The Economist is Stingy with Praise for Family Planning Accomplishments

By Marian Starkey, Director of Communications

The print edition of The Economist this week focuses on fertility and population. The lead story, "Falling Fertility" makes important connections between rapid population growth and poverty and the inverse relationship between population stabilization and economic growth. I was reading through the story, pleased with the facts covered, until I came to this paragraph:

In principle, there are three ways of limiting human environmental impacts: through population policy, technology and governance. The first of those does not offer much scope. Population growth is already slowing almost as fast as it naturally could. Easier access to family planning, especially in Africa, could probably lower its expected peak from around 9 billion to perhaps 8.5 billion. Only Chinese-style coercion would bring it down much below that; and forcing poor people to have fewer children than they want because the rich consume too many of the world’s resources would be immoral.

The well-meaning authors of this article are simply wrong here. If women around the world with an unmet need for family planning had affordable access to modern contraception, population growth could be slowing a heck of a lot faster. The authors also failed to disclose that the projection of 9 billion people in 2050 is dependent upon drastic fertility declines in the countries where population is growing fastest. So we're really talking about the difference between 9 and 11 billion (the projection if fertility rates stay the same as they are now), not 8.5 and 9 billion. And to suggest that any sane person supports a population policy that would force poor women to have fewer children so the rich of the world can consume more is just absurd.

The briefing, "Go Forth and Multiply a Lot Less" describes the global move toward replacement-level fertility (the level required for each generation to replace the last). This article at least mentions unwanted pregnancies and unmet need for family planning as factors in high fertility, but the reader is quickly diverted to discussion of girls' education--which is a proxy factor for lower fertility--and then reminded of the terrible coercion of China's one-child policy.

Another briefing, "The rich are different" quickly outlines the phenomenon of rising fertility in the developed countries that have higher gender equality than in the countries where fertility remains unprecedentedly low.

I hate to criticize whenever someone, especially a respected news source, pays attention to population issues, but I just had to point out a couple of the major flaws in the authors' arguments.

Here is the letter I sent in response to the lead article. Letters are published on Thursdays, so we'll see then if mine makes the cut. *Update: There were no letters printed about the fertility articles today. Maybe next week...

In “Go forth and multiply a lot less,” the UN medium population projection of 9.2 billion in 2050 is accepted as destiny. As The Economist surely knows, projections are dependent on assumptions. The scenario that would deliver a population of 9.2 billion is ambitious fertility decline starting now. In fact, projections range from 8-11 billion people, depending on how quickly fertility falls. If it drops drastically and soon, growth could stop at 8 billion; if fertility decline stagnates, population will still be growing at 11 billion in 2050.

Kenya’s fertility rate was declining impressively until a couple of years ago, when the country experienced a significant reduction in family planning aid. As a result, population projections for 2050 were doubled. Timing is everything because of the inherent momentum that keeps population growing even after “replacement level fertility” is achieved. The larger the base of women yet to reach their reproductive years, the larger the population will grow once they start having children.

The rapid fertility decline in Matlab, Bangladesh was precipitated by the availability of contraceptives, not higher incomes or better health—those followed as a result. Fertility drops when incomes rise because people can finally afford contraceptives. When contraception is available at no cost, all economic quintiles have similarly low fertility, as in Thailand and Vietnam. Educated women are, indeed, more likely to want fewer children. But they’re also more likely to be in economic positions that allow them to purchase contraceptives.

The article got most things right, but it simplified the role of family planning in fertility decline. Women want smaller families and tend to use contraception if they are educated about the methods and most importantly, if they have access. Sub-Saharan Africa continues to have high fertility because many women have no access. Donor countries have fallen shamefully short of the amounts they pledged for family planning assistance at the International Conference on Population and Development in Cairo in 1994. Every year that we under-fund family planning is another step closer to a world of 11 billion.

U.S. finally on board with progress

By Brian Dixon

Last week, the United Nations held a special session to commemorate the 15^th Anniversary of the International Conference on Population and Development (ICPD) and to review progress toward meeting the ambitious goal of ensuring universal access to family planning by 2015.

At this meeting, a U.S. official delivered an important statement reiterating that President Obama and Secretary of State Clinton are committed to expanding global access to family planning. He said, “The United States strongly supports the goals and ideals of the ICPD, and under President Obama’s leadership has renewed our commitment to work with the international community to implement the ICPD Program of Action.”

