Last week I had the good fortune of being in Mexico for a PAI study tour of the country’s family planning and reproductive health (FP/RH) programs. Thanks in part to twenty years of U.S. FP/RH assistance (from the mid-1970s to the late-1990s), Mexico has made major improvements in the health of women and children and its demographic situation. Although challenges on these issues certainly remain, particularly in terms of the needs of its adolescent and indigenous populations, Mexico is a clear success story when it comes to the effectiveness of investments in voluntary family planning programs.
Consider a few statistics that underscore the progress Mexico has made. In 1970, a few years before Mexico initiated its national family planning program — with significant assistance from the United States and the United Nations Population Fund (UNFPA) — less than a quarter of women used contraceptives, average fertility rates were about seven children per woman, infant mortality rates were 69.0 per 1,000 live births, and average life expectancy was 62 years of age.
By contrast, today two-thirds of Mexican women use contraceptives, average fertility rates are 2.2 children per woman, infant mortality rates are 20.5 per 1,000 live births, and average life expectancy is 75 years of age.
In other words, as contraceptive use has skyrocketed and women have
been able to achieve their desired (smaller) family size, birth rates
and infant mortality rates have fallen by as much as two-thirds. Not
surprisingly, maternal mortality rates have dropped dramatically, too.
Fortunately, Mexico is hardly alone in these successes. Thanks in part
to pioneering U.S. family planning funding and technical assistance,
first begun in the late 1960’s, countries such as Egypt, Indonesia,
South Korea, Thailand and Tunisia have achieved major improvements in
the health and economic development of women, families and their nation
as a whole.
Unfortunately, the “job” of expanding access to voluntary FP/RH
services is far from done. In fact, more than 200 million women in
poor, developing nations who would like to delay or end childbearing
are not using modern contraceptives (PDF).
And demand for birth control is steadily increasing around the globe.
So the challenge today is to replicate the successes that have been
achieved in places like Mexico in those parts of the developing world
that are still beset by high infant and maternal death rates, lack of
knowledge and access to family planning, and the resulting high birth
and population growth rates: namely, sub-Saharan Africa and parts of
the Middle East and south Asia.
But replicating these successes is running into trouble because the
United States and other donor nations are investing far less in FP/RH
programs than they used to — and, most importantly, far less than is
needed. Current U.S. funding for international FP/RH programs is a
whopping 40 percent less than what we provided back in 1995 (when
adjusted for inflation).
Apparently, one of the reasons for this decline is that not enough
policymakers see the interconnections between voluntary family planning
and larger, more pressing humanitarian and foreign policy goals, even
though these linkages exist in everything from poverty and hunger to
security and climate change.
I think “what if” questions on these issues are fascinating and don’t
get the attention they deserve. For example, if Mexico’s birth rates
had remained where they were in the early 1970’s, its population today
would be about 50 million greater. That staggering 50 percent increase
(its population today is about 107 million) would certainly have major
negative ramifications in a country where widespread poverty still
compels millions of its citizens to risk their lives in a search of a
better life in the United States. And it obviously would have a
significant impact on the United States as well.
It’s these types of interconnections that policymakers need to think
about when deciding how much to invest in international FP/RH
programs. Unfortunately, it seems that most of them don’t think about
these links, and because of that we all pay a price — from the micro
level of the women themselves and their quality of life to the macro
level of the future sustainability of our world.
So, one last “what if?” question before I wrap up. What happens in
terms of global population if access to voluntary family planning
doesn’t improve and birth rates remain where they are today? If that
happens, we will likely grow from 6.7 billion people to just under 12
billion by 2050. In other words, we’ll add the equivalent of the
entire world population in 1990.
Do our policymakers really think this would be a good thing?