Hospital in a tent

Youth Family Planning Policy Scorecard: Measuring Commitment to Effective Policy and Program Interventions

The Youth Family Planning Policy Scorecard evaluates the favorability of 28 current national policy and program environments for youth access to sexual and reproductive health services.

The March 2022 edition of PRB’s Youth Family Planning Policy Scorecard evaluates the favorability of 28 current national policy and program environments for youth access to sexual and reproductive health services. The Scorecard allows users to quickly assess the extent to which a country’s policy environment enables and supports youth access to and use of family planning through the promotion of evidence-based practices. Users can explore the digital interface and self-select countries to compile their own Scorecard!


Governments around the world are increasingly creating policies to formalize the rights of adolescents and young people to access sexual and reproductive health services. Despite growing commitment from decisionmakers, many barriers remain for young people who want to use contraception. A limited evidence base has hampered systematic assessment and mapping of the key policies and programs that govern young people’s ability to access family planning information, services, and commodities. Governments and their partners lack clear guidance on which interventions will ensure that their commitments to expanding family planning use among young people are realized. Similarly, efforts by civil society to monitor the state of policy environments for youth family planning are needed to understand how countries are addressing these needs and identify areas for improvement.

To address this evidence gap, PRB conducted research and analysis to identify the most effective policies and program interventions to promote uptake of contraception among youth, defined as people between ages 15 and 24. This research has been compiled into the Youth Family Planning Policy Scorecard to evaluate and compare the favorability of current national policy and program environments.

Based on a review of existing evidence and expert consultations, the following indicators were selected as evidence-based interventions for inclusion in the Scorecard:

  • Policy barriers related to consent (parental, spousal, or service provider); age; and marital status.
  • Policies supporting access to a full range of family planning methods.
  • Policies related to comprehensive sexuality education.
  • Policies supporting/inhibiting youth-friendly family planning service provision.
  • Policies related to an enabling social environment for youth family planning services.

The Scorecard can be used by governments, donors, and advocates to evaluate a country’s youth family planning policy environment, set policy priorities, guide future commitments, and compare policy environments across countries.

The March 2022 edition of the Scorecard includes data for 28 countries: Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Côte d’Ivoire, Democratic Republic of the Congo, Ethiopia, Guinea, Haiti, India, Kenya, Madagascar, Malawi, Mali, Mauritania, Nepal, Niger, Nigeria, the Philippines, Senegal, Sindh (Pakistan), Tanzania, Togo, Uganda, and Zambia.


PRB launched the March 2022 Edition of the Youth Family Planning Policy Scorecard on March 9 and March 10 through a webinar delivered in French and English. The webinar shares new country policy analyses and digital platform features. It also features guest speakers who share their experiences using the Scorecard to advance policy change.


Webinar: Using the Youth Family Planning Policy Scorecard to Advance Policy Change

The Youth Family Planning Policy Scorecard allows for a quick assessment of the extent to which a country’s policy environment enables and supports youth access to and use of FP, can be used by governments, donors, and advocates to evaluate the inclusion of evidence-based interventions and policy language and set policy priorities and guide future commitments.

This webinar shares new updates and functions from the March 2022 edition of the Scorecard, and features guest speakers from Bridge Connect Initiative Africa and SERAC-Bangladesh sharing their experiences using the Scorecard to advance policy change.

Webinaire: Tableau de bord des politiques de planification familiale pour les jeunes

Le Tableau de bord de la politique de planification familiale pour les jeunes est conçu pour permettre une appréciation rapide de la mesure dans laquelle l’environnement politique d’un pays permet et soutient l’accès des jeunes à la PF et son utilisation, en encourageant des pratiques fondées sur des données probantes. Le Tableau de bord peut être utilisé pour évaluer l’inclusion des interventions fondées sur des données probantes et les politiques avérées efficaces pour réduire les obstacles et/ou améliorer l’accès des jeunes à la contraception dans les pays. Au cours du webinaire, nous partagerons les nouvelles analyses et fonctionnalités du Tableau de bord et comment il a été utilisé pour motiver des changements de politiques.


A Microfinance Network Fights Malnutrition in Haiti

(October 2010) By 2008, Haiti’s largest microfinance organization, Fonkoze, was providing savings accounts or loans to 190,000 clients, mostly women, at its 39 banking offices in rural areas. But 2008 also presented challenges for Fonkoze’s clients, particularly for the poorest, many of whom do not know where they will get their next meal and often miss at least one meal a day. Prices of food had skyrocketed beginning in late 2007 due to drought in grain-producing countries and a spike in the cost of petroleum products used to produce fertilizers. Then, in the summer of 2008, Haiti was battered by four hurricanes in one month, destroying over half the country’s harvest. Many Haitians suffered from gangou klowox, an expression that describes their hunger as bleach burning in their stomachs. When a helicopter accessed an area of Fonkoze clients isolated by damage from the storms, dozens of severely malnourished children were found and had to be flown out for treatment.

When the earthquake struck Port-au-Prince in January 2010, the Fonkoze headquarters office was destroyed, five employees were killed, more than half had their homes seriously damaged or destroyed, and nearly 19,000 clients lost their business, their home, or both. Of the 41 branches in rural areas, nine were destroyed or critically damaged, but staff continued to operate programs in courtyards or from vans and were able to provide vital services to clients by keeping remittance payments flowing.

Anne Hastings is co-founder of Fonkoze; she has over 13 years of experience working with Haiti’s poor. When she learned in 2008 that the child of a Fonkoze client had died from malnutrition, her faith in her work was shaken. “I thought, ‘What if her loan had contributed to the problem? Was there the possibility that, despite our efforts, this woman’s loan had created problems for her? Could she have denied her child food in order to repay her loan?’,” Hastings recalls. The experience challenged her belief that microfinance provided the tools to help women make their way out of poverty. If she was wrong, could she continue working to build this bank that the poor could call their own?

But Hastings did not give up. Instead, she came to see microfinance in a new light: Fonkoze’s network of branches and women coordinators of borrowers were a platform that could be used to connect clients with health services for their malnourished children. The women’s groups that had developed over the years could be the leading edge in a new campaign to combat malnutrition.

How Fonkoze Works

Anne Hastings, co-founder of Fonkoze (left), talks with a Fonkoze client and her child together with a center chief about the number of times she has gone to the clinic and the weight gain with each successive visit.

Photo: Fonkoze

Across rural Haiti, Fonkoze borrowers had formed solidarity groups of five women who take out loans together. Between six and 10 of these groups are organized into credit centers, long-term associations of women committed to bringing themselves out of poverty. They work together to promote community development, and the groups receive training in literacy and business skills from Fonkoze staff. Each credit center is led by a center chief elected by the group. Fonkoze’s network includes 2,000 centers, and the center chiefs have been trained in leadership. “All we had to do was leverage this organization of women,” says Hastings. That was the starting point for a pilot program to detect and treat child malnutrition launched in late 2008.