Such an expression comes after eight years of Bush administration actions designed to undermine progress on family planning. Speeches are nice and can be helpful, but actions are more important. To that end, we’ve been extremely pleased by the significant increases in international family planning that the president has called for and that congress is moving toward approving. We’re also very happy with the president’s decision to restore U.S. aid to the United Nations Population Fund (UNFPA) and to lift the harmful Global Gag Rule that barred U.S. assistance to some of the most experienced and effective providers of family planning in the developing world.

"Not Yet Rain" had advocates pouring in

By Rebecca Harrington, National Field Coordinator

On Thursday, October 15, we held a film screening in Columbus, OH, the first in a series of events for our Double the Money campaign. We showed the film Not Yet Rain at the well-loved Studio 35 Cinema and Drafthouse. A one-screen theater with a vintage feel, funky wall murals, and a cozy bar, the theater is a staple of Clintonville, a hip northern Columbus neighborhood.

For the screening, we partnered with the Columbus International Film and Video Festival and the local chapter of the Sierra Club. The Film Festival prides itself on 57 years of showing and granting awards to unique and edgy films. The Sierra Club chapter works on environmental issues specific to central Ohio.

A diverse and interesting crowd braved the Ohio cold to watch the film, chat with Population Connection staff and other guests, and to eat delicious food from the local Surly Girl Saloon, another Columbus favorite. In addition to discussing the film as a group and connecting with people at a reception following the screening, many of those in attendance signed our petition to Double the Money, and requested copies of the film to share with classes, groups, and friends.

A few especially memorable guests included a physician’s assistant student from Cleveland, who was grateful for (and startled by) all she’d learned from the film and discussion; an anthropology professor from Tennessee, who wants to screen the film with her classes; and a mother and daughter pair who are passionate about both the arts and women’s issues.

In addition to representing a diversity of interests, people of all ages attended the screening. Everyone was equally energetic and engaged, and the group melded nicely. Free dinner, beer, and cupcakes always brings a group together!

The screening was a great way to kick things off in Ohio, and we’re very much looking forward to our next event in Columbus.

Lots of Surprising Results

By Marian Starkey

The XXVI International Population Conference (IUSSP) ended last Friday in Marrakech and I am finally settling back into my normal office routine. I didn't have the greatest Internet connection while I was overseas so I neglected to post a final blog entry about the conference sessions. Here it is, a week late.

Climate change was a bigger topic of discussion at this conference than at other demography conferences I've attended in recent years. Brian O'Neil, who does population/climate research at the International Institute for Applied Systems Analysis (IIASA) in Laxenburg, Austria was supposed to present his research but was not able to make it to Marrakech at the last minute. His colleague, Leiwen Jiang, presented in his place. Basically what they've found is that aging has a negative effect on carbon emissions while urbanization and smaller households have a positive effect (in this instance, negative means "good" i.e. fewer emissions, and positive means "bad" i.e. more emisisons). They stress that although the number of people on earth does have an effect on emissions, more potent factors are the age structure and lifestyle choices of those people.

The Guttmacher Institute led a training session early on Thursday morning for demographers who wanted to learn to translate their research results into policy recommendations. Session panelists encouraged researchers to communicate their results by starting with the study conclusions and not getting bogged down in methodology, which lawmakers and program managers trust them to execute responsibly. I have to admit that sometimes at these conferences I wish demographers would spend more time presenting their results than their methods for the same reason. Their papers are usually available for download for those who wish to delve deeper into the study methods they used.

A few sessions focused on the demographic consequences of HIV/AIDS. Lori Hunter, who edits the journal Population and Environment, found that families in South Africa who have experienced the death of a family member due to AIDS were negatively affected in terms of food security. One person she talked to actually said, "Locusts are our new beef." Losing an adult in a family of dependents has severe destabilizing effects, both socially and economically.

Another researcher found that female infidelity in Africa might be more widespread than previously believed, based on the high number of couples in which only the woman was infected with HIV. The somewhat counterintuitive results also suggest that girls who attend school are at higher risk of contracting HIV because they are away from their families and experience more independence than girls who stay home.

Joseph Potter from the University of Texas-Austin presented a very interesting study of women in El Paso, TX who use the contraceptive pill. Those who traveled across the border to Mexico to buy pills over the counter for about $5 per pack had much lower discontinuation rates than women who got one pack at a time at the El Paso clinic for free. Only when women were given six packs or more at the clinic did their discontinuation rates drop to the level of the women who bought them at Mexican pharmacies. These results imply that increasing ease of accessibility (no clinic appointment) and providing multiple months of protection at a time increase the continuation rates of pill users.

