Population Growth – Impact on the Millennium Development Goals
Introduction
As a reproductive health professional with a specific expertise in rights-based development
work, my main purpose with this piece is not to demonstrate the effect of population growth
on the achievement of the Millennium Development Goals (MDGs), since many people with
greater expertise than mine can and will attest to that, but to emphasize the importance of
ensuring that efforts to draw attention to population growth also emphasize the importance of
respecting and protecting human rights. This paper will examine three of the core topics
under review – the effect of population growth on poverty and hunger, gender equality and
the empowerment of women, and maternal health, and will seek to demonstrate that, while it
is clear that population growth militates against the achievement of these MDGs, it important
that, in advocating increased attention to population growth, adherence to the values that
underpinned the ICPD consensus is critical, not only to secure the success of such efforts,
but in order to ensure that civil society advocacy of sexual and reproductive health and rights
– so crucial for building the Cairo consensus - is sustained, and not destroyed in the
process.
The Past as Prologue
During the 1960s and 1970s, population growth was promoted by some groups as a
panacea to several global development problems, principally by advocates from the North
whose keenness to reduce population growth rates in the South led to the growth of vertical
family planning programmes, which often favoured permanent methods of contraception
over others, and did much to generate the backlash that was encapsulated in the slogan
current at the 1974 Bucharest World Population Conference that “Development was the best
contraceptive”. Development approaches which made contraceptives available, but did little
to improve other aspects of the health and well-being of individual women and men were
sometimes successful in lowering birth rates, but were often and legitimately criticized for
generating “Population Control” programmes which, while some may have achieved
demographic targets, did little to improve the overall wellbeing, or advance the rights of the
people for whom they were intended1.
During the years leading up to the 1994 International Conference on Population and
Development in Cairo, many civil society organizations, including leading women’s health
advocates, advocated effectively for a more inclusive framework, that placed women’s
empowerment, sexual and reproductive health, and human rights, at the centre of population
policy-making, and the “Cairo Consensus” that emerged was indeed a comprehensive
framework that integrated demographic concerns with an emphasis on programmes that
were ethically sound, and responsive to the wellbeing of the individual women and men they
were designed to serve.
Unfortunately, the meticulously costed Cairo Programme of Action was never adequately
funded, and the funding available for sexual and reproductive health has been increasingly
focussed on the global priorities related to the treatment and prevention of HIV/AIDS. This
has happened during an era when the Millennium Development Goals – a set of
international development priorities which omitted the Cairo goal of universal access to
reproductive health by 2015 - have dominated development policy. While “joined up
thinking” among donors, and has generally benefited international development approaches,
it hasn’t been particularly good for sexual and reproductive health; recent reviews of EU
country strategy papers, which are negotiated in-country, revealed that, of 78 papers for
Africa/Caribbean/Pacific countries, 13 mention health, but not one mentions reproductive
health. In this challenging environment, in which, to quote Professor Fred Sai, family
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planning has been “integrated out” of development, despite a perception that the issue has
gone away, fertility remains high in least developed countries; in 21 of the poorest countries
in sub-Saharan Africa, the total fertility rate – the average number of births per woman - has
remained high, or declined only slightly, since the 1970s2. In 2000-2005, fertility remains
above 5 children per woman in 35 of the 148 developing countries, 30 of which are least
developed countries3.
The key challenge is to generate increased awareness of the negative impact of population
growth, and it’s potential to derail progress towards achieving the MDGs, while preserving a
programmatic approach to sexual and reproductive health that reflects the Cairo consensus
that policies and services must respect and protect basic human rights.
So, what are the key ingredients of rights-based programmes? Core principles include
participation, accountability, and non-discrimination. Jodi Jacobson4 has identified the
following essential elements, stating that rights-based programmes: 
Address sexual violence and coercion, especially as they relate to restricting women’s
choices, and exposes women and girls to higher risks of morbidity and mortality

Incorporate communication and behaviour change interventions encouraging the
prevention of disease, the practice of safe sex, and changes in social norms that
encourage equitable partnerships

Incorporate multi-source reproductive health and rights education strategies, and seek to
instil a sense of entitlement among people and a rights-based ethos within programmes