Treating Malnutrition

The strategy for tackling malnutrition involves four steps. First, Fonkoze identifies health care providers to give treatment and administer food supplements to malnourished children, and connects the health care facilities with Fonkoze branch offices. Fonkoze then trains center chiefs to use a color-coded tape that detects malnutrition and measures its severity. Finally, Fonkoze creates educational and visual materials to present at meetings of the centers to show mothers how to feed children and keep them healthy with locally produced food.

The pilot program screened 106 children under age 5, and more than 35 tested positive for moderate or severe malnutrition. The diagnosis is painless: A UNICEF measuring tape is placed around the upper arm of a child, and the tape indicates whether the malnutrition is moderate or severe. Through a Fonkoze partnership with Zanmi Lasante (Partners in Health), all malnourished children were given free treatment at community-based outpatient clinics in the impoverished Central Plateau area.

The results were fast and dramatic. Within six months, malnutrition was eliminated among the group of ill children by providing them with a food supplement for six months at the clinic. A peanut-based supplement, known in Haiti as nourimamba, is produced locally. Another therapeutic food, Plumpy Nut, containing a peanut base and milk, minerals, and vitamins, is imported. A three-month follow-up treatment was offered by Partners in Health, during which Fonkoze taught the clients what types of inexpensive and locally produced foods—vegetables, beans, corn, and rice—make up a proper diet for their children.

The center chiefs were so enthusiastic with the speed of recovery that they wanted to measure all children in their area. The campaign “has a ripple effect which is exactly what we’re trying to do—to help center groups become development agents in the community,” says Carine Roenen, director of Fonkoze.
Partnering with other organizations was vital to the Fonkoze pilot’s success. The Partners in Health clinics are staffed with malnutrition specialists. Fonkoze has served as a distribution channel for pills donated by Vitamin Angels, a nonprofit supplier of vitamins; the deworming pill albendazole is provided by Planting Peace. In the past 12 months, over 683,000 multivitamins have been administered to more than 13,000 children, and 40,000 one-year doses of deworming medication have been distributed to Fonkoze clients and their children.

The pilot program got off the ground thanks to support from the Linked Foundation, a young philanthropy created five years ago dedicated to microfinance and health for women in Latin America and the Caribbean. Dorothy Largay, founder and CEO of the foundation, was so convinced by Anne Hastings and the strategic plan and benchmarks that she backed the program before it was launched. “I’m a strong proponent of the power of good leadership [and] I’m interested in the leverage and efficiency she is able to produce,” says Largay.

The Role of Center Chiefs

Center chiefs who are recognized for their leadership and maintain relationships of trust with Fonkoze clients in their locality are essential not only for diagnosing malnutrition but also for the delicate work of accompanying parents with their children to treatment centers. “When people are very poor and go to the hospital, sometimes they don’t get the right attention,” says Nicole Cesar Muller, health director with Fonkoze.

Forty-two center chiefs were trained with information about malnutrition and, using visual materials, they discuss the illness and treatment in a way that clients can comprehend. Most of the mothers are illiterate and, at first, are doubtful that their child is ill because their belief system tells them that sickness is caused by magic or casting of spells, and they usually seek help from a voodoo priest. “We convince them they have another way you can treat your malnourished child and, if you follow the treatments, the child gets better,” says Cesar Muller.

The cost of running the program is US50 cents per year per child treated. Those costs cover the health director and training of center chiefs; Fonkoze staff work to develop relations with partner organizations that participate in the program.

A child is screened for malnutrition using a simple color-coded tape measure. When it shows red, the child is severely malnourished.

Photo: Fonkoze.

Earthquake Damage, Scaling Up, and Next Steps

Fonkoze is redoubling its efforts to help clients recover from the earthquake through special financial arrangements that simulate a catastrophic insurance product that was being developed before the disaster. It is also continuing its client education, with a new module on risk management and disaster preparedness, and lending to small businesses of rural women that will provide them with income and help restart the economy. The institution has received funding to rebuild and expand its operations for special products targeted at alleviating poverty among Haiti’s rural poor.

The child malnutrition program was first scaled up to screen 1,000 children and provide treatment for 400 between December 2009 and June 2010. This second pilot program, funded by the SG Foundation, relied on the services of Partners in Health and other clinics in a wider area of the Central Plateau.
In the next two phases of the program, Fonkoze will introduce the malnutrition campaign to areas south of Port-au-Prince. The first step, based on a lesson learned from the success with Partners in Health, is to identify and establish working relationships with partners who can provide treatment. The program aims to screen 7,500 children, and connect about 2,500 malnourished children with partner clinics. Then, Fonkoze plans to widen the malnutrition campaign to other areas where its branches and center chiefs can work to screen 40,000 children and refer those needing treatment for care.

How such a program can be sustained financially and continue to expand is an ongoing question. Offering added services can benefit the microfinance institution itself by developing client loyalty and creating a strong image of responsibility for the community. In an environment where several microfinance institutions compete for clients, the added services can be the deciding factor for clients. “Fonkoze tries very hard to complement banking services, to add what is missing for the person as a whole to have some stability,” says Cesar Muller.

Lucy Conger is a writer based in Mexico City.


Forest Conservation and Population Growth Among Indigenous Peoples of the Amazon

(August 2008) Fertility has declined significantly throughout the developing world, and in Latin America total fertility rates (TFRs) have declined by 50 percent over the last three decades, from 5.0 births per woman in 1970 to only 2.5 today.1 Service providers have achieved many family planning and reproductive health (FP/RH) successes in Latin America, most notably the increase in modern contraceptive prevalence rates to 64.5 percent of sexually active women in 2007.2 These successes have led international health and development agencies to focus their attention on other regions that have yet to show similar improvements in reproductive health.

The successes in Latin America however, mask a great deal of regional variation. In countries such as Bolivia, Guatemala, and Haiti, total fertility rates, a measure of the average number of children a woman will have over her lifetime, are still nearly 4.0 or higher.3 Furthermore, in these countries, between 22 percent and 32 percent of women who do not desire another child or want to space their births still have no access to family planning services.4 Within the Latin American countries that have experienced substantial declines in fertility, there are sub-populations and regional pockets characterized by high fertility and lack of access to FP/RH services. Among those with the most limited access to basic reproductive health services are people living in the poorest and most remote communities—on the frontiers of lowland tropical forests like the Amazon and indigenous people living far beyond forest frontiers.