A researcher from the American University in Cairo studied the fertility differences between Morocco and Egypt. She asked the question "Why is fertility decline faster in Morocco when Egypt has a higher Human Development Index?" She found that although desired fertility is higher in Morocco, later marriage and longer birth intervals make actual fertility lower. The fertility rate of educated women in Morocco is lower than equally educated women in Egypt.

As usual, the most valuable parts of being at this huge conference were the side conversations I had with people at lunch and during coffee breaks. I made a lot of new professional alliances and reinforced existing ones for Population Connection. I know that our info table also helped spread the word about our unique and important work. By the end of the week, only a few copies of The Reporter remained in my booth--everything else had been taken.

The next IUSSP conference will be in four years, location as yet undecided. I am already looking forward to it and will make sure to stock my table more heavily with the fun supplies that conference-goers like to take home: pens, tote bags, stickers, etc. For a serious bunch of researchers, they sure do like their freebies.

Eager to show off

By Marian Starkey

Marrakech presents itself as laid back and fast-paced all at once. Men lounge at cafes drinking sugary mint tea while motor scooters whiz by, nearly crashing into pedestrians and each other at every turn. Horns honk and donkeys bray, trying to be heard over the calls to prayer which blare throughout the city over loudspeakers five times a day. Still, everyone has a smile and is eager to help the tourists from France? England? No, USA! Ah, USA! New York? No, Washington, DC. Ah, Washington, welcome my friends!

I spent the last two days playing hooky to conference sessions and instead visiting various agencies and organizations around Marrakech and the surrounding towns. Yesterday, my bus got a police escort and a royal welcome at the reproductive health clinic about an hour southeast of the city. Town residents lined up along the streets for miles, waving us in. Doctors and staff at the clinic were eager to show us their beautiful facility at the foot of the Atlas mountains. Women who had just given birth proudly showed us their newborn babies. We were all impressed to hear that all services at the clinic, from family planning to safe delivery, are free. Perhaps clinics like this are the reason why Morocco has been so successful at reducing its fertility rate from over 7 to 2.4 in just four decades. The urban fertility rate in Morocco is just an even 2, lower than the U.S. rate.

Today I visited an intake center at the hospital for women and children victims of violence. Doctors were sensitive to the victims' privacy and did not allow us to tour the center, but were happy to answer many of our most pressing questions in the courtyard outside.

This afternoon, I went to a local orphanage for kids 5-18 years old. Many of the 80 residents were plucked from the streets where they had been abandoned by their parents and were begging for a living. They now attend school full time and share a loving home with dedicated staff.

I always expect program directors to exaggerate the success of the work they're accomplishing, but all three of these operations truly did seem to be improving the lives of the most vulnerable women and children who live in and around Marrakech.

Tomorrow it's back to the grind with back-to-back research sessions all day. Publications are flying off my info table too, which is a very good thing, not least because it means I won't have to lug them back to good old Washington, DC.

International Population Conference Day 1

By Marian Starkey

Greetings from Marrakech! I am here for the International Union for the Scientific Study of Population (IUSSP) conference, which happens in a different location every four years. This is the first time that the conference has been held in an African and/or Arab nation, and King Mohammed VI has been a very gracious host so far. He even invited the participants to a special dinner on Tuesday evening. Of course, there are 2,300 of us, so I'm guessing it won't be an intimate affair with lots of photo ops one-on-one.

The conference started today with side meetings, rather than typical research presentations. My first session was a follow-up to the research conference I attended in Ghana last September. It was fun seeing friends that I made a year ago and hearing about the success many of them have had in getting their papers published. There was also a request for more research in the future that could be translated into policy, which I was happy to hear.

The next session I attended featured our expert Board member, Duff Gillespie, as a panelist. The topic was training a new generation of reproductive health specialists and how to do that most effectively. Duff told the story of his own career (I learned that he actually trained in criminology before becoming a USAID career professional!). He criticized donors for neglecting population studies and identified this as the core reason why the field of demography is not sustainable. He called for a renewed interest in population studies by private donors and governments in order to keep the field alive.

The day ended with the official opening ceremony. We heard from IUSSP president, John Cleland; UNFPA director Thoraya Obaid; and several other panelists (who spoke in Arabic so I could not understand their addresses, unfortunately). Berber percussionists rounded out the evening with their energizing chanting, dancing, and drumming.

