The International Planned Parenthood Federation IPPF began in the womb of the old Eugenics Society building in Eccleston Square. The Society supported the first home visiting family planning services put together by the Marie Stopes clinic in the 1960s and individual members of the Society were among the first to draw attention to rapid rates of population growth. Individual and social consequences of human fertility continue to be a recurrent theme in the intellectual life of the Galton Institute. Over the years, then, those who read this newsletter have contributed directly and indirectly to the freedom of choice that many couples around the world now enjoy to plan their families, to the scientific improvement of contraceptive methods and to the intellectual underpinning of a movement which has established family planning as a basic human right.
This is not to say that the road we have trodden has been without its blind endings and its painful falls. The democratic solution of demographic problems is still tainted by the past misappropriation of biological ideas by evil and ignorant people. Nevertheless, in the decades since the founding of the IPPF a great deal has been discovered about ways in which to offer family planning choices and their impact on fertility. In countries, such as Thailand, Colombia and Sri Lanka, where realistic services are being made available, birth rates have fallen two to four times as rapidly as they did in western industrialised nations at a similar stage in the demographic transition. In Bangladesh, where there has been little socio-economic change, contraceptive prevalence has begun to rise in parallel with the availability of realistic services. Even in sub-Saharan Africa, where fertility appeared to remain stubbornly high for decades, contraceptive prevalence has begun to rise rapidly in Kenya, once the services were accessible and respected individuals emerged.
The Demographic and Health Surveys funded by the United States Agency for International Development and other studies demonstrate that women all over the world want smaller families: there is an unmet need for contraception. Experience shows that the wider the range of methods made available, the more rapidly fertility declines. In particular, it is difficult to control family size without access to voluntary surgical contraception. Abortion rates appear to be partly independent of the law regulating the procedure, although the health consequences of unsafe abortions for women can be disastrous and the availability of legal abortion accelerates the trend to smaller families.
There are countries such as India and Egypt, where family planning acceptance is slow. But when services are looked at in detail, they are not reaching those in need and centrally organised services seem no more able to get Pills and condoms to individuals than the socialist economies of Europe and the Soviet Union were able to get bread and shoes to their citizens.
Of course, socio-economic variables are important predictors of family size. Richer, more educated people have smaller families and those who have smaller families become richer, and more educated: a virtuous spiral of relationships exists. But from the pragmatic point of view, as long as there is a demonstrable unmet need for family planning the obvious and soundest policy is to expand safe and responsible family planning services as rapidly as possible.
Yesterday’s population explosion will lead to a rapid increase in the number of women of fertile age in the 1990s (slightly under 30%). If contraceptive prevalences are to continue to rise then it may be reasonable to target a doubling of contraceptive users in developing countries (excluding the Peoples Republic of China) in the 1990s.
Many Third World couples will be able to pay the full cost of services (75% of current Pill users in Latin America do so already). Third World governments already put a good deal of money into family planning from their tax base and are likely to do even more in the l990s. Even so, large numbers of people will wish to plan their families but will require free or subsidised services, especially in the Indian sub-continent and in sub-Sahara Africa. Currently the industrialised nations give about £500 million a year to international family planning and this will need to double or triple if the above goals are to be met. Remarkably, only 0.9% of overseas aid currently goes to family planning, so much of the increase can come from a reallocation of money in current budgets. Population growth is not the only factor in the development equation but it is certainly more than 1% of the problem surrounding reproductive health, the autonomy and equality of women and the social and economic consequences of too rapid population growth. It would be reasonable to allot 2 - 4% of the total aid budget to family planning.
We know what needs to be done, we know what it costs, we even know where much of the money will come from; what is lacking is the technical commitment and political will to make it all happen. Too many people have a l960s image of family planning as an insoluble problem, as something that requires prior socio-economic development or risks coercion. Nothing could be further from the truth. The experience of the 70s and 80s is that people want to plan their families and that practical accessible services can be available for a modest cost.
It is going to cost huge amounts of money to clean up the environment. It is going to be difficult to persuade people to have smaller motor cars or to fly around the world less in jet airplanes. The one thing people do want is smaller families and this is cheap to provide. That message must be carried to politicians and decision-makers in as forceful and well-documented a way as possible.
Malcolm Potts