An analysis by the authors of regional and provincial data from Demographic and Health Surveys (DHS) show continued high fertility in the Amazon regions of several countries including Bolivia, Brazil, Colombia, Ecuador, and Peru (see Table 1). Total fertility rates are in most cases substantially higher than national rates: In Ecuador, fertility is higher in the Amazon than in any other region of the country. These averages mask substantially higher fertility in rural areas of the Amazon, which are almost unrepresented in DHS data. The DHS data for the Brazil North region, for example, contains only 14 rural observations. The DHS data from rural Amazon provinces of Colombia report no data. And fertility surveys from Ecuador do not report disaggregated rural data for the Amazon.

Table 1
Total Fertility Rates (TFR) for Select Areas of the Amazon Latin America

Country/year Provinces/regions in lowland areas TFR
Bolivia, 2003 National 3.8
Beni/Pando provinces 4.2
Brazil, 1996 National 2.5
North region 2.7
Central West region 2.3
Colombia, 2005 National 2.4
Amazonas province 2.8
Vaupes province 3.4
Guania province 2.9
Ecuador, 2004 National 3.3
Amazon region 4.2
Peru, 2004–06 National 2.4
Amazon region 3.4


Note: The total fertility rate (TFR) measures the total number of lifetime births a woman would have given current birth rates.
Sources: The TFRs for Bolivia, Brazil, Colombia, and Peru were obtained from Demographic and Health Survey (DHS) reports. The TFRs for Ecuador were obtained from the report for ENDEMAIN—a DHS-type survey conducted periodically by MEASURE and CEPAR.

Data on modern contraceptive prevalence rates for these same regions also reveal low rates of modern contraceptive use (see Table 2). The little rural data available suggest that contraceptive prevalence rates (CPR) among sexually active women of reproductive age are under 50 percent for the majority of the Amazon.


Table 2
Modern Contraceptive Prevalence Rates (CPR) for Select Amazon Tropical Forest Areas of Latin America



Country/Year Provinces/Regions in Lowland Areas Modern CPR (%)
Urban Rural
Bolivia, 2003 Beni/Pando provinces 53.9 45.0
Brazil, 1996 North region 69.0 44.4a
Central West region 80.0 76.4
Colombia, 2005 Amazonas province 55.0b – – – –d
Vaupes province 57.1b – – – –d
Guania province 65.3b – – – –d
Ecuador, 2004 Amazon region 65.3c – – – –c
Peru, 2004 06 Amazon region 53.4 33.7


a Rural North Region contains only 14 observations.
b Urban areas only.
c Women in unions. Rural and urban could not be disaggregated for Ecuador Amazon.
d Data not available.
Note: The total fertility rate (TFR) measures the total number of lifetime births a woman would have given current birth rates.
Sources: The CPR for Bolivia, Brazil, and Peru were calculated from Demographic and Health Survey (DHS) data and included women ages 15 to 49 who were currently married or in consensual union, and unmarried sexually active women. CPR for Columbia and Ecuador were obtained from the DHS and ENDEMAIN reports respectively.


Indigenous populations in lowland Latin America tend to be particularly underserved by health providers for many reasons, including cultural barriers, language, and accessibility. Available studies among these indigenous populations indicate TFRs from 7.0 to 8.0.5 Some researchers have argued that fertility rates among these indigenous women remain high because of a strong desire to have large families. However, survey data from indigenous women in the Ecuadorian Amazon contradict this argument, and indicate that approximately 50 percent do not want another child. Yet 98 percent of these women were not using a modern contraceptive method.6 While some might argue that the populations are too small to warrant attention from development agencies, the social and environmental implications of this growth are of great interest to the environmental community.


Conservation, Population, and Indigenous Peoples


Latin American tropical forests, including the Amazon basin, contain the world’s greatest concentration of biodiversity and play a critical role in climate change. More than two decades of conservation efforts have sought to decrease rates of deforestation in Latin American tropical forests. Despite these efforts, estimates of Amazon deforestation from 2002 to 2004 were near their highest levels since monitoring began in 1988, with an average of 2.5 million hectares annually.7 After three years of improvement, recent reports of deforestation during the last months of 2007 and first months of 2008 were the highest ever recorded for the wet season.8 The causes of this deforestation include underlying forces such as crop prices, land and forestry policies that encourage logging, and weak enforcement institutions at the national and global level. These forces drive local-level human activities such as agricultural expansion, timber extraction, and infrastructure growth that directly result in forest loss.9


In response, conservationists are seeking new strategies and new partners to protect the largest remaining tracts of tropical forest. Indigenous lands now encompass the single largest category of protected area in the Amazon, and 20 percent of the Amazon is now under the permanent rights of indigenous people. Indigenous lands are now touted as a critical barrier to future deforestation.10 Many of the largest conservation groups now work with indigenous groups, and international development agencies are beginning to finance conservation projects that work with indigenous groups. Central to the conservation objectives of these programs is the improved well-being of indigenous populations. Thus, indigenous communities and conservation organizations together should assess how demographic change will impact the health and livelihoods of indigenous households and the ecosystems in which they live.


The direct linkages between fertility and deforestation are often thought to be obvious (for example, more people leads to larger farms and thus more deforestation). In reality, however, the relationship between high fertility and land use has not been found to be as clear as is often stated. Research on the causes of tropical deforestation has found population growth to be a consistent underlying factor contributing to deforestation, though this growth is often due to migration and settlement of new colonists rather than high fertility rates.11 A more established link is the cyclical relationship between fertility and poverty, in which high fertility and poor maternal and child health outcomes are both symptoms of poverty and contributors to impoverishment, and affect the way people use, conserve, or overuse resources.


Changes in indigenous livelihoods are already evident at the household level, where increasing wage employment, market-based agriculture, and migration to cities have begun to replace traditional livelihoods of subsistence agriculture, hunting, fishing, and gathering of forest products. Less understood, however, are how demographic changes might affect the communal management groups that have traditionally managed agricultural lands, rivers, and forests. These communal management groups, for example, often make decisions regarding who can hunt, when they can hunt, and what they can hunt on indigenous lands. Now, these groups must confront the added challenges of greater external pressure from the growing population surrounding indigenous lands as well as greater internal pressure from their own growing populations.12


Role of Conservation Organizations


Over the last several years, a few conservation organizations have piloted projects that address the complex links between reproductive health, poverty, and conservation. These projects have adopted an integrated approach to community development that has been termed the Population, Health, and Environment (PHE) approach. The central tenets to this approach are first, that in many remote areas, conservation organizations are among the only institutions providing communities with development assistance; and second, providing men and women with health services and the opportunity to plan their families is beneficial both to the well-being of households and to the long-term sustainability of the forest, fishing, and hunting resources they manage.


