Note: This document may not always reflect the actual appropriations determined by Congress. Final budget allocations for USAID's programs are not determined until after passage of an appropriations bill and preparation of the Operating Year Budget (OYB).
BENIN
FY 1998 Development Fund for Africa . . . . . . . . . . . . . . . . . $16,200,000 FY 1998 P.L. 480 . . . . . . . . . . . . . . . . . $1,904,000
Introduction
Benin is of interest to the United States because of its remarkable transition to a democratic free-market society and its resulting political and economic prominence in West Africa. Benin's civilian-led multi-party system of democracy is a model for other African nations. The Government of Benin (GOB) has played an active role in facilitating, monitoring and advancing the Liberian peace process in close collaboration with the United States Government (USG). Benin has proven to be an ally in the region and beyond, as the only African nation to contribute to the United Nations peace-keeping forces in Haiti. The success of its democratization process and the political stability have also facilitated an improved environment for U.S. investment in Benin. In October 1996, for example, a three year multi-million dollar oil exploration and drilling contract was signed between the GOB and TARPON, a U.S. Oil Drilling Company based in Dallas, Texas.The Development Challenge.
In February 1990, Benin radically changed from a Marxist-Leninist regime to a democracy. A National Conference was held to redefine the political, economic and social orientation of the country. An interim civilian-led government was mandated to establish democratic institutions and to organize the first free and transparent multi-party legislative and presidential elections. Benin's commitment to the resolutions of the National Conference has been demonstrated in the subsequent organization of legislative and presidential elections in 1995 and 1996. Legislative and judiciary institutions are functional and have exerted their influence resulting in popular support for the new system of government. Benin is now among the minority of countries in Africa carrying out comprehensive political, economic and social reforms. These gains on the democratic front need to be sustained.The cumulative effects of almost two decades of state control have resulted in an imbalanced economy. Benin started the Structural Adjustment Program (SAP) in 1989. Many of its measures, while promoting growth in the long run, are perceived as major constraints for social and economic well-being in the present. For example, privatization, liquidation and public sector downsizing have resulted in the loss of over 18,000 jobs in the last three years. Employment opportunities in the private sector remain scarce and critical social programs still lack funding. The 1994 devaluation of the local currency reduced consumer and government purchasing power substantially and doubled the prices of imported goods. Stimulation of local production still is not at a level to offset the increased cost of importing goods.
Benin is engaged in economic reforms to generate economic opportunities. As a result, prospects for sustained economic growth in the region are more encouraging than in the past. However, attempts to create a regional market remain unfulfilled due to the region's different languages, laws, and commercial systems. An increased regional approach to USAID's assistance in the medium and long term could promote improved regional collaboration. In Benin, growth prospects are further enhanced by a successful democratic transition, along with the privatization of state assets and fiscal reforms. However, bureaucracy and corruption, especially within the highly centralized public administration, remain deterrents to investment. The immediate challenge to the newly-elected government is the improvement of the legal and regulatory framework in order to attract more local and foreign investors. Foreign private investment in Benin was $50 million in 1995 and $52 million in 1996.
Despite some social challenges resulting from the SAP, the effects of the democratization process are evident in current economic indicators. Fundamental changes in political and economic policies have created a more favorable basis for economic growth. Under the SAP, beginning in 1989, majorachievements were made in reforming the fiscal and tax systems, restructuring the banking sector and changing significantly the monetary policy. Progress was also made in restructuring public enterprises to the benefit of the private sector. In 1996, the economy grew at approximately 6% while inflation was reduced to 4%.
Although the economy is improving, Benin still remains among the poorest African countries. Its 5.6 million people are unevenly distributed, with nearly 70% of the population living on 12% of the land in the southern part of the country. The 3.1% population growth has offset economic growth and has burdened the limited social infrastructure. Only half of the population has easy access to the general health care services and only one fifth actually uses the services. HIV infection rate has increased from 0.5% in 1990 to a projected 3% in 1996. A population policy was recently adopted in May 1996 which will allow USAID to move forward with its strategy in the family health sector.
During the pre-democracy period, the educational system collapsed. In 1991, the enrollment rate was 49.7% rising to 66.8% in 1996. This rise is attributable to the education reform program initiated by USAID in 1991. While everyone is pleased with the growth in school enrollment, the increase has created human and material resource challenges to the GOB.
