Let's Not Be Squeamish About Family Planning's Fiscal Benefits
So often when we sing the praises of family planning, we go straight to applauding its health benefits: all the healthier babies and children, the hundreds of thousands of women who survive childbirth, and the millions of abortions prevented.
Family planning has changed the world for us all over the past few decades. But better health isn't the only advantage. There's another, though we in the global health field have often been hesitant about lauding it too loudly.
I'm talking about the relationship between family planning to prosperity.
The fiscal benefits for countries with robust family planning programs are huge. As more people than ever make the transition from large families and short lives to smaller families and longer lives, we're reminded that these three elements—health, family size, and prosperity—are irrevocably intertwined.
Part of this is due to a phenomenon called the demographic dividend, and this is how it works: After a period of low fertility in a population (such as when modern contraceptives enter the picture, and women and families begin choosing to have fewer children), there is a window of time during which the number of working-age adults grows faster than the number of nonworking-age people who depend upon them. If a country has its ducks in a row (for instance, by making sure there are enough jobs available for these working-age adults), it can take advantage of this window by growing its economy, freeing up resources, and using them to meet other pressing needs.
The results can be greater access to education and income for women, and higher quality of life for everyone.
Family planning is a key that can open this window of opportunity. And this type of equality among nations is precisely what we aspire to in global development. So shouldn't we be shouting about the demographic dividend from the rooftops and helping countries prepare to take full advantage of it?
Yes, particularly in West Africa, where countries have a lot of catching up to do.
But we've long avoided doing so, largely because health is easier and less controversial to talk about than population dynamics. There's nothing contentious about improving health for women and babies, for example. On the other hand, some skeptics still oppose family planning for a variety of reasons—on religious grounds, perhaps, or because they see it as a foreign imposition from the West to control the populations of poor countries.
But it's time to start talking about the demographic dividend so that more countries can enjoy the health and fiscal benefits of family planning. This is a moment of rare opportunity, because:
- People want family planning. Across regions, about 90% of young (15-24) sexually active, unmarried women want to avoid pregnancy. Yet in most African countries nearly half of these women are not using contraceptives. In Latin America and the Caribbean, more than a quarter of these women are not using contraceptives.
- Many low-income countries are economically poised to become middle-income countries. The African continent, for instance, has been the fastest-growing economy in the world. Countries that have long fallen behind are now ready to hear an economic argument for family planning.
- The world is growing younger and more culturally ready for family planning. There are more young people in the world today than ever before. And even if they're not yet ready to plan their families, they are ready to plan their futures (let's pay attention to our nomenclature with this group). Many are also ready to seek out education and good jobs, which the health sector can provide in wide variety. Think information technology, health administration, and all the different clinical branches of the health workforce.
- The U.S. and international donors are looking to the countries they aid to step up and start investing in their own domestic family planning programs. These investments will eventually reap savings that countries can then channel to education, food security, and other pressing needs.
- The Sustainable Development Goals—a global action plan for "people, planet, and prosperity"—include a specific objective (goal 3.7) to reach the 225 million women around the world who want access to family planning services but don't yet have it. We could make this happen by 2030 if we invest as a global community. In fact, each one of the goals will be affected—directly or indirectly—by family planning.
- There is precedent. Look at what the Asian tiger economies have accomplished by creating a demographic dividend through strong family planning programs. Indonesia, Thailand, and Singapore, for example, have created favorable policy environments, relaxed the laws that were holding their programs back, and invested greatly in their community health workforces. Thailand has essentially destigmatized family planning and made it a mainstream way of life. Many of these countries put line items in their budgets to buy contraceptives—that is domestic investment.
Let's take advantage of this moment. We at IntraHealth International and in the global health community must focus not only on getting young people involved and making sure women and girls have access to education, health care, and equal opportunities for employment; we must also help high-level policy-makers and other stakeholders understand the great demand for family planning and advocate to them to take full advantage of the window of opportunity the demographic dividend opens when fertility rates decline, new jobs are created, and economies prosper. (I'll be talking more about this in November at the International Conference on Family Planning in Indonesia.)
Family planning is one of the smartest investments we can make. And as Melinda Gates has said, there should be no controversy around this investment in our futures. It will help countries that have been receiving aid become independent and autonomous faster, which means less need for international development assistance.
It makes health sense. It makes economic sense. And we should certainly not shy away from that.