Population Toxification, Part II

How Family Planning Lost its Way

Contrast the blindness about human numbers now commonplace on both left and right with the wisdom of Martin Luther King, Jr. In a speech upon acceptance of the Margaret Sanger Award from Planned Parenthood in 1966, King decried the “modern plague of overpopulation.” “Family planning, to relate population to world resources, is possible, practical and necessary,” he said. “What is lacking is not sufficient knowledge of the solution but universal consciousness of the gravity of the problem and education of the billions who are its victims.”

During the heyday of family planning programs from 1960 through the mid-1990s — a progressive interregnum when pro-natalists seemed to lose the upper hand — much was made of the fact that handing out contraceptives and making abortion available did not lead necessarily to lowered rates of fertility. Such initiatives were necessary but not sufficient to reduce the number of children born in high fertility countries.

What was needed, as MLK made clear, was education. But it was a particular kind of education, targeted to both males and females, that emphasized that in a poor society there was an inordinate cost to having too many children: the lifelong burden it imposed, the health effects on mothers, the poverty in which it threatened to entrench parents, and the suffering it was likely to produce in children themselves, as society failed to expand services to meet the demands of exploding numbers.

The central tenet of family planning in its original iteration during the 1960-1995 period was the active promotion of E.F. Schumacher’s idea that small is beautiful, less is more, fewer babies means grown kids who are better treated, better educated, and better served by society, with parents who can better attend to them. The message was taught in community centers, schools, and people’s homes. It went out on television, radio, and in magazines, and was found on street posters, in brochures, on billboards, bumper stickers, coasters, calendars, and, in the case of Singapore, key chains. Typical slogans in India in the 1970s: “Have only two or three children, that’s enough”; “Big family: problems all the way; small family: happiness all the way.” In Bangladesh: “Boy or girl, two children are enough.” In South Korea: “Stop at two, regardless of sex.” In China: “Later, longer, fewer” — conceive later in adulthood, wait longer between pregnancies, and have fewer of them.

In 1977, researchers in the Matlab district of Bangladesh, a poor rural river-delta region, conducted a twenty-year field study comparing a control area where residents received only the basic family planning services available nationally and an experimental area that was provided a more proactive outreach program. The latter included “free services and supplies, home visits by well-trained female family-planning workers, and comprehensive media communication,” reported demographer John Bongaarts, vice president of the Population Council, in the journal Nature. “Outreach to husbands, village leaders and religious leaders addressed potential social and familial objections.” The benefits of what came to be known as comprehensive family planning, he concluded, were “clear-cut.”

“Contraceptive use jumped from 5% to 33% among married women of reproductive age in the experimental area. In the control area, little changed. As a result, fertility declined rapidly in the experimental area,” wrote Bongaarts. “Among the long-term consequences of this difference were the children in the experimental area being educated to higher levels, families having greater household assets, and the greater use of preventive health services.”

So it went in dozens of countries where comprehensive family planning was implemented, with total fertility rates plummeting and education, development, and per capita income rising — but only when the planning program included a broad public communications effort that actively sought to dissuade couples from having more than two kids.

By 1973, even a war criminal such as Robert McNamara, standing at the pinnacle of the national security and world government bureaucracy during the 1960s and 1970s, saw the unequivocal need for humane and voluntary family planning on a global scale. “The population problem,” said McNamara when he was president of the World Bank, “must be faced up to squarely and seen for what it is in fact — the greatest single obstacle to the economic and social advancement of the majority of the peoples in the developing world.” I happen to have on my shelf his slim 1973 book One Hundred Countries, Two Billion People (it has an air of innocence in a world that has passed eight billion), in which he reports that the successes of comprehensive family planning had shattered many of the myths that had arisen to buttress opposition to it. “This collection of myths obscure the essentials of the problem,” he remarked. “Worse still, it builds barriers to constructive action.”

McNamara noted, for example, the “generalized assumption that somehow ‘more people means more wealth’,” observing instead — and correctly — that “rapid population growth tends seriously to retard growth in per capita income,” so that “the developing nation soon discovers that its economic vigor is diminished rather than enhanced by the phenomenon of high fertility.” Similarly, he dismissed as “absurd” the much-trafficked notion that “family planning programs are sinister plots to coerce poor people into doing something they really do not want to do…The prevalence of voluntary illegal abortion should be enough to dispel that fiction.” (In India during 1973, according to McNamara, as many as a quarter million women were undergoing illegal abortions each month.) “The poor do not always know how to limit their families in less drastic and dangerous ways,” he wrote, “but there is overwhelming evidence that they would like to know how.”

