and promote broader positive masculinity. The government has embraced this anniversary in tandem with their 40th anniversary celebrations of Mexico's Family Planning Program. Investing limited family planning resources in male options is not only good for family planning, but it is necessary for a healthy society.

When men are involved in family planning and sexual health programs, men are more likely to participate in household work and childcare, financial resources are more readily allocated for female contraceptives, and domestic violence decreases. Research has shown that bringing men into the family planning conversation actually increases overall contraceptive use while making broader and critical strides toward increasing gender equality.

Instead of opening conversations by asking men whether they want to get a vasectomy, shoot for the big-picture: How important is it that the quality of life of your children be better than your own? From there, conversations naturally cover the impact of large family sizes on ability to provide, and their desire to be part of the decision-making process. When vasectomies are seen as a tool to achieve desired family sizes and a way to care for the children they already have, men are extremely receptive.

DKT has found that using dynamic, open, and fun social marketing techniques dramatically increases the uptake of the nonprofit condom brand, Prudence, in Mexico and other Latin American countries. Emphasizing that good sex and being responsible lovers are not mutually exclusive might be considered scandalous by some - but it works. The makers of Prudence have eroticized their condom messaging, celebrated sexuality, and used humorous vernacular without any medical jargon.

DKT also offers resources to men for questions about sexual health through major events such as concerts, school functions, and health care fairs, and through its social media, Red-DKT call center, and Whatsapp mobile chat service. The strategy of asking men to get a vasectomy as part of a public ritual celebrated globally transforms the common fear that a vasectomy leads to a loss of manhood into an increased sense of heroic purpose, all the while demystifying the procedure itself.

World Vasectomy Day uses videos and media products to dispel myths while cultivating community through shared stories of real patients before, during, and after their vasectomies. Since adopting the World Vasectomy Day program, Mexico has seen an By involving men in family planning programs, raising awareness of vasectomies as a simple and effective method, and celebrating the men who take part, we can truly shake up the stagnant growth in contraceptive use and global gender equality.

While being entertained, people's day-to-day experiences are changed by these stories. We all learn by watching role models. PMC's shows change ideas, self-perception, and self-confidence for millions of people at a time. The Trump administration's recent rule change makes it harder for women to obtain birth control, and the impact will reverberate far beyond simply inconveniencing women.

All of us - our families, our communities, our economy - pay a price when there are barriers to contraceptive access and The Trump administration's recent rule change makes it harder for women to obtain birth control,. Nearly half of all pregnancies in the United States are unplanned, resulting in 1. Babies born as a result of unplanned pregnancy are significantly more likely to arrive preterm or at a low birth weight.

This can lead to developmental problems and other health complications that often create lifelong issues and lead to pricey medical bills. When there is an unplanned pregnancy, young women often put their education on hold or leave the workforce, lowering earning potential and increasing the likelihood of poverty for them and their children. The places where many women get their healthcare make it very difficult to access the most effective methods of birth control, IUDs and implants.

When women have same-day access to the full range of birth control methods, and can choose the one that works best for them without cost, we start to stem the tide of unplanned pregnancy.

It is important that clinics offer free same-day access to all contraceptives. Helping women achieve their own goals and empowering them to decide when and if they want to become pregnant improves economic and health outcomes for parents, children, and communities.

But then they worked to to reduce barriers and improve access to birth control. Today, any woman in Delaware can get access to the method of birth control she wants for free.

Reducing access to birth control hurts women, families, and the economy. Our work is dedicated to ensuring providers offer all women - no matter where they live, their income, or their insurance status - easy, affordable access to the full range of birth control options. Doing anything less harms us all. Population growth can be slowed, stopped and reversed, even though it has rocketed in this century and last. A sustainable reduction in global population could happen within decades, according to the United Nations' most optimistic scenario.

Its main population prediction is in the middle of that range - 9. But if there were just half-a-child less, on average, per family in the future than assumed, there woud be two billion fewer of us than expected by - and five billion fewer of us by the end of the century.

