The arguments against donor involvement in family planning: How valid are they?

1. The arguments against donor involvement in family planning: How valid are they? Monica Das Gupta Development Research Group The World Bank

2. Outline of talk • Background: the support for family planning from the 1960s • Arguments underlying loss of donor interest in family planning from the 1980s • What happened in SubSaharan Africa while donors neglected family planning? • Conclusions: what needs to be done in SubSaharan Africa?

3. Background:the support for family planning from the 1960s • From 1960s, strong movements to reduce fertility in much of the developing world: • Driven (esp in Asia) by national governments deeply concerned by data showing their rapid population growth • And strongly supported by donors till 1980s

4. E.g. India • 1961 Census shock with high rates of population growth • And in early 1960s, serious food shortages • So the government began work on: • increasing food production (Green Revolution) • massive family planning campaign to • reduce demand for children through huge media effort • increase supply of free contraception • Total Fertility Rate fell. 2006 DHS estimates: • Fertility at or below replacement level of 2.1 children per woman in 10 states, and close to it in several more states • But in states of Bihar and Uttar Pradesh, current Total Fertility Rate around 4. Significant pockets still have high fertility.

5. And e.g. China • Faced similar problems of increasing food production and reducing population growth • Started campaign to reduce fertility around 1969 • Politically feasible to have a program with very strong sanctions against non-compliance. Esp following the Cultural Revolution • Fertility dropped like a stone

6. Source: Yao and Yin (1994) Basic Data of China’s Population, Beijing: China Population Publishing House.

7. Then donors lost interest:What arguments underlay this shift? • Fertility declining across much of developing world, lowered donor interest (but Asian governments maintained strong programs) • Political shifts against family planning: • Political and religious movements • Feminist movement to protect women’s Reproductive Health instead of imposing family planning (let women make own choices) • Intellectual shifts: • Argument that family planning programs don’t work • Argument that population growth may not make much difference to the prospects for economic growth: Human inventiveness will (at least in the long term) overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

8. Then donors lost interest:What arguments underlay this shift? • Fertility declining across much of developing world, lowered donor interest (but Asian governments maintained strong programs) • Political shifts against family planning: • Political and religious movements • Feminist movement to protect women’s Reproductive Health instead of imposing family planning (let women make own choices) • Intellectual shifts: • Argument that family planning programs don’t work • Argument that population growth may not make much difference to the prospects for economic growth: Human inventiveness will overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

9. Argument 2bHow best to improve RH? Reducing fertility has huge impact on women’s reproductive health: • adolescent health (reduce adolescent childbearing) • maternal mortality • maternal morbidity • maternal depletion Women’s mortality risk remains elevated for long after childbirth: a study in Bangladesh found that it is nearly twice as high as normal for up to two years after childbirth (Menken et al 2003)

11. Then donors lost interest:What arguments underlie this? • Evidence of declining fertility across much of developing world, lowered donor interest (but Asian governments maintained strong programs) • Political shifts against family planning: • Political and religious movements • Feminist movement to protect women’s Reproductive Health instead of imposing family planning (let women make own choices) • Intellectual shifts: • Argument that family planning programs don’t work • Argument that population growth may not make much difference to the prospects for economic growth: Human inventiveness will overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

12. Argument 3a:Family planning programs don’t work Studies show that: • Merely increasing contraceptive availability may not reduce fertility • But media campaigns have proved very successful at reducing desired family size and building demand for services • Much evidence of rapid uptake of idea that “smaller families are happier families” • Reduced demand for children followed by increased use of family planning

13. Then donors lost interest:What arguments underlie this? • Evidence of declining fertility across much of developing world, lowered donor interest (but Asian governments maintained strong programs) • Political shifts against family planning: • Political and religious movements • Feminist movement to protect women’s Reproductive Health instead of imposing family planning (let women make own choices) • Intellectual shifts: • Argument that family planning programs don’t work • Argument that population growth may not make much difference to the prospects for economic growth: Human inventiveness will (at least in the long term) overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

14. Argument 3b: Rapid population growth may not affect economic growth How did this work out in China? • Unique combination of development vision & ingenuity, and lack of political impediments to actualizing its vision • From 1970, reduced fertility at blistering speed • From late 1970s, blistering pace of: • economic growth • employment growth (manufacturing sector growth) • and poverty rates plummeted • And yet even today, many decades later: • there are still significant levels of poverty in China

15. Poverty trends in China • During 1981-2004: • the fraction of the population below the World Bank poverty line fell from 65% to 10% • and the absolute number of poor fell from 652 million to 135 million • But almost a third of China’s rural population was consumption poor in at least one year between 2001 and 2004 (% of the rural population that was dollar-a-day consumption poor in one or more years) Source: World Bank (2009) From poor areas to poor people: China’s evolving poverty reduction agenda

16. Argument 3b: Rapid population growth may not affect economic growth • Even in China, human ingenuity only mitigated (not negated) the impact of rapid population growth • Countervailing forces: • Population growth increases pressure on resources • Human ingenuity mitigates this effect Optimal outcomes if combine effects of lower population growth + human ingenuity

17. 3. What happened in SubSaharan Africa while donors neglected family planning? • Fertility levels remain high in much of subSaharan Africa • Rapid population growth

18. Source: United Nations World Population Prospects: The 2008 Revision

19. Source: United Nations World Population Prospects: The 2008 Revision

20. 3. What happened in SubSaharan Africa while donors neglected family planning? • Rapid increase in numbers shrinks the resources for investing in: • Human capital • Economic growth, to expand sources of livelihood • And poor Reproductive Health --- highest rates of maternal mortality

21. 4. Conclusions:What can be done in SSA? • The good news is that many countries in SSA show the beginnings of fertility decline • So people increasingly want smaller families (despite donors and national govts) • Can build on this changing demand for children and accelerate pace of fertility decline: • Media campaigns to accelerate the fall in desired family size and build demand for services Vast experience on this available from elsewhere, e.g. Mexico and India • And expand supply of family planning services to respond to growing demand