By: Rebecca Brindza, Editor-ICN International
ISRAEL: Policymakers in the present day have grown increasingly aware of the “multidimensional set of social processes that create, multiply, stretch, and intensify worldwide social interdependencies and exchanges while at the same time fostering in people a growing awareness of deepening connections between the local and the distant.” (Steger, 2005). Therefore, it is no surprise that within the globalized era, national policies have become deeply intertwined with global issues. This is echoed by the fact that developing states are increasingly susceptible to happenings in the global arena, and as a byproduct “have come to depend heavily on the international community for financial and technical assistance” (Zaei, 2014). It is within this context, that this paper will seek to analyze the changes in global governance relating to population control. It will do so by examining the historical evolution of global fertility polices, as well as global trends of access and use of contraceptive methods around the world. Using research and empirical data spanning seventy years, this paper will delve into the various changes of attitudes regarding women’s health by global players; from taboo to UN and government mandated programs and support. It will cover several important events and subsequent changes relating to women’s health, starting with the UN decade of development in the 1960’s all the way up to the 2000’s and commitments like Family Planning 2020 (FP2020).
For the purpose of this paper, population programs refer to “the enactment of nationally defined policies or organized strategies to affect demographic trends and patterns,” and family planning programs are viewed as “organized efforts to assure that couples who want to limit their family size and space their children have access to contraceptive information and services and are encouraged to use them as needed” (Tsui, 2001). These programs can either be implemented directly through national health services or indirectly through third parties such as family planning associations or NGOs.
1945-1960: Early Population Policies
Spurred by the advent of modern medicine and subsequent fall in death rates during the early 20th century, global demographics underwent considerable change as budding nation-states witnessed significant levels of population growth. Echoing the ideas of nineteenth century British theorist, Thomas Robert Malthus in his, ‘Essay on the Principle of Population,’ the United States forecasted that rapid population growth would lead to resource insecurities in the Third World, and ultimately serve as a barrier for socioeconomic development. It was in this nature, that international collaboration served as the impetus for several national governments to implement population policies and methods of family planning (Yeates, 2014).
Following the establishment of the UN in 1945, the need for demographic research on population growth and socioeconomic development based trends gained ground in the international community. Among the first states to receive UN assistance on demographic research and analytical studies were Brazil, India, Indonesia and Thailand. Moreover, the subject continued to gain leverage in 1954 when the international community convened in Rome for the first World Population Conference. The symposium was organized by the UN and delegates sought to “focus on the need to study all populations in the context of their particular economic, social and cultural conditions” (UN, 2003).
Yet, support for population control was not always cut and dry. This was signaled in a statement made by US President Eisenhower in 1959 when he rejected a plea to aid third world countries in this arena, arguing that it was “not a proper function or responsibility of the government” (UN, 2003). Undeterred by the waffling international arena during this time, several national governments in the developing world took matters into their own hands. In 1951, India became the first among developing states to endorse population control via “explicit policies such as promoting contraception and/or establishing incentives to have fewer children” (Joshi, 2011).
1960-1970: Family Planning and the ‘Birth Control Revolution’
After having been deemed the UN Decade of Development by the UN General Assembly, the 1960’s saw development become a primary target of UN assistance as well as several global initiatives regarding population control (UN, 2003).Prior to the meeting in Belgrade, the realm of global public health had customarily depicted family planning methods as a taboo instrument for population management due to concerns of it being an inappropriate form of governmental intervention. Be that as it may, the modern family planning movement persevered and was beginning to make waves in the global arena. In 1952, the International Planned Parenthood Federation (IPPF) was established in London with ‘birth control pioneer’ Margaret Sanger assuming the role of president (Robinson and Ross, 2007). Shortly thereafter the ‘birth control revolution’ started to gain speed as new forms of contraception, such as the pill and the IUD, entered the market (Pritchett, 1994). Moreover these developments concluded that sexual activity and pregnancy were no longer mutually exclusive, which propelled the idea that women could and should “exert some control over their reproductive lives” (UN, 2003).
