The importance of family planning within reproductive health

JOHN CLELAND: Family planning, or to give it it’s other term, contraception, has a wider range of potential positive impacts on mankind than any other single medical intervention. Imagine a world in which every time you made love you ran the risk of getting pregnant. Effective contraception prevents that risk and represents a huge extension of human freedom, the freedom to decide when you want to get pregnant and how many babies you want to have. Secondly, contraception has very big benefits for the health and survival of mothers and children. Far too many women die of pregnancies that they didn’t want to have, either through unsafe abortion or during the process of childbirth.

Contraception can cut the number of maternal deaths by at least 20% to 30%. And it also has benefits for children by the spacing pregnancies more widely. The safest time to get pregnant after a previous birth is between two and three years. And contraception along with breastfeeding allows you to do that. The other benefits of family planning come from the fact that it allows couples to have smaller families. Smaller families are less likely to slip into poverty, and if they do is this into poverty more likely to emerge from it. Small families have better educated children. Parents are able to spend more on the health care and general nurture of a small number of children than a large number.

And there are benefits at the national and international level as well. Contraception is the way in which birth rates are reduced and population growth arrested. So it has this very, very wide range of benefits extending far beyond the realm of health. When child mortality is high and contraception is unavailable, as was the case for our ancestors 200, 300 years ago, women spent the prime years of their adult lives either pregnant, giving birth, breastfeeding, or looking after infants. 18 to 20 years of their life, if not more, was spent in that.

Contraception allows women to have smaller families, and therefore frees women to engage in the labour force and participate in public life in a way they never have been able to do before the advent of contraception. So it’s a huge advance in gender equality. That’s the biggest single step the emancipation of women from an endless succession of pregnancies and lactation. Even above that it has these very considerable health advantages for women.

About 40,000 women die each year from unsafe abortion, many in poor countries where abortion is illegal and backstreet abortions are the only option. Contraception could avert nearly all those abortion deaths. And about a quarter of a million women die each year from childbirth. Poor obstetric services often is the case. And by preventing unintended pregnancies, contraception can reduce that number of maternal deaths each year by 20% to 30%, a huge advantage for the health of women. Children benefit from contraception by wider intervals between the end of one birth and the beginning of the next pregnancy.

We’ve known for two decades that children conceived within 18 months of an older sibling are more likely to be born premature, and if not premature to be low birth weight. And both of those factors throw the child at excess risk of dying in the first year of life. So contraception by widening the gap between one pregnancy and the next can save a fantastic number of child deaths per year. About 450,000 of the six million children who die each year, mainly in poor countries, 450,000 deaths could be prevented if contraception was used to space pregnancies at the optimum. Children also benefit from having a smaller number of siblings that contraception allows, as I mentioned before, couples who achieve smaller family sizes.

And we know that children from smaller families tend to do better at school. They tend to be better fed. And they tend to have better health care. And the reason for that is that parental resources and income can be spent intensively on two or three children, whereas a traditional family of five, six, or seven children those same resources are spread more thinly. And the childrens’ education, health, and progress suffers. In 1800, the world’s population was about one billion. Today it’s 7 billion. That’s a huge increase. And the cause that increase is a huge decline in mortality, while birth rates were hesitant to decline in parallel with death rates.

It’s always certain that another two billion people will be on this planet by the middle of the century. And that poses quite severe problems of food production and environmental degradation. Food production has to increase by 40% to 100% to handle the extra two billion people and improved diets. And that’s going to put a huge strain on agriculture and fresh water supply in the next 40 years. The environmental consequences of increased population include loss of biodiversity, degradation of fragile ecosystems as the need to grow more food impinges on fragile soils and environments with low rainfall. Now the only way to stop the population growing is through mass use of contraception.

And in the last 40 years birth rates in Asia and Latin America have tumbled down. And women in those regions are now bearing little more than two children per woman on average. And that two children a woman is a magic number. Because it ensures stability of population size in the long term. But there are a number of countries, mainly in Africa, where couples are still having, on average, five or more children. And I think for the future of mankind the promotion of contraception in those remaining high fertility countries is one really important root to save the planet for our children and grandchildren. It’s a hugely important instrument.

Because barring some unimaginable pandemic there is no other way but through contraception to bring birth rates into balance with death rates. So along with leaving fossil fuels and stopping the oceans acidifying contraception is one way in which we can produce a decent world for our ancestors.