Establish means of ensuring the accountability of programmes to the population and
means of redress for violations of rights
Programmes that embody these approaches will avoid the coercive nature of some of the
justifiably criticised programmes that characterized some of the more enthusiastic birth
control programmes of the 1960s and 1970s, that generated the backlash against family
planning that has, in part, been responsible for the notion that concern about population
growth should not be mentioned in polite society, and its status as a developmental issue
that dare not speak its name. Whether or not its re-emergence as a legitimate global priority
will succeed where the “neo-Malthusians” failed will depend in no small part on the extent to
which its advocates embrace the centrality of the Cairo consensus, and recognize the
central importance of respecting and protecting human rights.
Poverty and Hunger
Key facts5


Reproductive illnesses and unintended pregnancies weaken or kill people in their most
economically productive years, not only exacting a financial toll on individuals and
families but also undermining the economic development of nations. Sexual and
reproductive health conditions account for nearly one fifth of the global burden of disease
and 32 percent of the burden among women of reproductive age worldwide.
In sub-Saharan Africa, poor reproductive health accounts for nearly two-thirds of
disability-adjusted life years lost among women of reproductive age. In many developing
countries, women earn 40 percent to 60 percent of household incomes – a significant
economic contribution that is lost when a woman dies in pregnancy or is unable to work
due to poor reproductive health.
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
Smaller family size has contributed to economic opportunities. In 1950, East Asia’s
health, literacy, fertility and economic statistics were similar to present day sub-Saharan
Africa, the poorest region of the world. Increased access to desired reproductive health
services, including voluntary family planning programs, and its impact on fertility led to
higher ratios of workers to dependent children. This allowed families and governments to
invest more in each child – ensuring access to education and health care – and over
time, the ability to save more, invest more productively and, ultimately, stimulate
economic growth.
Key arguments2
 Investments in the economic rights of women—equal employment opportunities and
wages, credit, agricultural resources, inheritance and property rights—increase
productivity, farm yields, and family well-being. Women’s control over household
resources leads to higher investments in children’s health, nutrition and education.
 Many of the poorest countries are those in or emerging from conflict. Investing in women
and young people furthers the rebuilding of societies and economies, poverty reduction
and lasting peace and stability.
 Reproductive health problems disproportionately affect women and the poor and can
push families deeper into poverty.
Relatively recent analysis of demographic trends6 has identified a “demographic dividend”;
whereby, as a result of falling mortality rates, fertility declines, and a demographic transition,
characterized by changes in population growth rates and age structure changes produces a
“Boom Generation”. Whether or not the country experiences the benefits of this
demographic dividend depends, according to this analysis, on a policy environment that
encourages investment in public health, family planning and education. In many ways, this
is a restatement of the importance of maintaining a comprehensive approach to
development if lasting benefits are to be achieved from investment in family planning
programmes. Or, to put it another way, respecting and protecting the right to health care
and health protection, and the right to education makes sense in economic, as well as
developmental terms.
Gender Equality and the Empowerment of Women
Key Facts



For teenage girls, early pregnancy often brings an end to their education. Despite free
education programs and support for girls’ enrolment, only 46 percent of girls in Africa
complete primary school, and in more rural parts of the continent that rate drops below
15 percent. In its report to the UNDP, Ghana cites “minimizing the incidence of teenage
pregnancies” among its top five challenges to achieving equal access for boys’ and girls’
education.
Every year of education reduces the likelihood that a girl will bear a child in her teens or
live in poverty. Girls who complete their secondary education are between 3 and 13
times less likely to become mothers early in life and tend to have fewer and healthier
children.
Until a woman can determine the number and spacing of her children, she cannot
participate to the best of her abilities in society. The second of seven strategic priorities
recommended by the Millennium Project (MP) Task Force on Education and Gender
Equality is to “guarantee sexual and reproductive health and rights” pursuant to other
international agreements, such as the ICPD Programme of Action and the Beijing
Declaration and Platform for Action.
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Key Arguments






