|The Value of Family Planning Programs in Developing Countries (RAND, 1998, 98 p.)|
When the Marshall Plan began after World War II, the economically prostrated countries of Western Europe had 14 percent of the world's population. Today these countries have grown rich and, with their trade and mutual cooperation in many areas, provide a bulwark to American prosperity. But they are also a smaller part of the world than they used to be, with only half their previous share of the world's population. While the industrial countries were rebuilding their economies and achieving previously unattainable levels of prosperity, the rest of the world was setting its own records, with population growth rates exceeding 1.9 percent annually over the entire period. Population outside the advanced industrial countries has almost tripled in the past 50 years.1
1Unless otherwise indicated, historical demographic statistics are from United Nations (1996), and population projections use the World Bank (1997a) model.
This rapid population growth is not over, despite recent reports of lower fertility2 around the world. The first part of this report will argue that population growth persists and that family planning programs continue to be needed to moderate future growth. This argument involves several steps, to show (a) that the "population explosion" is not a "one-shot wonder" but is likely to be a nagging concern into the next century, (b) that rapid population growth because of high fertility robs countries of valuable opportunities for economic development, and (c) that high fertility is actually contrary to the preferences of many people, who would prefer smaller families but, because of ignorance and sometimes unfounded fears about health effects, do nothing to restrict births.
2For the purposes of this discussion, we follow the usage of demographers who define fertility as actual childbearing and fecundity as the potential to have children (the opposite of sterility). French demographers reverse these terms.
To show how family planning programs have made and could continue to make a difference, the middle part of this report will discuss their record. These programs are an unusual social invention, blending frank talk about previously taboo topics, large cadres of trained health workers, attractive advertising, and a strong concern with enhancing voluntary decisions and expanding women's options. Their value, if they are run properly, is demonstrated in studies ranging from the experimental to the cross-national. This contribution does not depend on a favorable socioeconomic and cultural environment, which is neither indispensable for success nor a guarantee of it. Rather, the contribution depends on how effectively a program exploits the opportunities in its environment and how it attends to the basics of service delivery.
Since no intervention is without cost, the last part of the report examines this issue. What programs cost is "pennies a day," as one report has been titled.3 Given their wide benefits for the population, even beyond those the clients themselves receive, these programs deserve government support. Donor support, provided in the past on humanitarian grounds and to promote global prosperity, is crucial and needs to be maintained.
3Family Health International (1990).