Then he got to the crux of the matter:

All of us accept the principle that in a free society the parents themselves must determine the size of their own family. We would regard it as an intolerable invasion of the family’s rights for the state to use coercive measures to implement population policy…Millions of children are born without their parents’ desiring that it happen. Hence, a free, rational choice for an additional child is not made in these cases. If we are to keep the right of decision in the hands of the family, where it clearly belongs, we must give the family the knowledge and assistance required to exercise that right.

**

Twenty years later, at the 1994 International Conference on Population and Development in Cairo — which turned out to be a watershed moment in population politics — McNamara’s argument was turned on its head. The message in what came to be known as the Cairo Consensus was that for Westerners to suggest women have fewer babies was itself a tacitly coercive measure that objectified women’s bodies and violated their reproductive rights. Any demographic concern was a veil for “gendered power relations,” any talk of population control conjured a nefarious cabal of white male Western elites — a conspiracy of the McNamaras of the world promulgating a cold Malthusianism.

Jane O’Sullivan, an agricultural scientist and demographer at the University of Queensland in Australia, has observed that the turn toward identity politics at Cairo signaled a tragic lost opportunity. It also led to the rewriting of history into a false narrative. Given that some instances of human rights abuses had indeed occurred in the name of family planning — one-child-only policies in China after 1980, forced sterilization in India during the 1970s — the reproductive rights focus and elevation of women’s interests was widely welcomed, said O’Sullivan, but it should have been seen as synergistic with the demographic goals essential for socioeconomic development. Instead, she told me, “the architects of the new agenda recast the deeply humanitarian motives of the family planning movement as a predatory northern agenda against the global south.”

Diana Coole, a professor of political and social theory at the University of London, observed that post-Cairo any environmental argument for stabilizing human numbers was seen as “advancing misogyny, racism, eugenics, nationalism and colonialism.” According to Coole, “the population issue became not just a volatile field rent by competing geopolitical interests and ideologies but also a shameful, morally indefensible, discourse.” At the same time, she observed, “identity politics was silencing legitimate biodemographic worries.”

This silencing-by-identitarianism has had real-world consequences, none of them good. In the U.S., it took the form of environmental NGOs like the Sierra Club abandoning principled positions on stabilizing U.S. population because of the fraught issue of immigration, with manufactured charges of racism and xenophobia besetting organizations terrified of a backlash that would chase off donors. Internationally, funding for comprehensive family planning, which was always meager, dropped away in the 1990s as the Cairo Consensus took hold in policy rooms, and the programs were now seen not as integral to the development agenda but reduced to peripheral activities of health departments.

In many developing countries where average family sizes had been falling, the pace of fertility decline slowed down or stalled; in some countries such as Egypt and Indonesia, fertility rebounded and rose. Kenyan demographer Alex Ezeh documented the stall in East African countries, noting the massive impact on future population growth. By 2020, Kenya already surpassed the population it should have reached in 2050 if it had followed the UN’s 1998 projections, calculated before the stall was recognized. Since 2012, there has been some renewal of effort under the Family Planning 2020 project (now Family Planning 2030) instigated by Melinda Gates, but the program failed to raise contraceptive use faster than the growth in numbers of women with unmet needs. Meanwhile, the world faces an unrelenting increase of roughly 81 million people a year, with unintended pregnancies still greater than 40 percent globally.

Truth, O’Sullivan told me, has been the great casualty of Cairo. It’s well-documented that promotion of a small family norm is far more effective than investing in any indirect driver of fertility decline, such as educating girls or reducing poverty – yet this isn’t mentioned anymore. “Shifting the motivation for family planning from demographic concerns to women’s rights,” O’Sullivan told me, “has starved reproductive health services and undermined women’s rights.” Malcolm Potts, an obstetrician and family planning veteran from the University of California at Berkeley, reflected, “The ultimate tragedy is [that] Cairo has actually left women worse off.”

The greater tragedy is that the delay in fertility decline will have added billions to the global population by the time it peaks, considerably raising the risk of mass suffering and perhaps mass mortality events if current trends hold. The people whose numbers are growing the fastest, in sub-Saharan Africa and the Middle East primarily – and the growth there is due in no small part to the gutting of comprehensive family planning – will see their children and family members suffer the worst as the effects of population pressure and climate change compound each other.

There has been no subsequent International Conference on Population and Development since 1994, and the Cairo documents have been declared sacrosanct and unimpeachable. “The U.N. has not allowed any opportunity,” said O’Sullivan, “to interrogate its legacy.” In that context, it may be that the “anti-Malthusian” paradigm dominant today, driven by northern identity politics, is more of an imposition of northern ideology on poor people of the south than the family planning agenda ever was.