The Most Controversial National Family Planning Program Is Closely Associated With
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Family planning programs occupy an unusual place in the public policy loonshit. They exist in virtually every nation in the earth (see figure), however they continue to spark controversy in some quarters. The Origins and Evolution of Family Planning Programs in Developing Countries, by Judith R. Seltzer, examines the primary critiques of family planning programs and places these in historical context. The report besides examines the research record to assess the validity of these criticisms and to document how programs have evolved in response to these criticisms. The intent in surveying this historical record is to enable readers to view current debates about family planning in a broader context and to evaluate the inquiry testify associated with claims fabricated by proponents as well equally critics of family unit planning programs.
The report addresses three master questions:
- What accept been the principal controversies and criticisms of family unit planning programs and were they valid?
- How have programs inverse in response to criticisms and concerns?
- What are the lessons for policy that emerge from agreement these criticisms and the evolution of family planning programs in response?
As of 1998, family planning programs exist and are directly or indirectly supported in 192 countries, which cumulatively contain 99 pct of the world's population
Assessing the Main Criticisms of Family Planning Programs
To empathize the main criticisms of family planning programs, it is helpful to review the three public policy objectives that have underpinned these programs:
- the demographic rationale, which holds that reducing fertility rates and slowing population growth benefit developing nations
- the health rationale, which focuses on mitigating the agin health consequences of loftier fertility for mothers and childre
- the human rights rationale, which rests on the premise that individuals and couples have a right to control reproductive decisions, including family size and the timing of births
The primary criticisms of family planning programs have paralleled these three objectives, ofttimes questioning the goals of the programs or the efficacy of programs to accomplish them. In addition, family unit planning programs have faced criticisms on cultural and religious grounds. Each of these areas is discussed in more than detail below.
Criticisms Associated With the Demographic Rationale
The demographic objectives of family planning programs are based on three assumptions: (1) Rapid population growth impedes economic evolution, and therefore lower rates of population growth and lower fertility will help improve living standards and human welfare; (2) couples in developing countries want fewer children and seek to regulate their fertility; and (three) making contraception widely available is an effective way to meet couples' desires for fertility regulation and to moderate loftier fertility. Each of these assumptions has been debated. More than recently, equally amass global fertility rates have connected to fall, some accept challenged the continuing demand for programs aimed at reducing fertility.
Economic Development
Criticism: Lowering high fertility and slowing population growth will non necessarily produce economic benefits. Concerns about the bear on of rapid population growth causeless that such growth would hinder economical development in developing countries and threaten nutrient supplies, natural resources, and the surround. This assumption was called into question by social scientists who disputed the link between high fertility rates and economic growth. The contend over the link between rapid population growth and economic development continued for decades considering the inquiry base was inadequate to resolve the areas of disagreement.
Valid? Until recently, there was no conclusive research prove that high fertility impedes economical development at the macro or national level. Nevertheless, research evidence from the final decade 1 has demonstrated that substantial economical benefits tin can follow from reducing high fertility. Known as "the demographic bonus," these benefits upshot from falling birth rates: A shrinking share of the population consists of dependent children and a greater share consists of working-age adults, boosting productivity and assuasive added savings or investment. This "bonus" is not inevitable, notwithstanding--it depends on other policy variables, including economical opportunity, education, and commitment to public health.
The Demand for Contraception
Criticism: People in developing countries want to have large families and are not interested in regulating their fertility. A common criticism of family planning programs voiced beginning in the 1960s centered on the demand for contraception. According to this criticism, most couples in developing countries would non be receptive to voluntary family unit planning because they preferred large families and thus had no desire to regulate their family unit size or the timing and spacing of births.
Valid? No. Since the 1960s, surveys of women and couples have consistently shown that a large proportion of them had favorable attitudes toward contraception and that many couples wanted no more children. The surveys also showed that among those not wanting more children, many were non practicing contraception and thus had an "unmet" demand for contraception.
Program Effectiveness
Criticism: Family planning programs are not an effective way to reduce fertility or tiresome population growth. The efficacy of family planning programs to provide contraceptive services that would contribute to lower fertility, and ultimately to lower population growth, has been another cardinal office of the fence over demographic objectives. Some social scientists and women's rights advocates questioned whether family unit planning programs were the appropriate policy intervention for reducing loftier fertility considering they favored a broader approach to lowering fertility.
Valid? No. The inquiry evidence gathered over many years has confirmed that voluntary family planning programs are an constructive public policy in many developing countries for enabling couples to regulate their fertility. Research has also shown that family planning programs have helped increase the prevalence of contraception, which has contributed substantially to reducing fertility rates. Granted, the level of development in a given setting has too been important for reducing fertility. Equally development progresses, fertility rates tend to fall.
Population Explosion or Implosion?
