I was visiting my family in Kent in southeast England. I rounded a bend and there was a queue of cars and trucks. Obviously an accident. I bumped over the median, read my map, and found another route. Another vehicle queue as far as I could see.
Another accident? No. This was a tiny part of the traffic held up by desperate migrants fighting to get through the Channel Tunnel. My five-hour trip that should have taken 90 minutes was a miniscule discomfort compared to the years of misery that make 3,000 migrants waiting in Calais risk their lives clinging to trucks on trains traversing the Tunnel.
The suffering of the migrants, along with a fear that humanitarian services will be overwhelmed, consumes the British media and gets frequent coverage in the US press. Yet by mid-century, today’s flow of migrants will seem a trickle compared to the tsunami of involuntary migrants who will be forced by global warming and rapid population growth to move elsewhere.
My focus in the School of Public Health is on the Sahel – the semi-arid zone below the Sahara, stretching from the Atlantic to the Red Sea. In 1950, 30 million people lived in this region. Today, it is 125 million. The U.N. medium population projection for 2050 is 321 million and still exploding. In addition, climatologists predict that by 2050 climate change in the Sahel – already a hot region – will wither the crops and kill the cattle.
I want to ask, why the billions of overseas aid given in the past 50 years to the world’s poorest counties (including those in the Sahel) has done so little to relieve the abject poverty and lack of job opportunities that drives young men to risk their lives to find employment.
I see the neglect of family planning, along with a stubborn unwillingness to accept the impact of rapid population growth, as perhaps the greatest policy folly of the development community of the past 50 years. Obviously, this is only one factor among several contributing to the lack of progress in the least developed countries, but failure to invest in family planning prevents other aspects of socio-economic development from taking off. Conversely, family planning offers women the autonomy that is their birthright. It helps create a more prosperous and peaceful world. It reduces maternal and infant deaths. Children from small families are more likely to enter and to stay in school.
The default position for a normal heterosexual relationships is a large family. Whether rich or poor, educated or uneducated, most women will have many children unless they are given the means and information to separate frequent sex from childbearing.
I like to quote the example of Queen Victoria. She was the richest woman in the world and well educated. She was 4’11” and childbirth was dangerous and painful. She thought breastfeeding was ‘disgusting’ and she never wanted many children. But she had nine babies in 21 years of a normal loving marriage – for exactly the same reason an average woman in Niger today has 7.6 children – lack of access to the information and means to separate a normal frequency of sexual intercourse from childbearing.
As the first Medical Director of the International Planned Parenthood Federation (IPPF) in the 1970s, I witnessed the launch of many voluntary family planning programs. In South Korea population growth had been more rapid than growth in income per capita. The Ministry of Finance poured money into the Ministry of Health to subsidize family planning. Voluntary family planning was a stunning success, turning a poor country into an Asian economic Tiger. Today, Korean women have an average of 1.8 children and the per-capita income is higher than it was in the UK only a few decades ago. There are no unemployed Korean men risking their lives to cross the Sea of Japan in rickety boats to seek better jobs in Tokyo.
Although nearly all heterosexual couples use contraception many people prefer to avoid talking about such an earthy subject. At a family planning conference in Bucharest in 1974, Mr. Karan Singh, leader of the Indian delegation, made lot of friends by coining the aphorism, ‘Development is the best contraceptive.’
The best contraceptive? The best development?
Many policy makers continue to cling to the flawed paradigm that development is the best contraceptive.
In 1993 I sat next to Mr Karan Singh at a conference in New Delhi when he admitted, “I have learnt that contraception is the best development.” If he had come to the conclusion earlier, India might have avoided the obscenity of coercive sterilization. Karan Singh’s boss, Prime Minister Indira Gandhi, had been taught that development is the best contraceptive. Believing this to be true she faced a dilemma. She was realistic enough to enough to know that socio-economic development was not going to happen in the poor parts of India. In the later 1970s her government began to give financial incentives for sterilization. Almost immediately these morphed into the obscenity of coercive sterilization.
I know that contraception is the best development because I have seen the power of family planning to change lives and to change society. Not only in Korea, but in the villages of Bangladesh, Thailand, Iran, Sri Lanka and many other countries I have learnt that if you respect women and offer them family-planning choices, family size will fall, even among illiterate, low-income families.
But “development is the best contraceptive” persists despite evidence to the contrary. The Harvard economist Jeffry Sachs has written, “impoverished families choose to have lots of children.”
Obviously, he has not been to an abortion ward in any African hospital as I have so many times. Every year 6,000,000 African women risk their lives to end an unwanted pregnancy, and a horrifying 26,000 woman die from unsafe abortions (equivalent to the death of every undergrad — male and female — on the Berkeley campus every year). Women who die from abortion were not choosing “to have lots of children.” Like Queen Victoria they simply have not been given the means and information to separate a normal frequency of sexual intercourse from conceiving more children than they want.
A recent study commissioned by Population Matters finds that over the past half century the international community has invested $400 billion in the 20 least developed counties having the highest birth rates, explicitly or implicitly buying into the “development is the contraceptive” paradigm. Only an astonishing miniscule 0.31% of these huge sums has gone into explicitly family planning activities. More emphasis on family planning would not have solved today’s migrant crisis, but it would have made it easier to solve.
Time for a reset?
If a policy doesn’t work after half a century and $400 billion, you would think it was time to try something new. “Development is the best contraceptive” has failed. Sachs helped create the Millennium Development Goals (MDGs), which guided development policies over the past 15 years.
The No.1 MDG goal was to eradicate poverty and hunger, but in many of the least developed countries, the absolute number of people living on $1.25 a day (the UN definition of poverty) is greater than ever before. By omitting the imperative of making information and access to family planning a central item of the development agenda, Sachs and others have contributed to the population momentum, which is one driver of the growing number of involuntary refugees.
At the 1994 Cairo International Conference on Population and Development, a small group of women advocates demanded that the focused family planning programs should be replaced with a broad range of sexual and reproductive health goals. The rhetoric was that all family planning before 1994 had been intrinsically coercive.
Family-planning budgets collapsed. Kenya will have 12 million more people in 2050 than it would have had if this policy switch had not occurred – when I first visited Kenya in 1969 the total population was 12 million. Worst of all, nothing was done to even begin family planning in some of the least developed countries, and as a result a great deal of population momentum has built up.
Slowing rapid population in a human rights’ framework is imperative and achievable. But if a mega-humanitarian disaster is to be avoided in the least developed countries, hundreds of millions of dollars will need to be invested immediately to make family planning realistically available. In the Sahel, where child marriage is common, billions will need to set aside to keep girls in secondary school.
One African proverb says, “The best time to plant a tree is 20 years ago; the second best time is today.” To ameliorate the suffering of economic migrants and ecological refugees in the second half of this century, today has arrived.