Sharply rising energy and food prices have once again raised the spectre of the human population outstripping the planet's natural resources. Ever since Malthus, pessimists have believed that mankind is doomed due to overpopulation and over consumption, while optimists have argued that technological innovation will improve standards of living and that population growth is at most a minor issue (Lomborg, 2001 and Ehrlich, 2005). While this renewed debate at the global level receives widespread media attention, another less visible but equally important discussion of the impact of demographic trends and policy options is under way among the leaders of the least- developed countries. A large majority of these leaders agree that population growth and birth rates are too high (United Nations, 2007). In many developing countries, these concerns have led to action. Since the 1960s, alongside efforts to increase educational opportunity and improve health conditions, the main policy response to concern about rapid population growth has been the implementation of voluntary family planning programs that provide information about, and access to, contraceptives.
In the developing world, 137 million women who don't want to get pregnant are not practicing contraception (United Nations, 2007). The key cause of this unmet need for contraception is that contraception is often quite costly to individuals in terms of commodities (pills, condoms, Intrauterine devices (IUDs) etc.), transportation, and provider fees for contraceptives and health care services, even when subsidies are provided by the government. Therefore, this paper seeks to discuss whether family planning programmes are obsolete and alternative programmes must be derived in amelioration of high fertility in sub-Saharan Africa.
It will start by defining key terms that will be used in the discussion, and discuss possible reviews of family planning programmes from countries that have effectively implemented and observed the changes thereof. It will also outline the alternatives to family planning programmes and other possible solutions. Then it will state the extent to which the author agrees to the statement that family planning programmes are obsolete, and thereafter draws a conclusion.
According to Lynn (2011), the term "family planning" generally refers to methods undertaken that allow women to control when they get pregnant. Frequently, family planning refers to hormonal birth control, such as the pill, injectable birth control, birth control patches and implants. Condoms, contraceptive sponges, diaphragms and spermicide are also frequently used as family planning methods. Finally, natural family planning, also called the rhythm method, requires no pills, hormones or devices. Instead, women monitor their menstrual cycle and refrain from sex during times of the month when conception is most likely to occur.
Total fertility rate represents the number of children that would be born to a woman if she were to live to the end of her childbearing years and bear children in accordance with current age-specific fertility rates (UN, 2011).
The choice of voluntary family planning programs as the principal policy instrument to reduce fertility has been based largely on the documentation of a substantial level of unwanted childbearing and an unsatisfied demand for contraception (Casterline and Sinding, 2000). Family planning programs provide a win-win solution. The welfare of individual women and children is improved, and the national economy and environment benefit. The international consensus on this issue is reflected in the Millennium Development Goals, specifically in Target 5.b. to provide universal access to reproductive health by 2015 and to reduce the unmet need for family planning (United Nations, 2009).
Therefore, USAID has undertaken a project to document the success of the family planning programs in three countries in Sub-Saharan Africa over the past 10–20 years and to identify which program interventions led to that success. The three countries selected for analysis are Ghana, Malawi, and Zambia, all of which have shown considerable growth in contraceptive prevalence and significant fertility decline despite a challenging environment and limited resources (ACQUIRE Project, 2005).
The three countries had all achieved success in their family planning programs, as evident in the increases in contraceptive use and the decreases in the total fertility rate (TFR). However, there had been notable differences in the speed of these changes, in the equity of improvements, and in rural-urban or regional disparities. For example, while the contraceptive prevalence rate (CPR) increased in Zambia to about 23% nationally, it varied greatly by province, from a low of 7% in Luapula Province to highs of 37% and 40% in Copperbelt and Lusaka Provinces. This can be explained in part by the fact that programs had primarily focused on these more densely populated urban areas because they could show the greatest impact of their programs. In Ghana, CPR ranged from lows of 8% and 10% in Northern and Upper East to highs of 25% and 26% in Brong-Ahafo and Greater Accra. For Malawi, there was minimal regional variation, although at the district level the CPR varied from about 16% in Salima to 38% in Blantyre (Ibid).
