(September 2007) The Global Family Planning Revolution chronicles family planning policies and programs in 22 countries over the past three decades.

This new book (published in June 2007) was co-edited by Warren C. Robinson and John A. Ross. In this PRB interview, Robinson, who is the founding director of the Population Research Center at Pennsylvania State University, explains both the challenging history of and future opportunities for family planning efforts around the world.

PRB: The book opens by discussing the beginnings of the modern family planning movement, when both the birth control (focused on women’s rights and empowerment) and population control (based in Malthusian theory) movements joined in 1952. What were the catalysts for the merging of these two forces?
Robinson: Both the modern (post-World War II) push for women’s rights and the population policy initiatives flowed from the perceived need for individuals and societies to take greater control over economic, social, and demographic trends, and the prospects confronting the world. This growing, common awareness was the catalyst. In today’s highly politicized public debates, population planning and women’s rights are sometimes depicted as being in opposition to one another. But, most of the country studies in our volume clearly show that empowering women (through education, employment, and ensured legal rights) always leads to rising use of birth control methods and is an important element of any successful population policy and program. Similarly, making family planning available is, in and of itself, an empowering and liberating step for women. The appearance of new contraceptive techniques—the IUD and the pill in particular, which could be administered on a large scale by both public and private programs and were acceptable to the vast majority of women—was perhaps a catalyst too.

PRB: The book states that socioeconomic modernization was, as some had predicted, nearly as important as the programs themselves. Could you elaborate on this idea?
Robinson: Modernization means many things but, most fundamentally, it reflects a change in the attitudes and outlooks of the individual—a growing belief that self-betterment (improved health, rising material standards, greater personal freedom and security) is possible and within one’s capacities to achieve. Education and social infrastructure help create such attitudes. When this mindset takes hold, it becomes much easier to introduce new techniques and behavior patterns such as contraception use and also to build effective organizations to delivery services. This describes nearly all our early achievers. Many of our studies also show that persistent family planning program efforts themselves helped contribute to the growth of a more modern outlook.

PRB: What do you consider the biggest obstacle to developing an effective family planning program in any country?
Robinson: Nearly all the “late achievers” in our case studies show lack of strong political will at the top; poor leadership at the program level; inconsistent, shifting goals and program structures; poor service delivery (including, most of all, the quality of services); inadequate use of modern behavior-change communications techniques; and failure to enlist the private commercial and noncommercial sectors as part of the program. These program inadequacies were usually firmly rooted in a poor socioeconomic background setting. All of these factors were obstacles.

PRB: Reaching rural women has proven to be difficult for many family planning programs. Do you have any suggestions on how to address this persistent shortcoming in service delivery?
Robinson: These days, electronic mass media and personal communication devices are increasingly making it possible to reach easily and routinely into areas previously thought of as inaccessible. The private commercial and noncommercial, nongovernmental sectors are leading the way, and family planning programs must learn from their experience and make greater use of the networks they are creating. Changes in attitude and outlook are the keys to changing behavior, but services and supplies must also be made more readily available through nonconventional outlets.

PRB: In sub-Saharan Africa, one in four women say they prefer to avoid or put off having a child, yet are not using contraception. What would be the most cost-effective way to improve family planning in sub-Saharan African countries where unmet need for family planning is the greatest?
Robinson: This is the great unanswered question and, since so few of our studies deal with sub-Saharan Africa, we can only attempt to extrapolate from our Asian and Latin American studies. The general answer is that such women are not being adequately served. We now know that all countries, however poor and inadequate their public health services appear to be, do typically have in place some type of private health-care delivery systems (traditional healers, pharmacists, village midwives, and so on). Village women have come to know and trust these suppliers for many health-related services. Some of our studies show how policy and programming have been able to upgrade and build on these existing networks to introduce family planning and maternal and child health services and supplies and that this has proven to be cheaper and effective than attempting to construct an entirely new system. This seems to offer the best hope for quickly reaching the underserved.

PRB: Many developed countries, especially in Europe, are currently facing extremely low rates of fertility. Do you think pronatalist policies can be effective here?
Robinson: The question is really whether policy and program can affect desired family size enough to bring fertility rates in Europe back to or above replacement. We are not yet sure, but the answer appears to be a cautious “yes.” Such measures are gaining public support and have actually been launched in many western and northern European countries, where they appear to be having a moderate impact. Children continue to be enjoyable to many prospective parents, but education and health costs are a consideration. Increased public financial support could well lead to a substantial recovery in presently low birth rates. Whatever does work, our experience tells us that government pressure for either low or high fertility definitely does not work and is likely to backfire.

Sara Maki is an intern at the Population Reference Bureau.

The Global Family Planning Revolution, by Warren C. Robinson and John A. Ross, is available through the World Bank website, http://publications.worldbank.org. (List price: $45; ISBN: 0-8213-6951-2; paperback, 490 pages; June 2007)