Family Planning

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Family Planning

Family planning is both a descriptive term and an organizational one. It was originally conceived as a public relations effort to emphasize the broadened scope of those involved in the struggle to spread the concept of birth control. The term achieved popularity in England before it did in the United States, and in May 1939, various British birth control groups amalgamated into the Family Planning Association, including in their program treatment for infertility and minor gynecological problems, child spacing, and contraceptive instruction and equipment. In the United States the name of the American Birth Control League was changed to the Planned Parenthood Federation in 1941 to emphasize the broad focus of family planning. The Planned Parenthood name was also adopted by the international federation that formed after the end of World War II, and family planning or planned parenthood became universal descriptors.

Broadly defined, family planning is the act of making a conscious plan about the number and timing of children's births. Timing may include the time of the first birth, the amount of space between births, and when to stop having children. It can include abortion, a discussion of the various means of contraception, and fertility testing and even treatment. Family planning involves not only the individual or couple, but society as well.

Methods and Effectiveness

People have consciously or unconsciously engaged in family planning throughout history. Abstinence, either lifelong or temporary, and prohibitions forbidding intercourse during certain times of the year or during certain festivals effectively curtail the fertility rate (the number of live births for each women during her lifetime). Separation of husbands and wives for long periods of time by war or business trips also curtails the fertility rate.

Abortion has often been used to limit family size, and descriptions of abortifacients, or agents that cause abortion, can be found in the herbal and other folklore of women and midwives of most societies. The deliberate abandonment of infants and young children, even killing of newborns, has not been uncommon in the past or even in some areas of the world today. Although the early Christian Church outlawed infanticide, it emphasized the stigma of illegitimacy, which meant that out-of-wedlock infants were brought to overcrowded orphanages and monasteries, where the majority of them died of starvation or disease within a few months.

Prolonged lactation is also a factor in spacing births. Lactation and the stimulus of the infant sucking ordinarily suppresses ovulation and menstruation, but it is highly effective as a birth control mechanism only when the infant consumes nothing but breast milk or when couples normally abstain from intercourse during lactation. As partial weaning takes place—as early as four to six months—the menstrual cycle returns in most women who are adequately nourished, and pregnancy is again possible.

Numerous devices such as condoms and IUDS (intrauterine devices) have been and still are used in family planning. Alternate methods of intercourse, including withdrawal and anal intercourse, also lessen the chance of pregnancy. One of the earliest results of the use of broad-scale methods sufficient to affect national fertility was the decline in the French birth rate from the end of the eighteenth century, a decline attributed to the widespread use of coitus interruptus (Van de Walle 1978). The continuing search for means of controlling contraception emphasizes an almost universal desire for humans to gain some control over the number and spacing of births.

The effectiveness of family planning is measured by the fertility rate, the total number of live births a woman at age fifty would have had. The replacement rate for a stable population is over two and under three. In the twentieth century, many countries had fertility rates below the replacement ratio but still gained population because people were living longer and several generations of a family were alive at the same time. In determining potential rates of increase without any family planning, demographers traditionally have used Hutterite women as their maximum standard for potential. The Hutterites are members of a religious denomination (in the northern United States and Southern Canada) who in the past did not use any method of family planning, although evidence suggests that this is changing. Their living standard is not luxurious, but their food supply is more than adequate, and they are regarded as very healthy. Hutterite women bore an average of twelve children in the early part of the twentieth century (Coale 1971), and this has been considered the maximum for a totally uninhibited rate of fertility that only could reached under the best possible conditions. Current fertility rates in some countries of the Third World, such as Saudi Arabia, Malawi, and Rwanda, were between seven and eight at the beginning of the 1990s, but even these had dropped to between six and seven at the end of the decade (International Planned Parenthood Federation 2002), indicating the growing influence of family planning.

Social Regulation

Organized efforts at family planning began to appear in the nineteenth century although, as in the case of France, some forces were at work earlier. The nineteenth-century efforts were started by individuals concerned with the poverty and malnutrition that seemed to be endemic among large families. Governmental bodies initially paid little attention to such efforts, and when they did they often opposed the advocates of family planning. In the United States, for example, governmental agencies such as the post office in the last part of the nineteenth century classified family planning materials as pornography. At the beginning of the twentieth century, President Theodore Roosevelt compared women who avoided pregnancy to men who refused to serve in the armed services in time of great national emergency. He argued that U.S. women had a patriotic duty to have children. Not until the last part of the twentieth century did governments in general take direct or indirect action to encourage family planning. This concern came primarily because of a growing concern about overpopulation, but it also reflected the growing influence of women on national policy.

At the beginning of the Industrial Revolution in the eighteenth century, the world population was estimated at 750 million. With growing urbanization and industrialization, growth escalated rapidly, reaching one billion in 1830, two billion in 1930, three billion in 1960, five billion by 1990, and six billion in 2000. It will probably continue to grow— unless there is radical change in trends—until 2020, after which a slow decline will begin. The growth, as indicated above, is due to declining mortality as the standard of living and sanitation have improved and communicable diseases controlled. The most rapid growth has not been in the highly industrialized countries but in those that have not yet industrialized. As the standard of living has risen in Western Europe, the United States, and similar countries, the fertility rate by 1990 had already fallen below two and in some as low as one and three-tenths (Green 1992).