The Population Reference Bureau’s PHE Program has been instrumental in developing the PHE approach by providing information to conservation organizations on the links between population, health, and environment, building the capacity of individuals and organizations to work on these cross-cutting issues, and encouraging institutions to form professional networks to share PHE experiences and lessons.


This approach, however, has principally been piloted in Africa and Asia because of the greater need for FP/RH services in these regions and, in part, because of the perception that most Latin American countries no longer need international assistance to provide FP/RH services.13 Furthermore, most Latin American ministries of health are just beginning to develop the capacity to procure and manage supply chains for contraceptives and have yet to focus on distribution of services to remote areas.14 Thus, despite the existence in Latin America of high-priority conservation areas with high unmet need for family planning, there is little indication that the next generation of PHE projects will focus on the unmet need of remote populations in Latin America.


Nonetheless, people in lowland areas of Latin America show an interest in and need for FP/RH services, and conservation organizations are among the few institutions building relationships with indigenous groups. There is, therefore, great opportunity for collaboration between health care providers and conservationists to better the welfare of indigenous peoples, a group typically underrepresented as benefactors of development in the Americas. Responding to this opportunity will require the creativity and commitment of the PHE community and the identification of new priority areas, new partners, and new sources of funding.


Jason Bremner is program director for Population, Health, and Environment at the Population Reference Bureau. Audrey Dorélien was a 2008 Bixby intern at PRB.




    1. United Nations Department of Economic and Social Affairs, World Population Prospects: The 2006 Revision (New York: United Nations, 2007).


    1. United Nations Department of Economic and Social Affairs, World Contraceptive Use 2007 (New York: United Nations, 2007).


    1. United Nations Department of Economic and Social Affairs, World Population Prospects: The 2006 Revision.


    1. United Nations Department of Economic and Social Affairs, World Contraceptive Use 2007.


    1. Kendra McSweeney and Shanha Arps, “A Demographic Turnaround—The Rapid Growth of Indigenous Populations in Lowland Latin America,” Latin American Research Review 40, no. 1 (2005): 3-29.


    1. Jason Bremner et al. “Fertility Beyond the Frontier: Indigenous Women, Fertility, and Reproductive Practices in the Ecuadorian Amazon,” Population Environment (forthcoming).


    1. Instituto Nacional de Pesquisas Espaciais, Annual Estimates of Deforestation 1988-2007, accessed online at, on June 5, 2008.


    1. Alexei Barrionuevo, “Brazil Rainforest Analysis Sets Off Political Debate,” The New York Times, May 25, 2008.


    1. Helmut J. Geist and Eric Lambin, “Underlying Driving Forces of Tropical Deforestation,” Bioscience 52, no. 2 (2002): 143-50.


    1. Daniel Nepstad et al., “Inhibition of Amazon Deforestation and Fire by Parks and Indigenous Lands,” Conservation Biology 20, no. 1 (2005): 65-73.


    1. Geist and Lambin, “Underlying Driving Forces of Tropical Deforestation.”


    1. Jason Bremner and Flora Lu, “Common Property Among Indigenous Peoples of the Ecuadorian Amazon,” Conservation and Society 4, no. 4 (2006): 499-521.


    1. John Pielmeier et al., Assessment of USAID’s Population and Environment Projects and Programming Options (Washington, DC: United States Agency for International Development, 2007).


    1. Thais Aguilar, Safeguarding the Contraceptive Supply in Latin America in an Era of Donor Phase Out (Washington, DC: Population Reference Bureau, 2006.



In Harm's Way: Hurricanes, Population Trends, and Environmental Change

(October 2004) In September 2004, four devastating hurricanes and tropical storms killed more than 1,500 Haitians, destroyed roughly 90 percent of Grenada, and wreaked billions of dollars of damage on the southern United States.

But such calamities from extreme weather are hardly an accident of nature. Instead, these tragedies highlight when and how environmental hazards combine with socioeconomic conditions—particularly population and environmental trends—to magnify the threat of disaster for tens of millions of people in both the developed and the developing world.

The Factors That Increase Vulnerability to Hurricanes

Hurricanes and tropical storms have always been one of the primary causes of natural disasters in the Caribbean and the coastal southern United States.1 But the economic impact of hurricanes in these areas is growing far more severe.

The insurance industry in the United States has paid out more than $39 billion since 2000 to cover hurricanes and other natural disasters—a figure more than half the total of all catastrophic event payments made by the industry in the preceding 30 years.2

This rise in insurance costs reflects not just greater hurricane activity, but people’s increased vulnerability to those storms due to three factors: population pressures, the effects of poverty and affluence, and other environmental changes that exacerbate a hurricane’s strength and effects.

Vulnerable Locations and Population Pressures

To some extent, human vulnerability to natural disaster is a geographical misfortune. For example, because of their fragile environments and economies, islands are highly vulnerable to devastating hydrometeorological and geological disasters. According to the United Nations Conference on Trade and Development, 13 of the 25 countries that suffered the greatest number of natural disasters during the 1970s and 1980s were small island states.3

But accelerating numbers of people are choosing to live in areas that are at increasing risk for natural devastation. For example, approximately 13 million Floridians now live in coastal counties, up from 200,000 a century ago.4 And more people live in South Florida’s Dade and Broward counties now than lived in the entire southeastern United States in 1930.5

Aggressive coastal development, especially the building of homes and businesses in these fragile areas, is also increasing human vulnerability to natural disasters.

A 2000 study commissioned by the Federal Emergency Management Agency found that Americans have built more than 350,000 structures within 500 feet of U.S. coasts. The study also warned that coastal erosion could claim one in four of those buildings within the next 60 years.6

Caribbean countries are equally vulnerable to tropical storms. Major population centers, agricultural areas, ports, and centers of industrial and commercial activity are mostly located in the coastal zone. And tourism—a mainstay of many Caribbean economies—is also largely concentrated in coastal areas.7

The vulnerability of these urban coasts is exacerbated by population growth. While fertility rates have fallen nearly everywhere in the developing world, population in the Caribbean will continue to grow as large numbers of young people move into their reproductive years.8

On average, roughly one-third of people in the Caribbean are under age 15. (Haiti has the most youthful population in the region, with 43 percent of its population under age 15.) This population growth is particularly acute among the poor, who have traditionally had the least capacity to exercise their reproductive preferences.9

Rural-to-urban migration and increasing urbanization has also aggravated the impact of natural disasters among developing countries in the Caribbean. Indeed, the Caribbean is the most urbanized island region in the world, with an urban population that grew an average of 1.58 percent annually from 1995 to 2000.10 Several islands—such as the Bahamas, Cuba, Dominica, Puerto Rico, and Trinidad and Tobago—are already predominantly urban.11

The trend towards urbanization provides additional pressures on the environment and increases vulnerability to natural hazards, particularly among the poor. The urban poor tend to live in informal settlements, and their housing is often inadequately constructed.12

Large urban areas such as Kingston in Jamaica and San Juan in Puerto Rico tend to be more hazardous locations than sparsely populated rural areas because of their population size and the potential scale of damage. In these urban areas, impervious surfaces such as roads and buildings generate more runoff than forested land. And fixed drainage channels may be unable to contain runoff from intense rains.

