Bringing population back into focus at World Bank

Posted: 20 January 2009

The inauguration of President Obama has raised hopes that the United States, and possibly the World Bank, might once again take a leading role in addressing the problems caused by the rapid growth of the world's human population, especially in the least developed countries. where birth rates remain high and where the impact of climate change is expected to be most severe. The steps needed to do this were set out clearly at the UN world conference on the subject at Cairo in 1994: when targets for improvements in family planning and reproductive health services were agreed alongside efforts to invest in the education of girls and the status of women more generally. Unfortunately the World Bank has shown few signs of changing its conservative position on the subject, says Steven Sinding, a leading expert who raised the issue in The Lancet medical journal, a year ago. But, as he made clear then, the Bank has not always been reluctant to lead on this thorny issue, and there are voices within that institution that would favour the Bank taking a more active role. "Perhaps if the United States shows the way, the Bank might now be prompted to follow suit" , he told People & the Planet this week. Here, as a contribution to the reviving population debate, we reproduce Dr Sinding's article which first appeared in The Lancet in November 2007.

Steve Sinding
Steve Sinding
Steve Sinding (Credit: IPPF)
Ever since the departure of Robert McNamara as its president in 1981, the World Bank has been ambivalent on the issue of population. McNamara was a convinced neoMalthusian, believing as he once stated that, after the threat of thermonuclear war, rapid population growth was perhaps the greatest threat to mankind. But not long after McNamara's departure, the World Bank's attitudes and thinking about population began to shift, in two ways.

First, many in the World Bank, especially the economists who dominate the institution's intellectual core, have been skeptical that rapid population growth is a key factor in the economic performance of countries, or in efforts to reduce the incidence of poverty within countries. Like many trained in the neoclassical tradition, they have seen rapid population growth as a marginal factor that might, in some circumstances, diminish the economic performance of nations and the wellbeing of families, but a factor that can be neutralised or even overcome by sound economic policies.

Second, the World Bank has long been divided between those who favoured aggressive lending for family planning programmes and those who doubted the efficacy of family planning in reducing high fertility. This debate revolved around the question of the demand for children and whether families, especially those living in rural poverty, would voluntarily reduce the number of children they bore. Again, economists tended towards the view that parents who had large families were acting rationally, bearing many children as a hedge against high infant mortality and as a source of household labour and old-age security.

Both of these debates explain the World Bank's lack of internal consensus and, therefore, the weakness of its policy dialogue and fairly low level of lending for population programmes in developing countries. To be sure, the Bank has provided financial assistance to family planning programmes for many years, often in the context of broader health lending, but population has figured prominently neither in its macroeconomic policy advice to governments nor in its own stated lending priorities.

Millennium goals

The decline in priority for population is by no means unique to the World Bank. Indeed, ever since the 1994 International Conference on Population and Development (ICPD), in Cairo, the issue of population growth has been more or less absent from the international development agenda. The ICPD definitively shifted the focus of programmes away from demographic considerations and towards individual reproductive rights. Many women's health and human rights advocates successfully argued at Cairo that demographically driven family planning led to human rights abuses and that they should be replaced by programmes to protect individual reproductive rights and health. It was also becoming clear by 1994 that population growth rates in many regions had fallen to the point that population growth was no longer high on the agenda for global collective action.

In the years since Cairo, population has rarely been mentioned in any international setting where pressing global issues were discussed. Indeed, universal access to reproductive health, Cairo's reframing of the family planning approach, was excluded from the UN's Millennium Development Goals (MDG) in 2000/2001, thus becoming the only international conference goal of the 1990s that failed to become an MDG. This is of great importance because the MDGs themselves are today the defining priority list for development strategy and investment. As a result, funding for population, family planning, and reproductive health has declined since the mid-1990s, especially if HIV/AIDS money is excluded.

Madagascar - mouths to feed
Madagascar - mouths to feed
Children in Madagascar - many mouths to feed. Photo: Christina Corbett/IRIN
Against this background, it is particularly noteworthy that World Bank staff have now produced a Discussion Paper entitled Population Issues in the 21st Century: The Role of the World Bank. This report seeks to take the Bank back to McNamara's original view that rapid population growth presents substantial obstacles to economic growth and poverty reduction. Recognising that much has changed in global demography since McNamara declared population growth to be a focus of intensive Bank effort, the report, nonetheless, challenges directly the prevailing views of orthodox World Bank economists about the importance of population as a macroeconomic factor, the demand for children, and the efficacy of family planning programmes in reducing fertility.

While recognising that the world is far more differentiated demographically today than it was 50, or even 35, years ago, Population Issues in the 21st Century focuses primarily on the 35 countries in the world with total fertility rates over 5ยท0, nearly all of which (31 of the 35) are in sub-Saharan Africa. The paper calls on the Bank first to undertake intensive analytical work to understand the determinants and the consequences of rapid population growth in individual countries. Perhaps most crucial is to understand the reasons that desired fertility remains high, particularly in central and west Africa-higher than in countries such as Indonesia and Bangladesh where strong family planning programmes stimulated rapid declines in fertility a generation ago. Also of great importance in many African states is understanding the interplay of HIV/AIDS and human reproduction and to design interventions that address both the risk factors that contribute to the spread of the pandemic and the unmet need for contraception that exists despite high desired fertility in many of these countries.

Renewed concern

The World Bank is then urged to place population high on the agenda of its overall development dialogue with these clients and to emphasise in these discussions the multipronged strategy required to reduce population growth rates, including measures to reduce infant and young child mortality, educate young women, promote gender equity and women's employment, and improve women's health, particularly the provision of family planning services.

Water may become a source of conflict during this century. Credit: Shehzao Noorani/Still Pictures
Water may become a source of conflict during this century. Credit: Shehzao Noorani/Still Pictures
Water may become a source of conflict during this century. Credit: Shehzao Noorani/Still Pictures
Population Issues in the 21st Century joins a growing list of publications urging a return to concern about rapid population growth, especially in Africa. But one should not be overly sanguine that the World Bank is about to sound a clarion call for intensified action on population. After all, this report is a discussion paper, not a policy document. Indeed, it's not clear that World Bank economists are convinced of the arguments put forth by the report. Some in senior Bank management may continue to oppose any involvement in policy advice or programme lending for population, family planning, or reproductive health. It was only a few months ago that a top Bank executive sought to expunge virtually all mention of these subjects from the aforementioned Health, Nutrition, and Population strategy paper and it was only after non-governmental organisations and a few member governments objected, and the Bank's president intervened, that population and reproductive health were restored to a position of some prominence in the strategy. Even with its commitment to hard evidence and solid analysis, the World Bank appears not to be immune to the ideological struggles that continue to bedevil this field.

Steven Sinding is a former Population Advisor to the World Bank, Director of Population Sciences for the Rockefeller Foundation and Professor of Population and Family Health at Columbia University. He was Director General of the International Planned Parenthood Federation (IPPF) from 2002-2006.