Other Donors
Between 1991 and 1995, Benin received approximately $1.6 billion in foreign assistance which represents about 15% of the annual Gross Domestic Product (GDP). Japan ($56 million), France ($54 million) and Germany ($51 million) are currently the largest donors followed by World Bank ($27 million), African Development Fund (AFDF) ($22 million) and the United States ($19.5 million). Foreign assistance to the Government of Benin was distributed as follows: 49% in capital projects, 25% in budget support, 23% in technical assistance and 3% in food aid.FY 1998 Program.
The USAID strategy in Benin is designed to consolidate the country's economic and democratic transformation by strengthening the country's human resource base, as specifically mandated by the 1990 National Conference, in order to broaden the benefits of economic growth. USAID is strengthening Benin's human resources by improving the quality of and expanding access to basic education, providing family health services, and strengthening civil society involvement in the conduct of public affairs.
USAID's strategy to strengthen Benin's human resource base combines three approaches: (1) The establishment of a quality and equitable basic education system that prepares the younger generations for a productive role and effective leadership within their society; (2) the consolidation of the democratic process and create an enabling environment for participatory development; and (3) the support and expansion of family health services including HIV prevention and child survival programs.
Agency Goal: Encouraging Broad-based Economic Growth.
Benin's economic restructuring can be sustainable only if the majority of Beninese have access to an education system which enables them to become more literate, self-reliant, creative, confident, and entrepreneurial. These are the essential attributes of a labor force which is competitive in the international economy. The primary focus of USAID's assistance is to improve the quality of and access to primary education. There are five mutually reinforcing target actions: 1) establish and maintain sufficient financing for primary education, 2) improve the institutional capacity for education planning, 3) upgrade key pedagogical systems to provide a quality learning environment, 4) increase equity of access to a quality primary education, and 5) promote widespread public participation.USAID's assistance to Benin's education system has played a prominent role in strengthening the institutional capacity of the Ministry of Education and increasing access to education, reducing gender and regional disparities, and improving the availability of textbooks, training materials and teacher training needed to improve overall quality. As a result, substantial improvements have been made in the education system, as publicly acknowledged by both government officials and parent associations. The GOB provided support to primary education of $5.3 million in 1994, $5.5 million 1995 and $8 million in 1996 matching the USG contribution over the same period. The share of GOB budget for primary education increased from 47% in 1992 to 55% in 1995. The non salary expenses for primary education rose from less than 10% in 1992 to over 20% in 1995.
Civil society has been increasingly involved in the decision-making process of the education sector. Local voluntary groups, non-governmental organizations, development associations and parent associations have been active in the implementation of educational reform measures including providing inputs for conception and production of new school curricula and overall school management. In 1997, new activities will be initiated to expand community-based interventions in education.
Continued increase in financial support for primary education should help sustain these achievements. A special effort to support girls' enrollment is still required, since it has only increased from 36% to 50% over the last four years. USAID will co-finance with UNICEF a two-year activity designed to support and improve girls' enrollment and retention rates.
As part of the education quality improvement target, teacher training activities initiated in 1996 will be expanded in 1997 to consolidate gains made under the Mission's basic education efforts to provide additional training opportunities for primary school leavers. In 1998, a new technical training activity will be initiated to reinforce the current one.
- Strategic Objective No. 1: Ensuring That an Increasing Number of School-aged Children Receive, on a More Equitable Basis, an Education Which Adequately Prepares Them for a Productive Role in their Society
Agency Goal: Building Democracy.
Since Benin's adoption of a multi-party democratic system of government, USAID has provided material, technical and financial assistance in support of the transition to democracy. Specifically, USAID provided indelible ink, ballot seals, funding for observers, and civic education for voters in 1991 and 1995 for legislative elections and in 1991 and 1996 for presidential elections. Other activities financed by USAID include a national forum on the judicial system; seminars, conferences and assessments of the electoral process, decentralization, and the role of women in democracy; and institutional support and technical training to national audit institutions to improve their performance in the management of public finance.The success of the democratization process depends on actors in the civil society having a clear understanding of the country's laws, possessing advocacy skills and engaging in policy dialogue with their government. USAID continues to provide appropriate technical expertise, training, and financial support to local non-governmental organizations (NGOs), research groups and local associations in order to reinforce their financial and managerial capacity and improve their advocacy skills. Since 1994, AFRICARE, a U.S. PVO, has implemented the Benin Indigenous NGOs Strengthening activity to reinforce the managerial and financial capacity of local NGOs. This activity has tremendously improved the participating NGOs' capacity to implement development activities and influence public policy. These NGOs help citizens monitor the actions and decisions of government and demand transparency and accountability in the management of public affairs. Though the NGO movement has made considerable progress, it continues to be hindered by the repressive law of 1901 which defines the legal framework of NGOs. In response to this constraint, USAID provides assistance in efforts to revise this law.