Poverty and Affluence

Poverty is a central component of vulnerability to tropical storms: Developing countries contain 90 percent of the victims from natural disasters and bear 75 percent of their economic damages.13

The World Bank estimates that 80 percent of the poor in Latin America, 60 percent of the poor in Asia, and 50 percent of the poor in Africa live on marginal lands characterized by poor productivity and high vulnerability to natural degradation and natural disasters.14

Where the poor live in the developing world contributes enormously to their vulnerability to tropical storms and their aftermath. These people often have no choice but to occupy the least-valued plots of land in disaster-prone areas such as riverbanks, unstable hillsides, deforested lands, or fragile water-catchment areas.

These patterns predetermine not only the poor’s susceptibility to natural disasters, but also their capacity to cope with their aftermath. Poorer families may be forced into increased debt in order to rebuild their homes, replace assets, and meet basic needs until they are able to recommence income-generating activities.15

More affluent societies and individuals also have put themselves at increased risk for natural disasters such as hurricanes, although they have more resources with which to brace for and handle the aftermath of such events.16

As noted above, disaster-prone areas of the United States are being settled by people with higher-than-average incomes—often to find jobs, to be near to recreation possibilities, or to build secondary homes.17 In some cases, economic incentives for responsible land use have been curtailed by legislated insurance rates and federal aid programs that effectively subsidize development in hazard-prone areas.18

Environmental Changes

Environmental degradation also increases vulnerability to tropical storms. Serious coral bleaching and mangrove loss, for example, make coastlines more susceptible to flooding.

Similarly, deforestation contributes to droughts, flash floods, and landslides. For example, rains from Tropical Storm Jeanne pounded land in Haiti that had been cleared for charcoal production, ultimately leading to the death of more than 1,000 people. By contrast, greater land cover buffered the coastline of the Dominican Republic (which shares the island of Hispañola with Haiti) against widespread flooding from Jeanne as well as subsequent landslides—resulting in significantly less deaths.19

Global warming could also contribute to a rise in the number and the intensity of hurricanes that will hit the Caribbean and the southern United States, although scientists are still debating the precise impact of such warming.

Recent research suggests that, by 2080, seas warmed by rising atmospheric concentrations of heat-trapping greenhouse gases could cause a typical hurricane to intensify about an extra half-step on the five-step scale of destructive power. Rainfall up to 60 miles from the storm’s core would also be nearly 20 percent more intense.20

Moving Out of Harm’s Way

Reducing vulnerability to hurricanes in the Caribbean and the southern United States must include an understanding of how population trends and environmental changes interact with geographic predisposition to natural hazards, policy choices, and economic drivers of change.

The upcoming World Conference on Disaster Reduction (WCDR) in Japan (in January 2005) will be an opportunity for world leaders to recognize these important linkages.

In preparation for the conference, the International Strategy for Disaster Reduction (ISDR) Secretariat and the United Nations Development Program have developed five focus areas for understanding, guiding and monitoring disaster risk reduction at all levels. These areas are: governance, risk identification, knowledge management, risk-management applications, and preparedness and emergency management.

Each of these areas carries potential considerations of the population and environment dimensions of disaster mitigation. Specific recommendations for participating nations include:

  • Strengthen policy and donor attention on population and environment dimensions of natural hazards. National economic plans should highlight natural hazards as an obstacle to sustainable development. And foreign assistance should better focus on disaster prevention by integrating it into traditional population and environment funding.
  • Produce maps that reflect the spatial distribution of risk and the magnitude and frequency of events likely to occur. Analyses of vulnerability should also pay attention to population density and distribution (to determine numbers at risk) and age structure (to determine young and older segments of the population that may be at greater risk).
  • Improve information management and communication about population and environment drivers of disaster. Researchers need to more effectively communicate the importance and economic benefits of disaster mitigation to educators, journalists, advocacy groups, and local communities—emphasizing the role of population and environment.

The World Bank and the United States Geological Survey, for instance, calculated that economic losses worldwide from natural disaster in the 1990s could have been reduced by $280 billion if $40 billion had been invested in preparedness, mitigation, and prevention strategies:21

  • Implement risk management interventions that address critical threats. Urban development strategies and sustainable land-use policies should be integrated with the promotion and provision of reproductive health services. Such integration would allow the urban and rural poor both to exercise their reproductive preferences for lesser fertility and to live in safe and secure environments.
  • Support formal and informal preparedness and emergency management plans. Formal early warning and preparedness plans should be supplemented by informal local-level preparedness driven by local communities. The people of Igbalangao on Panay Island in the Philippines, for example, make three-dimensional maps of their village, assessing the vulnerability of each household to disaster.22

Overall, mitigating vulnerability and promoting sustainability require a proactive approach to the use of space that balances economic benefits with social and environmental concerns.

Roger-Mark De Souza is technical director of the Population, Health, and Environment Program at the Population Reference Bureau.


