Resumen : This study examined current levels and trends of fertility and excess fertility by regions of the world and determined the costs of excess fertility. Strategies and costs of preventing excess fertility were estimated, and case management of unwanted pregnancies was discussed. Fertility was lowest in Latin America and the Caribbean and in Asia and highest in Sub-Saharan Africa. Fertility was also high in the Middle East and North Africa. The rate of natural increase rose in Sub-Saharan Africa, declined in Latin America and the Caribbean, and was mixed in Asia and the Middle East. The World Bank has determined that a rate of natural increase greater than 2% is detrimental to economic development. Excess fertility can be determined by the number of births needed to reduce the rate of natural increase (RNI) to 2%, to reduce total fertility (TFR) to 4, or to eliminate births at high-risk ages. The result applied to aggregate data was the requirement of a 14% decline in births to decrease RNI, a 16% decline for reducing TFR, and a 31% decline in high-risk births. Excess fertility varied by country. All countries of Africa had high levels of excess fertility. Four countries in Latin America and the Caribbean had fertility higher than 4, but all countries with the exception of Trinidad and Tobago had a RNI of 2% or higher. Excess was highest in the Asian countries of Nepal and Bangladesh, followed by India. Malaysia and the Philippines had TFRs under 4 but RNI above 2%. All countries of the Middle East and North Africa with the exception of Turkey had excess fertility for TFR and RNI. Excess fertility can be determined also by stated fertility preferences, fertility with perfect contraception, or prevalence of abortions. Although abortion rates were higher in Latin America and Asia, desired family sizes were higher in Sub-Saharan Africa. A measure of births averted from contraceptive protection and the costs per disability-adjusted life-year gained indicated the lowest costs were in the highest mortality countries of Pakistan and Bangladesh and a higher life expectancy country, Egypt. Mortality would be reduced the most through birth spacing promotion in family planning programs. The savings for society in terms of education and health were calculated. 11.6 million births were estimated as unwanted in selected countries, at a cost of $1.5 billion for averting these births or $4.2 billion annually for all developing countries.
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