Countries have had dramatic success in reducing their birth rates. Over million women who want to avoid pregnancy are not using modern contraception. Reasons for this include lack of access, concerns about side-effects and social pressure not to use it. Most of these women live in poor countries, where population is set to rise by 3 billion by Overseas aid support for family planning is essential - making sure supplies are adequate. People choose not to use contraception because they are influenced by assumptions, practices and pressures within their nations or communities.

In some places, very large family sizes are considered desirable; sometimes the use of contraception is discouraged or forbidden.

However programs that change attitudes towards contraception and family size have been very successful. Religious barriers may also be bypassed. In Iran the country's religious leader declared the use of contraception was consistent with Islamic belief and a very successful family planning campaign was initiated.

Portugal and Italy have some of the lowest fertility rates in spite of the fact that they are predominantly Catholic. Escaping poverty is a vital way to bring birth rates down.

Decreasing child mortality, improving education and providing people with economic opportunities all help to reduce fertility. International aid, fair trade and global justice will help bring global population back to sustainable levels. Where women and girls have economic empowerment, education and freedom, they normally choose to have smaller families.

Greater freedom usually leads to greater uptake of family planning and ending child marriage pushes back the age at which women have their first child, which often reduces family size. African women with no education have, on average, 5. When family sizes are smaller, that also empowers women to gain education, take work and improve their economic opportunities.

In the developed world, most of us have the power to choose the size of our families [Note: We also have a disproportionate impact on the global environment through our high level of consumption and greenhouse gas emissions - in the UK, for instance, each individual produces 70 times more carbon than someone from Niger.

Many of the rural people do not understand Swahili. This would be true in many African and Asian countries where the rural population speaks languages different from the national language. I wonder if Health surveys take that into account when they tabulate reasons women don't use contraception. It is not just a matter of 'choosing a smaller family'. It is likely a matter of having access to affordable and effective contraception.

Bangladesh has grown from 75 million people in to almost million today, more than double in 46 years. The United Nations estimated in that the population of Bangladesh would be about million in Bangladesh has a population an average population density of 1, persons per sq.

The life expectancy at birth is 71 years, with women having slightly higher lifespan than men 72 years vs. Bangladesh is now experiencing a demographic transition with the continuous decline trend of the natural growth rate. The population growth rate in Bangladesh was 1. Bangladesh is an intermediate position between low-growth countries, such as Thailand, Sri Lanka and Myanmar and medium growth. Medium growth countries in the region are India and Malaysia.

Bangladesh's Family Planning Program has had a tremendous role in slowing population growth over the last 50 years. Bangladesh's progress in the family planning movement has been cited as one of the role models to follow.

Family Planning was introduced in Bangladesh then East Pakistan in the early s through the voluntary efforts of social and medical workers.

The government of Bangladesh, recognizing the urgency of its goal to achieve moderate population growth, adopted family planning as a government sector program.

Beginning in , the FP program received virtually unanimous, high-level political support. In , the government declared the rapid growth of the population as the country's number one problem and adopted multi-sectoral FP program along with National Population Policy.

From extremely high levels of 6. According to the Population Reference Bureau PRB in , even if Bangladesh reached replacement level fertility, population stabilization would take another 15 years, and the growth is being fuelled by the large young population of the country.

PRB predicted the replacement level fertility by which did not take happen. The s saw a steep decline in TFR. This was followed by a decade-long plateau which was the consequence of a 'tempo effect'. The adoption of FP by Bangladeshi couples has always been after the first birth. The age at marriage did not change and there was no delay in age at first birth, and as such, no tempo effect was operating on first births.

Now, however, fertility levels are quite uneven - remarkably low in the west of the country below replacement, on average and worryingly high in the east up to 1.

In order to attain any of the reasonable population estimates projected for mid-century which range from to million a substantial increase in the contraceptive prevalence rate CPR will be required in the next five years by Bangladesh has considerable built-in population momentum because of high fertility in the past, and even with reduced fertility, many young women will pass through reproductive ages over the coming decades.