USAID aims to improve the transparency and accountability of the public sector with regard to the management of public finances and responsiveness to citizen's needs. Improvement in this area will restore confidence between the citizens and the government. USAID plays an important role in support of Benin's efforts to decentralize public administration. Through financial aid and technical assistance, USAID will promote good governance at decentralized levels by improving the legal and regulatory framework necessary for transparent and accountable local government .
In a partnership with the European Union, USAID is presently conducting a macro assessment of governance in Benin (financial, economic and political sectors). The recommendations of this assessment will provide a framework for a strategy to reinforce the accountability of government and democratic institutions, increase public participation in decision-making and promote an enabling environment conducive to market-driven initiatives. FY 1997 and 1998 assistance funds will be used to finance activities defined by this strategy and which complement the ongoing program.
- Special Objective No. 1: Improve Governance and Reinforce Democracy
Agency goal: Stabilizing World Population Growth and Protecting Human Health
Of the total funding requested for population and health, $3,200,000 is planned for population activities and $3,800,000 for health.The estimated population of Benin is 5.6 million with a population growth rate of 3.1% per year. Since the 1995 Cairo Population Conference, pressure from donors as well as local NGOs has forced GOB to take steps toward meeting its demographic challenge. In May 1996, Benin adopted a population policy which sets as one of its goals a 40% contraceptive prevalence rate by the year 2016, an increase of approximately 1.5% per year over the next 20 years. This policy has not yet been implemented but plans for implementation and solicitation of support from donor organizations has begun. Efforts continue to modify the 1920 law forbidding the distribution of contraceptives. The national health strategy which includes reproductive health services and the creation of the Directorate of Family Health in 1994, should facilitate the integration of family planning into its maternal and child health services.
The Demography and Health Survey (DHS) completed in September 1996 shows an overall fertility rate of 6.3, with the rural rate remaining high at 7. The national contraceptive prevalence rate is estimated from 1% to 3.5%. In spite of this low rate, the DHS shows an expressed need of 60% of Beninese woman for either birth spacing or limitation. These figures represent a significant demand for family planning services in Benin.
Infant mortality remains relatively high at 94 per 1,000. The mortality rate for children under five is 167 per 1000 live births. Though there has been a decline in the past ten years in these rates, recent trends show the possibility for an increase in these rates as the result of some decline in child survival services. From 0.5% seroprevalence rate in 1990, HIV is at approximately 3% in 1996 showing a steady increase according to the National AIDS Control Program. Given the high rates in neighboring countries and migratory patterns, prevention efforts are of the utmost priority.
In preparation for the development of a family health project, USAID funded a series of family health activities in 1996 including support for an oral rehydration program, the social marketing of oral rehydration salts and condoms, institution-building for the National AIDS Prevention Program.
The Mission intends to develop a family health program which aims to support efforts to increase access to and quality of family health services in the areas of family planning, HIV prevention, and child survival. The focus will be on (1) improved policy environment for family planning through effective implementation of the population policy; (2) increased access to family planning information, services, and commodities in the public, private, and NGO sectors; (3) social marketing of condoms and childsurvival products; (4) institutional building of governmental agencies and NGOs to provide sustainable family planning and HIV prevention services; (5) promotion of selected child survival practices and services.
The need, which has been well documented through a series of USAID-funded assessments, as well as the enabling conditions and structures which have been put into place by the GOB, all serve to enhance the potential effectiveness of a USAID intervention in family health at the present time. USAID also expects that the promotion of girl's education will have significant and lasting impact on family health since studies have shown that there is a high correlation between the years of girls' schooling with contraceptive use and decreased infant mortality.
