Population Council Research that makes a difference

ANNUAL REPORT 2011

Family planning: A key to prosperity

by John Bongaarts

Family planning programs are highly cost-effective, have demonstrable poverty-reducing effects, and provide important health and human rights benefits to those who would otherwise have trouble achieving them. Yet international support for such programs has not kept pace with the need. As a result, many developing countries, particularly in sub-Saharan Africa, continue to face rapid population growth and other impediments to social and economic development.

Investing in voluntary family planning is one of the most cost-effective ways to address global development challenges.

The Population Council has worked for many decades to improve family planning services, empower women, and increase contraceptive choice so that women who want to avoid pregnancy can do so. Our work has played a pivotal role in defining the ability of family planning to improve lives and strengthen societies. We are encouraged to see some of the world's major donors—such as the U.S. government and the World Bank—starting to take a renewed interest in this issue.

But much more must be done.

Some 215 million women in the developing world do not want to get pregnant but are not using an effective method of contraception, resulting in unintended pregnancies and preventable maternal and infant deaths. The poorest parts of the world—where individuals are already struggling to overcome hunger—will see continued population growth of more than 70 million per year. The population of sub-Saharan Africa is expected to increase by 1 billion by 2050. And high unemployment and inequality among rapidly growing young populations are contributing to the spread of political violence and civil strife.

Family planning does more than provide health benefits; these programs also reduce poverty and improve lives:

First, by reducing the birth rate, family planning programs can create a "demographic dividend" that boosts economic growth for a few decades by increasing the size of the labor force relative to both young and old dependents, and by making it possible for people to save money. About a third of the rapid economic growth rates experienced in recent decades by East Asian tiger economies is the result of this dividend.
Second, slower population growth allows families and communities to invest more in providing quality education and health care and to improve infrastructure. Children who are healthy and educated are primed to become productive adults who can help to fuel the economy.
Third, when families are able to plan and space their pregnancies, they can invest more in each family member. And women who have fewer children have more time to earn wages outside the home, which boosts family income and quality of life and reduces poverty.

The Population Council documented these benefits of family planning in studies of a landmark project undertaken by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in the Matlab district of Bangladesh. The Matlab population of 173,000 people was divided into two areas: an experimental area, where access to high-quality family planning services was greatly expanded to include home visits, a wide array of contraceptive choices, and follow-up care; and a control area, which received the standard set of less-intensive services that were available country-wide.

The Council's research showed that the impact in the experimental area was large and immediate: contraceptive use increased markedly, fertility declined rapidly, and women's health, household earnings, and use of preventive health care improved. Children living in households that received family planning outreach were more likely to survive to the age of five and to attend school than were children from households that did not participate.

The program was so successful that it was expanded across the country, with extensive technical assistance and support from the Population Council. Today, Bangladesh is widely recognized as a world leader in family planning. We have learned that robust, high-quality voluntary family planning programs are among the most important policy responses for improving the lives of people in developing countries. As in Bangladesh, in other countries that adopted voluntary family planning programs—such as Indonesia, Kenya, and Rwanda—economies, public health, and standards of living are improving.

The argument for investing in family planning is persuasive: women and children, communities, and societies all benefit. Family planning should be a high policy priority and should be seen not only in terms of its benefits to people's health and rights, but as a critical investment in economic development and higher living standards. Around the world, the Council continues to work closely with ministries of health and other local partners to fight poverty by strengthening health systems, with a special focus on increasing access to family planning and improving reproductive health.

John Bongaarts is a Population Council vice president and distinguished scholar. His research focuses on the determinants of fertility, population–environment relationships, the demographic impact of the AIDS epidemic, population aging, and population policy options in the developing world.