Family Planning: A Key to Prosperity

John Bongaarts

Yet international support for such programs has not kept pace with the need for family planning. As a result, many developing countries, particularly in sub-Saharan Africa, continue to face rapid population growth and other impediments to social and economic development.

Cross-posted with permission from the Population Council.

See all our coverage of the 2012 Global Family Planning Summit here.

Family planning programs are highly cost-effective, have demonstrable poverty-reducing effects, and provide important health and human rights benefits to those who would otherwise have trouble achieving them. Yet globally, funding for such programs has not kept pace with the need. As a result, many developing countries, particularly in sub-Saharan Africa, continue to face rapid population growth that jeopardizes social and economic development.

While family planning may be treated as a political football in the U.S., the good news is that international support is growing. In recent years, donors have demonstrated a renewed interest in family planning, and new research has proven that high-quality voluntary family planning programs advance economies and improve health. International family planning conferences in 2009 in Kampala and 2011 in Dakar drew unexpectedly large turnouts. And major donors like the Gates Foundation, the World Bank, and the UK Department for International Development have voiced new commitments to the issue.

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But much more must be done.

Some 215 million women in the developing world do not want to get pregnant but are not using an effective method of contraception, resulting in unintended pregnancies and preventable maternal and infant deaths. The poorest parts of the world — where individuals are already struggling to overcome hunger — will see continued population growth of more than 70 million per year. The population of sub-Saharan Africa is expected to increase by 1 billion by 2050. And high unemployment and inequality among rapidly growing young populations are contributing to the spread of political violence and civil strife.

Research shows that family planning does more than provide health benefits; these programs also reduce poverty and improve lives:

  • First, by reducing the birth rate, family planning programs can create a “demographic dividend” that boosts economic growth for a few decades by increasing the size of the labor force relative to both young and old dependents, and by making it possible for people to save money. About a third of the rapid economic growth rates experienced in recent decades by East Asian tiger economies is the result of this dividend.
  • Second, slower population growth allows families and communities to invest more in providing quality education and health care and to improve infrastructure. Children who are healthy and educated are primed to become productive adults who can help to fuel the economy.
  • Third, when women are able to plan and space their pregnancies, they can invest more in each family member. And women who have fewer children have more time to earn wages outside the home, which boosts family income and quality of life and reduces poverty.

The benefits of family planning can be seen clearly in controlled and “natural” experiments. One of the most compelling controlled experiments demonstrating the benefits of family planning is the landmark project undertaken by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in the Matlab district of Bangladesh. The Matlab population of 173,000 people was divided into two areas: an experimental area, where access to high-quality family planning services was greatly expanded to include home visits, a wide array of contraceptive choices, and follow-up care; and a control area, which received the standard set of less-intensive services that were available country-wide.

Population Council research showed that the impact in the experimental area was large and immediate: contraceptive use increased markedly, fertility declined rapidly, and women’s health, household earnings, and use of preventive health care improved. Children living in households that received family planning outreach were more likely to survive to the age of five and to attend school than were children from households that did not participate.

The program was so successful that it was expanded across the country. Today, Bangladesh is widely recognized as a world leader in family planning.

“Natural” experiments, which compare two countries with similar social, economic, cultural, and religious characteristics – but with differing approaches to family planning programming – also demonstrate the powerful impact of voluntary family planning. One very recent example of this can be seen in Rwanda and Burundi. The two countries share many cultural and social characteristics, and their development indicators are similar. But in the early 2000s, the government of Rwanda renewed a lagging commitment to family planning, and with strong support from international donors, sharply increased access to contraceptive methods throughout the country. In just five years, fertility dropped from 6.1 births per woman in 2005 to 4.6 in 2010. Family planning has not been a policy priority in Burundi, and fertility remains at 6.4 births per woman. The sharp ongoing fertility decline in Rwanda substantially improves the prospects for development in that country.

In both Bangladesh and Rwanda, we have learned that robust, high-quality voluntary family planning programs are important policy responses for improving the lives of people in developing countries. And in other countries that adopted voluntary family planning programs—such as Indonesia, Kenya, and Iran —economies, public health, and standards of living are improving.

The argument for investing in family planning is persuasive: women and children, communities, and societies all benefit. Family planning should be a high policy priority and should be seen not only in terms of its benefits to people’s health and rights, but as a critical investment in economic development and higher living standards.

Keys to prosperity infographic

Click here for PDF of the family planning infographic.

Commentary Politics

In Mike Pence, Trump Would Find a Fellow Huckster

Jodi Jacobson

If Donald Trump is looking for someone who, like himself, has problems with the truth, isn't inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn't understand health care, and bases his decisions on discriminatory beliefs, then Pence is his guy.

This week, GOP presumptive presidential nominee Donald Trump is considering Mike Pence, among other possible contenders, to join his ticket as a vice presidential candidate.

