Population trends today are a highly contested issue that emerge in a range of related debates: climate change; development; environmental sustainability; migration and, in the case of the advanced industrial nations like the UK, ageing. Often they are either cast simplistically as the amplifier of all society’s problems or simply omitted from the debate, deemed politically inflammatory.
We need public engagement on population growth and its effects. At the moment it can be cast as the bête noir of public discourse, because no one wants to be accused of being Malthusian or neocolonialist. In the developed world, where people have access to information, education and services, women have been empowered and are able to choose smaller families – and population growth has declined. The developed world does not want to be seen to be dictating to developing countries, where population growth still continues at a rapid pace in some areas.
The UN predicts that global population will increase between 35–60 per cent by 2050 from today’s levels, reaching either 8.0, 9.2 or 10.5 billion in their low, medium and high estimates. Over 95 per cent of this increase will take place in developing world regions. So the distribution of population growth is what really underwrites concern with population increase, since it is concentrated in poor countries that are already struggling to meet the social and economical needs of their citizens.
The extent of this global population increase by 2050 will depend significantly on political will today to invest in women across the developing world. The difference in global fertility of just half a birth higher or lower over the next 40 years will dictate whether the global population will reach the low or high projections in 2050 of 8 or 10.5 billion respectively. Yet today, despite rising unmet need and demand for family planning services, funding has dropped by 30 per cent in real terms since the mid nineties.
From statistics to rights
While many in the sector are familiar with the history of the population question, few working outside it know of the critical paradigm shift that underpinned family planning services in global development resourcing. In 1994, at the International Conference on Population and Development in Cairo, health advocates and women’s rights activists shifted the conceptual framework from something primarily driven by demographic targets for fewer people to human rights concerns centred on individual health and well being. Talk of ‘human numbers’ was out and ‘reproductive health’ was in.
The change came through engagement with women in developing countries and advancing their interests in international fora.
The Cairo agenda was developed as a rational response to the draconian programmes experienced in some parts of East and South Asia in the 70s and 80s (notably in China and India), designed explicitly to limit fertility and slow population growth. These programmes gave family planning a bad name. There is little resemblance between today’s provision of family planning and reproductive health programmes and those of pre-Cairo. ‘Population control’ is a misnomer for the 21st century: the guiding principles of service provision today are high quality, culturally appropriate and most importantly, voluntary and rights-based in nature.
While the quality of service has dramatically improved as a result of this paradigm shift, indicators in maternal wellbeing, fundamentally dependent on the ability of women to determine their reproductive behaviour, have not improved. This contrasts dramatically with the great gains recorded in slowing the rates of HIV infection, consonant with the massive injection of resources over the past decade.
Over half a million women globally still die from pregnancy and thousands more are left disabled in childbirth every year, some morbidly so. I recently visited the Addis Ababa Fistula Hospital, in Ethiopia, to see the wonderful work being done to restore the health and dignity of thousands of women. Words cannot express the trauma and distress I witnessed. Young girls curled up in the foetal position, doubly incontinent and unable to walk, due to obstetric fistula. It is a moral outrage that millions of women are allowed to suffer like this, in the 21st century.2
At least 200 million women, many of whom have very high fertility and who would like to delay or prevent their next pregnancy have no access to contraceptive services.
Cost and cost-effectiveness
It would cost in the region of three and a half billion dollars to provide universal contraceptive services to women around the globe, a pinch in comparison with other development or political initiatives. Furthermore, the cost effectiveness of this type of investment is almost unparalleled. Family planning is known amongst medical practitioners as a unique intervention in the breadth of benefits it offers not only a woman, and her household but also at the community, sub national and national level.
The contribution of population growth issues to climate change is highly topical and controversial. Population trends are not the main driving force of climate change at the moment, but they will make emissions abatement goals in 50 years time much harder to come by. There are implications in the immediate to medium term for rapid population growth rates which, emerging evidence indicates, exacerbate human vulnerability to the impacts of climate change in developing countries.
Demand for family planning has never been higher, yet the funding for this area has dried up and public recognition of its importance as a development and rights issue is limited.3
We need to promote open and rational debates on the issues and challenges raised above, most obviously through media, in order to rally public opinion to secure the rights of the world’s poorest citizens to something that every man and woman in the West takes for granted.
It is, in general, extremely difficult to generate media interest in issues around sexual reproduction and human rights, gender and women’s empowerment, which are not seen as newsworthy. In the developing world, female constituents often do not have any or very little education, information or services and have little or no status in the community. They do not have a consciousness of ‘needs’ or ‘rights’ and as a result can not shout loud enough for politicians to hear and legislate.
In the UK, the most powerful advocates are constituents who have votes. People should write to their MPs about these issues to make their voices heard. Parliamentarians will respond to such powerful lobby.
There are important win/win synergies to be gained by delivering reproductive autonomy to women across the world. Closing the gap between desired and unplanned pregnancy offers policy makers something that on first glance appears to be a political danger zone, but on closer inspection presents too many advantages to continue to disregard.
1 See UK All Party Parliamentary Group on Population, Development and Reproductive Health (2009) Better off Dead?
2 See UK All Party Parliamentary Group on Population, Development and Reproductive Health (2007) Return of the Population Growth Factor- Its impact upon the Milennium Development Goals