Most countries have relied on education in family planning to lower fertility rates, although more drastic means have also been used. In India, for example, the government of the late Indira Gandhi was forced to cut back on their program because it was alleged that sterilization was being forced on the less educated peasants. The problem of overpopulation is compounded in many of the underdeveloped countries because the largest segment of their population is in the childbearing years. In these places, even with the more or less drastic lowering of fertility ratios, population will continue to grow. The People's Republic of China in the 1980s became the first country in the world to embark on a deliberate and comprehensive course to reach zero population growth by the end of 2000 or as soon after that as possible. In spite of drastic efforts to limit families to one child, forcing families in the cities to get permission to even try to get pregnant, and the use of drastic sterilization and abortion programs, the country failed to meet its goal, and its population in 2001 was nearly 1,300,000,000. It is, however, well on its way to doing so, and soon it will be surpassed as the country with the largest population by India (which stands at 1,034,000,000).

The Chinese policy uses, on the one hand, the carrot and stick, with promises of better schooling and other rewards for families who have only one child, and on the other hand, forced abortions or sterilizations for those who have more. In 1993 the government approved a bill to forbid marriages of persons with hepatitis and other sexually transmitted diseases, mental illness, and congenital disabilities, but the Chinese experiment emphasizes the difficulty that even authoritarian states have in encouraging family planning. In the United States, where the fertility rate is under two, in the year 2000 more than 30 percent of the women did not use any modern mechanical or chemical method of contraception. Half of the U.S. pregnancies are believed to be unplanned or unwanted, a rate that is higher than in most other industrial countries. This is one reason for the high—although declining— abortion rate in the United States. Most of the pregnancies in the United States occurred among women who came from disadvantaged backgrounds and were under twenty-five. This suggests that in general, not everyone in the United States has fully changed to the belief in an overpopulated world. How much they should change their beliefs is a matter of public discussion. That fact that not all the U.S. states gave people access to contraception until 1965, and that abortions were prohibited until 1973, emphasizes the difficulty family planning had in being accepted.

Evidence suggests that about 600 million people use contraception, and millions more would do so if they had access to high-quality services. To reach them, family planning advocates have adopted an educational four-point program that points out what family planning does: First, it saves women's lives. Avoiding unintended pregnancies could prevent about one-fourth of all maternal deaths in developing countries. Using contraceptives helps women avoid unsafe abortions, limit birth to their healthiest childbearing years, and prevent giving birth more times than is good for their health. Second, family planning saves children's lives. Spacing pregnancies at least two years apart helps women have healthier children and improves the odds of infants' survival by about 50 percent. Limiting births to a woman's healthiest childbearing years also improves her children's chances of surviving and remaining healthy. Third, women are given more choices. Controlling their own childbearing by using effective contraception can open the door to education, employment, and community involvement. Couples who have fewer children are more likely to send their daughters as well as sons to schools. Fourth, family planning encourages the adoption of safer sexual behavior. All sexually active people need to protect themselves against sexually transmitted infections (STIs), including HIV/AIDS. Using condoms or avoiding sex except in a mutually monogamous relationship are the best ways to do so. Advocates also emphasize that effective family planning helps protect the environment and aids economic development by slowing population growth.

Although governments increasingly have taken an active role in pushing family planning, many professionals believe that the keys to success are also encouraging individual advocacy—presenting stories of people's personal experiences showing how family planning improves individual lives— and encouraging nongovernmental organized groups to carry out educational campaigns. Several published guides on advocacy are available, including International Planned Parenthood Federation's Advocacy Guide and the Population Information Program at Johns Hopkins University, A Frame for Advocacy. The optimal situation for family planning involves a discussion between both members of the couple before they begin to have sexual relations and includes a sharing of mutual hopes and desires to make sure they are sufficiently congruent to achieve a good marriage or partnership. These discussions should include all aspects of planning (whether marriage will occur and when, whether children are planned and when, and the number and spacing of children). They should consider early in the discussion whether the individual man or woman wants to have children. Most young people want at least one child, although they may change their minds over time. If a couple decides to have children, they must then plan the number of children. People make these decisions in the context of the norms of their individual groups, although it is good to keep in mind that such norms can also change, which emphasizes the need for ongoing discussion.

Infertility

Perhaps the best indicator of the North American and increasingly worldwide desire for children is the growing ongoing concern with infertility, something that is also part of family planning. Somewhere between 10 and 15 percent of all couples have difficulty conceiving, with the causes about equally divided between men and women. Major causes include venereal infections, failure to ovulate, low sperm count, obstructions in either the male or female reproductive organs, and impenetrable cervical mucus. Sometimes these problems can be treated with antibiotics, surgery, or hormones. If these methods fail, couples may also try artificial insemination or in vitro fertilization— approaches that have have been successful for many couples. The down side to their use, however, is that now that these technological approaches to conception are available, some couples feel obligated to try to have a baby. The complex approaches, including in vitro fertilizations, are expensive, time consuming, and often disappointing.

Conclusion

Ideal family planning includes consideration of the timing of marriage, number and spacing of children, and when the first and last births will occur. It requires that couples discuss sexuality, contraception, and other long-range plans such as schooling or work plans that affect births. North Americans still do little of this planning, and teenagers receive insufficient instruction about these topics. Family planning should be an important part of the modern lifestyle. If individuals do not take on this responsibility, there is always the potential that government, as in the case of China, will see a need to intervene.

See also:Abortion; Acquired Immunodeficiency Syndrome (AIDS); Abstinence; Assisted Reproductive Technologies;Birth Control: Contraceptive Methods; Birth Control: Sociocultural and Historical Aspects; Childcare; Childlessness; Circumcision; Fertility; Hutterite Families; Infanticide; Pregnancy and Birth; Sexuality; Sexuality Education; Sexually Transmitted Diseases; Single-Parent Families

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