Family Planning Is Back -- John May

This week’s London Summit on Family Planning marks a renewed focus on a long neglected development issue. As my guest, former World Bank demographer and CGD visiting fellow John May writes this week in the Financial Times (gated) and on CGD’s Global Health blog that access to contraception is not only a human right and health issue but also essential to poverty reduction and sustainable economic growth.John knows what he is talking about: he is the author of the recently published landmark book, World Population Policies: Their Origin, Evolution and Impact.  He tells me the world’s population has more than doubled in the past three decades, to 7 billion, and is expected to reach 9.3 billion by 2050. Though the average number of children per woman has declined in high and middle income countries, sometimes to less than replacement level, many poor countries still have quite high fertility. Globally about 215 million women lack desired access to family planning services and too often resort to abortion when these services are not available.The London Summit is a step towards addressing these challenges, he says. “I don't think family planning has been funded the way it should have been over the last 20 years,” says John. “So the summit is an important step to improve the health of women and their socioeconomic prospects.”John tells me family planning has received little attention or funding in recent years due to a number of factors – including the emergence of other important global health issues, such as HIV/AIDS, complacency due to the success of family planning programs in some countries, and, especially in the United States, politics linked to the hot-button issue of abortion.There was a time, however, when family planning and the “population explosion” was a grave public concern. John and I recall the impact of Erlich’s 1968 best-selling book, The Population Bomb.  Amid widespread concern, many governments responded with increased provision of family planning services and advocacy and support for smaller families. Worldwide fertility fell from about five children per woman in 1968 to the current global average of  2.5 children per woman, John tells me.“These countries set up organized family planning programs. They offered quality services to women and couples. I think that was enough to really bring fertility down, because women didn't want to have as many children as they did before,” explains John. However, some countries did not take action and today many poor developing countries still have fertility rates above 4.5 children per woman, John says.John welcomes the London Summit, which is organized by the UK Department for International Development (DFID) and the Bill & Melinda Gates Foundation. He predicts it will include pledges from multiple donors to provide $4 billion over the next eight years to serve 120 million women and couples who would like to use family planning but lack access to contraception.John and I then review four recommendations he has offered for the London Summit and the broader family planning movement.

• First, John says, policymakers must have a sense of urgency. “Fertility is not coming down in the least developed countries and they account for 16 percent of world population.” Given current trends, he says, the population in these countries will triple between now and the end of the century.

• Second, family planning must be voluntary, not coerced.

• Third, family planning efforts must be complemented with wider development interventions, especially female education and empowerment.

• And finally, policymakers must be attune to macro-demographic considerations and linkages between population growth and other development sectors.

I end our Wonkcast by asking John what the likelihood is that the Summit will strengthen action within his four recommendation areas. He appears optimistic. “I think the prospects are bright, although the success will depend on the implementation” says John. “There will be resources from Gates and DFiD and other donors…I think there is now a consensus around the world for renewed action.”If you have iTunes, you can subscribe to get new episodes delivered straight to your computer every week. My thanks to Alexandra Gordon for her production assistance on the Wonkcast recording and for assistance in drafting this blog post.