  1. A study of the 153 Caribbean disasters recorded between 1900 and 1988 found that hurricanes and tropical storms had caused two-thirds of these disasters. See Robert Potter et al., The Contemporary Caribbean (Essex, UK: Pearson Prentice Hall, 2004): 142.
  2. University of California, San Diego, “Hurricanes and Global Warming,” accessed online at, on Sept. 1, 2004.
  3. United Nations/International Strategy for Disaster Reduction (UN/ISDR), “Small Island Developing States, Disasters, Risk and Vulnerability” (background consultative paper), accessed online at
    eng/wcdr/meetings/docs/SIDS-Consultative-paper-2.0.doc, on Oct. 18, 2004.
  4. Michael Grunwald and Manuel Roig-Franzia, “Along the Beach, a Spike in Property Damage: As Development Sprout on Once-Empty Sand, Storms Unleash Fury on Structures in their Paths,” The Washington Post, Sept. 19, 2004.
  5. Mark Lynas, “Warning in the Winds,” The Washington Post, Sept. 19, 2004.
  6. Grunwald and Roig-Franzia, “Along the Beach, a Spike in Property Damage.”
  7. United Nations Environment Programme (UNEP), Caribbean Environmental Outlook (London: UNEP, 1999): 15.
  8. Lori Ashford, World Population Highlights 2004 (Washington, DC: Population Reference Bureau, 2004).
  9. George Martine and Jose Miguel Guzman, “Population, Poverty, and Vulnerability: Mitigating the Effects of Natural Disasters,” ECSP Report 8 (Summer 2002): 45-68.
  10. United Nations, Department of Economic and Social Affairs, “World Urbanization Prospects, The 2003 Revision Population Database,” accessed online at, on Oct. 14, 2004
  11. Carl Haub, 2004 World Population Data Sheet (Washington, DC: Population Reference Bureau, 2004).
  12. UN/ISDR, Small Island Developing States, Disasters, Risk and Vulnerability: 6.
  13. Martine and Guzman, “Population, Poverty, and Vulnerability.”
  14. John Twigg, “Disasters, Development and Vulnerability,” accessed online at
    TWIGG.HTM, on Oct. 14, 2004.
  15. Charlotte Benson, “The Cost of Disasters,” accessed online at
    BENSON.HTM, on Oct. 14, 2004.
  16. Wealthier countries such as the United States can also afford increasingly sophisticated early warming and communications systems, allowing people more time to move to safe places and resulting in fewer deaths and injuries.
  17. Gregory van der Vink et al., “Why the United States is Becoming More Vulnerable to Natural Disasters,” (Princeton, NJ: Princeton University, Department of Geosciences), accessed online at
    sci_soc/articles/eisvink.html, on Oct. 14, 2004.
  18. Van der Vink et al., “Why the United States is Becoming More Vulnerable to Natural Disasters.”
  19. “Haiti: Human disaster is preventable, says Chief of Disaster Reduction Secretariat,” accessed online at
  20. Lynas, “Warning in the Winds.”
  21. Benson, “The Cost of Disasters.”
  22. Twigg, “Disasters, Development and Vulnerability.”

Domestic Violence in Developing Countries: An Intergenerational Crisis

(September 2004) A new comparative study using nationally representative information on domestic violence in nine developing countries finds that women whose fathers abused their mothers are twice as likely to suffer domestic abuse themselves.

The report, Profiling Domestic Violence: A Multi-Country Study, published by ORC Macro, also finds that domestic violence in these countries is highly correlated with a husband’s drunkenness and controlling behaviors. But the study did not find that a woman’s poverty, lack of education, or lack of decisionmaking control consistently elevate her risk of being abused.1

“Gender-based violence is a gender issue,” explains Kiersten Johnson, a co-author of the study and a researcher at ORC Macro. For example, the study found that women who shared the bulk of household decisions with their male partners were at a lower risk of abuse—regardless of their household’s income levels.

Domestic Violence is a Worldwide Problem

The report is based on data from the Demographic and Health Surveys (DHS) in nine developing countries: Cambodia, Colombia, Dominican Republic, Egypt, Haiti, India, Nicaragua, Peru, and Zambia. These surveys, conducted mostly after 1998, collected comprehensive demographic and health data from women ages 15 to 49. In addition, information was collected on “empowerment” indicators such as education, employment, and participation in household decisionmaking.

Researchers also asked the women about their experience of domestic violence throughout their adult lives, including detailed questions about their experience of physical, sexual, and emotional violence within their current relationships. The percentages of women who said an intimate partner had ever abused them ranged from 48 percent in Zambia and 44 percent in Colombia to 18 percent in Cambodia and 19 percent in India. (A 1998 Commonwealth Fund study put levels of similar violence in the United States at 31 percent.2)

More than one in six married women in each country that was studied reported being pushed, shaken, slapped, or targeted with a thrown object by their male partners. At least one in 10 has been threatened or publicly humiliated by their husbands.

Co-author Sunita Kishor, a senior gender specialist at ORC Macro, cautioned that survey questions differed across some of the countries, making absolute comparisons of domestic-abuse prevalence problematic. But Profiling Domestic Violence makes clear that domestic violence remains a problem in these nine countries—and that in at least several of them, women are socialized into accepting its legitimacy under some circumstances.

“Educated women tend to disagree [with the practice of domestic abuse] more, but it’s not as if you get a zero-level of disagreement even among them,” says Kishor. “In most countries, the gender-role norm violation that woman are most likely to agree with as deserving of a beating is a woman’s neglect of her children. This is very, very telling—there’s a huge buy-in to the care of children being a very fundamental duty of women.”

Culture of Violence ‘Akin to Second-Hand Smoke’

The wealth of data collected by DHS also enabled Kishor and Johnson to identify common global risk factors for domestic violence—all of which, they stress, are largely beyond a woman’s control.

“Often there’s this belief that you see in public discourse that women who are beaten are in some way to blame—they’re too fat or unattractive, for example,” says Johnson. “But it’s not any one characteristic or aspect of your life. Instead, there are multiple factors at the individual, husband, and family level—including your ‘inheritance’—that are dynamically interacting.”

By “inheritance,” Johnson means a woman’s experience as a child of her mother’s abuse. Such experience, Kishor says, has “tremendous intergenerational implications.”

“I don’t think enough attention is being paid to these matters,” says Kishor. “The data shows that even exposure to a mother’s experience of abuse, not just firsthand violence, almost doubles your risk [of being abused yourself]. It’s akin to the literature about secondhand smoke—even exposure to it can have ill-effects” (see Table 1).

Table 1
Percentages of ever-married women age 15-49 who experienced spousal violence ever and in the past 12 months, by whether their mother was ever beaten by their father

Family History Cambodia Colombia Dominican
Haiti Nicaragua Peru
Ever Experienced Spousal Violence
Father beat mother
No 15.2 36.1 20.0 27.0 27.4 35.8
Yes 29.7 55.4 36.3 37.8 36.6 50.0
Don’t know 20.7 46.5 27.9 32.1 35.4 46.3
Experienced Violence in the Past 12 Months
Father beat mother
No 13.1 u 9.2 20.5 11.4 u
Yes 28.1 u 21.6 33.2 17.2 u
Don’t know 17.7 u 18.2 22.8 15.5 u

u = Unknown (not available)
Note: Data not available for remaining three countries studied in report.

Profiling Domestic Violence also found that other common correlates of domestic abuse—besides having husbands who frequently get drunk or exhibit controlling behaviors (such as limiting her outside contact or repeatedly accusing her of infidelity)—include:

  • Being married more than once;
  • Being married young;
  • Having multiple children; or
  • Being older than your husband.

In addition, Kishor and Johnson found that many abused women in developing countries do not seek help, ranging from 41 percent in Nicaragua to 78 percent in Cambodia. And those who do reach out often contact people they know rather than health professionals.