The Conference at Belgrade “discussed national family planning programmes in some 20 developing countries, and the question appeared to be not whether programmes were needed but whether they were effective” (UN, 2003). By this time several countries in the developing world had already commenced family planning programs of their own, yet the reasoning behind doing so varied greatly. In Latin America, for example, Chile was the first to fuse family planning into national health services due to increasing government apprehensions regarding the increase in illegal abortions being performed at the time. On the other hand, contraceptive prevalence within the developing regions of the world still fell under 20%. While Asian and Latin American states had managed to break the 10% margin, those in the the Middle East and Africa continued to lag barely pushing 5% (Tsui, 2001). Reasons for so still pertained to unfavorable national attitudes concerning international involvement in domestic matters of population and family planning (UN, 2003).
Despite the lagging support, representatives at the Human Rights Conference gathered in Tehran, and on May 13, 1968 agreed that as the international community, it was of their utmost concern to protect the family unit by acknowledging that all questions surrounding family planning, in essence when to conceive as well as how many children to have, were explicit functions in the basic human rights held by all parents worldwide. Furthermore, they set the threshold for future matters of population control by establishing that all children should be wanted children and as an implication of so, “Governments had an obligation to accept responsibility for the provision of family planning information and services to enable couples to plan the size of their families” (UN, 2003).
1970-1990s: Global Failures that lead to Global Funding Initiatives
The decade surrounding the 1974 World Population Conference in Bucharest ushered in a new realm of international support for population control. Whereby, international involvement increased, attitudes changed and various multilateral development-funding initiatives were formed. In addition, “modern contraceptives had been further improved and were more widely available, thus facilitating the promotion of their use” (UN, 2003).
Despite the UN’s achievement in placing population control and family planning at the top of the international political agenda, direct implementation of said policies and programs had yet to unfold. Developing nations continued to struggle with taming their rapidly expanding populations well into the late 1960s, and began to adopt a more tolerant stance towards international population assistance. The influx in requests from developing nations for population assistance prompted several external organs of the UN, such as WHO, UNICEF, FAO, UNESCO, ILO and the World Bank, to enter the realm of family planning (UN, 2003). Thus by the end of the 1960s and with much financial support coming from the US, the UN had established the United Nations Fund for Population Activities (Yeates, 2014). Within a period of 2 years, the fund had received donor commitments from more than 50 states (UN, 2003).
Throughout 1971 to 1974, attitudes at the national and global levels turned from cautious and indirect to explicit and necessary as policy formation became the preferred method to combat population growth. The sixteenth session of the United Nations Population Commission concluded that in order for birth rates to reach replacement levels in the developing world, it was pertinent for states to draft county-specific initiatives. This prompted a significant decrease in the number of national governments opposing population policies, as well as the UN Secretariat to publish “a complete review of policies intended to affect fertility—including such controversial methods as abortion and sterilization” in 1972 (UN, 2003).
At the 1974 World Population Conference in Bucharest representatives discussed the rationale for family planning and discerned that international strategy should have explicit focus on development rather than population control. The result of this conference was the World Population Plan of Action (WPPA), a policy document that in addition to reiterating that family planning was a basic human right to be respected and upheld by all states, sought to encourage additional research on available methods of family planning. Yet as strategies that had come before, the WPPA failed “to provide any recommendation in favor of family planning and the provision of modern family planning methods” (UN, 2003). Moreover, the document shed light on the need to close the widening opinion gap between developed and developing states. While Western states clung to the assumption that “rapid population growth was a serious impediment to development,” developing states under the leadership of Algeria and Argentina professed that the “population problem was a consequence, not a cause, of underdevelopment, and that it could be solved by a new international economic order” (UN, 2003). Despite downfalls, the WPPA would solidify population growth as primary subset in national policies and assist the spread of international population assistance within the developing world (UN, 2003).
Yet against a backdrop of economic disarray, the 1980s developing world witnessed a considerable decline in global population growth and a significant increase in the endorsement of family planning programs and supply of modern forms of contraception (UN, 2003). For example, East Asia had jumped from just under 20% in 1960 to 75% in 1990. Latin American, South Asian, as well as the Middle East and North Africa also experienced significant increases in contraceptive prevalence (Tsui, 2001). Further questions on how to expand the volume of international cooperation and assistance for population policies and family planning programs, particularly in Sub-Saharan Africa, were brought to attention at the 1984 International Population Conference in Mexico City. The conference set out to revise the WPPA policy and introduced “references to urgency and universality, and the specific reference to the rights of individuals” (UN, 2003). In the following years, several Sub-Saharan states began to remove legal barriers in order to adjust their policies, thereby adopting a more favorable approach to contraception. The most notable of which, were the states still upholding their pre-colonial, pronatalist beliefs, such as those in Francophone Africa, who began to support the provision of NGO-backed contraceptive services, and in subsequent years would provide family planning services of their own (UN, 2003).
