The Fruits of Birth Control

January 04, 1994

Conventional wisdom has its uses. Relied on too glibly, however, it can blind us to richer understandings of reality. Such is the case with the usual demographic explanations for population growth.

Demographers have long linked falling fertility rates to rising economic prosperity. There is ample evidence that prosperity brings with it a lower birth rate, lower death rates and a relatively stable population. For years, this thinking helped shape foreign-aid policies. The idea was to jump-start economies of impoverished countries, then wait for soaring birthrates to fall as the development strategy took hold.

A new study by three demographers, including Bryant Robey of Johns Hopkins School of Hygiene and Public Health, challenges that view. The study notes that poor countries with reasonably effective family planning programs are seeing dramatic drops in fertility before economic prosperity spreads. Contraceptives, these observers say, are the best contraceptive.

While that pronouncement may strike many people as simple common sense, it's important to note that this particular bit of wisdom also must be seen in context. The size of a family is not determined only by poverty or prosperity, or even by contraceptives alone. It is, rather, the product of conscious decisions and desires of a couple, together with the means to implement that decision.

But common sense about birth control has often fallen victim to ideology. A prime example was the Reagan and Bush administrations' denial of U.S. aid for international family planning programs that were suspected of tolerating abortion. Now the Clinton administration has reversed that dangerous policy. But there is little time to waste if world population is to stabilize at a sustainable rate.

Surveys have produced informed estimates that as many as 125 million women of reproductive age would like to postpone pregnancy or already have all the children they want. They want birth control but have no access to it. Meeting this demand for contraceptives, which would cost about $16 per year for each couple, would have a dramatic effect on world fertility rates.

That approach demands fresh thinking and major shifts in foreign aid and economic development priorities, but the change is overdue. Policy makers have never attempted to postpone basic health programs until economic development strategies took root. So it seems foolish to single out family planning programs, which can have as much bearing on the physical health of a family as clean water or an adequate diet.

The stakes in this debate are enormous. World population will stabilize one way or the other. But will it happen before pressures on the environment and on frayed political systems become too great?

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