- Special Objective No. 2: Expanding the Availability, Quality, and Use of Sustainable Family Health Services, Including Family Planning, HIV Prevention, and Child Survival.
Agency Goal: Providing Humanitarian Assistance
Catholic Relief Services implements the P.L. 480 Title II food aid program in Benin. Although Benin is not a food deficit country, small pockets of malnutrition persist. Food aid will be distributed at the following venues: (1) maternal and child health centers, as an incentive for pregnant women and mothers with children aged 0-2 years to attend nutrition education sessions; (2) nutritional recuperation and education centers for the treatment and recuperation of children suffering from acute malnutrition; (3) other child feeding centers, such as schools for children aged 6-14 (primary and technical schools); and, (4) general relief or welfare centers as well as orphanages, leprosy, tuberculosis hospitals, etc.
- Special Objective No. 3: Decrease Infant Child and Maternal Mortality Through Targeted Health and Nutritional Education and Complementary Activities
BENIN FY 1998 PROGRAM SUMMARY
-
Encouraging Broad-based Economic Growth Stabilizing Population Growth and Protecting Human Health Protecting the Environment Building
DemocracyProviding Humanitarian Assistance
TOTALS USAID Strategic Objectives
SO 1. Ensuring that an Increasing Number of School-aged Children Receive, on a more Equitable Basis, an Education which Adequately Prepares them for a Productive Role in their Society - Dev. Fund for Africa
8,400,000
---
---
---
---
8,400,000
SPO 1. Promoting Governance and Reinforcing Democracy - Dev.Fund for Africa
---
---
---
800,000
---
800,000
SPO 2. Expanding the Availability, Quality, and Use of Sustainable Family Planning and HIV Prevention Services - Dev. Fund for Africa
---
7,000,000
---
---
---
7,000,000
SPO 3. Decreasing Infant Child and Maternal Mortality through Targeted Health and Nutritional Education and Complementary Activities - PL 480 Title II
---
---
---
---
1,904,000
1,904,000
Totals - Dev. Fund for Africa
- PL 480 Title II
8,400 ,000
---
7,000,000
---
---
---
800,000
---
---
1,904,000
16,200,000
1,904,000
USAID Mission Director: Thomas E. Park
ACTIVITY DATA SHEET PROGRAM: BENIN
TITLE AND NUMBER: Ensuring That an Increasing Number of Primary School-aged Children Receive, on a More Equitable Basis, an Education Which Adequately Prepares them for a Productive Role in their Society, 680-S001
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1998: $8,400,000 DFA
INITIAL OBLIGATION: FY 1996; ESTIMATED COMPLETION DATE: FY 2002
Purpose: To facilitate the development of a basic education system in Benin that is equitable, efficient, effective and sustainable.
Background: During the Marxist-Leninist period, the basic education system in Benin was in crisis. Quality of education had declined, enrollment had dropped and teachers were no longer being paid on a regular basis. In 1990, a national education conference was held at which education reform was identified as a government priority. Since that time, USAID has launched the primary education program which includes health education in primary schools, community participation in educational reform and technical training of teachers and staff of the Ministry of Education. To consolidate gains made under the basic education program, in 1996 USAID initiated a pre-service teacher training program and activities to increase girls' enrollment levels.
USAID Role and Achievements to Date: Since 1991 USAID support includes technical and budgetary assistance to the Government of Benin in its implementation a comprehensive reform of the primary education system. As a result, enrollment has increased significantly, and progress is being made in the areas of equity (regional and gender) as well as quality of education. For the first time in recent Beninese history, the Ministry of Education has developed a decentralized approach to several key planning functions, thus strengthening institutional capacity and encouraging broader participation.
Description: The USAID program focuses on five activity areas: establishing and maintaining sufficient financing for primary education; improving the institutional capacity for education planning; upgrading key pedagogical systems to provide a quality learning environment; increasing equity of access to a quality primary education; and promoting widespread public participation. In addition to primary education, USAID is specifically targeting technical training for primary school drop-outs as a key area for new intervention. In 1998, another technical training program will be designed to complement the activities initiated in 1996. Other target areas are expansion of health and sanitation education throughout the country.
