One of the defining characteristic of mothers with the good fortune of living in developed nations is having the means to control childbearing to promote their health and their family’s welfare. The vast majority of women in the United States have used a family planning method at some point in their reproductive lives. And for all practical purposes, this cuts across all religious, social and cultural groups.
It is in this context, that as a Christian, I am mystified by the recent political debates about providers restricting access to family planning methods, because I believe the practice of fertility control is one of the core values of responsible parenthood. I am speaking from the perspective of a health professional who has worked for over 45 years on public health programs in developing countries and has seen the devastating consequences for women and their families when they have not had the freedom, the information and means to exercise fertility control.
Bangladesh provides a good example. For eight years in the period between 1965 and 1979, I lived and worked in Bangladesh (formerly East Pakistan before 1971). When I first arrived in 1965, women were averaging six births, but almost 20 percent of the children died before the age of 5. And women had a lifetime risk of greater than 1 in 16 of dying in childbirth.
When Bangladesh gained its independence from Pakistan in 1971, it was considered one of the world’s basket cases due to poverty, illiteracy, a lack of any industrial base or natural resources, and a very high population growth rate of over 3 percent per year.
The Bangladesh government was beginning to respond, but the national family planning program, largely based on clinical services, was very weak. Beginning in 1976, USAID supported a series of rural family planning projects that demonstrated the effectiveness of trained female field workers going house-to-house to deliver pills, injections and condoms backed by the full range of clinical services (intrauterine devices and sterilization) in helping women to achieve their fertility control goals. In three years, the use of family planning rose from 4 percent to 30 percent and birth rates dropped by 25 percent in the project area. Over the next three years, the government of Bangladesh adopted this strategy, recruiting more than 30,000 women field workers to reach a national population of over 85 million.
Over the next three decades, the fertility transition was dramatic. Around 55 percent of women in Bangladesh are now practicing family planning and the fertility rate has declined to 2.3 births per woman. Correspondingly, child mortality has fallen by 75 percent and the risk of death in childbirth has dropped by 70 percent. Over this same period, as mothers have gained control over their reproductive lives, social and economic development has rapidly advanced. For example, now 90 percent of children go to elementary school.
I could recount similar stories in many other parts of the developing world where mothers have gained control of their fertility and experienced great improvements in health and welfare. To me, a value central to motherhood is the ability to choose when she will bear children, and how many she will have. We know from the experience in our own country that given the knowledge and means, the overwhelming majority of women will exercise this choice by practicing family planning when they wish to delay or prevent a pregnancy. The global tragedy is that there are upwards of 215 million women around the world who have an “unmet need” for effective family planning, and thus cannot fully share in the joys of being a mother who can responsibly care for her family.
Returning to the debate mentioned earlier, I should note the fact that there is no controversy about family planning among the vast majority of Christian organizations actually working in the field of international health. In 2008, Christian Connections for International Health, a network of 160 Christian organizations working in international health around the world, conducted a survey of its members. The results revealed the majority were providing family planning services and saw family planning as an important component of international health. Furthermore, in June 2011, at a major interfaith consultation in Nairobi, Kenya, an Interfaith Declaration supporting family planning as an essential component of maternal and child health and family welfare was crafted with participation by Muslims, Hindus, Buddhists, and both Catholic and Protestant Christians.
The provision of modern family planning services does not exclude Catholics, since American Catholics use all the same modern methods used by non-Catholics. In addition, the World Health Organization now recognizes a natural method known as the Standard Days Method as a modern method of family planning. Natural methods are used widely by Catholic health programs.
Fortunately, the international community interest in supporting family planning has been reinvigorated in the past few years. I am encouraged to see the interest of philanthropist Melinda Gates of the Bill and Melinda Gates Foundation, speaking from her Catholic background, in getting this issue back on the global health agenda. Her talk April 5 at the TEDxChange made the case that there is no legitimate reason family planning should be controversial and that it enables couples to give their children a chance for a healthy and productive future. I agree. Let’s return the discussion of family planning back to the health issue it is, and not the political issue it has become.
W. Henry Mosley, MD, MPH, is professor emeritus at Johns Hopkins Bloomberg School of Public Health. He is also a member of Christian Connections for International Health.
This post has been updated.