Family Planning Programs and National Prosperity

Abstract

David E. Bloom and David Canning's Policy Forum “The health and wealth of nations” (18 Feb., p. [1207][1]) does a commendable job of characterizing the feedback loop connecting positive public health outcomes and economic growth. The authors, however, do not include a critical component of this loop that has, all too often, been underfunded or excluded from primary healthcare clinics: reproductive health services including family planning. More than half of Bloom and Canning's Policy Forum is devoted to aspects of productivity growth that researchers have determined to be related to declining fertility and managed birth spacing. Among these reproduction-related economic benefits are the accumulation of savings, improved maternal and child health, and the benefits of elevated ratios of working-age adults to dependent children (the “demographic dividend”). The authors appear to credit antibiotics and improved sanitation for paving the way for the East Asian economic “miracle,” although these were not unusual interventions in developing countries during the second half of the 20th century. Yet they do not mention a more distinctive and relevant intervention: the unparalleled mobilization of and the millions of dollars of investment in voluntary family planning services that occurred in these countries in the late 1960s and 1970s ([1][2], [2][3]). Much of this investment was assisted by foreign aid programs in the United States and other industrialized-country governments. Few policymakers would object to improving sanitation, water treatment, or vaccination. Reproductive health programs, despite their importance to reducing maternal mortality and slowing both population growth and the onslaught of HIV/AIDS, still face religious and political opposition in many countries, including the United States. During every budget cycle, some members of Congress attempt to eliminate U.S. assistance to international family planning programs. Congress has cut this program's budget by 35% from 1994 levels, in the face of increasing worldwide demand for such assistance. The population of women and men of reproductive age is growing rapidly, and higher proportions of this population seek reproductive health services. Scientific evidence of these programs' contribution to economic development is mounting, but the political will needed to maintain them is fragile and now waning. It is critical that demographers and economists give family planning and reproductive health programs the credit they deserve when discussing the connections between the health and wealth of nations. 1. [↵][4]1. A. O. Tsui , “Family planning programs in Asia: approaching a half-century of effort” (Asia-Pacific Population Research Reports, East-West Center, Honolulu, HI, 1996). 2. [↵][5] Emerging Asia: Changes and Challenges (Asian Development Bank, Manila, 1997). # Response {#article-title-2} Coen and Cincotta are right to emphasize the important role of family planning programs in the demographic transition. We are well aware of its importance and noted so in our Policy Forum (indeed, one of us was a principal author of the “Emerging Asia” report Coen and Cincotta cite in support of their argument). But we believe that general health deserves more emphasis than reproductive health and family planning, because it was the trigger mechanism that set off cumulative economic development; family planning entered the picture at a later stage of development, when desired fertility began to decrease. For example, desired and actual fertility in Africa are generally close in magnitude, so the availability of contraceptives is not at present the decisive issue. Later in the development process, however, family planning does become crucial, as it was in the East Asia “miracle” and is now in South Asia. [1]: /lookup/doi/10.1126/science.287.5456.1207 [2]: #ref-1 [3]: #ref-2 [4]: #xref-ref-1-1 View reference 1 in text [5]: #xref-ref-2-1 View reference 2 in text