During the first decade of the 21st century, the number of women of reproductive age increased from around 32 million to 41 million as the children born in the higher fertility s and early s entered their childbearing years, according to UN estimates.

Investments in female primary and secondary education in Bangladesh manifest themselves in improved opportunities for formal sector employment for young women, and parents will tend to favor smaller families, investing more per child in education-quality versus quantity.

This trend will also be influenced by the saturation of the rural labour force and the fragmentation of agricultural land holdings such that there will be decreasing employment opportunities for unskilled workers. Having a huge mass in the youth age population is worrying. If they don't get the job on time or get the opportunity to have the skills for future earnings, some of the social menaces will continue, like dropping out from the schools, early marriages followed by early pregnancies.

This vicious cycle will become the hindrances of our national programs that contribute to continue fertility decline and population growth. A stagnating CPR is a cause for concern. While the government through its new plans to expand the contraceptive mix by specially promoting permanent methods, it should also think of fertility awareness based methods, such as long acting methods LAM , which mimic traditional methods and may be more acceptable to users of traditional methods.

To increase levels of unmet need, the government, with help from its non-governmental partners, should continue with its family planning messaging and counseling services and try and match the demand for family planning services and supplies.

Bangladesh has a high adolescent fertility rate, one of the highest amongst the south-east Asia region nations. Early initiation of child bearing leads to rapid increases in population by not only lengthening the productive period in the woman's life, but also by shortening the inter-generational span. As most of the adolescent child bearing occurs within the realm of marriage, it means that the law governing the age at marriage needs a much stricter reinforcement.

It is heartening that the government plans to make special efforts to reach out to adolescents with family planning messages and individual and community level counseling services. One of the main reasons that fertility rates stalled at around 3.

A woman who has a high school education will have two fewer children than her non-educated peers. Long-term contraceptives or the pill can also make periods irregular or stop them all together which can mask the symptoms of pregnancy.

This could be why women are having late-term abortions past 20 weeks because they were using long-term methods so didn't take notice of pregnancy symptoms. As policymakers, donors, and advocates gather for the Family Planning Summit in London, new data released by Marie Stopes International reveals the 1. If all of the 69 FP focus countries provided contraception to every woman who wants it by , as agreed under the UN's Global Goals for Sustainable Development SDGs , family planning would prevent:.

Marjorie Newman-Williams, vice-president and director of international operations at Marie Stopes International said:. Without access to contraception, women are likely to have more children than they want or can care for.

Frequent births in quick succession imperils a woman's health, stresses her family's well-being and future prospects, and overwhelms countries' social and economic resources. Over the last five years, the world has made impressive progress in expanding access to modern contraception.

Despite population increases, for the first time in history, unmet need for contraception has fallen, with a record million women and girls across 69 of the world's poorest countries now using modern contraceptives. But huge numbers of women are still missing out, particularly the young, people in humanitarian crises and women in the most remote places on earth.

Laos, Nepal and Myanmar have the next-to lowest number of contraceptive users in Asia. Growth in the number of contraceptive users is projected to be specifically high for south Asia. Bhutan is similar, so it is amazing that its contraceptive prevalance is so high. I was also surprised that Myanmar had such a low ranking in view of its fertility rate of 2.

Fertilty rates for these Asian countries in order of fertility rate are: Bill Ryerson, founding Director of the Population Media Center, has been gathering Demographic and Health Surveys on the reasons people in high-birthrate nations give for not using available Family Planning FP services. Some of the DHS surveys include women who would like to become pregnant, so the surveys taken in some nations show "desire for pregnancy.

The surveys estimated that million women in the surveyed regions had an "unmet need" for FP services. They defined unmet need as not wanting to be pregnant in the next two years, but not using any modern method of contraception.