Gender inequality slows development. Equal political, economic, social and cultural
rights are required to reduce poverty.
Women’s ability to decide freely the number and timing of children is key to their
empowerment and expanded opportunities for work, education and social participation.
Men play a pivotal role in achieving gender equality, poverty reduction and development
goals, including improved infant and maternal health and reduced HIV transmission and
gender-based violence.
Violence against women and girls results in high social and economic costs—to
individuals, families and public budgets.
Eliminating child marriage, enabling adolescent girls to delay pregnancy, ending
discrimination against pregnant girls, and providing support to young mothers can help
ensure that girls complete an education. This can help break the cycle of
intergenerational poverty.
Girls’ secondary education provides high payoffs for poverty reduction, gender equality,
labour force participation and reproductive health, including HIV prevention and women’s
and children’s health and education status overall.
Amartya Sen has argued that “Advancing gender equality, through reversing the various
social and economic handicaps that make women voiceless and powerless, may also be
one of the best ways of saving the environment and countering the dangers of overcrowding
and other adversities associated with population pressure. The voice of women is critically
important for the world’s future – not just for women’s future”.
Steven Lewis, UN Secretary-General’s Envoy for HIV/AIDS in Africa has said that “The toll
on women and girls… presents Africa and the world with a practical and moral challenge,
which places gender at the centre of the human condition. The practice of ignoring gender
analysis has turned out to be lethal.”
Maternal Health
Key Facts



This is the MDG toward which countries have made the least progress, according to the
MP Task Force on Child Health and Maternal Health. More than 500,000 women die
every year from pregnancy-related causes, and more than 99 percent of these deaths
take place in the developing world. This statistic alone captures the impact of poor
access to contraception and lack of skilled care in pregnancy and childbirth, as well as of
pregnancies that occur too early in life, too late or too often.
Unintended and unwanted pregnancies contribute directly to maternal mortality. Access
to reproductive health services, including contraception as well as care in pregnancy and
childbirth, reduces a woman’s exposure to fatal obstetric complications – which account
for approximately 80 percent of maternal deaths globally – and enables a woman to plan
the timing and spacing of her children. A study of 15 West African countries found that
those with the highest contraceptive prevalence have the lowest maternal mortality rates,
and vice versa.
Improved access to comprehensive reproductive health services in Mauritius helped
reduce maternal mortality by roughly three-quarters between 1990 and 2000. The
country credits its primary health care strategy for this success, which includes an
increase in skilled birth attendants, 100 percent coverage of antenatal and postnatal
care, the provision of birth control during post-natal care, and improved access to family
planning services overall.
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
Providing skilled birth attendants and monitoring maternal mortality is not enough. Even
with the best primary care, 15 percent of women will experience potentially fatal
complications during pregnancy or childbirth and require emergency obstetric care, and
with each additional child, a woman increases her risk. The MP Task Force on Child
Health and Maternal Health recommends the addition of an indicator that explicitly tracks
the coverage of emergency obstetric care, recommending a minimum of “one
comprehensive and four basic functioning emergency obstetric care facilities per
500,000 people.”
Key Arguments



