PRB

This is the final installment in a series profiling people who have influenced thinking about population over the past century. A year’s worth of profiles could not do justice to all the people who deserve recognition. Our hope is that, by bringing you the insights of today’s population specialists on the contributions of their predecessors and contemporaries, we have personalized a century of population change and demographic work.

(Population Today, November/December 2000) Many people think of Nafis Sadik as the symbol of the remarkable new consensus that emerged from the International Conference on Population and Development (ICPD) in Cairo in 1994. This profile is an account of how Dr. Sadik helped make ICPD happen and why she deserves much of the credit for its success.

Nafis is an “in-from-the-field, up-through-the-ranks” leader with a masterful grasp of population issues. As a young doctor in Pakistan in the late 1950s, she taught rural women and men about family planning. She also helped develop the country’s first population policy as a member of the National Planning Commission. After joining the UN Population Fund (UNFPA) in its formative years, Nafis quickly rose to become director of operations, assistant executive director, and then executive director.

I have known Nafis since 1975. When I headed the U.S. Agency for International Development’s Office of Population in the early 1980s, she and I worked to minimize disruptions caused by the Reagan administration’s efforts to eliminate U.S. population assistance. I knew from the beginning that Nafis was an extremely able program manager; I learned later what a skillful diplomat she is.

In 1992, Nafis was named secretary-general of the ICPD. At that time, two political currents with profound implications for ICPD were flowing through the international community. The first was opposition to population policies that placed demographic objectives ahead of women’s health. The second was demand for a more active role for nongovernmental organizations (NGOs) in international political affairs. Nafis’ challenge was to channel both in a positive direction.

Rights advocates argued that demographic targets led to heavy-handed, even coercive, programs. Program administrators defended targets as necessary to keep program workers focused. Nafis, a longtime program administrator, was inclined to side with the latter. But as she listened to the impassioned voices of women, she changed her mind. When it was time to draft the conference document, her position was clear: The objective should be to serve individual needs. If that were done well, population growth would take care of itself. That point of view prevailed.

Representatives of international NGOs and foundations urged Nafis to open the ICPD to NGOs. Nafis at first hesitated but realized that civil society would not be denied a significant role in future global negotiations. She urged all governments to include NGO representatives in their delegations, and she supported an NGO presence throughout the ICPD process. In turning a political necessity into a virtue, Nafis also helped permanently change the role of civil society in international political conferences.

Perhaps Nafis’ most important contribution to ICPD was the introduction of global goals for the year 2015. Speaking before the final preconference meeting in April 1994, she proposed five 20-year goals: increased availability of family planning services; reduced infant mortality; reduced maternal mortality; increased life expectancy; and increased access to education, especially for girls and women. Her proposal demonstrated the interrelationship of key development goals: None could be achieved unless all were achieved.

ICPD culminated a distinguished career: from grassroots doctor to architect of one of the most successful international agreements of the last 30 years — certainly the most important in the history of the global population movement. While many deserve credit for the new ICPD orientation toward population and family planning, Nafis Sadik stands tallest because of her imagination, political skill, and leadership.

Steven Sinding is professor of clinical public health at Columbia University. He directed population programs at the Rockefeller Foundation from 1991 to 1999, and at the U.S. Agency for International Development from 1983 to 1986.

Articles in This Series

• Alfred Lotka, Mathematical Demographer 
• Margaret Sanger, Birth Control Pioneer 
• Alan F. Guttmacher, People’s Physician 
• Gregory Pincus, Father of the Pill 
• John D. Rockefeller 3rd, Statesman and Founder of the Population Council 
• Reimert T. Ravenholt, USAID’s Population Program Stalwart 
• Nafis Sadik, Architect of ICPD 

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.

Articles in This Series

• Alfred Lotka, Mathematical Demographer
• Margaret Sanger, Birth Control Pioneer
• Alan F. Guttmacher, People’s Physician
• Gregory Pincus, Father of the Pill
• John D. Rockefeller 3rd, Statesman and Founder of the Population Council
• Reimert T. Ravenholt, USAID’s Population Program Stalwart
• Nafis Sadik, Architect of ICPD

This is the fifth 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 contemporary population specialists on the contributions of their predecessors.

