Reimert T. Ravenholt is now president of Population Health Imperatives, in Seattle.
This is the sixth in a series of profiles of the people who have most influenced thinking about population over the past century. The profiles bring you the insights of today's population specialists on the contributions of their predecessors and contemporaries.
As director of USAID's Office of Population from 1965 to 1979, Reimert T. (Rei) Ravenholt created a family planning juggernaut that still provokes both praise and disdain. Ravenholt was a remarkable leader, full of perplexing contradictions. He dazzled people with his brilliance one moment and shocked them with his myopic ethnocentrism the next. He could be strategically wise and tactically reckless. Ravenholt's controversial reputation masks his many contributions, which are still evident 20 years after he was forced from his leadership of USAID's population program.
When Ravenholt took charge of USAID's nascent population program, the setting was not auspicious for success. The program had no staff, budget, or mandate. Few developing country governments outside of Asia wanted anything to do with subjects as controversial as population control and family planning. And there was great debate about whether family planning programs worked. Many doubted that couples would use family planning services and, if couples did use them, that the services would have any impact. But Ravenholt believed that people would use family planning and that it would have a global demographic impact.
Ravenholt succeeded in a hostile environment primarily because he considered the word "no" to be operative only when he used it. If governments said "no" to family planning assistance, Ravenholt got nongovernmental organizations (NGOs) to implement USAID-supported family planning activities. If the physician-dominated health programs did not make family planning easily available, then community-based and social marketing programs would. If couples said "no" to existing contraceptives, new methods would be developed. Circumventing naysayers was a crusade that all staff were expected to join. If you went to a country that forbade contraceptives, you were to carry two suitcases — one for clothes, the other for contraceptives. Such a tactic led to awkward situations, like explaining to a disbelieving, but amused, custom official that the suitcase of condoms were for one's personal use.
Examples of Ravenholt's legacies abound. In response to governmental indifference to AIDS, donors turned to NGOs — typically family planning NGOs whose antecedents can be traced to Ravenholt's initiatives — to combat the spread of the disease. The World Fertility Survey, which Ravenholt established despite much resistance, has evolved into the Demographic and Health Survey, perhaps the most valuable source for health data on the developing world.
Why was Ravenholt relieved of his job after so many accomplishments? Besides ignoring his superiors' direct orders, Ravenholt simply wore out his welcome at USAID. Although much was being accomplished, Ravenholt was impatient with the pace of change and became driven by a self-imposed urgency to solve the population problem. But his notion of a population problem (too many people), whose solution was greater availability of voluntary family planning, was being dismissed. Yet Ravenholt was unswerving in the certainty of his approach. He had to go.
Ravenholt began a program that has devoted $8 billion to population and reproductive health. In 1965 the world's fertility rate was 4.9 children per woman. Today it is 2.9. While today's program differs from his, especially in its emphasis on reproductive health, its programmatic underpinnings remain Ravenholt's. Few people have had a more positive impact on the developing world than Reimert Ravenholt.
Duff G. Gillespie is deputy assistant administrator for Population, Health and Nutrition in the Global Bureau of USAID.
Note: The views expressed here do not necessarily represent those of the U.S. Agency for International Development.
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