The Global Family Planning Revolution Three Decades of Population Policies and Programs Warren C. Robinson John A. Ross Editors The Global Family Planning Revolution The Global Family Planning Revolution: Three Decades of Population Policies and Programs Warren C. Robinson and John A. Ross, Editors THE WORLD BANK Washington, D.C. © 2007 The International Bank for Reconstruction and Development / The World Bank 1818 H Street NW Washington, DC 20433 Telephone: 202-473-1000 Internet: www.worldbank.org E-mail: [email protected] All rights reserved 1 2 3 4 10 09 08 07 The findings, interpretations, and conclusions expressed in this volume do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. 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All other queries on rights and licenses, including subsidiary rights, should be addressed to the Office of the Publisher, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2422; e-mail: [email protected]. ISBN-10: 0-8213-6951-2 ISBN-13: 978-0-8213-6951-7 eISBN-10: 0-8213-6952-0 eISBN-13: 978-0-8213-6952-4 DOI: 10.1596/978-0-8213-6951-7 Cover design: Quantum Think, Philadelphia, Pennsylvania Cover photo: Peter Adams/Getty Images Library of Congress Cataloging-in-Publication Data The global family planning revolution : three decades of population policies and programs / Warren C. Robinson and John A. Ross (editors). p. cm. Includes twenty-three case studies. Includes bibliographical references and index. ISBN-13: 978-0-8213-6951-7 ISBN-10: 0-8213-6951-2 ISBN-10: 0-8213-6952-0 (electronic) 1. Population policy—Developing countries—Case studies. 2. Birth control—Developing countries—Case studies. 3. Contraception—Developing countries—Case studies. 4. Fertility, Human—Developing countries—Case studies. 5. Population—Developing countries—Case studies. I. Robinson, Warren C., 1928- II. Ross, John A., 1934- HB884.F35 2007 363.909172'4—dc22 2007003152 Contents FOREWORD: THE FAMILY PLANNING PROGRAM REVOLUTION IN PERSPECTIVE ix Ronald Freedman and Albert I. Hermalin PREFACE xi ABOUT THE EDITORS AND AUTHORS xiii 1. Overview and Perspective 1 Steven W. Sinding Part I. Middle East and North Africa 13 2. The Evolution of Population Policies and Programs in the Arab Republic of Egypt 15 Warren C. Robinson and Fatma H. El-Zanaty 3. Family Planning in Iran, 1960–79 33 Richard Moore 4. Tunisia: The Debut of Family Planning 59 George F. Brown 5. Morocco: First Steps in Family Planning 71 George F. Brown Part II. Europe and Central Asia 83 6. Emergence of the Family Planning Program in Turkey 85 Ays¸e Akin Part III. Latin America and the Caribbean 103 7. Family Planning in Chile: A Tale of the Unexpected 105 Hernán Sanhueza VI | CONTENTS 8. Against the Odds: Colombia’s Role in the Family Planning Revolution 121 Anthony R. Measham and Guillermo Lopez-Escobar 9. Guatemala: The Pioneering Days of the Family Planning Movement 137 Roberto Santiso-Gálvez and Jane T. Bertrand 10. Family Planning and the World Bank in Jamaica 155 Timothy King Part IV. East Asia and the Pacific 175 11. The Korean Breakthrough 177 Taek Il Kim and John A. Ross 12. Hong Kong: Evolution of the Family Planning Program 193 Susan Fan 13. Singapore: Population Policies and Programs 201 Yap Mui Teng 14. The Emergence of Thailand’s National Family Planning Program 221 Allan G. Rosenfield and Caroline J. Min 15. Formative Years of Family Planning in Indonesia 235 Terence H. Hull 16. The Family Planning Program in Peninsular Malaysia 257 Nai Peng Tey 17. Development of the Philippines’ Family Planning Program: The Early Years, 1967–80 277 Alejandro N. Herrin Part V. South Asia 299 18. Emergence of the Indian National Family Planning Program 301 Oscar Harkavy and Krishna Roy 19. Family Planning Programs and Policies in Bangladesh and Pakistan 325 Warren C. Robinson 20. Early Family Planning Efforts in Sri Lanka 341 Nicholas H. Wright 21. Emergence and Development of Nepal’s Family Planning Program 363 Jayanti M. Tuladhar CONTENTS | VII Part VI. Sub-Saharan Africa 377 22. Family Planning in Ghana 379 John C. Caldwell and Fred T. Sai 23. Family Planning in Kenya in the 1960s and 1970s 393 Donald F. Heisel Part VII. Conclusions and Lessons for the Future 419 24. Family Planning: The Quiet Revolution 421 Warren C. Robinson and John A. Ross Foreword: The Family Planning Program Revolution in Perspective The family planning programs carried out in many developing countries from the 1950s through the 1980s represent one of the important social experiments of the post–World War II period, but the details of their operations, their