(Population Today, August/September 2000) The motivation for John D. Rockefeller’s interest in population issues eluded many of his closest associates and advisors. It grew out of his humanity and his concern for the well-being of all people. Indeed, he took a broad view of “population control” as a means to address poverty and economic development rather than as an end in itself.

His first public undertaking came in 1952, when he initiated the convocation of the Conference on Population Problems, in Williamsburg, Va. The discussion took up food supply, industrial development, depletion of natural resources, and political instability resulting from unchecked population growth. The presence of medical doctors, chemists, geologists, economists, and other scientists gave serious weight and prominent attention to the emerging and unrecognized facts of demographic change.

Soon after this conference, Rockefeller established the Population Council. From philanthropic funds at his disposal, he provided $1 million within the first year of operations.

In 1967, Rockefeller initiated, lobbied heavily for, and finally achieved a World Leaders’ Statement signed by 30 heads of state including U.S. President Lyndon Johnson. The values and beliefs enumerated included the ideas that “the population problem must be recognized by government as a principal element in long-range planning” and that “the objective of family planning is the enrichment of human life [in that it] frees man to attain his individual dignity and reach his full potential.” No mention of women, but the relevance of the status of women had not yet permeated the policy consciousness. This document drew attention to population growth as a world problem and engendered political support for family planning as the solution.

Three years later, President Nixon established a Commission on Population Growth and the American Future, with Rockefeller as chairman. Several issues that the commission hotly debated mirrored what would become the Cairo agenda. Some members felt, for instance, that consideration of the social and economic circumstances of women went beyond the commission’s purview: examining from a demographic perspective the need for safer, more secure fertility control. The most controversial issue was abortion. Members of the commission disagreed, but the majority called for “creating a clear and positive framework for the practice of abortion on request.” A furor ensued, with the president rejecting the recommendations of his own commission, and Rockefeller became embroiled in a public debate about the legalization of abortion.

Undaunted, Rockefeller again addressed the broad social and economic issues of development, poverty, and the lives of women in his controversial 1974 “Bucharest speech.” Speaking at the World Population Conference, he called for “new and urgent attention to the role of women as a vital characteristic of modern development.” Many people who had worked on developing contraceptive methods and family planning as the primary means to reduce population growth saw the text as a professional and personal rejection. Although Rockefeller regretted the personal nature of the debate, its intensity did not surprise him. As his advisor, I had told him frankly how his words would be received. Time, change, and the flood of history have muted the resistance to those ideas and values, many of which are reflected in the Cairo consensus.

The thread that runs through Rockefeller’s population work is one of moral courage. He taught me to be tenacious, to hold focus on what I knew and believed. At the beginning of this new century, we miss his leadership, but his legacy is alive and well.

Joan Dunlop, former advisor to John D. Rockefeller 3rd, directs A Women’s Lens on Global Issues, a project of The Aspen Institute, for the Rockefeller Brothers Fund in New York.

Articles in This Series

• Alfred Lotka, Mathematical Demographer 
• Margaret Sanger, Birth Control Pioneer 
• Alan F. Guttmacher, People’s Physician 
• Gregory Pincus, Father of the Pill 
• John D. Rockefeller 3rd, Statesman and Founder of the Population Council 
• Reimert T. Ravenholt, USAID’s Population Program Stalwart 
• Nafis Sadik, Architect of ICPD 

This is the fourth 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.

Gregory Goodwin “Goody” Pincus was Dr. Pincus because of his Harvard Ph.D. in biology, not because of a medical degree. Yet his work may have been the most important medical advance of the century for improving women’s health and status. If any one person merits recognition as the father of the birth control pill, it was Goody Pincus.

He was a brilliant scientist. When he took up Margaret Sanger’s challenge in 1950 to develop an oral contraceptive, he had already achieved in vitro fertilization of rabbit eggs, foreshadowing later successes in assisted human reproduction that have enabled tens of thousands of couples to overcome infertility.