In most countries the most common reasons for not using contraception given by married women in this category were: Referring to a article published by several demographers concerning the studies, Mr. Ryerson quotes two excerpts stating reasons for non-use:. Cost was not a frequently cited obstacle to use among married women with an unmet need: A substantial proportion of these married women were sexually active within the three months preceding the survey, including about half of women with an unmet need in Latin American and Caribbean countries.

A June paper by two of the authors of the paper essentially came to the same conclusions. There is still need for expanded FP services, especially if the informational and cultural barriers to use of FP methods can be overcome.

Today the reasons for non-use are quite different from those given in The mission of the Population Media Center PMC is to use entertainment-education and mass media to promote social and cultural change. PMC sponsors dramatized communication campaigns that, without telling people what to do, provide attractive role modeling. PMC's soap opera-type programs focus largely on women's rights, including education for girls, and communication between husbands and wives about the future of their families - promoting more awareness that smaller families lead to better health and greater prosperity.

It may be that the pastoral peoples in remote areas were not included in the survey. PMC serves people who have access to radio.

The people in the Maasai Harmonial project area do not have access to radio. In addition, the pastoral Maasai culture is very different from the culture of the people who live in the areas where radio is available. The majority of the Maasai do not speak the national language of Swahili or English, so they would not benefit from a radio program produced in Swahili.

PMC has done wonderful things, but it must be recognized that a large part of population growth in Africa comes from hard-to-reach rural areas where a large variety of languages are spoken. Oregon and Washington may follow suit. The US average is similar: Global health experts call unintended pregnancy an epidemic because it's so common, and the toll on physical health, mental health, and child development so large. Reducing unsought pregnancies results in: After implementation of the Colorado Family Planning Initiative, teen births and abortions dropped by nearly half.

High-risk births, including preterm births, also diminished. Unsought pregnancy is four times as common and unsought birth seven times as common among poor women as among their more prosperous peers, so poor families benefited the most. In Colorado, much of the improvement came from switching away from error-prone family planning methods that require action every day or every time they have sex -- such as pills and condoms-- to long-acting IUDs and implants that make pregnancy prevention easy.

These methods are "get it and forget it. When a woman wants to get pregnant, her healthcare provider can remove the implant or IUD, usually in a five-minute procedure, and normal fertility returns almost immediately.

Louis a study of 9, women called the Contraceptive Choice Project demonstrated that long-acting contraceptives dramatically reduce unplanned births and abortions.

It also showed that most women prefer these technologies when high cost and other barriers are removed. The US Centers for Disease Control and Prevention CDC and the American Congress of Obstetricians and Gynecologists have declared these methods far more effective and safer than any other method and far safer than the risks from pregnancy itself.

One of these methods, the hormonal IUD, has bonus health benefits, including protection against some cancers. Women were able to access services wherever they might encounter the healthcare system.

All sorts of health care workers were trained in improved counseling and to insert and remove implants and IUDs. More flexible hours at these health centers improved access for working women. CFPI integrated family planning into primary care, labor and delivery, and post-abortion care. CFPI funding made all methods available with no co-pay, a standard that later would be incorporated into Obamacare now on the chopping block, of course.

Implants and IUDs are cheaper in the long run than other forms of birth control, especially if you include the costs associated with an unplanned pregnancy. But until recently, the up-front price of long acting contraceptives has made these methods unavailable to many women. CFPI worked to normalize conversations about sexual health and promote healthy decisions and planning. Young Latinas, who have a higher-than-average teen pregnancy rate, talked with each other in culturally proficient after-school programs.

Social service agencies offered sexuality workshops or provided onsite access to educators. A website, BeforePlay, offered practical information about contraception and sexual health, as well as specific resources available across the state. Reimbursement policies were changed so that women could get an IUD or implant of their choice immediately postpartum in hospitals. Oregon Governor Kate Brown recently affirmed that she and the Oregon Health Authority "place a high priority on improving women's health and reducing unintended pregnancies by implementing pregnancy intention screenings and providing effective contraceptives to women who do not wish to become pregnant.

