COMMENTARY: The case for family planning that Rio+20 forgot

Posted: 2 July 2012

Author: John Rowley

A few days ago Rio+20, the global mega-gathering on the planet’s sustainable future, published an outcome document that contains no reference to population or to family planning. (The Vatican, it seems, was driving the consensus.)

Goodluck Jonathan
President Goodluck Jonathan.

Now a week later the president of Nigeria, Goodluck Jonathan, a former environmental protection officer, has risked controversy by raising these ‘very sensitive’ issues. Calling on Nigerians to limit the number of children they have to what they can afford, he said that managing population growth is essential to economic planning and that the government could adopt policies aimed at curbing rapid population growth and encouraging ‘birth control’.

Nigeria with a very youthful population of some 160 million is on course to grow to 300 million by 2030, some 400 million by 2050, and a less certain 730 million by 2100, according to UN projections. Growing at 2.5 to 3.2 per cent a year it has an average family size of over five children, a number which Jeffrey Sachs, special adviser to the UN says has to come down.

"It is not healthy. Nigeria should work towards attaining a maximum of three children per family,” he said, though others point out that this will this will not be an easy task in a very religious country with high infant mortality and a widespread belief that children are ‘given by God’.

The case for more investment in family planning and reproductive health, alongside a much greater effort to educate women and girls (as well as men), has a long history. But at a global policy level It was set out most clearly – and agreed with detailed funding pledges - at the 1994 Cairo Conference on Population and Development. Only to be largely forgotten in the years that followed.

Indeed I can look back to an article that Peter Adamson wrote in the very first issue of People & the Planet magazine, exactly 20 years ago to see how little has changed to alter the essential facts of the human price that women, children and the environment pay for the neglect of these issues during the intervening years.

Adamson, founder-editor of The New Internationalist magazine and for 15 years the author of UNICEF’s annual State of’ the World’s Children Report and senior adviser to the executive director, James Grant, was in a good position to know what he was writing about

His essay began as follows: “The responsible planning of births is one of the most effective and least expensive ways of improving the quality of life on earth –both now and in the future –and one of the greatest mistakes of our times is the failure to realise that potential.

“Family planning could bring more benefits to more people at less cost than any other single ‘technology’ now available to the human race. But it is not appreciate widely enough that this would still be true even if there were no such thing as a population problem.

Raising condom awareness, Madagascar
Raising condom awareness, Madagascar. Photo credit: Blue Ventures Conservation

“In part, an awareness of the full range of benefits available from the responsible planning of births has been hidden from the public by the clouds of controversy which have long hung over this issue. But such is the range of methods now available and such the experience that has been gained in recent years, that family planning can now be promoted and practised in ways which are sensitive to the religion and culture of almost all societies. The benefits of family planning need be denied to no-one."

Adamson went on to summarise these benefits:

  • First, family planning could save the lives one quarter to one third of the 500,000 women who now die every year from causes related to pregnancy and giving birth. It could also prevent unknown millions of disabilities – many of them painful , permanent, embarrassing, and secret – which are the common consequences of high-risk - and often unwanted births.
  • Second, family planning could prevent many if not most of the more than 50,000 illegal abortions which are now performed on women every single day and which result in the death s of 150,000 young women every year.
  • Third, family planning can drastically improve the quality of women’s lives – in both short and long-term – by reducing the physical and mental burden of having too many children too close together, or at too early an age. It can increase the time available for women’s education, for vocational training, for earning incomes, for improving child care, for community activities, for personal development, and for the rest and leisure which is virtually unknown to millions of women in the developing world today.
  • Family planning could save the lives of several million children each year. Family planning would prevent, predominantly, those births known to be high risk – births that are within two years of a previous birth, or to mothers who are under 18 or over 35, or who already have three or four more children. Because the great majority if child deaths are associated with these risk factors, the well-informed timing and spacing of births would result in a far more proportionate reduction in child deaths.
  • Fifth, family planning can significantly improve the nutritional health of children throughout the developing world. Fewer and more widely spaced births allow mothers more time for breast-feeding and weaning, and helps to prevent the low birth weights which are strongly associated with malnutrition throughout the earliest years if life.
  • Sixth family planning improves the quality of life for children. The quality of child care -- including play and stimulation as well as health and education – inevitably arises as parents are able to invest more of their time, energy and money in bringing up a smaller number of children.