The controversy generated by this pioneering work probably cost him tenure at Harvard, prompting his move to Clark University in Worcester, Mass. Screaming headlines about “test-tube babies” and “fatherless rabbits” had elicited anti-science and anti-Semitic attacks. This notoriety may have made Harvard too uncomfortable to keep Pincus on the faculty, but it did not prevent the university in 1936 from citing his work as one of Harvard’s outstanding scientific achievements in its 300-year history.

At Clark, Pincus teamed up with Hudson Hoagland, another scientific pioneer-explorer, to create the Worcester Foundation for Experimental Biology in 1944. Pincus attracted Cambridge-trained physiologist M.C. Chang to the foundation. Chang had demonstrated that progesterone and progesterone-like compounds could suppress ovulation in laboratory animals. This finding made it feasible to search for an oral contraceptive. It was the Pincus-led team that developed the first oral contraceptive, in spite of revisionist claims to the contrary.

In 1960 few scientific leaders were working on the control of fertility, a field that distinguished British reproductive biologist Lord Zuckerman described as a “scientific wasteland.” Pincus was among the few whose distinction and recognition encouraged young scientists to enter the field. Pincus thought enough of my early work on antiestrogens as a potential postfertilization contraceptive to invite me to present a paper at the Laurentian Hormone Conference, endocrinology’s most prestigious annual gathering, in 1963. While preparing to deliver my paper, I dreamed that Pincus — an intense intellectual whose graying moustache and prominent eyebrows gave him an imposing, Einsteinian appearance — was sitting in the front row, fingering his moustache and listening intently to every word, expecting excellence.

I soon learned that the stern taskmaster of my nightmares was really a sweet, considerate man. In the early days of the Population Council, when I moved from the University of Iowa to create the Council’s laboratory at the Rockefeller Institute, I became Goody’s friend. Five years later, the Council offered me the position of biomedical director, and Goody encouraged me to accept.

Although he guided one of the monumental medical advances of the 20th century, Pincus was never awarded the Nobel Prize and was not elected to the National Academy of Sciences until shortly before his death. Before succumbing to a rare blood disease, he published The Control of Fertility. The preface ends: “There is more to discover than we now know. But in the blazing or flickering light of what we do know … willful prejudices fade, and our considered and tested knowledge offers a firm basis for what we can and should do.” My inscribed copy of this book is one of the most cherished in my library.

Sheldon Segal is Distinguished Scientist of the Population Council and former director for population sciences at The Rockefeller Foundation.

For More Information

Gregory Pincus, Father of the Pill

Gregory Pincus, The Control of Fertility (New York: Academic Press, 1965).

_____________, The Eggs of Mammals (New York: The Macmillan Company, 1936).

The Pincus and Chang story of how they linked up with the G.D. Searle Company of Illinois and gynecologist John Rock of Boston to create the first oral contraceptive has been amply reported. David Halberstam’s book The Fifties (New York: Villard Books, 1993; New York: Fawcett, 1994) provides one comprehensive account, and the brilliant and lively article “Annals of Medicine: John Rock’s Error” by Malcolm Gladwell (The New Yorker, March 13, 2000) offers new insights.

Articles in This Series

Alfred Lotka, Mathematical Demographer

Margaret Sanger, Birth Control Pioneer

Alan F. Guttmacher, People’s Physician

Gregory Pincus, Father of the Pill

John D. Rockefeller 3rd, Statesman and Founder of the Population Council

Reimert T. Ravenholt, USAID’s Population Program Stalwart

Nafis Sadik, Architect of ICPD

This is the third 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 contemporary population specialists on the contributions of their predecessors and contemporaries.

(2000) Although Alan F. Guttmacher spent his professional life as a physician specializing in obstetrics and gynecology, and later in family planning, he was foremost a humanist, driven by a belief in the immense social value of medicine. Twenty-five years after his death, Alan Guttmacher is well-remembered for his teaching, his leadership in the early birth control movement, and his social consciousness.

