Family planning: a life and death issue


Lowering fertility rates is equally as important as cutting death rates in developing countries, writes John Gibbons

CLIMATE CHANGE and the related global sustainability crisis are processes driven first and foremost by human activity. Finding humane methods to quickly halt and then reverse our spiralling population is no less urgent than reversing CO2 emissions. A glaringly obvious place to start would be to facilitate people in only having the children they choose to have. Yet, for a multiplicity of reasons, this is just not happening in many countries.

As Unicef has stated, effective family planning would bring the most benefits to the most people more cost effectively than any other technology.

Despite its overwhelming efficacy, and its key role in controlling diseases such as Aids, family planning remains largely a taboo subject. It is also highly politicised. In 1984, the then president Ronald Reagan changed US policy to cut off funds to any organisation applying for USAid funding which was involved in any way, even peripherally, with abortion.

This so-called "gag rule" also effectively gagged most aid organisations from even offering advice on contraception. This rule was revoked by the Clinton administration, yet promptly reinstated by George Bush within weeks of his taking office in 2001.

By 2002, US Aid had ended contraceptive shipments to 16 countries under the notorious gag rule.

Under the guise of being anti-abortion, the ideologically driven US neo-conservatives have attacked and undermined legitimate family planning efforts. In so doing they have helped fan the flames of the Aids epidemic, which now kills 6,000 Africans every day, and creates millions of orphans in the process.

Concerns about population control being coercive also colour the debate. China's "one child" policy introduced in the 1970s is a case in point. Understandably this heavy handedness turned many people against any form of family planning.

Squeamishness about contraception is not a uniquely American phenomenon. While many Catholics in Ireland and elsewhere in the western world have quietly ignored church teaching on contraception, it still holds huge sway in the developing world.

Trócaire is the overseas development agency of the Catholic Church in Ireland. Trócaire states that it envisages a world "where people have control over their own lives". Yet, in line with church policy, the organisation steadfastly ignores the single intervention that could most empower many desperately poor families - the ability to control their own fertility. Trócaire's ban extends to not providing condoms even to prevent the transmission of Aids.

Concern, another major Irish-based charity, is non-denominational. Yet it too says that it "does not support abortion, contraception, sterilisation or population control programmes".

Breda Gahan, Concern's global HIV/Aids programme adviser, explains that the organisation's position is less black and white than the above statement would suggest. "All preventive options, including delaying sexual intercourse among youth, reduction in the number of sexual partners and condoms are promoted to reduce risk of vulnerability of people to infections such as HIV and Aids", says Gahan.

John O'Shea of Goal says: "Our experience on the ground keeps us busy enough with the problems of those already in the world. It's not the role of an NGO like ourselves to act as a moral enforcer or thought police".

While many NGOs skirt anxiously around the issue of family planning, a recent editorial in the British Medical Journalpointed out that "demand for contraception increases when it becomes available accessible and accompanied by correct information about its appropriateness and safety".

An important question arises here: can governments and aid agencies really wash their hands of their responsibility to actively promote and foster family planning? They are not neutral players in the population explosion in the developing world. As Breda Gahan points out: "When Concern went into Bangladesh in 1972, there were around 60 million people; now it's more like 150 million - we're a part of that".

There is absolutely no question but that aid agencies do tremendous good in providing essential aid to people in desperate need; however, these well-intentioned interventions, unless matched with well organised and funded family planning, may be unwittingly tilting countries like Bangladesh into overpopulation and ecological catastrophe. It is a classic example of the law of unintended consequences.

Irish Aid, our Government agency for overseas aid, accepts there is a serious imbalance when it states: "High population growth, largely due to an unmet need for family planning, exacerbates the cycle of poverty and ill health".

The solution to the population crisis lies in matching dramatically lower death rates with a similar drop in fertility rates. At least two in five pregnancies in the developing world are unplanned, so the need is very real. The work of many aid agencies is akin to a lifeboat rescuing people from the sea; unless we also address why people are falling in in the first place, it's only a matter of time before the lifeboat itself becomes overloaded and all are lost.

• John Gibbons is founder of