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The arguments against donor involvement in family planning: How valid are they? Monica Das Gupta Development Research Group The World Bank

The arguments against donor involvement in family planning: How valid are they?

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The arguments against donor involvement in family planning: How valid are they?. Monica Das Gupta Development Research Group The World Bank. Outline of talk. Background: the support for family planning from the 1960s - PowerPoint PPT Presentation

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Page 1: The arguments against donor involvement in family planning:  How valid are they?

The arguments against donor involvement in family planning:

How valid are they?

Monica Das Gupta

Development Research GroupThe World Bank

Page 2: The arguments against donor involvement in family planning:  How valid are they?

Outline of talk

1. Background: the support for family planning from the 1960s

2. Arguments underlying loss of donor interest in family planning from the 1980s

3. What happened in SubSaharan Africa while donors neglected family planning?

4. Conclusions: what needs to be done in SubSaharan Africa?

Page 3: The arguments against donor involvement in family planning:  How valid are they?

1. Background: the support for family planning from the 1960s

• From 1960s, strong movements to reduce fertility in much of the developing world:

– Driven (esp in Asia) by national governments deeply concerned by data showing their rapid population growth

– And strongly supported by donors till 1980s

Page 4: The arguments against donor involvement in family planning:  How valid are they?

E.g. India• 1961 Census shock with high rates of population growth

• And in early 1960s, serious food shortages

• So the government began work on: – increasing food production (Green Revolution)– massive family planning campaign to

• reduce demand for children through huge media effort• increase supply of free contraception

• Total Fertility Rate fell. 2006 DHS estimates:– Fertility at or below replacement level of 2.1 children per woman

in 10 states, and close to it in several more states – But in states of Bihar and Uttar Pradesh, current Total Fertility

Rate around 4. Significant pockets still have high fertility.

Page 5: The arguments against donor involvement in family planning:  How valid are they?

And e.g. China

• Faced similar problems of increasing food production and reducing population growth

• Started campaign to reduce fertility around 1969

• Politically feasible to have a program with very strong sanctions against non-compliance. Esp following the Cultural Revolution

• Fertility dropped like a stone

Page 6: The arguments against donor involvement in family planning:  How valid are they?

Fertility Decline in China, 1965-1992

1

2

3

4

5

6

7

1965 1970 1975 1980 1985 1990

Year

Tota

l Fer

tility

Rat

e

"One-Child" Policy

Fertility reduction campaign

Source: Yao and Yin (1994) Basic Data of China’s Population, Beijing: China Population Publishing House.

Page 7: The arguments against donor involvement in family planning:  How valid are they?

2. Then donors lost interest: What arguments underlay this shift?

1. Fertility declining across much of developing world, lowered donor interest (but Asian governments maintained strong programs)

2. Political shifts against family planning:a) Political and religious movementsb) Feminist movement to protect women’s Reproductive Health

instead of imposing family planning (let women make own choices)

3. Intellectual shifts:a) Argument that family planning programs don’t workb) Argument that population growth may not make much

difference to the prospects for economic growth:Human inventiveness will (at least in the long term) overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

Page 8: The arguments against donor involvement in family planning:  How valid are they?

2. Then donors lost interest: What arguments underlay this shift?

1. Fertility declining across much of developing world, lowered donor interest (but Asian governments maintained strong programs)

2. Political shifts against family planning:a) Political and religious movementsb) Feminist movement to protect women’s Reproductive Health

instead of imposing family planning (let women make own choices)

3. Intellectual shifts:a) Argument that family planning programs don’t workb) Argument that population growth may not make much

difference to the prospects for economic growth:Human inventiveness will overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

Page 9: The arguments against donor involvement in family planning:  How valid are they?

Argument 2b How best to improve RH?

Reducing fertility has huge impact on women’s reproductive health:

• adolescent health (reduce adolescent childbearing)

• maternal mortality

• maternal morbidity

• maternal depletion

Women’s mortality risk remains elevated for long after childbirth: a study in Bangladesh found that it is nearly twice as high as normal for up to two years after childbirth (Menken et al 2003)

Page 10: The arguments against donor involvement in family planning:  How valid are they?

Tre nds in the Ratio of Male to Fe male Mortality in India, 1970-1990

0.6

0.7

0.8

0.9

1

1.1

1.2

1.3

1.4

1.5

1.6

0 1 5 10 15 20 25 30 35 40 45 50 55 60 65 70

Age

Mal

e / F

emal

e ra

tio

in m

orta

lity

1970-1975 Male q(x)/ Female q(x)

1988-1992 Male q(x)/ Female q(x)

Source: Government of India, Sample Registration Bulletin 16(1), June 1982, and SRS Based Abridged Life Tables 1988-92, New Delhi: Registrar-General of India.

