Population control: why Bangladesh, Iran beat Pakistan

August 08, 2009
  • Fatwas in Iran protect a woman’s right to control her fertility
  • Door-to-door family planning in Bangladesh dispenses birth control to village women
  • Pakistan paid for IUDs, with poor results
  • China experienced unprecedented population imbalances

Where in the world must couples attend contraception classes before getting married? Where has free distribution of contraceptives, increased access to sterilization and edicts from religious leaders affirming women's rights contributed to one of the most dramatic drops in birth rates ever recorded?  

The answer is Iran. Between 1988 and 1996 the average family halved in size from 5.2 to 2.6 children after the authorities launched a family planning campaign.

It encouraged women to wait three to four years between pregnancies and discouraged childbearing for women younger than 18 or older than 35. Fatwas confirmed a woman’s right to control her fertility.

Iran became a poster child for advocates of family planning and population programs.

Bangladesh also benefited from innovative government policies, says Professor John Cleland of the Centre for Population Studies at the London School of Hygiene and Tropical Medicine

From the mid-1970s, Bangladesh adopted a community-based approach, recruiting married, literate village women trained in basic medicine and family planning to go door-to-door dispensing contraceptive pills and condoms and referring women for clinical contraception.

“They acted as a bridge between the modern medical world and the village world,” says Cleland. “Because they were literate, they were part of the elite, and as villagers, they had credibility among a suspicious and very religious population.”

Simultaneously, the government prioritized girls' education. Continuing education delays marriage and childbearing and equips girls with the knowledge, status and confidence to have greater control over their lives.

“Education is a major predictor of fertility levels; when women have opportunities to work outside the home it has a major impact on fertility,” says Ralph Hakkert, technical adviser at the UN Population Fund (UNFPA).

Fertility rates in Bangladesh subsequently halved from about six children per women in the early 1970s to fewer than three children per women today.

In contrast to Bangladesh’s broad-based strategy, Pakistan in the 1960s prioritized just one form of contraception – the intrauterine device (IUD). It paid doctors and midwives to promote the device and paid women to have it inserted

“All that money meant vast corruption and falsified figures, while there was not enough medical backup so when women had problems with the IUDs they had nowhere to go,” Cleland says. “When someone did an honest survey, they found that no-one was using IUDs.”

As a result of these failings, Pakistan banned advertising for family planning and cut funding for similar projects during the 1970s and 1980s.

The resulting comparison with Bangladesh is stark. In 1970, Pakistan’s population was five million people smaller than Bangladesh’s, but by 2050 it is expected to be larger by 62 million people.

China’s birth control policies have certainly curbed birth rates, which have fallen steeply since the 1970s to under 1.7 children per woman today.

The authorities began with a largely voluntary and highly effective 'two-child' policy, spearheaded by widely available contraception and the slogan “later, longer, fewer.”

It then implemented the 'one-child' policy in urban areas from the 1980s, mainly through female sterilization and IUDs. Fertility rates fell further.

However, this came at a cost. Due to the cultural preference for boys, sex-selective abortions and even female infanticide increased leaving China with gender imbalances unprecedented in human history.  Moreover, the policy has contributed to a rapidly aging population.

The policy is now effectively being dismantled as all ‘only child’ couples nationwide are now eligible to have two children.

Historically, Western Europe reduced fertility rates prior to the Second World War without state intervention or modern contraception. Couples had smaller families as they moved to cities, became wealthier and more educated.

Similar patterns have been observed in Algeria, Saudi Arabia, and Turkey, countries without population programs.

Brazilians even reduced their birth rates despite successive military governments blocking family planning.

In 1960, the average Brazilian woman had more than six children. But by 1986, that fertility rate had fallen to 3.5 children thanks to local authorities, NGOs and doctors defying the state and providing contraception.

However, large differences emerged between rich and poor, urban and rural regions, and educated and uneducated people. In 1986, rural fertility in Brazil was 66% higher than in urban areas.

Wherever the country, poverty and fertility are intimately linked. Hence many poor countries rely on family planning programs to curb population growth rather than waiting for people to become richer and better educated.

James Tulloch

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