The Oregon Foundation for Reproductive Health has developed a technique -- now a national model -- that makes it easier for primary care, chronic care, and mental health providers to open up conversations about family planning. It is called One Key Question, and the question is: Would you like to get pregnant in the next year?

If a woman says yes, this leads to a conversation about preparing for a healthy pregnancy, called "preconception care". If she says no, she has an opportunity to explore contraceptive options, including top-tier methods that might not be familiar.

A new Oregon law allows retail pharmacists to prescribe oral contraceptives or patches. A second law, the first in the nation, requires insurers to cover a month supply of birth control at a single prescription fill.

Oregon also has a mandate for comprehensive sexual health education in public schools and expansion of family planning coverage through Medicaid. Despite promising trends, the US teen pregnancy rate is far higher than any of the other 34 countries in the Organization for Economic Cooperation and Development. National funding cuts could make things worse: But there will be opportunities to increase intentional parenthood through practice improvements and better public awareness. Oregon's One Key Question could make the state a national leader in healthcare integration.

This will mean incorporating routine pregnancy-intentions screening into primary care, labor and delivery, chronic care, mental health, and drug treatment programs. Public officials in the state of Washington have paid close attention to the models in St. Louis, Colorado, and Delaware.

Washington Governor Jay Inslee's office has voiced support for upgrading contraceptive care statewide. When Planned Parenthood showed that low reimbursement for IUD insertions had become an obstacle for clinics serving poor women, the state changed reimbursement rates.

School-based clinics in Seattle now offer the full-range of birth control options to high school students, and Neighborcare Health, which runs several of these clinics, employs educators who help teens and their parents explore options. In , King County Public Health secured a small grant to train and provide technical assistance to school-based health centers so they could offer IUDs and implants on-site, with follow-up support from Public Health.

Three of these health centers hired half-time sexual health educators, who taught in biology and health classes, and provided contraceptive counseling to teens and their parents. One Washington State imperative addresses the epidemic of opioid addiction.

Neonatal care units are overflowing with newborns suffering from Neonatal Abstinence Syndrome, a form of withdrawal. With long-acting methods offering years of protection and with each person in charge of his or her own fertility, children will come into the world by the mutual consent of two people who want to create a child together.

But even if Planned Parenthood is spared, Trump's proposed rollback in Medicaid and contraceptive coverage will inevitably increase unintended pregnancies and the demand for abortion services. The AHCA, on the other hand, by making contraception more expensive and less accessible, would roll back some or all of those gains. In addition Congress may also eliminate funding for comprehensive sex education in schools. The House of Representatives has been trying to do just that for the past four years, and this year it may be able to override Senate opposition.

Humanitarian programs, including international family planning, could face draconian cuts. USAID's family planning program helps parents better feed, educate and care for their children. US-supported family planning programs are slowing rapid population growth in some of the least stable countries in the world, including Afghanistan, Democratic Republic of Congo, Ethiopia, Mali, Nigeria, Pakistan, South Sudan and Yemen.

Cutting international programs to pay for increased defense spending will undermine US security and likely increase the demands on the Defense Department. Defense Secretary James Mattis once declared: Two years after Texas slashed its support for family planning by two-thirds in , Medicaid expenditures soared because of the increase in unplanned pregnancies. While the state was forced to do an about-face and re-fund family planning, it persisted in its attacks on Planned Parenthood, forcing dozens of clinics to close, leaving many women in Texas without access to family planning services.

Unless Congress stands down on cutting contraceptive services, it will find itself in the perverse position of driving up teen pregnancy rates and Medicaid costs. In most states, hormonal contraception requires a prescription. Getting that prescription takes time and money for doctor visits that some women just don't have.

Oral contraceptive pills are well-studied, and The American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians agree that they are safe for over-the-counter use. The idea even has bipartisan support in Congress, except on issues like whether insurance companies should have to pay the bills. The next step was to find a pharmaceutical company willing to go through the long and costly process of seeking FDA approval.