Host Country and Other Donors: The World Bank assists in in-service teacher-training, provision of pedagogical materials and school construction. Other multilateral organizations and international NGOs also contribute to Benin primary education reform. The GOB is committed to financing the education sector and in 1997 the Ministry of Education is provided with the same budget equivalent to 8.2% of total GOB non-salary recurrent cost budget.
Beneficiaries: Approximately 700,000 children will benefit from USAID-financed activities in primary and technical training.
Principal Contractors, Grantees, or Agencies: Activities are implemented through private American firms and U.S. and local non-governmental organizations such as the Mitchell Group, World Education, Medical Care Development International and SONGHAI.
Major Results Indicators: Baseline Target Gross Enrollment Rate 49.7% (1990) 78%(2002) Girls Enrollment Rate (Girls/Boys ratio) 0.58 (1990) 1.00(2002) Pass rate, primary school leaving exams 40% (1990) 80%(2002) Technical training: To be determined
ACTIVITY DATA SHEET
PROGRAM: BENIN
TITLE AND NUMBER: Promote Governance and Reinforce Democracy, 680-SP01
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1998: $800,000 DFA
INITIAL OBLIGATION: FY 1997; ESTIMATED COMPLETION DATE: FY 2000
Purpose: To strengthen civil society and improve transparency and accountability of public and democratic institutions and to improve the business environment to promote private initiatives.
Background: Benin has made progress in establishing constitutionally mandated democratic institutions. These institutions themselves have made remarkable strides in carrying out their responsibilities, however, issues concerning accountability and transparency still exist. In addition, civil society's ability to influence decision-making at all levels is still weak. This situation is, in part, due to a heavily centralized bureaucracy. Since the installation of the current administration, decentralization and local government fiscal autonomy have become priorities. The decentralization bill is now before the parliament awaiting ratification and municipal elections are tentatively scheduled for 1997. In order to participate in decentralized government, civil society, especially non-governmental organizations (NGOs), local associations, and small entrepreneurs need to be better trained in areas such as networking and lobbying.
USAID Role and Achievements to Date: USAID has strengthened the institutional capacity of non-governmental organizations working at the grassroots level through the Benin Indigenous NGO Strengthening program and has funded conferences, seminars and civic education training in the area of governance.
Description: USAID will provide support to sustain the growth of active NGOs so they can play their advocacy role and defend civil society's needs and interests. Activities will be geared to helping government institutions be more accountable and responsive to the citizens. The implementation of democracy and governance activities will reinforce the technical capacities of democratic institutions such as the National Assembly; alleviate some of the legal and regulatory constraints to NGO activity in Benin; increase NGOs' efficiency and effectiveness in responding to the citizens needs; ensure effective implementation of policy reforms by broadening the range of actors involved; increase the sustainability of sectoral reforms through broad participation and commitment and; provide NGOs with capacities to better play their role in the civil society and monitor government's actions.
To stimulate initiatives in the private sector, USAID will finance micro-credit programs and provide technical expertise and training for micro-entrepreneurs, policy planners, and legislative/ judicial branch institutions. These various entities working together will create a more enabling environment for sustainable micro-enterprise development.
Host Country and Other Donors: Among the donors, two German foundations, the Konrad Adenauer and Hans Seidel Foundations, are the most involved in democracy and governance in Benin. Their activities cover information, education and communication programs on democracy and governance topics. Danish Cooperation and local NGOs such as the Research Group on the Democratic, Social, and Economic Development of Africa and New Ethics are involved in the development of advocacy skills. The French Cooperation, the Ministry of Interior and local communities work on decentralization issues. The Ministry of Finance and public audit institutions implement accountability activities. The European Union has joined USAID to conduct a macro-governance assessment.
Beneficiaries: All Beninese citizens.
Principal Contractors, Grantees or Agencies: USAID implements the activities through private non-profit organizations, and U.S. and host country NGOs
Major Result Indicators: Baseline TargetNGOs strengthened in finance and management 0 (1993) TBD (year 1998)
NGOs active in Civic Affairs 12 (prior to 1991) TBD (year 2000)
Number of public Institutions audited TBD
*TBD-To be determined
ACTIVITY DATA SHEET
PROGRAM: BENIN
TITLE AND NUMBER: Expanded Family Planning and HIV Prevention Services, 680-SP02
STATUS: Continuing
PROPOSED OBLIGATION AND FUNDING SOURCE: FY 1998: $7,000,000 DFA
INITIAL OBLIGATION: FY 1997; ESTIMATED COMPLETION DATE: FY 2002
Purpose: To expand the availability, quality, and use of sustainable family health services including family planning, child survival and HIV prevention.
