Maternal Health III: Population Control

For my third post, I would like to delve very briefly into the subject of population.

This is a huge subject and really deserves a blog series all on its own, but population control is so readily bandied about as a solution to Africa's problems that it merits a mention here.

The received wisdom is that poor people, particularly Africans, just can't stop breeding and that people = poverty. A few facts for you to mull over:

• The population density of Europe is 134 people per square mile.
• The population density of Britain is 634 people per square mile.
• The population density of Africa is 66 people per square mile.

And yet we reserve the right to dictate to African women how many children they should have. Western governments spend millions providing contraception to developing countries when one in ten people around the world - the overwhelming majority of them in developing countries - have no access to safe drinking water.

Western arrogance

It is said that one American consumes the same resources as 12 Bangladeshis. So if anything, rather than westerners having the arrogance to tell people in developing countries to stop breeding, they have every right to tell us to stop being so greedy. You don't have to have a new mobile phone every six months; you don't have to run a Land Rover to cart your two children across London to their smart prep school; you don't have to fly out to the other side of the planet every year to enjoy a nice holiday.

There is nothing wrong with considering on a daily basis the impact your activities are having on the planet. I wouldn't call myself an environmentalist but I do believe that we are the stewards of creation and the planet does not owe us a consumerist lifestyle.

A few words of warning regarding the population debate:

Unmet Need for Contraception

You will hear the expression "unmet need for contraception" quite a bit in debates about  population and development - but what exactly is an unmet need for contraception and how is it defined, let alone calculated? One definition on a UN website is:

The percent with an unmet need for family planning is the number of women with unmet need for family planning expressed as a percentage of women of reproductive age who are married or in a union. Women with unmet need are those who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the birth of their next child.

For a start, as with other politically motivated estimates, how accurate can this estimate be? Has UNFPA conducted extensive surveys, sending armies of smiling individuals with tabards and clipboards into every remote region on the globe to ask women whether or not they fancy popping the Pill? Even if surveys were a reliable way of gaining objective data, which they notoriously are not, it is highly unlikely that more than a tiny percentage of women in developing countries have ever been consulted on the matter.

Pro-contraception agencies tend to make vague claims that "women we talk to want contraception" whereas, strangely enough, groups like the Population Research Institute have found that women in developing countries they consult do not even include contraception on their wish-list. They're too busy requesting safe drinking water, vaccination programmes and basic education for their children.

But even the definition is pretty shaky. Some pro-abortion agencies have pointed out that, for starters, it is a bit odd to include only women who are married or in a union when, just occasionally, unmarried women also get pregnant. Most obviously though, the definition may well completely exclude couples who are using natural methods of family planning. Under this definition, I would have an unmet need for contraception. My doctor certainly thinks so - I don't. Unmet need or an assumption of a need?

Family Size

Beware western assumptions about family size. If you live in a country with little or nothing in the way of a welfare state and high infant mortality, large families do not equal poverty. Children = security. Children = the future. In a recent article, a Nigerian engineer wrote - and I'm paraphrasing slightly because it was quite a lengthy article:

Western media are shrilly calling for Nigeria to put a check on her population growth. No way, sorry. We Nigerians are rejoicing. Africans love children. First for financial security ... Second, many children ensure that we avoid the problem of ageing populations.

We know that in Europe and America, birthrates are far below replacement level. Their populations are ageing and a huge pension debt is resting on the shoulders of shrinking numbers of their working youths. A day of reckoning is looming for them. Nigerians want to avoid this. Third, our large population supplies our economy with the dynamic and youthful workforce it needs to grow, as well as huge markets for all types of businesses. The real reason for poverty is corrupt rulers, not a lack of birth control.

Last Resorts

Beware most of all promises by environmental groups that they are in favour of voluntary one or two child policies only and forced one or two child policies as 'a last resort'. That is the position of groups like Population Matters. When the state gets involved in dictating family size, it is difficult to see how such a policy will not be coercive on some level. Even making having a third child socially unacceptable involves a level of coercion because most people don't want to be socially excluded or stigmatised.

But a state two-child policy would necessarily involve making it easier to have a small family but more socially and economically difficult to raise a larger family. That's rather the point. I would say, incidentally, as someone attempting to raise three children in the south-east of England, that we are pretty close to that situation already. As to forced policies being a 'last resort', I am very suspicious of the words 'last resort.' I generally find people talk about the 'last resort' as a way of justifying a course of action they know instinctively to be unjustifiable.

It is actually quite a threatening position to take, carrying with it the implication that the people touting the last resort are moderate, forbearing individuals who would "hate to see it have to come to this" and those who will suffer the last resort have in some way brought it upon themselves. I have heard all sorts of disgraceful things justified as a last resort - bullying, malicious gossip, deceit, and even such human rights abuses as torture, and here the population controllers are saying 'get yourself sterilised freely or the state may one day have to force you.'

If an action is objectively evil and destructive, a gross attack on human rights, then surely it can never be justified even as a 'last resort?

This is the third post in a 4-part series Fiorella is writing on maternal health - catch up on Part 1 and Part 2 if you've missed them, or read Part 4!