In all three countries, the CPR was higher in urban areas than in rural areas. For example, in Ghana, the CPR in urban areas was 24%, compared with 15% in rural areas. In Zambia, the urban rate was almost three times as high as the rural rate (39% vs. 14%). It was notable that Malawi had seen the most significant increase in rural areas, with the CPR having increased from 6% to 24% between 1992 and 2000, whereas in urban areas the CPR rose from 17% to 38%.
The existence of a high level of unmet need for contraception convinced many policymakers that family planning programs would be acceptable and effective. This conclusion is supported by results of such experiments as the one conducted in the Matlab district of rural Bangladesh (Cleland et al, 1994). Initially, family planning programs received minimal support in Zambia: “Politicians didn’t see family planning as part of development but as part of the white man’s efforts to control the growth of the black population.” In addition, a number of factors contributed to high fertility in Zambia, such as low educational levels, desires for large families, high levels of infant and child mortality, and low levels of family planning knowledge and use (ACQUIRE Project, 2005).
A shift occurred in Zambia in the early 1990s, however, as the reintroduction of multiparty democracy brought about a number of changes, including health-sector reform. The Population Policy of 1989 also signalled changing attitudes toward family planning, highlighting that overall economic development depended on lowering fertility, and that family planning was good for the welfare of the mother and the child, and that information and access to family planning services was a fundamental human right (Ibid).
Another convincing illustration of the impact of voluntary family planning is the program introduced in Iran in 1989. Free contraceptive services were provided throughout the country by an extensive network of village health workers. The response was immediate and large: Fertility declined from more than five births per woman in the late 1980s to just two in 2000. No other country experienced a decline of that magnitude during the 1990s. While it is likely that some fertility change would have occurred without these new services, the unprecedented pace of the fertility decline argues for a substantial impact of the program (Roudi-Fahimi, 2002).
By the end of 2006, a cumulative total of about 25 million individuals had died of AIDS. The death toll will reach much higher levels in the future because 33 million individuals are currently infected and many new HIV infections are occurring each year. Despite the substantial mortality from AIDS, UN projections for all developing regions, including Africa, predict further large population increases. This is because the annual number of AIDS deaths (two million) is equivalent to just 10 days' growth in the population of the developing world. The population of Sub-Saharan Africa is expected to grow by one billion between 2005 and 2050. In fact, high AIDS mortality is not expected to cause a decline in the population of any African country between 2005 and 2050. Even with the steady future declines in fertility assumed by the UN, most populations in Sub-Saharan Africa are projected to more than double (UN, 2007).
Unfortunately, funding for family planning programs has faltered for more than a decade. Between 1995 and 2008, while funds committed by donors and developing countries to HIV and AIDS programming increased by nearly 300%, funds devoted to family planning declined by some 30%. As a result, many countries are less able to provide family planning services today than they were a decade ago, and much of the earlier commitment has waned. There are indications that fertility declines are levelling off or even being reversed in some countries (Bongaarts, 2008).
Family planning programs have had a major and unambiguous impact on fertility rates in most countries where it’s been effectively implemented, therefore, to a large extent, family planning programmes are not obsolete if effectively implemented and sensitised to all people in the country. This is because ignorance is the root cause of all evils. Ignorant people generally have a large number of children. They believe it to be the business of God to bestow as many children on them as He likes. They do not want to interfere with the work of God. This wrong notion must be uprooted from the masses. By educating them we can help them to realize that they can control their families in different ways (Chaterjee, 2012). Family planning may seem to be obsolete due its 30% decline in donor funding which is now focused on AIDS, hence the governments of the developing countries are not adequately funding it.
Increasing girls’ education is an important support to family planning programs as well as an alternative. Education is consistently linked with higher use of contraception and lower fertility. Many education programs explicitly include lowering fertility as one of their goals (ACQUIRE Project, 2005).
In conclusion, family planning programmes are to a very large extent not obsolete, much of today's discussion about family planning programs, a principal instrument through which population policies have been implemented over the past 50 years, is based on faulty perceptions and misinformation. Large-scale national family planning responses to unprecedented rates of population growth were an invention of the mid-20th century, and for the most part they have been remarkably successful. Family planning programs have had a major and unambiguous impact on fertility rates in many countries, and they are highly cost-effective. The cost of averting births is small in comparison with the savings those averted births represent to families and countries.