I got my information table set up this morning and by the end of the day all of the tote bags and pens that I brought were gone! Hopefully now that the "fun" freebies are gone, people will feel compelled to pick up a copy of The Reporter or some of our educational materials.

More tomorrow, after I visit a local reproductive health clinic...

Is family planning a carbon mitigation panacea?

By Marian Starkey

Several newspaper articles have covered the release of a report about family planning and climate change from Optimum Population Trust (OPT), an organization in the UK. I have been posting those articles on our website's "News" page. The attention has now reached a critical mass and now it's time to comment.

The study claims to prove that meeting all unmet need for family planning is a more cost effective way of reducing carbon emissions than are other "green" technologies. To do this, the researchers calculated how many tons of carbon will be emitted between now and 2050 without meeting unmet need. They also determined how many tons of carbon would be emitted if unmet need were met (i.e. if there were fewer people emitting carbon). Then they subtract the latter from the former to calculate the difference in tons of carbon emitted between the two scenarios. Finally, they divided the total cost of providing family planning to the women with unmet need for the next 40 years by the number of tons of carbon that would be avoided by meeting unmet need. This is the cost per ton of carbon mitigated, which they estimate is $6.46.

The press releases have all stated that OPT commissioned the London School of Economics (LSE) to do the research, which leads one to believe that world-class faculty researchers are behind the paper. This is not the case. The research paper was actually written by a student at the LSE with the help of a non-faculty supervisor.

While population stabilization is obviously crucial to solving the climate crisis, there are a few methodology issues in this study that must be addressed. Here are the biggest ones, in descending order of importance:

• The figure used for current unmet need--201 million women--refers only to women in the developing world. The authors calculate the proportion of people in the world with unmet need by dividing 201 million by the current world population--6.8 billion (the result is 3%). They assume that this proportion of "unmet need" equals "demand for family planning," which they hold constant for each year between now and 2050 for their cost-benefit analysis. Of course, demand for family planning is not actually the same as unmet need, and is much greater than 201 million women worldwide.
• Then they take a figure from Guttmacher Institute, again for developing countries only, that unintended births could be reduced by 72% if all unmet need in the developing world were met. They apply this figure to every country in the world, including developed countries. Meaning, for example, that they assume that women in the United States who have unintended births would have 72% less if only they had access to contraception. The problem with this methodology is that in most developed countries, most women do have access to family planning if they want it. So spending an additional $22 per woman (the estimated cost of providing contraception to a woman in the developing world each year) on contraceptive supplies will probably not actually reduce the percentage of unintended births by very much. In the United States especially, more money must be spent on teen pregnancy prevention and reproductive health education. Indeed, the most prevalent answers women give in the U.S. for becoming pregnant accidentally are that they didn't expect to have sex and they didn't think they could become pregnant. Spending more money on birth control pills would not help these women. Education and better preparation would.
• It is not clear which population projection was used for the scenario in which unmet need is not met. The authors simply state that the projection came from the UN. The UN produces several projections based on different fertility and mortality assumptions and it would be helpful to know which one was used for this study. * Correction: the author directed me to a footnote that I overlooked, which stated that the medium UN population projection was used.
  

Having said all this, the discussion of the role of family planning in climate change mitigation is long overdue. Indeed, any serious effort to combat global climate change simply must include a commitment to universal access to family planning and contraceptives.

Is it even possible to have a more equitable distribution of emissions with a decent standard of living in a world of 12 billion people or more? It will already be hard enough in a world of 8 or 9 billion. Right now, in our world of 6.8 billion people, too many are not using enough carbon to sustain healthy, productive lifestyles. Yet, we are still raising the concentration of carbon in the atmosphere to dangerous levels.

The per capita emissions in wealthy countries have to be dramatically reduced. But, at the same time, in some developing countries, per capita emissions will have to increase if people are to meet their most basic needs. Reaching that balance that allows everyone a healthy quality of life while protecting the environment will be a challenge made even more difficult by a growing population.

Meeting the existing unmet need for family planning is an important and cost-effective way to help meet the climate crisis. But, it alone will not solve the problem. In fact, the author found that only 9.3 gigatons of carbon emissions would be averted over the next 40 years, which is just a little more than what we currently emit globally in one year. But it must be part of any thorough discussion on mitigation strategies and any rational discussion on climate justice.