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How effective are family-planning programs
at improving the lives of women? Some
perspectives from a vast literature
In the past 50 years, family-planning programs have been heavily promoted across the developing world. A vast academic literature now tests both the intellectual rationale for these programs, as well as their impact on a wide range of demographic and economic outcomes. In recent years, the availability of new methods and new datasets from the developing world has intensified the academic research on these issues even though the support for family-programs themselves has diminished. This paper examines the economic and demographic literature on family planning programs and summarizes evidence of their impact on fertility as well as additional outcomes such as child mortality, investments in children’s human capital, the economic status of households and the macro-impacts on communities. The goal is to provide policy-makers with an understanding of the strengths, limitations and points of agreement that emerge from this vast literature.
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In the past 50 years, family planning (FP) programs have been heavily promoted across the developing world as a means to reduce fertility rates and promote economic development. The central assumption behind such programs is that the decline in birth rates during the early stages of demographic transition can promote economic growth, reduce environmental pressures, reduce dependency ratios and strengthen a societies’ ability to invest in health and education (Coale, Hoover, and Press 1958). At the micro-level, it has been assumed that a decline in fertility would relieve women of the burden of repeated child-bearing and free up opportunities for them to increase schooling and participate in the labor-force.
A significant literature – shaped by economists and demographers – now tests these assumptions (Kelley and McGreevey 1994; Kelley 1995). Much of the literature however, remains either theoretical or focused on macro-correlations between variables such as fertility or population growth and indicators of development such as GDP growth or female education. The causal impact of declining fertility and/or the impacts of FP programs on fertility have proved to be difficult to find. One of the main challenges faced by researchers is that fertility decline is affected by a wide range of variables, including socioeconomic variables such as income, education (particularly female education) and female employment. Changes in these variables can affect the demand for FP, the structure of the programs, and their ultimate impact. There is also the issue of policy itself. FP programs are rarely rolled out randomly. Placement of programs in areas with distinct characteristics made it difficult to identify the precise policy driver of any observed change in behavior.
In recent years, the research has been enriched by the availability of new methods and new datasets from the developing world. This includes cross-sectional surveys such as the Demographic and Health Surveys (DHS), panel datasets such as the Family Life Surveys, and the use of random assignment evaluation methods that study causal relationships under careful scientific experimental structures. This paper examines this literature and summarizes evidence of the impact of FP programs on fertility as well as additional outcomes such as child mortality, investments in children’s human capital, the economic status of households and the macro-impacts on communities. We define an FP program as any organized effort to encourage couples to limit their family size, and space their births by using contraceptive information and services. This includes legislative, regulatory, and programmatic efforts to supply contraceptives to a population as well as efforts to reduce the demand for children and/or...
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