The global family planning revolution: three decades of population policies and programmes
Matthews Mathai a
The birth control movement initially focused on the individual woman and her well-being. However, falling death rates in the twentieth century, without a similar reduction in numbers of births, led to concerns about the adverse effects of large populations. Actions were taken in different countries to tackle the potential problem of population explosion. For example, in 1952, India developed its first national family planning policy. Around the same time, the International Planned Parenthood Foundation and the Population Council were established, thus marking what is arguably the start of the modern family planning movement.
Using case studies from 23 countries, this book chronicles the history of family planning in the second half of the twentieth century, more specifically between the 1950s and the 1980s. The authors of these case studies are pioneers who share their experience, often first hand, in establishing family planning programmes. The enthusiasm of the initial approaches, the disappointments and challenges which led to the evolution of successful programmes are covered well. What emerges is that there is no single global strategy for success: multiple approaches are required for successful programme implementation.
The statement “Development is the best contraceptive,” made by Dr Karan Singh at the World Population Conference in Bucharest in 1974, highlighted a change of thinking and the need for a more balanced approach to population control. Social development had a role in reducing the fertility rate at this time by creating a more conducive environment. By the mid-1990s, however, the focus had moved from the narrow area of family planning to reproductive rights and reproductive health.
The book also documents the change in donor interest in family planning over time. Initially, these activities were supported by private foundations in the United States of America. Later, the governments of the USA and of some European countries (Sweden, in particular) provided large-scale funding for family planning programmes. Also, the World Bank recognized that rapid population growth is a major hindrance to development and provided assistance; and the United Nations Fund for Population Activities (UNFPA) was set up to support family planning programmes. More recently, however, funding for population growth issues from the USA has decreased.
The bulk of the book consists of 23 country case studies, one per chapter, that document the promotion of family planning in these settings. The information provided is not easily accessible elsewhere and give an insider’s view into the major events that have contributed to the evolution of the programmes. All the case studies use a similar format: a box presented near the beginning of each provides a quick overview of the major events that have influenced the family planning programme in the country concerned, followed by a detailed description and analysis of the situation. That roughly half the case studies deal with Asia reflects the early uptake of family planning programmes in this continent. In contrast, only two case studies are from sub-Saharan Africa.
This book should interest all who work in the area of public health, policy and programme implementation. The experience of implementing family planning programmes in the 23 countries that it reports provides useful information that can be applied in other countries. Moreover the lessons learned from the global experience in a controversial but integral part of primary care will be useful when the world faces other priority health challenges against a background of limited resources. ■
- Making Pregnancy Safer, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.