Family planning: myths versus facts

Posted: 10 April 2009

Funding for international family planning programmes in developing countries has declined by 30 per cent since the mid-1990s. Decisions by policymakers and donors to reduce investments in contraceptive services and supplies were based on plausible-sounding-but misguided-arguments, according to a new study.

"Donor fatigue" and persistent opposition from conservative governments and institutions, in particular the Bush administration and the Vatican, contributed to this decline. Family planning programmes were placed on the back burner as other pressing problems, such as the AIDS epidemic, rose in prominence.

A group of women hold their newborns at a family planning clinic in Kampala, Uganda. Photo: 2001 Hugh Rigby/CCP, Courtesy of Photoshare
A group of women hold their newborns at a family planning clinic in Kampala, Uganda. Photo: 2001 Hugh Rigby/CCP, Courtesy of Photoshare
Family planning must have higher priority. Clinic in Kampala, Uganda.© Hugh Rigby/CCP, Courtesy of Photoshare
In "A response to critics of family planning programs", published in International Perspectives on Sexual and Reproductive Health, the Population Council's John Bongaarts and co-author Steven W. Sinding aim to set the record straight and to urge that family planning become a higher priority on the international development agenda.

Myth: Family planning programmes have little or no effect on fertility.Fact: Decades of research show that comprehensive family planning and reproductive health services lead to sharp rises in contraceptive use that help women avoid unwanted pregnancies. Over a thirty-year period (1960-1990), fertility declined in the developing world from more than six to fewer than four births per woman, and almost half of that decline - 43 per cent - is attributable to family planning programmes.

Myth: Fertility declines are under way everywhere, so the population problem has largely been solved and family planning programmes are no longer needed.Fact: Population will keep growing even if fertility could immediately be reduced to the replacement level of 2.1 births per woman, because:

  • Current birthrates still leave fertility above the level needed to bring about population stabilization.
  • People live longer as higher standards of living, better nutrition, expanded health services, and greater investments in public health measures have reduced death rates, and further improvements are likely.
  • The large number of young people entering their childbearing years will result in population growth for decades to come. For example, in sub-Saharan Africa, 43 per cent of the total female population was younger than 15 years in 2005.
Myth: The death toll of the AIDS epidemic makes family planning undesirable and unnecessary.Fact: Despite the substantial mortality from AIDS, UN projections for all developing regions predict further large population increases. Despite a severe epidemic in sub-Saharan Africa, the region's population is expected to grow by at least one billion between 2005 and 2050. This is because the annual number of AIDS deaths (two million) is equivalent to just 10 days' growth in the population of the developing world.

Myth: Family planning programmes are not cost-effective.Fact: The World Bank estimates the cost of family planning at $100 per life-year saved. This is of the same order of magnitude as other health interventions, such as basic sanitation for diarrheal disease, a short course of chemotherapy for tuberculosis, and condom distribution for HIV prevention. All these interventions, including those for family planning, are much more cost-effective than antiretroviral treatment of AIDS, which currently receives a large proportion of health-related development aid.

Myth: Family planning programmes at best have made women the instruments of population control policies and, at worst, have been coercive.Fact: Today, nearly all programmes around the world respect the right of couples to make informed reproductive choices, free from undue persuasion or coercion. An important exception is China, however, where the one-child policy continues to violate reproductive rights standards.

Population growth and what to do about it has been the subject of controversy since the 1700s. Perhaps because at its most fundamental level the subject deals with sex, it has been a peculiarly incendiary topic of public policy debate. Yet much of today's discussion about family planning programs, a principal instrument through which population policies have been implemented over the past 50 years, is based on faulty perceptions and misinformation. Large-scale national family planning programs have, for the most part, been remarkably successful.

Why does this matter? Because women and children continue to suffer and die as a consequence of unwanted and unintended childbearing. Beyond that are renewed concerns about a variety of environmental issues and about the security of nations and the stability of governments, as well as deepening worries about food security and pervasive poverty.

"In the face of declining political and financial commitment to family planning programmes, we must address head-on the faulty criticisms that have held back efforts to satisfy the unmet demand for family planning services," say Bongaarts and Sinding. "High fertility and rapid population growth remain real problems that merit our attention and action."