Criticism: Because global fertility rates are falling and rates of population growth are diminishing, family planning programs are no longer needed. Some recent commentators on public policy have sounded an warning about a coming population implosion--the so-called "birth famine"--implying that population growth is no longer an important policy concern and therefore that family planning should no longer be a public policy priority.
Valid? Non for developing countries. The nascence-dearth discussion has focused selectively on Western Europe and a few other highly adult nations, such every bit Japan, where fertility rates are below replacement level (defined as 2.1 births per couple). While fertility rates have declined in many nations in the past half-century, global population growth is projected to continue well into the 22nd century. There remain sizable variations among regions and countries in levels of population growth and fertility. For most of the earth's nations, especially in the Eye East, Africa, and S Asia, the major demographic claiming over the side by side several decades will go on to exist reducing bloodshed and fertility through a combination of economical growth and social-sector programs, including those in education, wellness, and family planning.
Criticisms Associated with the Health Rationale
The health objectives of family planning programs have prompted four primary concerns. The beginning criticism, voiced past health advocates and women'southward rights advocates, has focused on contraceptive technology and contraceptive safety. The second consequence is whether there were indeed health benefits associated with regulating fertility. The tertiary, and most controversial, attribute is the relationship between ballgame and contraceptive utilize. The quaternary, also raised by health advocates and women's rights advocates, concerns the quality of care in family planning programs and the importance of considering family planning in the broader context of reproductive health, including rubber pregnancy, women'south nutrition, breast-feeding, and HIV/AIDS prevention.
Narrow Technological Focus
Criticism: Family unit planning programs are sometimes too narrowly focused on contraceptive technology. Critics of the part of contraceptive technology have questioned whether programs would be the technological fix that proponents assumed. Many health advocates thought more accent should attach to the social and cultural influences on women'south lives, which affect their ability to accept advantage of contraception. They held that the rubber and efficacy of diverse contraceptive methods were also very much shaped by the health infrastructure, which is weak in many settings.
Valid? Many of these concerns were valid. Equally a result, family planning programs accept in many instances given both greater attending to contraceptive safety issues and greater accent to the broader context of women'south lives. As a result, women's perspectives have had greater impact on contraceptive development and research.
Health Benefits
Business organisation: Family planning and fertility regulation may not provide the important health benefits for women and children that they are presumed to offer.
Valid? No. The health benefits of family planning have been well documented. Research has confirmed that safe and constructive contraception helps to reduce maternal mortality by reducing the number of births and high-risk pregnancies, including unintended pregnancies. Family planning can also improve kid health and survival by reducing the number of births associated with college risks (births less than two years apart; births to very young and older women; and higher-social club births, i.e., birth of the fifth or subsequent child). The documented health benefits of family planning have go an important consideration in the adoption of national population policies, especially in African countries. Equally the promotion and employ of condoms has become an important component in the campaign against the spread of HIV and AIDS in the developing world, the wellness benefits of family planning accept get even clearer.
Abortion and Contraceptive Use
Criticism: Family planning programs promote ballgame or increase its likelihood. In contempo years, the question of whether family planning programs advocate or promote abortion has figured prominently in the U.Due south. policy debate over public funding for family planning programs overseas.
Valid? The preponderance of evidence suggests not--that, in fact, the opposite is true. A sizable torso of research conducted in many areas, including Bangladesh and the former Soviet Union, has shown that the presence of quality family planning services can reduce abortion by reducing the incidence of unintended pregnancies. It is as well increasingly recognized that some women will choose to finish unintended pregnancies through ballgame regardless of whether it is legal in their land. Given this reality, family planning programs that provide postabortion care, which includes contraceptive counseling, are increasingly supported as a way to reduce repeat abortions. This fact as well means that information technology is specially important to provide family planning to reduce unintended pregnancies in areas where abortion is illegal, considering of the high risks of maternal bloodshed and wellness problems associated with unsafe abortions.
Quality of Care
Criticism: Family planning programs pay insufficient attention to client needs and quality of care and tend to ignore other aspects of women'due south reproductive wellness care. For more than a decade, there has been increased involvement in the quality of care provided by family planning programs. Health care advocates, women's rights advocates, and others pointed to evidence--such as levels of discontinuation of contraceptive employ and the unmet need for contraception--that implies that clients' needs and quality of care were receiving insufficient attention. And they have pointed to women'south other health needs that besides merit attention.
Valid? Yes, in some settings family planning programs focused heavily on contraceptive supply without enough accent on the quality of services delivered or women's other health needs. Concern over this issue helped motivate inquiry aimed at improving the quality of family planning services and thinking most the best ways to integrate family planning services with other aspects of reproductive health, without disproportionately compromising the former. At the International Conference on Population and Development (ICPD), held in Cairo in 1994, representatives of 180 countries agreed to the goal of universal access to reproductive health information and services by 2015. The ICPD Program of Action endorsed the broader context of reproductive health instead of the narrow approach to family planning. Family planning was considered one of the bones reproductive health services (the others included prevention of sexually transmitted diseases; boyish reproductive health; and maternal health care, e.g., condom pregnancy, safety abortion where legal, and women's nutrition). USAID has joined the general move toward more client-centered approaches to family planning and also the shift to the broader context of reproductive wellness for its family planning assistance. Studies that assess the effects of improved quality have shown initial, promising results. Efforts to measure and better the quality of care and to integrate family planning with other reproductive wellness services present ongoing challenges for health services in countries around the world and for the international donor and research communities.
