As policymakers, donors, and advocates gather in London for the second Family Planning Summit on World Population Day, amidst the biggest drawback of United States support for global health, skeptics in U.S. Congress and more broadly need to understand that spending U.S. taxpayers’ money on family planning in far-away countries is well worth the investment. Why? The answer is simple: Because fewer unintended pregnancies make for richer, healthier, more peaceful, and less dependent countries, as well as fewer epidemics of deadly diseases that can potentially reach U.S. shores.
Despite the advantages of family planning programs, many oppose them on economic, moral, or nativist grounds. Here are three major arguments that advocates should consider using more frequently to convince such skeptics that family planning produces extensive benefits for poorer nations in the short term and is less expensive for Americans in the long run.
Reason 1: The demographic dividend
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When family planning usage increases and fertility declines, economic growth can follow. This is because workers need to support fewer children, which can lead to increased savings at both the family and national level. These savings, when combined with investments in education, health care, and effective macroeconomic policy, can lead to significant economic growth. For example, among the Asian Tigers, up to one third of economic growth from 1965-1990 is estimated to have resulted from the demographic dividend. And there are additional benefits as well: Lower youth unemployment, higher levels of education, and less fertile ground for extremism. Investing in family planning can reduce the future need for foreign aid, military intervention and counterterrorism measures.
Reason 2: Saving lives and preventing abortion
Family planning reduces the number of unsafe, illegal abortions and unintended pregnancies, thus reducing the risk of maternal mortality. It also leads to pregnancies that are spaced further apart, which confers advantages to women, infants, and older children. Research shows that cuts to family planning during the George W. Bush Administration led to increased numbers of abortions in sub-Saharan Africa. While some advocates have been too shy to argue for family planning as a means to prevent abortion, they need to overcome these hesitations in order to build stronger alliances with groups and countries who strongly oppose abortion. In the U.S., pro-life groups predominantly support Republican lawmakers, and thus can have significant impact on Congress as it formulates the 2018 budget.
Reason 3: Strengthening health systems
Historically, family planning programs have helped to strengthen health systems in developing countries and, in so doing, to assist those nations to deal with new and unexpected health threats. As I show in my new book, Intimate Interventions in Global Health, family planning programs in sub-Saharan Africa helped to prepare countries to address the HIV epidemic when it emerged in the 1980s.
Continuing to fund family planning, as well as global health more broadly, safeguards Americans and other wealthy donor nations from diseases — including Ebola, severe acute respiratory syndrome, Middle East respiratory syndrome, and many others — that emerge in generally poorer countries. Although this argument pains those — myself included — who would prefer wealthy countries to justify funding family planning programs on the grounds of improved reproductive health and rights, as well as altruistic obligations associated with their greater resources, branding family planning funding as a way to prevent the spread of infectious disease to the U.S. certainly has traction.
In Africa in the 1970s and 1980s, family planning programs funded by the U.S. and other countries led to the creation of NGOs before the HIV epidemic emerged. These NGOs, most of which were affiliated with the International Planned Parenthood Federation, Population Services International, or Marie Stopes International, were able to reach citizens on the village level and to serve as gatekeepers for culturally-sensitive conversations related to sex and reproductive health and behaviors. As I show in my book, countries with a family planning NGO that predated the HIV epidemic experienced statistically greater declines in HIV prevalence during the 2000s than countries without such an organization. Through their family planning outreach, groups such as the Society for Family Health and the Association for Reproductive and Family Health in Nigeria, the Association Sénégalaise pour le Bien-Être Familial in Senegal, and Banja la Mtsogolo in Malawi, gained the respect of citizens, and, in many cases, the trust of political and traditional leaders. This respect and trust increased their capacity to address HIV when it emerged.
Family planning programs also inspired the individuals who would work actively and effectively when the HIV threat emerged. Souleymayne Mboup and Ibraham Ndoye in Senegal convinced USAID to use family planning funds to support their laboratory for the study of sexually transmitted infections. This lab facilitated Dr. Mboup’s co-discovery of the HIV-2 virus and provided Senegal with global scientific legitimacy, which in turn fostered the willingness of politicians and religious leaders to respond to HIV. In Nigeria, Minister of Health Olikoye Ransome-Kuti spearheaded the 1988 population policy, which was supported by global donors before and after its creation. He then jolted Nigeria to attention about the problem of HIV in 1997 when, at the public funeral of his brother Fela, the famous Afrobeat musician, he announced that Fela had died of AIDS.
On this World Population Day, we need to advance new ways to convince skeptics that family planning is worth the investment. Advocates should use the demographic dividend to justify investments now in order to save money later. They should try to build new coalitions by stressing that family planning programs reduce abortion. And they should draw a lesson from history — that family planning programs strengthened health systems and, in turn, helped to lay the groundwork for HIV prevention — to encourage greater family planning investments in the name of stopping infectious disease threats before they reach our shores.
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