POPULATION: Bridging the Family Planning Gap

WASHINGTON, Jan 21 2009 (IPS) – Some 43 countries around the world now have populations that are either essentially stable or declining slowly.
In countries with the lowest fertility rates, including Japan, Russia, Germany, and Italy, populations will likely decline somewhat over the next half-century.

A larger group of countries has reduced fertility to the replacement level or just below. They are headed for population stability after large numbers of young people move through their reproductive years. Included in this group are China and the United States.

A third group of countries is projected to more than double their populations by 2050, including Ethiopia, the Democratic Republic of the Congo, and Uganda.

United Nations projections show world population growth under three different assumptions about fertility levels. The medium projection, the one most commonly used, has world population reaching 9.2 billion by 2050. The high one reaches 10.8 billion. The low projection, which assumes that the world will quickly move below replacement-level fertility to 1.6 children per couple, has population peaking at just under 8 billion in 2041 and then declining.

If the goal is to eradicate poverty, hunger, and illiteracy, and lessen pressures on already strained natural resources, we have little choice but to strive for the lower projection.
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Slowing world population growth means that all women who want to plan their families should have access to the family planning services they need. Unfortunately, at present 201 million couples cannot obtain the services they need.

Former U.S. Agency for International Development official J. Joseph Speidel notes that if you ask anthropologists who live and work with poor people at the village level they often say that women live in fear of their next pregnancy. They just do not want to get pregnant.

Filling the family planning gap may be the most urgent item on the global agenda. The benefits are enormous and the costs are minimal.

The good news is that countries that want to help couples reduce family size can do so quickly. In just one decade Iran dropped its near-record population growth rate to one of the lowest in the developing world.

When Ayatollah Khomeini assumed leadership in Iran in 1979, he immediately dismantled the well-established family planning programmes and instead advocated large families. In response to his pleas, fertility levels climbed, pushing Iran s annual population growth to a peak of 4.2 percent in the early 1980s, a level approaching the biological maximum.

As this enormous growth began to burden the economy and the environment, the country s leaders realised that overcrowding, environmental degradation, and unemployment were undermining Iran s future.

In 1989, the government did an about-face and restored its family planning programme. In May 1993, a national family planning law was passed. The resources of several government ministries, including education, culture, and health, were mobilised to encourage smaller families.

Iran Broadcasting was given responsibility for raising awareness of population issues and of the availability of family planning services. Some 15,000 health houses or clinics were established to provide rural populations with health and family planning services.

Religious leaders were directly involved in what amounted to a crusade for smaller families. Iran introduced a full panoply of contraceptive measures, including the option of male sterilization a first among Muslim countries. All forms of birth control, including contraceptives such as the pill and sterilisation, were free of charge. In fact, Iran became a pioneer the only country to require couples to take a class on modern contraception before receiving a marriage license.

In addition to the direct health care interventions, a broad-based effort was launched to raise female literacy, boosting it from 25 percent in 1970 to more than 70 percent in 2000. Female school enrollment increased from 60 to 90 percent.

Television was used to disseminate information on family planning throughout the country, taking advantage of the 70 percent of rural households with TV sets. As a result of this initiative, family size in Iran dropped from seven children to fewer than three.

From 1987 to 1994, Iran cut its population growth rate by half. Its population growth rate of 1.3 percent in 2006 is only slightly higher than that in the United States.

While the attention of researchers has focused on the role of formal education in reducing fertility, soap operas on radio and television can even more quickly change people s attitudes about reproductive health, gender equity, family size, and environmental protection. A well-written soap opera can have a profound short-term effect on population growth. It costs relatively little and can proceed even while formal educational systems are being expanded.

The power of this approach was pioneered by Miguel Sabido, a vice president of Televisa, Mexico s national television network, with a series of soap opera segments on illiteracy. The day after one of his soap opera characters visited a literacy office wanting to learn how to read and write, a quarter-million people showed up at these offices in Mexico City.

Eventually 840,000 Mexicans enrolled in literacy courses after watching the series. Sabido dealt with contraception in another soap opera, and within a decade this drama series helped reduce Mexico s birth rate by 34 percent.

Other groups quickly picked up this approach. The U.S.-based Population Media Centre has initiated projects in some 15 countries and is planning launches in several others. Their radio dramas in Ethiopia, for example, address issues of health and gender equity, such as HIV/AIDS, family planning, and the education of girls. A survey two years after the broadcasts began in 2002 found that 63 percent of new clients seeking reproductive health care at Ethiopia s 48 service centers reported listening to one of the dramas. Demand for contraceptives increased 157 percent.

The costs of providing reproductive health and family planning services are small compared with their benefits. Expanding these services to reach all women in the developing countries would take close to 17 billion dollars in additional funding from both industrial and developing countries.

Shifting to smaller families brings generous economic dividends. For Bangladesh, analysts concluded that 62 dollars spent by the government to prevent an unwanted birth saved 615 dollars in expenditures on other social services. Investing in reproductive health and family planning services leaves more fiscal resources per child for education and health care, thus accelerating the escape from poverty.

Helping countries that want to slow their population growth to do so quickly brings with it what economists call the demographic bonus. When countries move quickly to smaller families, growth in the number of young dependents those who need nurturing and educating declines relative to the number of working adults. In this situation, productivity surges, savings and investment climb, and economic growth accelerates.

This effect lasts for only a few decades, but it is usually enough to launch a country into the modern era. Indeed, except for a few oil-rich countries, no developing country has successfully modernised without slowing population growth.

The United Nations estimates that meeting the needs of the 201 million women who do not have access to effective contraception could each year prevent 52 million unwanted pregnancies, 22 million induced abortions, and 1.4 million infant deaths. Put simply, the costs to society of not filling the family planning gap may be greater than we can afford.

*Lester Brown is president of the Earth Policy Institute. This essay is adapted from Brown s book, Plan B 3.0: Mobilizing to Save Civilization (New York: W.W. Norton Company, 2008).