Economists have long debated the relationships between population growth, economic growth, and poverty alleviation. The most famous argument was made by Thomas Malthus, who famously predicted that human population growth would outpace food production, deplete fixed resources, and keep most people in abject poverty.
In the modern era, Malthusian fears intensified after World War II, when newly independent colonies experienced rapid population growth. Modern family-planning (FP) technologies began to be heavily promoted. Proponents of these programs argued that FP programs contribute to fertility decline, which in turn promotes economic growth, reduces environmental pressures, reduces dependency ratios, and strengthens a society’s ability to invest in health and education. Critics of the programs, however, over time began to question these assumptions and instead argued that many programs do not actually succeed in lowering fertility at all, violate human freedoms, and involve unnecessary health risks. By the year 2000, however, the voices of the skeptics were so strong that the pendulum swung in the complete other direction. FP almost disappeared from the international policy agenda and support for FP programs diminished to the lowest levels since 1950. The UN’s Millennium Development Goals, agreed to by nearly all nations in 2000, did not even mention family-planning.
While policy debates on this issue have been quiet in recent years, academics continue to push ahead. Micro-research now confirms that well-designed and voluntary programs can indeed have broad benefits for women and their families. My forthcoming paper in the journal Demography with Paul Schultz (Yale University) is one such study. We examine a program in Matlab, Bangladesh that was established in 1977. Community health workers visited married women in their homes once every two weeks to offer a choice of contraceptives. Nearby centers treated childhood diseases, maternal health problems, or complicated side-effects from the use of contraceptives. The program also provided other health services such as vaccinations and treatment of early-childhood illnesses. We find that over 30 years, the program had profound effects: Fertility declined by about 15%, child mortality (particularly for girls) decreased, and there were broad improvements in women’s health as measured by their weights, BMIs, and risks of premature mortality. The program also led women in the program area to use preventive health inputs more frequently for themselves and their children.
So the question that emerges here is whether governments should subsidize and promote family planning technologies in the world’s poorest places? The programs are not cheap, but my research suggests that such interventions lead to broad improvements in well-being, and so are worthy of policymakers' consideration. Family-planning should be treated the same way as women’s education: Whether or not women use it, having the opportunity is valuable in its own right for it expands women's choices, opportunities, and freedoms. The key challenge is to make sure that programs are voluntary, integrated into broader systems of health care delivery, and do not expose anyone to health risks.
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