Early in his career, as an obstetrician at The Johns Hopkins Hospital in Baltimore, Guttmacher noted a disparity in fertility rates among his patients of differing socioeconomic status. He realized that women without access to private physicians also lacked access to contraceptive information and services. Guttmacher joined the birth control movement and began to promote family planning, which he considered “an urgent, democratic form of medicine.”

In 1933, Guttmacher published the first of a series of books for lay people. These books served to educate several generations of women — first about pregnancy and delivery and later about contraception, abortion, and infertility — at a time when reproductive anatomy and physiology were solely the domain of the physician. His works displeased many of his colleagues, who found it professionally disreputable for a doctor to write for a lay audience.

In 1952, Guttmacher moved from Baltimore to New York to become director of obstetrics and gynecology at Mount Sinai Hospital.

In New York, Guttmacher attempted to introduce contraceptives into municipal hospitals, which provided the majority of medical services to low-income women. He was unsuccessful, however, and discovered that a heavy-handed, but unwritten, policy prohibited physicians at municipal hospitals from providing contraceptive services or referring women elsewhere for services. The commissioner of hospitals, appointed by the mayor, asserted that birth control was not the responsibility of a city hospital and declared the issue untouchable; the health department claimed no jurisdiction in matters related to contraceptives.

Guttmacher and several colleagues led a campaign to overturn the ban. The New York Post, which exposed the ban and reported on the campaign, ran this statement by Guttmacher in July 1958: “New Yorkers who can afford the services of a private physician or private hospital have no difficulty in obtaining competent instruction in contraception. I wish to speak on behalf of the thousands of women who are discriminated against in our great municipal hospitals by this prohibition. Must this type of backward medicine be perpetuated?”

The campaign not only succeeded in New York City, but also laid the groundwork for the provision of family planning services by public health agencies throughout the country in the 1960s and later for the establishment of the Title X program.

In 1962, Guttmacher became president of the Planned Parenthood Federation of America, a position he held until his death.

In the late 1960s, as congressional interest in establishing national and international family planning programs grew, Guttmacher saw the need to provide data for the development of policy. In 1968, he founded the Center for Family Planning Program Development, a division of Planned Parenthood. After his death, the center was renamed The Alan Guttmacher Institute. Guttmacher changed the way physicians and the public thought about access to contraceptives. He helped legitimize family planning in medical education and clinical services.

Allan Rosenfield, M.D., is dean of the Joseph L. Mailman School of Public Health at Columbia University. Emily Figdor, a research assistant to Dr. Rosenfield, is completing her master’s degree in public health.

For More Information

Publications by and about Alan Guttmacher include the following:

William Berkowitz, Conversation with … (New York: Bloch Publishing Company, 1975).

Alan F. Guttmacher, Babies by Choice or by Chance (Garden City, New York: Doubleday and Company, 1959).

— — — — , The Complete Book of Birth Control (New York: Ballantine Books, 1961).

— — — — , Life in the Making (New York: The Viking Press, 1933).

— — — — , Pregnancy and Birth: A Book for Expectant Parents (New York: Viking Press, 1957).

— — — — , with Winfield Best and Frederick S. Jaffe, Planning Your Family: The Complete Guide to Birth Control, Overcoming Infertility, and Sterilization-With a Special Section on Abortion (New York: Macmillan, 1964).

Alan F. Guttmacher, Winfield Best, and Frederick S. Jaffe, Birth Control and Love 2ed. (London: Macmillan, 1969).

Alan F. Guttmacher and Joan Gould, Why Can’t You Have a Baby? (New York: Public Affairs Committee, 1960).

Alan F. Guttmacher and Joan Gould, New Facts About Birth Control (New York: Public Affairs Committee, 1959).

Frederick S. Jaffe, “Alan F. Guttmacher,” Family Planning Perspectives 6, no. 1 (1974): 1-2.

Joseph J. Rovinsky, “In Memoriam,” Mt. Sinai Journal of Medicine 41, no. 4 (1974): 503-504.