Background: The Republic of Benin has made considerable progress in the past ten years in meeting the health care needs of its population. This has been due in part to a relatively functional public health system and successful implementation of cost-recovery through a centralized structure for drug sales and distribution. Benin boasts one of the highest rates of immunization in West Africa and, though infant and child mortality remain high (94 and 167 per 1,000 live births respectively), mortality has shown a considerable decrease over this period of time.
In spite of this success, progress in other aspects of reproductive health has been slow. Maternal mortality is at 473 per 100,000, the contraceptive prevalence rate is 3.5%, total fertility rate remains at 7 in the rural areas, and the population growth rate is at 3.1%. Though the exact dimensions of demographic pressure in Benin have not been fully studied, it is clear that continued rapid population growth will adversely affect the country's development objectives. A population policy was adopted in May of 1996, however, it has not yet been implemented. HIV infection rates, though low in comparison to other West African countries, have increased exponentially from 0.5% in 1990 to 2.1% in 1995 and approximately 3% in 1996.
USAID Role and Achievement to Date: USAID has supported HIV/AIDS prevention activities through condom social marketing, community education campaigns, and institutional strengthening of the National AIDS Control Program. As a result, condom sales rose from 355,000 in 1990 to 2,200,000 in 1995. Support for child survival activities has been through social marketing of oral rehydration salts (ORS), training of village health volunteers in diarrhea prevention and management, and through a grant to UNICEF's child survival program. As a result of these interventions, usage of ORS in the target regions has gone from an average of 10% to 30%. USAID also financed a series of studies including a population/family planning needs assessment (1994) and a Demographic Health Survey (DHS), the first ever in Benin, which was completed in September 1996. These studies indicate the need for immediate intervention to strengthen the Government of Benin capacities in maternal and child health, to integrate family planning services into the ongoing public sector programs, and to develop initiatives in the NGO sector to increase access to adequate family planning and maternal/child health services. USAID also financed U.S. and third-country training for family planning service providers and Beninese participation in international workshops and conferences.
Description: USAID will begin the development of its Family Health program in 1997. This program will expand and improve the quality of family health services including family planning, child survival, and HIV/AIDS prevention and will strengthen their integration into the primary health care system, in both the public and the private sectors. The focus will be on (1) improved policy environment for family planning through effective implementation of the population policy; (2) increased access to family planning information, services, and commodities in the public and private sectors; (3) social marketing of condoms and child survival products; (4) institution-building of governmental agencies and NGOs to provide sustainable family planning and HIV prevention services; (5) promotion of selected child survival practices and services.
To ensure efficiency and sustainability, USAID, in partnership with other donors will encourage the initiative of health related NGOs to form networks. These networks will promote dialogue andpartnership with the Ministry of Health and other government entities to address common issues in family health. This public/private collaboration has been identified as a priority by the Ministry of Health.
Host Country and Other Donors: The World Bank supports the Ministry of Health in implementing a health care development project which provides the framework for the integration of family planning within the general health care system. The GOB is committed to financing the health sector and in 1997 the Ministry of Health is provided with a non-salary recurrent cost budget equivalent to 5.8% of total GOB non-salary recurrent cost budget. The International Planned Parenthood Federation provides assistance to the Beninese Association for the Promotion of the Family. The World Health Organization, the French Cooperation, and the European Union support the National AIDS Control Program. Assistance in the health arena is also provided by Germany, Switzerland, Holland, and Canada.
Beneficiaries: Direct beneficiaries of the proposed activity will be children up to age 5, women of child-bearing age, and groups at risk for HIV and other sexually transmitted infections.
Principal Contractors, Grantees or Agencies: USAID will implement the activity through the Ministry of Health, U.S. organizations to be determined (TBD) and local NGOs.
Major Result Indicators: Baseline TargetInfant mortality (0 to 1 year) 94/1000 (1996) TBD
Child mortality (0 to 5 years) 167/1000 (1996) TBD
Maternal mortality 473/100,000 est (1992) TBD
Contraceptive prevalence rate 3.5% (1996) TBD
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