Family Planning

Organized efforts at family planning began to appear in the nineteenth century although, as in the case of France, some forces were at work earlier. The nineteenth-century efforts were started by individuals concerned with the poverty and malnutrition that seemed to be endemic among large families. Governmental bodies initially paid little attention to such efforts, and when they did they often opposed the advocates of family planning. In the United States, for example, governmental agencies such as the post office in the last part of the nineteenth century classified family planning materials as pornography. At the beginning of the twentieth century, President Theodore Roosevelt compared women who avoided pregnancy to men who refused to serve in the armed services in time of great national emergency. He argued that U.S. women had a patriotic duty to have children. Not until the last part of the twentieth century did governments in general take direct or indirect action to encourage family planning. This concern came primarily because of a growing concern about overpopulation, but it also reflected the growing influence of women on national policy.

At the beginning of the Industrial Revolution in the eighteenth century, the world population was estimated at 750 million. With growing urbanization and industrialization, growth escalated rapidly, reaching one billion in 1830, two billion in 1930, three billion in 1960, five billion by 1990, and six billion in 2000. It will probably continue to grow— unless there is radical change in trends—until 2020, after which a slow decline will begin. The growth, as indicated above, is due to declining mortality as the standard of living and sanitation have improved and communicable diseases controlled. The most rapid growth has not been in the highly industrialized countries but in those that have not yet industrialized. As the standard of living has risen in Western Europe, the United States, and similar countries, the fertility rate by 1990 had already fallen below two and in some as low as one and three-tenths (Green 1992).

Most countries have relied on education in family planning to lower fertility rates, although more drastic means have also been used. In India, for example, the government of the late Indira Gandhi was forced to cut back on their program because it was alleged that sterilization was being forced on the less educated peasants. The problem of overpopulation is compounded in many of the underdeveloped countries because the largest segment of their population is in the childbearing years. In these places, even with the more or less drastic lowering of fertility ratios, population will continue to grow. The People's Republic of China in the 1980s became the first country in the world to embark on a deliberate and comprehensive course to reach zero population growth by the end of 2000 or as soon after that as possible. In spite of drastic efforts to limit families to one child, forcing families in the cities to get permission to even try to get pregnant, and the use of drastic sterilization and abortion programs, the country failed to meet its goal, and its population in 2001 was nearly 1,300,000,000. It is, however, well on its way to doing so, and soon it will be surpassed as the country with the largest population by India (which stands at 1,034,000,000).

The Chinese policy uses, on the one hand, the carrot and stick, with promises of better schooling and other rewards for families who have only one child, and on the other hand, forced abortions or sterilizations for those who have more. In 1993 the government approved a bill to forbid marriages of persons with hepatitis and other sexually transmitted diseases, mental illness, and congenital disabilities, but the Chinese experiment emphasizes the difficulty that even authoritarian states have in encouraging family planning. In the United States, where the fertility rate is under two, in the year 2000 more than 30 percent of the women did not use any modern mechanical or chemical method of contraception. Half of the U.S. pregnancies are believed to be unplanned or unwanted, a rate that is higher than in most other industrial countries. This is one reason for the high—although declining— abortion rate in the United States. Most of the pregnancies in the United States occurred among women who came from disadvantaged backgrounds and were under twenty-five. This suggests that in general, not everyone in the United States has fully changed to the belief in an overpopulated world. How much they should change their beliefs is a matter of public discussion. That fact that not all the U.S. states gave people access to contraception until 1965, and that abortions were prohibited until 1973, emphasizes the difficulty family planning had in being accepted.

Evidence suggests that about 600 million people use contraception, and millions more would do so if they had access to high-quality services. To reach them, family planning advocates have adopted an educational four-point program that points out what family planning does: First, it saves women's lives. Avoiding unintended pregnancies could prevent about one-fourth of all maternal deaths in developing countries. Using contraceptives helps women avoid unsafe abortions, limit birth to their healthiest childbearing years, and prevent giving birth more times than is good for their health. Second, family planning saves children's lives. Spacing pregnancies at least two years apart helps women have healthier children and improves the odds of infants' survival by about 50 percent. Limiting births to a woman's healthiest childbearing years also improves her children's chances of surviving and remaining healthy. Third, women are given more choices. Controlling their own childbearing by using effective contraception can open the door to education, employment, and community involvement. Couples who have fewer children are more likely to send their daughters as well as sons to schools. Fourth, family planning encourages the adoption of safer sexual behavior. All sexually active people need to protect themselves against sexually transmitted infections (STIs), including HIV/AIDS. Using condoms or avoiding sex except in a mutually monogamous relationship are the best ways to do so. Advocates also emphasize that effective family planning helps protect the environment and aids economic development by slowing population growth.

Although governments increasingly have taken an active role in pushing family planning, many professionals believe that the keys to success are also encouraging individual advocacy—presenting A poster promoting the "One-Child Family" policy in the People's Republic of China. China was the first country in the world to embark on a deliberate and comprehensive course to reach zero population growth by the end of 2000. OWEN FRANKEN/CORBIS stories of people's personal experiences showing how family planning improves individual lives— and encouraging nongovernmental organized groups to carry out educational campaigns. Several published guides on advocacy are available, including International Planned Parenthood Federation's Advocacy Guide and the Population Information Program at Johns Hopkins University, A Frame for Advocacy. The optimal situation for family planning involves a discussion between both members of the couple before they begin to have sexual relations and includes a sharing of mutual hopes and desires to make sure they are sufficiently congruent to achieve a good marriage or partnership. These discussions should include all aspects of planning (whether marriage will occur and when, whether children are planned and when, and the number and spacing of children). They should consider early in the discussion whether the individual man or woman wants to have children. Most young people want at least one child, although they may change their minds over time. If a couple decides to have children, they must then plan the number of children. People make these decisions in the context of the norms of their individual groups, although it is good to keep in mind that such norms can also change, which emphasizes the need for ongoing discussion.