Human Rights Concerns
Criticism: Family planning programs can be coercive and ignore basic principles of voluntarism and private welfare and rights. Man rights advocates have contended that the emphasis on demographic goals and targets ready by some government programs in developing countries may interfere with women's rights to autonomy in decisions about childbearing and contraception and can have a coercive event on reproductive decisions.
Valid? Aye; to some extent in some areas, these criticisms have been validated by research. Goal- or target- oriented programs in several nations, notably Red china, India, and Republic of indonesia, take exhibited varying degrees of coercion or social pressure. People's republic of china in particular has been the focus of humanitarian concerns. These concerns have resulted in a number of policy and program changes and have heightened the sensitivity of international donor organizations to these bug. For instance, the United Nations Population Fund (known equally UNFPA), 1 of the largest donor organizations, has prompted the Chinese government to permit experimentation that sets up culling models of service delivery to address quality-of-care issues and choice of methods. By late 1999, some 660 counties and urban districts had begun pilot projects emphasizing quality of care.
In 1998, the U.S. Congress passed legislation to reinforce human being rights principles associated with U.S.-supported family unit planning programs in developing countries. Known as the Tiahrt Amendment, the legislation renewed emphasis on USAID's long-standing delivery to the principles of voluntarism and informed choice in family unit planning and opposition to coercive sterilization and ballgame.
Cultural and Religious Criticisms
Cultural Intrusiveness
Criticism: Family planning programs stand for a cultural intrusion into the affairs of developing countries. Charges of cultural intrusion by the West have occasionally been directed at family planning programs from several perspectives, including Islamic fundamentalists and South American leftists. Family planning programs were sometimes viewed as attempts past foreign powers to incorporate the growth of developing nations' populations. These concerns often presumed that the desire to regulate fertility was a Western preoccupation not shared by a bulk of women in developing countries.
Valid? Cultural sensitivity issues have arisen in some countries in connection with plan implementation and service delivery. Many programs have adjusted services to fit cultural contexts, such as providing door-to-door delivery in more than traditional Islamic countries where women are discouraged from appearing in public. Community participation in programme development has been key in addressing cultural concerns. Furthermore, surveys of women in developing countries have shown both widespread desire to regulate fertility and an acceptance of family planning.
Organized religion
Criticism: Family unit planning violates the teachings of some religious traditions. Concerns about respecting religious teachings in particular regions and localities take been a long-continuing consideration for some family unit planning programs. Perhaps the strongest opposition comes from the Catholic Church, which prohibited artificial contraception in 1930. The Church opposes interfering with the process of conception and likewise views contraception as immoral because it may promote marital infidelity and lead to the debasing of women. However, the teachings and beliefs of most religious traditions are various and complex, making it difficult to generalize virtually religious responses.
Valid? Research is a severely limited tool in assessing religious or ethical appropriateness. Studies accept shown, however, that religious concerns over family planning programs vary widely in developing countries, and that such programs are not incompatible with the beliefs of many. Thus it is not surprising that the bulk of couples in predominantly Catholic and Islamic countries use contraception. One important observation from research is that involving religious leaders in policy development has improved credence and understanding of family unit planning programs.
Lessons for Policy
Several lessons for guiding policy emerge from reviewing the criticisms and controversies surrounding international family planning programs.
- Since their origins in the 1960s, family planning programs in the developing world have not been static. They take evolved in response to valid criticisms, changing views of their needs and objectives, lessons from program assessment, and increasing knowledge most effectiveness in varying political and cultural contexts.
- Programs must proceed to adapt as the global challenges evolve. Approximately 1 billion adolescents--the largest cohort in history--volition before long be entering their years of sex activity and childbearing. They will exist among the growing numbers of individuals and couples seeking services. Satisfying their needs volition add considerably to the challenges of service delivery in the futurity.
- Adapting the health care rationale to electric current global conditions will require new organizational and financing arrangements. New combinations of reproductive wellness services, particularly those that accost HIV/AIDS and sexually transmitted diseases, will require reconfiguring services every bit well as new expertise, preparation, and financial resources.
- Governments and donor organizations should proceed to support the participation of women's groups and health advocates, whose criticisms have contributed to improvements in policy and program design.
- Research continues to be vital in agreement how and where programs take been most constructive, and in identifying future needs and how they might be addressed.
Notes
Population Matters is funded by the William and Flora Hewlett Foundation, the David and Lucile Packard Foundation, and the Rockefeller Foundation.
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