“For all of these reasons”, he concluded. “a renewed effort to put family planning at the disposal of all would advance not one but many of the basic human goals. These benefits alone would be sufficient to justify the claim of ‘family planning for all’ to a special priority. It would, of course, also help to resolve one of the other great problems on the human agenda – the problem of rapid population growth.”

Child marriage, Sahel
In Niger, where the average age of marriage is under 16, one in five women has or more children.

Now, in a new effort to tackle the family planning issue, developing country leaders, donors  and NGOs will be meeting in London on July 11 (World Population Day)  for the London Family Planning Summit at the invitation of the UK Government and the Bill and Melinda Gates Foundation. The British prime minister, David Cameron, will attend as will Melinda Gates, who has given a high priority to the issue by the Foundation. “Together," she says, "we can raise our voices for the millions of women and girls who want access to contraceptives but don’t have it.”
 
The UN Population Fund (UNFPA) is supporting the initiative which will see the launch of an effort to meet this unfilled need for modern family planning by some 120 million women in developing countries by tackling the estimated $3.6bn (£2.3bn) annual shortfall in investment. "Having spearheaded the fight to extend voluntary family planning to all who want it, we at UNFPA are excited by the potential of this initiative." The summit's aim is to mobilise the political will and extra resources needed to give 120 million more women access to family planning by 2020.

So how far on are we? In the intervening years some of Adamson’s figures have been better researched and estimates more accurately made, but the reasoning is unchanged. Fortunately we have just had available the latest report from the Guttmacher Institute and the UN Population Fund (UNFPA), showing just how big the need for family planning still is and how long a way there is to go.

The report, Adding it Up: Costs and Benefits of Contraceptive Services - Estimates for 2012, shows that there are still an estimated 222 million women in the developing world who want to avoid a pregnancy in the next two years, but who are not using a modern contraceptive method, virtually unchanged from the previous report, four years ago. There has, however, been a slight (one per cent) improvement in the proportion of married women in the developing world using a modern method.

Unmet need diagram

There has been ‘notable progress’ in some parts of the developing world, says the report, but in the 69 poorest countries there was no decline in the number of women with an ‘unmet need’. In fact in sub-Saharan Africa that figure went up from 50 million to 53 million in 2012.

That leaves the world very far short of the Millennium Development Goal of universal access to family planning by 2015. This lack of progress is deadly says the report, with 287,000 women dying every year from maternal mortality causes.

Already modern methods of family planning are estimated to be preventing 118,000 maternal deaths in 2012. And if the family planning gap was filled pregnancy-related deaths would fall by 79,000 – most of them in sub-Saharan Africa, with 1.1 million infant deaths averted. All this without mentioning the appalling toll in sickness, pain, stress and embarrassment suffered by millions of girls and women from the fallout of unwanted and too frequent pregnancy.

Throw in the many social, economic and planet-saving benefits of slowing population growth in those regions where it is making so many desperate problems so difficult to solve, and the silence of Rio stands as a sad signpost pointing backwards.

John Rowley is founder/editor of Planet 21.

In an effort to draw attention to the issues raised in this Commentary, organisations and experts from around the world will meet in London on 11 July 2012 at the invitation of the UK Government and the Bill and Melinda Gates Foundation at the London Family Planning Summit.

The Guttmacher Institute and UNFPA are encouraging US readers to join their call to action by writing to their senators or representatives at http://capwiz.com/population/issues/alert/?alertid=61466911

The full report Adding it Up: Costs and Benefits of Contraceptive Services -Estimates for 2012 is available here.