A response to critics of family planning programs.

Sharply rising energy and food prices have once again raised the specter of the human population outstripping the planet's natural resources. Ever since Malthus, pessimists have believed that mankind is doomed due to overpopulation and overconsumption, while optimists have argued that technological innovation will improve standards of living and that population growth is at most a minor issue. 1,2 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 birthrates are too high. 3 Potential adverse effects include poor health among women and children, slow economic growth and poverty, overcrowded schools and clinics and an overburdened infrastructure, as well as the depletion of environmental resources. 4 In addition, high unemployment and inequality among rapidly growing young populations may contribute to the spread of political violence and civil strife. 5–7 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. This policy has permitted women and men to control their reproductive lives and avoid unwanted childbearing. Only in rare cases, most notably in China and briefly in India, has coercion been used. 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. 8,9 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. 10 Despite this long-standing and widely accepted rationale for voluntary family planning programs, funding for these programs has declined by 30% since the mid-1990s. 11 A number of reasons can be cited, including the (in our view, mistaken) claim that the need for such programs has declined, given the significant progress made in reducing fertility, especially in …