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Gates and the British Government Seize the Lead for Family Planning


Birthing in Nepal
Yasodha Ojha, a nurse-midwife, came from three hours away to Dikha Village, in Nepal, to help deliver a breached birth. Pregnant women flocked to her for her expertise. GATES FOUNDATION

With the world population now growing faster than predicted only two years ago by the United Nations Population Division, a campaign to make family planning and the wider provision of contraceptives higher priorities in foreign aid policy after years of neglect has taken off. But it is largely being done outside the UN system, a leading American expert says.

Steven Sinding, who has developed a global following for his expertise gained through a long career in reproductive health — director of the United States population program in the United States Agency for International Development, a Columbia University professor in the Mailman School of Public Health and head of the International Planned Parenthood Federation, among other roles — is a leader of the current campaign. He said in an interview that it took the efforts of the British government and the Bill and Melinda Gates Foundation to spark new interest in family planning.

The UN system as a whole has shied away from the issue, Sinding said. Family planning, contraception and safe abortion have all been hot topics of contention and political resistance for years among UN member governments, who frequently justified their stand by religious or cultural restraints. Yet often these attitudes masked the low regard for women in society and little commitment to their rights.

The drift from financing family planning was most pronounced, ironically, after the 1994 International Conference on Population and Development, held in Cairo. At that conference, a large majority of member nations agreed to pledges giving women greater control over their sexual health and a greater role in development, but these unleashed a backlash.

Lately, however, the discussion has turned more often to the unspoken links between the persistent poverty in the least developed countries — reflected in the Millennium Development Goals that are falling farthest behind — as well as the increasing pressures on natural resources, especially water, and the increasingly apparent relationship of these phenomena to a lack of reproductive choices for women and their partners.

Globally, the UN Population Division, part of the Department of Social and Economic Affairs, says in its newest report that the projection made two years ago that the world would have 9.3 billion people by 2050 has now in 2013 been revised upward to 9.6 billion by midcentury and rising. That is a medium projection; it could be lower but more likely would be higher, given new uncertainties about fertility rates. The world population today is 7.2 billion.

Of particular concern is sub-Saharan Africa. In 2011, the UN said that Africa had passed the 1 billion population mark in 2009 and would add another billion by 2044, just 35 years later, even though fertility (the number of live births per woman) would drop from 4.6 children in 2005-2010 to 3.0 children by 2040-2045, and growth would peak by 2052. This year, the Population Division revised the figures, saying that fertility rates were not falling, but actually rising, by more than 5 percent in 15 high-fertility countries of sub-Saharan Africa.

“More than half of global population growth between now and 2050 is expected to occur in Africa,” the UN said in its new report, adding that the population of Africa could more than double by midcentury, increasing from 1.1 billion today to 2.4 billion in 2050, and potentially reaching 4.2 billion by 2100.

Against this background, Sinding said in the interview that he was encouraged that there seems to be a growing sense of commitment to financing family planning more generously as part of a development agenda. He told his insider story of how the situation was turned around in little more than a year or two.

“The initiative to resurrect family planning and to focus on population began in two different places and gradually coalesced,” he said. “One of those places was the UK, and a particular individual, a Conservative MP by the name of Richard Ottaway. As a member of Parliament, Ottaway joined an all-party group on population and development.

“Ottaway was very uncomfortable with the exclusion of reference to population growth and family planning in much of what came out after Cairo,” Sinding said. “I put it that way, rather than to say in Cairo, because in fact both family planning and population growth were referred to in the Cairo document. But the interpretation after Cairo of what happened, in the UN Population Fund and many governments, including essential virtually all of the European governments, excluded mention of overpopulation or family planning altogether, or nearly so. Ottaway was very unhappy about that.”

By 2005, Ottaway had persuaded the all-party group to embark on a study of the population factor in development. A series of hearings were held, and Malcolm Potts and Martha Campbell of the University of California at Berkeley, became senior consultants. They have written extensively on population effects in development.

“The other important source was the Gates Foundation,” Sinding said. “A couple of things happened in 2007-2008 that were really important. One of them was that Bill Gates started writing an annual letter, sort of patterned on Warren Buffet’s annual letter to shareholders. This [Gates letter] was more of an annual letter to stakeholders on what the Gates Foundation was doing. In the first report that he wrote, he basically embraced the child survival hypothesis: if we can get mortality rates down, population rates will follow. And that really got a lot of us very upset.”

Sinding and others formed a group of about 13 population experts who wrote to Bill Gates, “saying that while he was not wrong [in saying] that mortality reduction is a prerequisite for fertility decline, the rate at which fertility declines is also very much a function of the availability of contraception and family planning services, information — and that there were many examples around the world that had demonstrated that essential truth,” Sinding said.

“In the next year’s report, Gates acknowledged that,” Sinding added. “He wrote back to us, and thanked us for that contribution and said he would ask his staff to follow up on it.” It proved to be a turning point.

“Ultimately, the result of that was Melinda Gates’ conversion to a strong belief in family planning,” Sinding said. “She then made a very strong speech at the Women Deliver conference in 2010 in Washington. That really signaled a policy shift at Gates.” Grants began to flow to institutions and organizations advancing family planning.

Melinda Gates
Melinda Gates in 2012. She actively promotes the foundation's work in maternal health and birth control.

Then came the family planning “summit” in London exactly a year ago, organized by the Gates Foundation and development officials in the British government. “The US was there in a supportive way but not in a leadership role,” Sinding said. “The Australian government was very much involved, and even the European governments — initially with some reluctance — sort of came around to the point of view that family planning had been inappropriately neglected in the decade or decade and a half after Cairo, and that it was really important to establish its priority amongst the sexual and reproductive health programs. So a new kind of consensus began to emerge.”

At this point, Babatunde Osotimehin of Nigeria, who had become executive director of the UN Population Fund (UNFPA) in 2011, reversed institutional squeamishness on the subject and brought that UN agency into the picture. Its 2012 flagship population report, “By Choice, Not by Chance: Family Planning, Human Rights and Development,” was devoted to the campaign.

“But it was clear to everybody that UNFPA was a latecomer, a somewhat reluctant partner — you could even say a straggler,” Sinding said. “The momentum clearly had shifted to a much stronger emphasis on family planning than has been present since Cairo, and the leadership of that is coming from the Gates Foundation and a handful of governments — the UK, the US and Australia.”

Sinding is involved in organizing a nascent campaign with various other former US officials in the field to get the Obama White House to focus more on family planning in foreign aid. Congress has shown support for family planning, he said, “but the White House is not paying attention.”

“The most important outcome of the London summit was a commitment of very substantial additional resources,” Sinding said. “How much of that commitment will actually be realized remains to be seen. But some of it is bound to be, so a reversal of the downward trend in population issues certainly seems to be in the offing.”

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We welcome your comments on this article.  What are your thoughts?

Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a member of the Council on Foreign Relations. She has also contributed to the Oxford Handbook on the United Nations.

Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and previously its chief correspondent in Southeast Asia and South Asia. She is the author of “So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas,” “The Great Hill Stations of Asia” and a Foreign Policy Association study, “India Changes Course,” in the Foreign Policy Association’s “Great Decisions 2015.”

Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.

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