commonalities, and their differences have been insufficiently archived given the programs’ day-to- day pressures and the large numbers of people involved. This volume helps fill this gap with much useful information and informed analysis. The programs were complex undertakings in difficult settings that had little prior experience to draw upon. Not surprisingly, as the case studies described here demon- strate, no single strategy was available that could be employed across these diverse situations, and procedures that were successful in one country did not necessarily function well in another. However, a common thread wove through the multiplicity of approaches: more often than not, an effective starting point was built from insights into a particular country’s social, economic, and cultural settings along with a realistic appraisal of resources available and the political will to move forward. Many of these efforts also demonstrate that persistence is important. For a program to encounter unforeseen problems was not unusual, but those countries that adopted a trial-and-error mentality could often overcome these setbacks and get the program back on track. The case studies also indicate that developing a successful program was as much an art as a science. The key ingredient was being able to distinguish when a some- what radical new approach was needed and when only some fine-tuning was neces- sary. That wisdom cannot be taught. However, many countries were fortunate in that their leaders and those who helped develop and run the programs had this skill at crucial times in a program’s development. While not a focus of this book, the family planning programs had several important, indirect effects on the field of population studies that merit attention as part of the record. First, uncertainty about the programs’ worth and how to measure the extent of their success spurred a great deal of research on the measuring and modeling of fertility and contraceptive practice, on fecundity issues, on the effect of marriage patterns on fertility, and on a host of related topics. Investigators developed new meth- ods of collecting data and measuring these dimensions, and the challenge of making X | FOREWORD: THE FAMILY PLANNING PROGRAM REVOLUTION IN PERSPECTIVE good estimates in the face of incomplete and fragmentary information spurred a num- ber of advances in formal demography. Second, the programs greatly advanced the science of evaluation. How did one demonstrate that the programs were working in the face of the social and economic changes also ongoing in most countries? Researchers developed a number of new evidence-based techniques, many built on the new models of fertility and fecundity, while others advanced statistical practice in contextual or multilevel analysis. Third, the programs led demographers to work with specialists from many other disciplines, including public health, economics, sociology, political science, and psy- chology. These disciplinary perspectives became key ingredients of population stud- ies and, in turn, the demographic perspective influenced the other fields. The collab- orations also widened the subject matter scope of demography, making it much more open to pursuing broader questions of health, economic status, family dynamics, and other facets of societal functioning. For example, a look at the current programs of the annual meetings of the Population Association of America as compared with those of the 1950s reveals how the field has expanded to tackle a wide array of health and societal issues. Finally, the family planning efforts attracted many new and talented people to the field of population studies. Motivated in part by concern about rapid population growth, which was highly publicized at the time, many students from different disci- plines chose to undertake graduate work in demography and population studies. In addition, the family planning programs helped pave the way for many subse- quent health, social, and economic programs. They helped establish the feasibility and legitimacy of mounting large-scale interventions aimed at such objectives as improv- ing maternal and child health, eradicating disease, improving nutrition, enhancing educational opportunities, and undertaking village economic development. Of course, many health efforts were launched before the 1950s and many kinds of programs were motivated by other sources, but the family planning efforts around the world con- tributed to the development of a mindset that massive, worthwhile efforts were feasi- ble and desirable.