Benjamin Viel, “Dr. Alan F. Guttmacher: As Remembered by a Latin American Physician,” Mt. Sinai Journal of Medicine 42, no. 4 (1975): 335-336.

Alden Whitman, “Alan Guttmacher, Pioneer in Family Planning, Dies,” The New York Times Biographical Edition, March 1974: 356-357.

Articles in This Series

• Alfred Lotka, Mathematical Demographer
• Margaret Sanger, Birth Control Pioneer
• Alan F. Guttmacher, People’s Physician
• Gregory Pincus, Father of the Pill
• John D. Rockefeller 3rd, Statesman and Founder of the Population Council
• Reimert T. Ravenholt, USAID’s Population Program Stalwart
• Nafis Sadik, Architect of ICPD

This is the first in a series of profiles of the people who have most influenced thinking about population over the past century. The profiles will bring you the insights of contemporary population specialists on the contributions of their predecessors and contemporaries.

Mathematical demography is rarely used in heated political debate. But the classic 1925 article “On the True Rate of Natural Increase,” which synthesized years of work by Alfred Lotka and several collaborators, led off with a snipe at those who had just passed the most restrictive immigration law ever seen in the United States.

Lotka and Louis Dublin showed that the surplus of births over deaths in the resident American population was an artifact of a disproportionately large number of men and women in the peak ages for reproduction. The age distribution was itself the result of high rates of immigration in preceding decades. If the population of the United States, or of any other country, were “stable” — closed to migration in or out, and subject to its current schedule of age-specific birth and death rates — then it would settle down fairly quickly to an unchanging age distribution and a characteristic — in this case, surprisingly low — rate of increase. Far from worrying about the nation filling up with foreign-born “undesirables,” Lotka cautioned that Americans ought to be concerned about a declining population.

Looking for portents of decline below the surface of current trends may have come more naturally to Lotka than to his compatriots. Born in 1880, in what is now Poland, to American missionaries, he was educated in France and Great Britain, where concern with decline in the quantity and “quality” of populations bordered on the obsessive even before World War I. Lotka came to the United States in 1902 and eventually joined the Metropolitan Life Insurance company. From then on he concentrated on life tables and on his passion to bring the insights of mathematics to the problems of biology. In 1931, Lotka helped found the Population Association of America, later serving as its president.

In the view of Nathan Keyfitz, one of his most important successors, Lotka’s work on the mathematics of stable populations was “the greatest single contribution to population theory.” Despite the efforts of the exclusionists, the United States never was completely closed to immigration, nor have birth and death rates ever been fixed. Thus there never was a “stable” population exhibiting all the relations worked out by Lotka and his successors. But stable populations are useful constructs, like perfect vacuums in physics. They don’t literally exist, but with a few assumptions and approximations, we can use them to make progress on practical problems otherwise too complex to approach.

For example, stable population theory provided the basis for indirect methods of demographic estimation, which allow use of partial information and reasonable assumptions to infer levels of fertility or mortality in populations where births and deaths are not well-recorded. This has been the case in most of the world until recently. Lotka’s work was also the foundation of what we know about the importance of momentum for future population growth. As a new century begins, momentum — the effect of a young age structure — shapes the level and pattern of population growth until we reach that so-far elusive stable population.

Lotka is also well-known among biologists for one of the first mathematical models applied to ecology, the Lotka-Volterra model of interaction between a predator and a prey species. Considering just two species in an ecosystem, with basic differential equations describing population dynamics and how one species eats the other and captures its stored energy, Lotka showed how a variety of stable equilibria could be produced. The model proved a useful teaching tool and a starting point for more complex analysis.

John Haaga is director of Domestic Programs at the Population Reference Bureau.

Articles in This Series

• Alfred Lotka, Mathematical Demographer
• Margaret Sanger, Birth Control Pioneer
• Alan F. Guttmacher, People’s Physician
• Gregory Pincus, Father of the Pill
• John D. Rockefeller 3rd, Statesman and Founder of the Population Council
• Reimert T. Ravenholt, USAID’s Population Program Stalwart
• Nafis Sadik, Architect of ICPD