The best way to slow population growth is by ensuring that all people have the means and the power to make real choices about childbearing. That means access to family planning and other reproductive health services. It also means addressing the economic and gender inequities that limit choices for so many of the world’s people.
Sexual and reproductive rights are human rights. In 1994, 179 nations adopted the Cairo Program of Action at the International Conference on Population and Development (ICPD) in Cairo, Egypt. The Program of Action recognized “the basic rights of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so.” It also recommended that all countries provide comprehensive reproductive health care, including family planning; safe pregnancy and delivery services; abortion where legal; prevention and treatment of sexually transmitted infections; information and counseling on sexuality; and elimination of harmful practices against women such as genital cutting and forced marriage.
Coercive policies are unnecessary, counterproductive, and wrong. The fear of devastating global climate change is reviving calls call for “population control.” But one has only to look at China’s one-child policy and the forced abortions that accompany it or India’s forced sterilization of millions of poor men and women during the 1970s to see the human rights violations that inevitably flow from population control programs. And coercion often backfires. A brutal policy of forced sterilization of poor Peruvian women in the 1990s produced a backlash by the Religious Right, and a setback for reproductive rights.
Programs that are consistent with the ICPD agenda lead to lower fertility rates. Programs that respect and embrace sexual and reproductive rights lead to positive outcomes, including lower birth rates. In the late 1990s, the government of Bangladesh expanded its focus on family planning to include more comprehensive services such as emergency obstetric care, HIV/AIDS prevention, and work with young couples. After only two years, the proportion of women receiving prenatal care increased from 26 percent to 56 percent, contraceptive prevalence rose from 50 to 58 percent, infant mortality declined by 24 percent, and the total fertility rate dropped from 3.3 to 3.0—a substantial reduction for such a short time span.
Gender inequality fuels population growth. Population growth rates have fallen in most of the world but remain high where poverty and gender inequality are most intractable. Where women are denied education, secure livelihoods, property ownership and the full legal and social rights of citizenship, they are forced to rely on childbearing for survival, status, and security. In many parts of the world, girls and women are forced into early marriage and/or childbearing either by the subtle pressure of social norms or by the overt coercion of threats and violence. Empowering women is the key to slowing population growth. When women have more control over their lives, they have healthier, smaller families and invest more in each child.
The unfinished revolution. Although the Cairo approach has spurred real change, the revolution remains unfinished. Funding for family planning and other elements of reproductive health (except HIV/AIDS) has fallen sharply since the mid-1990s. Because of the shortfall in public funding, shocking inequities persist in the reproductive health of rich and poor, both within and between countries. A 2003 survey by the United Nations found that most countries still lack comprehensive sexual and reproductive health programs. President Obama’s decision soon after taking office to restore U.S. funding for the United Nations Population Fund was an important step in the right direction. Still, some 200 million women in developing countries lack access to family planning services, and every year, pregnancy-related complications kill half a million women, one every minute. The time for a restored commitment to the Cairo agenda is now.
- Family planning is key to slowing population growth. Since the international family planning movement was launched in the mid-1960s, contraceptive use in the developing countries increased from less than 10 percent to nearly 60 percent, and average fertility fell from six children per woman to about three.
- Since the mid-1990s, funding for reproductive health services has declined worldwide. Today, some 200 million women in developing countries lack access to family planning services.
- Complications during pregnancy are the leading cause of death globally for young women aged fifteen to nineteen, and women die of pregnancy-related causes at a rate of about one per minute, or approximately 536,000 maternal deaths worldwide in 2005.
- Almost 74,000 women die from unsafe abortion every year, and at least 5 million others suffer serious injuries.
- Nearly half the young women in south Asia are married before the age of eighteen. Girls who are married in their teens have more children, on average, and both they and their children fare worse than children of older mothers.
- One year of female schooling reduces fertility by 10 percent, according to the World Bank. Women with formal education are much more likely to use reliable family planning methods, delay marriage and childbearing, and have fewer and healthier babies than women with no formal education.