1990-2000: Integrating family planning and women’s rights
Dedicated preparation at the national, regional, and global level allowed representatives at the 1994 International Conference for Population and Development in Cairo to make unprecedented moves in the realm of family planning and women’s reproductive health. At the onset of the 1990s, advocacy groups specializing in women’s health and women’s rights made it their prerogative to shift the focus of the “final major global United Nations population conference of the twentieth century ”from “demographics and targets to women’s lives (Casterline, 2000).
Thus, the emerging Programme of Action was framed around the promotion of women’s rights and considered female empowerment to be “a cornerstone of population and development programmes” (UN, 2003). In addition from a third of all calls to action having direct reference to women and girls, what made this a truly revolutionary document for its time are the inclusion of men’s fertility development and the condemnation of social ills and traditional practices that had long been taboo in the international arena, such as genital mutilation. Therefore, it was in this light that representatives called upon national governments to adopt the following roles. Firstly, access to reproductive health services should be made available to “all individuals of appropriate ages.” Secondly, it was the government’s duty to “assess the unmet need for good-quality family-planning services and take steps to meet this need,” and lastly primary healthcare should be expanded to include maternal and children’s health services (UN, 2003).
21stCentury: Grassroots and Global Awareness
The onset of the new century perpetrated the aftereffects of the ICPD. Throughout the developing world, reproductive health services were being integrated into national health policies, and in 2001 the percentage of national governments providing support for both direct and indirect methods of contraception had reached 92% worldwide. In Asian and Pacific states, the merging of family planning services with other aspects of reproductive-health services have grown in popularity and are now being provided by the Islamic Republic of Iran, the Republic of Korea, Sri Lanka and Thailand (UN, 2003). However, there is still a significant gap in the use of family planning methods between the developed and developing worlds due to the lack of access to modern contraceptive practices within less developed states (UN, 2002). This is highlighted by the 2015 WHO estimates, stating that over 225 million women in the developing world alone would like to exercise some form of reproductive control but, at the current time are not using any form of contraception (WHO Fact Sheet, 2015).
In current times, the UN attributes any existing constraints to various socio-cultural or traditional beliefs, fear of side effects from older methods, and a general deficiency in up-to-date information. To face the need to combat the lack of awareness within communities, international interests began to employ educational campaigns that sought to “sensitize the population about reproductive health and HIV/AIDS” (UN, 2003). Operations like so are often facilitated indirectly at the grassroots level, and have taken direct aim at the populations in Sub-Saharan Africa. An example of such is the FP2020, which is a global partnership spearheaded by several organizations such as the Bill and Melinda Gates Foundation, USAID and various UN bodies. Following the 2012 London Summit, the FP2020 “pledged to bring modern contraception within reach of an additional 120 million women and girls by the year 2020” (FP2020, 2015). Since the launch of FP2020 just over three years ago, the initiative has gained commitments from over 80 bodies in the public, private, and civil sectors, and the number of women and girls using contraception has increased by more than 24.4 million (FP2020, 2015).
Conclusion
Spanning the 1945 establishment of the UN throughout the present day, international involvement in population control has shed light on the global need for family planning and the proliferation of modern contraception. However, this growth of international support and inclusion of fertility-related population policies at the national level is a reflection of not only commitments by governments to create their own internal changes, but also an indication of their “alliance with the international community” on matters concerning population growth (Tsui, 2001).
Rebecca Brindza is an inquisitive researcher and social scientist. Her areas of expertise include international affairs, diplomacy and strategy, conflict resolution, mental health issues and disaster & emergency management.Her independent research involves discovering innovative, track-2 approaches for cross-cultural collaboration within the Greater Middle East in the fields of health, science, and innovative technology etc.