Disempowerment and Violence: No Clear Connection

Surprisingly, several measures of female empowerment—employment, education, or attitudes related to gender equity, such as believing that women have the right to refuse sex to their husbands—did not directly correlate in the study with a reduced risk of abuse. And women who make most of their household’s decisions alone—such as whether to make large purchases or to have another child—were victims of domestic violence at the same rate as those with little say in the allocation of their family’s resources. Instead, the study found that women who made decisions jointly with their male partners suffered far less abuse.

“The causality is not clear from these data between increased risk of abuse for women who make most of the decisions alone,” Kishor says. “Is it because she is in such a dysfunctional relationship that she is forced into taking charge? Or is it because she’s taking the decisions alone that she’s actually being beaten?” This uncertainty, she adds, raises questions about conventional indices of empowerment.

“We need to be looking closely at a lot of these indicators and asking what they’re really telling us in different contexts,” Kishor says. “While empowerment usually implies that you are in control of your life, the data suggest that, within a marital context, ‘dominating’ [these] decisions may not equate to empowerment.”

The Health Consequences of Abuse

The study found clearer connections between abuse and degraded health for victimized women and their children. For instance, women in almost all the surveyed countries who had experienced abuse from their intimate partners had higher rates of unwanted births and nonlive births (by 33 percent to 72 percent) than those who had never been abused.

Women who experienced violence were also more likely to have had sexually transmitted infections, their pregnancies were substantially less likely to have received first-trimester antenatal care, and their children between the ages of 12 months and 35 months were less likely to have been fully vaccinated. The children of abused women were also more likely to die before age 5.

Both authors stress that including national domestic violence statistics alongside health and demographic information is a large step forward in addressing the roots of abuse.

“Up until recently, there wasn’t the kind of impetus or interest in this kind of data, or even the recognition of domestic violence as an issue of public health and development,” Johnson says. “It’s important to know that there are multiple factors involved, and thus multiple arenas in which interventions can occur.”

Robert Lalasz is a senior editor at PRB.


  1. Sunita Kishor and Kiersten Johnson, Profiling Domestic Violence: A Multi-Country Study (Columbia, MD: ORC Macro, 2004).
  2. Karen Scott Collins et al., Health Concerns Across a Woman’s Lifespan: The Commonwealth Fund 1998 Survey of Women’s Health, accessed at, on Sept. 14, 2004.

For More Information

Profiling Domestic Violence: A Multi-Country Study is available at


Caribbean Countries Pay for Successfully Addressing Population Issues

(April 2002) In a move that marks the Caribbean’s success in various spheres of socioeconomic activity, international funding agencies are reducing their financial support for the region’s sexual and reproductive health programs. The move could adversely affect the delivery of population services — including those designed to stop the spread of HIV/AIDS — unless alternate sources of funding are found.

The United Nations Population Fund (UNFPA), the International Planned Parenthood Federation (IPPF), and the World Bank have all signaled that the region has achieved success in socioeconomic development (including various population activities) and therefore should not continue to receive current levels of assistance. As a result, some countries will see their assistance phased out altogether while others will have their funding reduced over time.

Population Characteristics

This process of “graduation” from international assistance follows achievements in addressing a number of population problems. Infant mortality, birth rates, and population growth have declined during the last decade or so and the decline has been rapid in some cases.1 As a consequence, population growth has slowed while life expectancy at birth continues to rise.

Total fertility rates (TFRs) are expected to decline significantly for most countries over the next decade. In Belize, for example, the average number of children per woman is estimated to decline by more than 58 percent — from 5.4 in 1980-1985 to 2.6 in 2005-2010. A decline of some 53 percent is projected for Trinidad and Tobago, with the TFR dropping from 3.2 to 1.6 during the period.2 Haiti recorded the highest number of children per woman during 1980-1985 with 6.2, but this number is expected to decline by 40 percent (to 3.6) by 2005-2010.

Crude death rates or deaths per 1,000 people are also declining in the region. Countries estimated to record the highest declines during the periods 1980-1985 and 2005-2010 include Haiti (a 42.7 percent decline), Belize (35.1 percent), Guyana (23.9 percent), and the Dominican Republic (23.5 percent).

As a direct consequence of this declining mortality (from all causes of death including AIDS), life expectancy at birth has been increasing. Guadeloupe is estimated to record the highest life expectancy at birth of 76.0 years (males) and 82.5 years (females) during 2005-2010, an increase of 10.3 percent for men and 8.3 percent for women over the figures for the 1980-1985 period. Haiti (18.2 percent for males and 17.8 percent for females) is projected to record the highest percentage change in life expectancy during the 1980-1985 to 2005-2010 period, although the actual life expectancy at birth is estimated to be a modest 59.8 years for males and 62.8 years for females during 2005-2010.3

In line with declining fertility and mortality and limited net international migration, population growth rates are expected to remain low in the Caribbean.4 Cuba is expected to record the highest decline in the population growth rate, going from 0.8 percent during 1980-1985 to 0.3 percent during 2005-2010 — a nearly 63 percent drop. Estimates for Trinidad and Tobago show the growth rate falling from 1.7 percent during 1980-1985 to 0.5 percent in 1995-2000, before rising slightly to 0.7 percent in 2005-2010. The growth rate for the Dominican Republic is expected to go from 2.3 percent in 1980-1985 to 1.3 percent during 2005-2010, while in Jamaica the rate is expected to decline from 1.5 percent to 0.9 percent.

The Price

This overall success is costing the Caribbean international support for its population activities. UNFPA prioritizes and allocates funds to developing countries according to population needs. Most Caribbean countries have been placed in category B in the last five years (mid-level need) and slated for funding reduction, while the Bahamas and Barbados have been placed in category C (low-level need) and slated for a funding phase out.5

Many international agencies use the UNFPA classification to make funding decisions. The IPPF has announced its decision to phase out funding for some Caribbean countries and drastically implement a phased reduction in funds for many others. While the IPPF decision is also the result of a reduction in funding from the Federation’s own donors, other international agencies may follow suit. These cuts are expected to have a far-reaching impact. Until recently, for example, many Caribbean family planning programs received a substantial amount of funding from the IPPF.

While some governments already provide support for these programs, many are unlikely to be able to meet the funding shortfall. Governments such as Barbados and Trinidad and Tobago already spend substantial amounts of funds on their countries’ family planning programs. Others, including Grenada and Antigua and Barbuda, allow family planning associations to import supplies without customs duties and offer other non-cash concessions.

Emerging Population Issues

While the UNFPA reclassification was based on demographic data in the early to mid-1990s, new population challenges are emerging in the region. Notable among them are population aging, HIV/AIDS, and the need to sustain the levels of fertility, mortality, population growth, and related achievements that resulted in the reclassification.

