Family Planning Can Succeed Even in Very Traditional Societies
SUSTAINABILITY FORUM on the Population Factor
As the population explosion got underway in Asia, Latin America, the Middle East, and Africa during the 1950s and 1960s, policy makers became concerned about the threat it posed to the well-being of these poor societies. In response, many governments in the developing world—with substantial international assistance—implemented policies to reduce fertility, which included a heavy reliance on voluntary family planning programs to provide information about, and access to, contraceptives. This approach permitted women and men to control their reproductive lives and avoid unwanted childbearing. Only in rare cases, most notably in China and briefly in India, has coercion been used.
Throughout the past half-century, the choice of voluntary family-planning programs as a principal population policy instrument (other important measures included investments in education and primary health care) rested on the existence of a substantial level of unwanted childbearing caused by an unsatisfied demand for contraception. Each year about 184 million pregnancies occur in the developing world and fully 40 percent of these (74 million) are unintended. These unintended pregnancies end in abortions (48 percent), unintended births (40 percent) or miscarriages (12 percent), with detrimental health and economic outcomes for women and their families.
Unintended pregnancies occur when women don't want to get pregnant but are not using contraception. Among the reasons for this unmet need for contraception are a lack of knowledge about contraception, difficult access to supplies and services, the cost of contraception, fear of side effects, and opposition from spouses and other family members. Family planning programs reduce these obstacles, thus reducing unintended pregnancies and birth rates.
Direct evidence that family planning programs reduce unmet need and fertility comes from experiments such as the one undertaken in the Matlab district of Bangladesh. In 1977, Matlab's population was divided into roughly equal experimental and control areas. The control area received the same services as the rest of the country, while in the experimental area comprehensive high-quality family planning services were provided.
The impact of the new services was large and immediate. Contraceptive use jumped from 5 to 33 percent among women in the experimental area. As a result, fertility declined more rapidly in the experimental than in the control area and a difference of about 1.5 births per woman was maintained over time.
The Matlab experiment demonstrated that family planning programs can succeed even in very traditional societies, a finding confirmed at the national level when Bangladesh subsequently scaled up the Matlab approach nationwide.
Reducing fertility and population growth brings a range of benefits. Fewer pregnancies means fewer maternal deaths. A smaller number of young people stimulates economic growth and reduces poverty by allowing more investments in health and education, by freeing women's time to work for wages outside the home, and by reducing competition for limited jobs. In addition, slower growth makes it easier for societies to address several alarming environmental trends, such as rising food and energy costs, global climate change, widespread deforestation, loss of biodiversity, shortages of fresh water, depletion of soils, and rising pollution levels.
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