In doing so, Trump would pick the “pro-life” governor of a state with one of the slowest rates of economic growth in the nation, and one of the most egregious records on public health, infant and child survival, and poverty in the country. He also would be choosing one of the GOP governors who has spent more time focused on policies to discriminate against women and girls, LGBTQ communities, and the poor than on addressing economic and health challenges in his state. Meanwhile, despite the evidence, Pence is a governor who seems to be perpetually in denial about the effects of his policies.

Let’s take the economy. From 2014 to 2015, Indiana’s economic growth lagged behind all but seven other states in the nation. During that period, according to the U.S. Department of Commerce, Indiana’s economy grew by just 0.4 percent, one-third the rate of growth in Illinois and slower than the economies of 43 other states. Per capita gross domestic product in the state ranked 37th among all states.

Income inequality has been a growing problem in the state. As the Indy Star reported, a 2014 report by the United States Conference of Mayors titled “Income and Wage Gaps Across the US” stated that “wage inequality grew twice as rapidly in the Indianapolis metro area as in the rest of the nation since the recession,” largely due to the fact “that jobs recovered in the U.S. since 2008 pay $14,000 less on average than the 8.7 million jobs lost since then.” In a letter to the editor of the Indy Star, Derek Thomas, senior policy analyst for the Indiana Institute for Working Families, cited findings from the Work and Poverty in Marion County report, which found that four out of five of the fastest-growing industries in the county pay at or below a self-sufficient wage for a family of three, and weekly wages had actually declined. “Each year that poverty increases, economic mobility—already a real challenge in Indy—becomes more of a statistical oddity for the affected families and future generations.”

In his letter, Thomas also pointed out:

[T]he minimum wage is less than half of what it takes for a single-mother with an infant to be economically self-sufficient; 47 percent of workers do not have access to a paid sick day from work; and 32 percent are at or below 150 percent of the federal poverty guidelines ($29,685 for a family of three).

Despite the data and the struggles faced by real people across the state, Pence has consistently claimed the economy of the state is “booming,” and that the state “is strong and growing stronger,” according to the Northwest Indiana Times. When presented with data from various agencies, his spokespeople have dismissed them as “erroneous.” Not exactly a compelling rebuttal.

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As a “pro-life” governor, Pence presides over a state with one of the worst infant mortality rates in the nation. Data from the Indiana State Department of Health reveals a “significant disparity” between white and Black infant mortality rates, with Black infants 1.8 times more likely to die than their white counterparts. The 2013 Infant Mortality Summit also revealed that “[a]lmost one-third of pregnant women in Indiana don’t receive prenatal care in their first trimester; almost 17% of pregnant women are smokers, compared to the national rate of 9%; and the state ranks 8th in the number of obese citizens.”

Yet even while he bemoaned the situation, Pence presided over budget cuts to programs that support the health and well-being of pregnant women and infants. Under Pence, 65,000 people have been threatened with the loss of  food stamp benefits which, meager as they already are, are necessary to sustain the caloric and nutritional intake of families and children.

While he does not appear to be effectively managing the economy, Pence has shown a great proclivity to distract from real issues by focusing on passing laws and policies that discriminate against women and LGBTQ persons.

He has, for example, eagerly signed laws aimed at criminalizing abortion, forcing women to undergo unnecessary ultrasounds, banning coverage for abortion care in private insurance plans, and forcing doctors performing abortions to seek admitting privileges at hospitals (a requirement the Supreme Court recently struck down as medically unnecessary in the Whole Woman’s Health v. Hellerstedt case). He signed a “religious freedom” law that would have legalized discrimination against LGBTQ persons and only “amended” it after a national outcry. Because Pence has guided public health policy based on his “conservative values,” rather than on evidence and best practices in public health, he presided over one of the fastest growing outbreaks of HIV infection in rural areas in the United States.

These facts are no surprise given that, as a U.S. Congressman, Pence “waged war” on Planned Parenthood. In 2000, he stated that Congress should oppose any effort to recognize homosexuals and advocated that funding for HIV prevention should be directed toward conversion therapy programs.

He also appears to share Trump’s hatred of and willingness to scapegoat immigrants and refugees. Pence was the first governor to refuse to allow Syrian refugees to relocate in his state. On November 16th 2015, he directed “all state agencies to suspend the resettlement of additional Syrian refugees in the state of Indiana,” sending a young family that had waited four years in refugee limbo to be resettled in the United States scrambling for another state to call home. That’s a pro-life position for you. To top it all off, Pence is a creationist, and is a climate change denier.

So if Donald Trump is looking for someone who, like himself, has problems with the truth, isn’t inclined to rely on facts, has little to no concern for the health and welfare of the poorest, doesn’t understand health care, and bases his decisions on discriminatory beliefs, then Pence is his guy.

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.