Population Aging

Falling fertility and mortality and increasing life expectancy at birth provide a good mix for population aging and for increases in the proportion of older people in the population. The proportion of the population 65 years of age and older is expected to increase throughout the region between 1990 and 2020. In the Bahamas, where the largest percentage change is expected to occur, the proportion of the population 65 years old and older is expected to increase from 4.6 percent to 9 percent over the 30-year period. Cuba and Guyana are also expected to record massive changes in the proportion of older people.6 For Cuba, the proportion will increase from 8.4 percent to 15.8 percent. In Guyana the proportion of older people is expected to increase from 3.4 percent to 7.0 percent.

The increasing proportion of older people in the population brings with it a host of socioeconomic issues that will have to be addressed by these countries, including increased demand for health care, housing, recreation, transportation and other geriatric services and programs, with inherent implications for funding.


The Caribbean has the second highest prevalence rate of HIV/AIDS in the world (2.2 percent) after sub-Saharan Africa (8.4 percent). While there are wide variations in the region, the largest number of people living with HIV/AIDS is found in Haiti where 200,000 adults ages 15-49 and 5,200 children under 15 years have the virus (see table below).

Table 1
Estimated Number of People Living with HIV/AIDS and Deaths by Country, 1999

People living with HIV/AIDS Deaths
Country Adults (15-49) Adult HIV prevalence rate Women (15-49) Children (0-15) All ages
Bahamas 6,800 4.13 2,200 150 500
Barbados 1,700 1.17 570 <> 130
Belize 2,400 2.01 590 <> 170
Cuba 1,950 0.03 450 <> 120
Dominican Republic 130,000 2.80 59,000 3,800 4,900
Guyana 15,000 3.01 4,900 140 900
Haiti 200,000 5.17 67,000 5,200 23,000
Jamaica 9,700 0.71 3,100 230 650
Suriname 2,900 1.26 950 110 210
Trinidad & Tobago 7,600 1.05 2,500 180 530

Source: Compiled from UNAIDS and WHO Epidemiological Fact Sheets.

The Dominican Republic follows Haiti with 130,000 adults and 3,800 children living with HIV or AIDS. Countries with moderate numbers of people living with HIV/AIDS include Guyana with 15,000 adults and 140 children, Jamaica with 9,700 adults and 230 children, Trinidad and Tobago with 7,600 adults, and the Bahamas with 6,800 adults and 150 children. Barbados, Cuba, Belize, and Suriname have the fewest people living with HIV/AIDS (see table above).

AIDS-related mortality is low in the Dominican Republic and moderate to high in the other countries, especially Haiti. The largest number of AIDS deaths in 1999 occurred in Haiti (23,000 deaths) and this constituted 11.2 percent of the total number of people living with the disease that year (see table above). The Dominican Republic recorded the second largest number of deaths with 4,900, but this constituted the lowest proportion of deaths of only 3.7 percent. Death proportions from AIDS were moderately higher in Cuba (5.6 percent) and Guyana (5.9 percent). The numbers were higher in the Bahamas (500 and 7.2 percent), Barbados (130 and 7.2 percent), Suriname (210 and 7.0 percent), Trinidad and Tobago (530 and 6.8 percent), and Belize (170 and 6.8 percent).

Most local family planning associations have been dealing with HIV/AIDS prevention at the grassroots level, including through programs in schools and through community outreach projects. According to the Barbados Ministry of Education, sexual activity is rife among school children in the country: children as young as 9 years old are involved in such activity, increasing their risk of contracting sexually transmitted infections, including HIV.7 A survey of family planning associations indicates that many would cut services if the shortfall from declining international funding is not found elsewhere.8 HIV/AIDS services are likely to be curtailed as part of these overall service cuts.

In the meantime, governments in the region are setting up national advisory councils and national commissions on AIDS as they try to curb the epidemic’s spread and impact. Caribbean Community (CARICOM) members have also agreed to adopt a regional approach to tackling HIV/AIDS, and discussions are afoot among member states about how this regional approach would be funded and implemented. The role of the family planning associations in this new approach is unclear at this stage, but it is hoped that they would be funded to continue work at the grassroots level since they have the potential to contribute significantly to any anti-AIDS efforts.


The Caribbean’s success in addressing population issues was achieved with a certain level of funding, without which the gains may be lost. The end of preferential trade status with the European Union, globalization, and trade liberalization, as well as fall out from the September 11 attacks on the United States (especially in relation to tourism) are adversely affecting revenues, and there can be no guarantee that the Caribbean countries will continue to maintain their current levels of income generation and economic growth. Some of the more developed countries in the region, such as Barbados, are technically in a recession (having recorded a third consecutive year of declining economic growth).9

The problem is exacerbated by competition from other sources of government expenditure, and it is most unlikely that many governments will be able to meet the shortfalls in international funding. The results could be devastating for the region in view of the emerging population issues and the need to sustain levels of success.

David Achanfuo Yeboah is senior fellow and inter-campus coordinator of the Special Studies and Research Methods Unit at the Sir Arthur Lewis Institute of Social and Economic Studies, the University of the West Indies, in Cave Hill, Barbados.


  1. 1. D. A. Yeboah, “A Demographic Profile of the Caribbean,” CARICOM Perspectives, no. 70 (2001): 104-105.
  2. United Nations Economic Commission for Latin America and the Caribbean (ECLAC), Statistical Yearbook for Latin America and the Caribbean (Santiago: ECLAC, 1999); and Yeboah, “A Demographic Profile of the Caribbean.”
  3. ECLAC, Statistical Yearbook for Latin America and the Caribbean.
  4. D.A.Yeboah, “A Demographic Profile of the Caribbean.
  5. D.A. Yeboah, “Strategies Adopted by Caribbean Family Planning Associations to Address the Challenges of Declining International Funding,” International Family Planning Perspectives (forthcoming, June 2002).
  6. ECLAC, Statistical Yearbook for Latin America and the Caribbean; and Yeboah, “A Demographic Profile of the Caribbean.”
  7. Barbados Ministry of Education, A Survey of Sexual Behaviour Among School Children (Bridgetown: Ministry of Education, 2001); and Ruben del Prado, United Nations Press Conference on AIDS, Port-of-Spain, Trinidad and Tobago, December 7, 2001.
  8. D. A. Yeboah, “Strategies Adopted by Caribbean Family Planning Associations to Address the Challenges of Declining International Funding.”
  9. “Third Year of Decline: Report of the Governor of the Barbados Central Bank,” Nation (Barbados), January 31, 2002.<.li>