That too has now been done. HRA Pharma in Paris is partnering with advocates and experts from Ibis Reproductive Health to start the process, which may take several years to complete. There are two major types of oral contraceptives, progestin-only and pills that contain both progestin and estrogen. Ibis and HRA plan to seek FDA approval for a progestin-only pill similar to others already approved for emergency contraception. Progestin-only pills present the fewest barriers for the broadest population, Ibis president Kelly Blanchard said.

Both types of pills are equally effective, but combined pills with estrogen can cause potential problems for women who smoke or have high blood pressure. Blanchard said that after the first OTC pill is approved, it shouldn't be difficult to get other forms of birth control approved, too. That would allow women more than one over-the-counter option, since not every pill or every birth control method is right for every woman.

Not making women pay extra on top of their insurance premiums makes birth control much more accessible. But repeal of the ACA may eliminate that benefit. Republicans proposed legislation in to speed up the FDA's over-the-counter approval process for contraception - but Democrats and women's health advocates called that bill a ploy to undermine the ACA while only appearing to support birth control and women's health. That bill would also have imposed an and-over age restriction, which Blanchard says is completely unnecessary.

As for whether Trump's appointees could cause political problems for approving over-the-counter contraception, Blanchard said she hopes that the FDA "will follow their process and judge it on its merits. And we think the merits are strong. For at least a decade the national trend has been to put off having kids and have fewer of them.

But in California, the lingering recession of the late s and high real estate prices have created obstacles for young couples looking to have kids. While California's population grew to According to the state Department of Finance, between July 1, , and June 30, Californians had just The lowest birth rates occurred in California's small northern counties, where jobs for young families are scarce.

But coastal spots, including the booming bay area and the central coast had affordability problems. Though the state figures don't specify ethnicity, U.

Even among the Hispanic population, among the nation's fastest growing, birthrates have been falling since The rate of population growth has declined along with the birthrates. People continue coming, but since the late s migration to California has been relatively low. Between July of and July of , the state gained , people through migration from another country.

But it lost , people due to migration between states. In all, about 70, more people arrived than left. Schwarm said that even if the state's fastest growth is in the past, California has plenty to lure the best and brightest. This video features key experts in the family planning field, including Melinda Gates, Ellen Starbird, Anju Malhotra, Latif Dramani, and Jason Bremner, making the case for investing in family planning in urban areas and explaining how this can impact the environment and economy of countries, as well as add to women's empowerment.

The Zika virus outbreak in Brazil had some world class female athletes considered staying home from the Summer Olympics to avoid the disease that can cause profound birth defects in children of infected women. But what of the millions of Brazilian women of childbearing age, especially those in the poor and overcrowded neighborhoods, who were adviced by health experts: Unfortunately for women in Brazil and many other developing nations, birth control can be hard to obtain.

And research shows that millions of people around the world want more access to family planning. Unplanned pregnancies can create severe economic hardships that perpetuate poverty, and they result in millions of abortions every year, many of them performed under unsafe conditions by untrained people. Having one baby after another often causes complications and even death. Inadequate pre-natal care and unsafe births and abortions are among the biggest killers of women globally.

For women to exercise the right to decide when to get pregnant, they need access to contraception and information about family planning. About million women worldwide who are either married or in a partnered relationships want to delay or stop having children, but aren't using contraception. A bigger obstacle is the lack of knowledge, particularly in developing nations, about family planning.

Many women fear the potential side effects of contraceptives. They may not understand the risks that come with pregnancy and how to minimize them. They be worried about reactions from husbands or families, or religious leaders. Education and counseling go a long way toward overcoming these obstacles. For many women, the first opportunity to learn about family planning comes during a visit to a clinic to have a baby, an abortion or treatment for a miscarriage.

It's essential to seize that opportunity and present information on how to delay or prevent another pregnancy to any woman who wants it. Women who become pregnant less than five months after giving birth are 2.

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