Page 11: The arguments against donor involvement in family planning:  How valid are they?

2. Then donors lost interest: What arguments underlie this?

1. Evidence of declining fertility across much of developing world, lowered donor interest (but Asian governments maintained strong programs)

2. Political shifts against family planning:a) Political and religious movementsb) Feminist movement to protect women’s Reproductive Health

instead of imposing family planning (let women make own choices)

3. Intellectual shifts:a) Argument that family planning programs don’t workb) Argument that population growth may not make much

difference to the prospects for economic growth:Human inventiveness will overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

Page 12: The arguments against donor involvement in family planning:  How valid are they?

Argument 3a:Family planning programs don’t workStudies show that:

• Merely increasing contraceptive availability may not reduce fertility

• But media campaigns have proved very successful at reducing desired family size and building demand for services – Much evidence of rapid uptake of idea that “smaller

families are happier families”– Reduced demand for children followed by increased

use of family planning

Page 13: The arguments against donor involvement in family planning:  How valid are they?

2. Then donors lost interest: What arguments underlie this?

1. Evidence of declining fertility across much of developing world, lowered donor interest (but Asian governments maintained strong programs)

2. Political shifts against family planning:a) Political and religious movementsb) Feminist movement to protect women’s Reproductive Health

instead of imposing family planning (let women make own choices)

3. Intellectual shifts:a) Argument that family planning programs don’t workb) Argument that population growth may not make much

difference to the prospects for economic growth:Human inventiveness will (at least in the long term) overcome the pressure on resources placed by population growth --- e.g. through greater efficiency in service delivery, higher productivity, technological innovation

Page 14: The arguments against donor involvement in family planning:  How valid are they?

Argument 3b: Rapid population growth may not affect

economic growth

How did this work out in China?

• Unique combination of development vision & ingenuity, and lack of political impediments to actualizing its vision

• From 1970, reduced fertility at blistering speed

• From late 1970s, blistering pace of: – economic growth– employment growth (manufacturing sector growth) – and poverty rates plummeted

• And yet even today, many decades later:– there are still significant levels of poverty in China

Page 15: The arguments against donor involvement in family planning:  How valid are they?

Poverty trends in China• During 1981-2004:

– the fraction of the population below the World Bank poverty line fell from 65% to 10%

– and the absolute number of poor fell from 652 million to 135 million

• But almost a third of China’s rural population was consumption poor in at least one year between 2001 and 2004(% of the rural population that was dollar-a-day consumption poor in one or more years)

Source: World Bank (2009) From poor areas to poor people: China’s evolving poverty reduction agenda

Page 16: The arguments against donor involvement in family planning:  How valid are they?

Argument 3b: Rapid population growth may not affect

economic growth

• Even in China, human ingenuity only mitigated (not negated) the impact of rapid population growth

• Countervailing forces: 1. Population growth increases pressure on resources2. Human ingenuity mitigates this effect

Optimal outcomes if combine effects of lower population growth + human ingenuity

Page 17: The arguments against donor involvement in family planning:  How valid are they?

3. What happened in SubSaharan Africa while donors neglected family planning?

• Fertility levels remain high in much of subSaharan Africa

• Rapid population growth

Page 18: The arguments against donor involvement in family planning:  How valid are they?

Fertility trends in SubSaharan Africa, 1970-2005

1

2

3

4

5

6

7

8

9

1970-1975

1975-1980

1980-1985

1985-1990

1990-1995

1995-2000

2000-2005

Tota

l Fer

tility

Rat

e

SSA Niger

Source: United Nations World Population Prospects: The 2008 Revision

Page 19: The arguments against donor involvement in family planning:  How valid are they?

Source: United Nations World Population Prospects: The 2008 Revision

% change in population aged <15 years, 1970-2005, China and SubSaharan Africa

-50

0

50

100

150

200

250

300

350

China SubSaharan Africa Niger

% c

hang

e 19

70-2

005

Page 20: The arguments against donor involvement in family planning:  How valid are they?

3. What happened in SubSaharan Africa while donors neglected family planning?

• Rapid increase in numbers shrinks the resources for investing in:– Human capital– Economic growth, to expand sources of

livelihood

• And poor Reproductive Health --- highest rates of maternal mortality

Page 21: The arguments against donor involvement in family planning:  How valid are they?

4. Conclusions:What can be done in SSA?

• The good news is that many countries in SSA show the beginnings of fertility decline

• So people increasingly want smaller families (despite donors and national govts)

• Can build on this changing demand for children and accelerate pace of fertility decline:

– Media campaigns to accelerate the fall in desired family size and build demand for services

Vast experience on this available from elsewhere, e.g. Mexico and India

– And expand supply of family planning services to respond to growing demand