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Family Planning Is an Investment in Development

Putting more money into family planning programs in the developing world makes populations healthier and boosts national stability, writes John Bongaarts, vice president of the Population Council.

Written by John Bongaarts Published on Read time Approx. 3 minutes
Women wait for referral for their children at a hospital in Dhaka, Bangladesh, during a cold spell in 2006. Family planning programs can help reduce the stress on healthcare services. AP/Pavel Rahman

Let’s consider the difference between deciding you want two children and deciding you want two TV sets. Both involve figuring costs and benefits relative to income. Both require supplies and expense. Both invoke comments from friends and relatives, and both may preclude something else – nights out, perhaps, or a bicycle or a car.

Many economists would say these are choices people make. But that assumes the couple that chooses to have two children can access, purchase and effectively use modern contraceptives. With this line of argument, we would not need programs to promote family planning. Because unwanted pregnancies would be as rare as unwanted TV sets.

The reality is that more than 220 million women in the developing world who don’t want to be pregnant aren’t using modern contraception. As a result, 74 million unplanned pregnancies occur each year. Unlike TVs, pregnancies occur unless an effort is made to avoid them. A woman who wants only two children will spend about five years seeking to become pregnant, being pregnant or recovering from pregnancy. Unless she uses 100 percent effective contraception for the rest of her reproductive years (about 25 years), she will likely have additional pregnancies.

Lack of access to contraception is an obvious reason for non-use, but it is only one of several obstacles. Girls and women in the poorest communities rarely have access to education and information about how their bodies work, or know that contraception is even possible, much less how to use the various kinds. Spouses, family members and community or religious leaders may oppose family planning, citing side effects, foreign influences, theology or tradition. They may reject the concept that girls and women should have decision-making rights or options for their lives beyond childbearing. Customary gender roles may demand large families. These are important factors that can’t be overlooked – programs that provide contraceptive supplies without addressing these broader problems often fail.

One of the most compelling controlled experiments demonstrating the benefits of family planning is the landmark project undertaken in the Matlab district of Bangladesh in the late 1970s. The Matlab population of 173,000 people was divided into two areas: a control area, which received the standard set of healthcare services that were available countrywide, and an experimental area, where access to services was expanded to include home visits, a variety of contraceptive choices and follow-up care.

The impact in the experimental area was large and immediate: contraceptive use increased dramatically and fertility declined quickly. The program was expanded nationwide, contributing to a rapid fertility decline in Bangladesh. Similar results followed similar programs in Iran after 1989 and in Rwanda after 2005.

As we commemorate World Population Day this week, we should not overlook another important role that family planning plays: advancing global development. When women have access to high-quality, voluntary family planning information and services, including a wide range of contraceptive options, fertility declines. This decline has wide-ranging benefits: families, societies and whole nations are healthier. A better-educated workforce has fewer dependents and more resources, and this “demographic dividend” spurs economic growth. Governments are better able to keep pace with – and even get ahead of – meeting infrastructure needs of their citizens. Like building new roads, new schools, new health clinics. Fewer young people are unemployed or emigrate, boosting national stability.

Increasing access to family planning also helps to slow population growth, which remains extremely high in the poorest countries of the world. For example, driven by population growth in sub-Saharan Africa (where many of the women with unmet need for contraception live), the number of people in Africa is projected to quadruple by 2100, to nearly 4 billion. Slowing population growth fights poverty: It eases pressure on natural resources, and demand for health, education and infrastructure services becomes more manageable.

Despite these benefits, global investments in family planning are woefully inadequate. Currently, family planning represents just 1 percent of all overseas development assistance.

So why isn’t more overseas development assistance devoted to family planning? It should be doubled, at the very least. Why are such programs usually buried in health ministries rather than part of finance or development ministry portfolios, where they are more likely to be funded? Long-standing institutional rigidities, opposition from conservative groups and lack of knowledge about the multi-sectoral benefits of family planning are largely to blame.

As colleagues from USAID recently wrote, investing in family planning is clearly a “best buy” for those who care about women’s health and rights as well as global health and development. For every U.S. dollar invested in family planning, up to $6 can be saved in interventions aimed at achieving other development goals, according to a 2009 U.N. study. The world needs to recognize that choosing a smaller family involves much more than choosing how many TVs to buy. Enabling the first choice can change the world.

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