Monica Das Gupta John Bongaarts John Cleland Shareen Joshi Family Planning Programs for the 21st Century: Rationale and Design Reconsidered Monica Das Gupta John Bongaarts John Cleland Shareen Joshi

Outline of talk Why discuss family planning, not female education? Rationale for family planning programs. Review literature on: Does rapid population growth affect developing countries prospects of economic growth? Does rapid population growth affect prospects of sustainable management of resources? Are family planning programs effective? The donor retreat & its implications: The donor retreat Implications for Sub-Saharan Africa Implications for women’s health Designing family planning programs: Strengthening the supply of services Building demand for services Conclusions

Section 1 why discuss family planning, not female education?

Why discuss family planning, not female education? Female education strongly associated with lower fertility and better outcomes of many kinds But well-established in the policy arena, Well-recognized private & social returns By contrast, family planning relatively neglected by donors Less awareness of its intrinsic benefits & positive externalities World Bank (2009) notes its support for population nearly disappeared

Percent of donor expenditures on population assistance by activity, 1995-2007 Source: UNFPA 2003:Table 5, UNFPA 2009:Table5

Section 2 the Rationale for family planning programs: a literature review

Coale-Hoover ― rapid population growth hinders economic growth 1a: Does rapid population growth affect developing countries’ prospects of economic growth? Coale-Hoover ― rapid population growth hinders economic growth (in poor, agrarian 1950s India): Resources diverted from investment in production to meet needs of: Growing population Rising youth dependency ratios Studies challenging these models ― and rationale for family planning programs (cross-country regressions 1960s to 1980s) Recent studies indicate: Low dependency ratios: can increase productivity, invest in future growth Household-level: lower fertility ass with better health, schooling, laborforce participation Population increases associated with lower growth in per capita income Rapid population growth can constrain economic growth, especially where policy settings hinder productivity rise Throughout, broad consensus that policy & institutional settings are key driver of economic growth, while population growth rate plays a secondary role.

Innovation obviates population pressure on resources: 1b: Does rapid population growth affect prospects of sustainable management of resources? Innovation obviates population pressure on resources: Population growth induces innovation Innovation makes resource base effectively infinite (Simon) Constraints to innovation: Where resources are free or under-priced Difficulties of managing use of global common property resources

Intensive agriculture has contributed to the proliferation of dead zones Source: World Bank (2010a) World Development Report 2010: Map 3.4 (derived from Diaz and Rosenberg 2008).

Required growth in agricultural productivity Source: World Bank (2010a) World Development Report 2010: Figure 3.5 (derived from Lotze-Campen et al 2009). We thank Dr Lotze-Campen for disaggregating the “business as usual” scenario into two estimates: (1) with population held constant at the 2005 level, and (2) the WDR 2010’s “business as usual” scenario, which includes anticipated population increase to 9 billion by 2055.

1c: Are family planning programs effective? (Pritchett): fp programs little effect on fertility Controlling for desired family size Mass media found effective at reducing desired family size Major component of fp progs Randomized evaluation data virtually non-existent But many careful studies indicate fp programs reduce fertility

Section 3 implications for Sub-Saharan Africa implications for women’s health

2b: Implications for Sub-Saharan Africa

Trends in fertility by region, 1960-2010 Source: UN 2009

% increase in population aged 0-14, 1970-2005 Source: UN 2009

Changes in per capita food production, 1961-2005 Source: The Royal Society 2009: Figure 1.4

Growth in GDP per capita, 1960-2004 Source: World Bank 2007b: Figure 2.5, derived from the World Bank World Development Indicators database  Note: GDP per capita index 1960=100

Fertility decline helps improve women’s health: Ratio of Male to Female Mortality, India, 1970-1990

Section 4 Designing family planning programs

Section 4: Designing family planning programs Strengthening the supply of services Strengthening the demand for services

Population projections for sub-Saharan Africa Maintaining one less birth per woman reduces projected population size in 2050 by half a billion Source: UN 2009

Section 5: Conclusions