Key reproductive health components—family planning, skilled birth attendance and
emergency obstetric care—save lives.
Family planning can reduce maternal mortality by 20 to 35 per cent.
Improved quality of care and access to maternal health services (prenatal, during
delivery, post-partum) improves women’s health and quality of life for them and their
families.
Mahmoud Fathalla has said that “For obstetricians and midwives practising in developing
countries, maternal mortality is not about statistics. It is about women; women who have
names, women who have faces. Faces which we have seen in the throes of agony, distress
and despair. Faces which continue to live in our memories and continue to haunt our
dreams. Not simply because these are women in the prime of their lives who die at a time of
expectation and joy; not simply because a maternal death is one of the most terrible ways to
die... but above all because almost every maternal death is an event that could have been
avoided, and should never have been allowed to happen.” It is the fact that so many of
these deaths are preventable that makes maternal health a human rights issue.
Conclusion
It is incontrovertible that population growth, in countries where it is high, has the potential to
render it impossible to achieve the MDGs, particularly those related to poverty and hunger,
gender equality and the empowerment of women and maternal health. The key factor to
determine is whether or not those who advocate greater attention to this issue will learn from
the mistakes made during the last century, when overenthusiastic adoption of “population
programmes” brought the field into serious and not entirely undeserved disrepute. Given
cultural, racial and political sensitivities, it is more important than ever that advocacy on this
issue, during a period when HIV/AIDS is devastating the globe, is sensitive and respectful of
human rights. Sub-Saharan Africa is home to 25.8 million people living with HIV, almost one
million more than in 20031. Two thirds of all people living with HIV are in sub-Saharan
Africa, as are 77% of all women with HIV. Very high HIV prevalence—often exceeding 30%
among pregnant women—is still being recorded in Botswana, Lesotho, Namibia and
Swaziland and there is no clear evidence of a decline in HIV prevalence.
In Swaziland HIV prevalence among pregnant women soared to 43% in 2004, up from 34%
four years earlier. In 1992, prevalence had stood at 4%. Levels of knowledge of safe sex
and HIV remain low in many countries – even in countries with high and growing prevalence.
In 24 sub-Saharan countries two-thirds or more of young women (aged 15-24 years) lacked
comprehensive knowledge of HIV transmission. According to a major survey carried out in
the Philippines in 2003, more than 90% of respondents still believed that HIV could be
transmitted by sharing a meal with an HIV-positive person. Talk of decreasing population
growth in Sub-Saharan Africa where estimated 3.2 million people in the region became
1
HIV/AIDS data from UNAIDS
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newly infected, while 2.4 million adults and children died of AIDS is important, because
HIV/AIDS prevention depends on persuasive advocacy of condom use, but must be done
with great sensitivity, and lead to the development of programmes which individual women
and men feel are responsive to their needs.
Equally, advocacy on the impact of population growth on the world’s non-renewable
resources needs to be mindful of different resource consumption patterns. To put it another
way, it should become impossible to see facts and figures such as
Every day in 2003, some 11,000 more cars merged onto Chinese roads—4 million
new private cars during the year. Auto sales increased by 60 % in 2002 and by more
than 80 % in the first half of 2003. If growth continues apace, 150 million cars could
jam China’s streets by 2015—18 million more than were driven on U.S. streets and
highways in 19997.
- unless they are balanced by facts such as these: 


The United States, with less than 5 % of the global population, uses about a
quarter of the world’s fossil fuel resources—burning up nearly 25 % of the coal,
26 % of the oil, and 27 % of the world’s natural gas.
As of 2003, the U.S. had more private cars than licensed drivers, and gasguzzling sport utility vehicles were among the best-selling vehicles.
New houses in the U.S. were 38 % bigger in 2002 than in 1975, despite having
fewer people per household on average.
- or these: Calculations show that the planet has available 1.9 hectares of biologically productive
land per person to supply resources and absorb wastes—yet the average person on
Earth already uses 2.3 hectares worth. These “ecological footprints” range from the
9.7 hectares claimed by the average American to the 0.47 hectares used by the
average Mozambican.
If the MDGs are to be reached, population growth is one of the issues that must be
addressed. If addressed sensitively, with programmes that respect and protect rights, and
are planned with the communities they will be serving, and deliver sexual and reproductive
health care services, the MDGs become more feasible. If the lessons of the 60s and 70s are
not learned, the civil society coalition that generated the Cairo consensus will fracture, and
the programmes that are needed to prevent HIV/AIDS, reduce high-risk, including teenage
pregnancies, and reduce high birth rates will not materialize. The price of getting it wrong
this time is too high to contemplate.
1
Sen, G, Germain, A, Chen, L C. Population Policies Reconsidered: Health, Empowerment and Rights.
Boston, MA: Harvard School for Public Health, 1994.
2
UNFPA State of the World Population 2005. New York: UNFPA, 1995. Also source for “Key Arguments”
3
United Nations, Department of Economic and Social Affairs, Population Division. World Population
Prospects: the 2004 Revision. New York: UN, 2005.
4
Jacobson, J L, 2000. Transforming Family Planning Programmes: Towards a Framework for Advancing the
Reproductive Rights Agenda. Reproductive Health Matters 8 (15): 21-31
5
“Key Facts” taken from Population Action International. How Access to Sexual & Reproductive Health
Services is Key to the MDGs. Washington DC: PAI, 2005
6
Bloom, D, Canning, D, Sevilla, J. The Demographic Dividend: A New Perspective on the Economic
Consequences of Population Change. Santa Monica: Rand, 2003
7
Facts and figures below taken from Worldwatch State of the World Trends and Facts.
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