6

# The Role of Government

16. The effects on the poor of their own high fertility, and the fact that there is unwanted<sup>fertility,</sup> particularly among the poor in developing countries, have provided a critical justification<sup>for pubiic policy</sup> attention to family planning. In the 1984 WDR, the Bank defended public intervention to<sup>reduce ferti!ity on</sup> two grounds: the possible gap between private and social costs of children; and the failure<sup>of markets in the</sup> family planning area. The second justification for public policy concern was also<sup>ewn'hasized in the National</sup> Academy of Sciences report. Information about fertility control is not fully marketable;<sup>for example, there</sup> is no opportunity for profit from informing people about such means of contraception<sup>as rhythm and</sup> withdrawal. There are also like'- failures in the markets for contraceptive services;<sup>for example, where the</sup> demand for modem private health ca . is limited, e.g., in the rural areas of many developing<sup>countries, the</sup> private sector will not provide such contraceptive methods as the pill and the<sup>intrauterine device, since these</sup> are jointly produced with medical services. Or the pill, for example, will be provided<sup>privately through</sup> pharmacies, but without attention to safety and follow-up.

17. The Bank has for these reasons -- the effects of high fertility on poor women and<sup>children, and the</sup> poor markets for contr?ceptive services in developing countries -- put heavy emphasis on the<sup>logic of public</sup> support for family planning programs. The po.ential for access to finily planning to<sup>improve women's</sup> welfare by increasing their control over their own fate has also been increasingly emphasized;<sup>such an</sup> improvement could have implications for aggregate growth, as well if it were to generate<sup>rew externalities</sup> in terms of women's development of their own human capital and that of their female children.

# Conclusion

18. While the rationale has shifted somewhat over time, the Bank's long-standing concern<sup>for population</sup> and family planning remains compelling.

- A In a critical set of countries, where population growth is rapid, per capita income is low, and institutional, market, and policy failures are clear, rapid population growth adds to the constraints inhibiting economic growth and limiting the government's<sup>ability to promote</sup> human development. In these countries (probably including much of Africa, the poor countries of the Middle East and south Asia and some countries of South<sup>and Central</sup> America) continuing, and in some cases renewed, attention by the Bank to population issues is clearly warranted. In other countries, where there is more room for debate about whether rapid population growth is a small or a serious problem, prudence still<sup>suggests strong</sup> attention; this applies all the more when there are likely negative environmental effects that will be very costly, if not impossible, to rectify. The nature and content of the Bank's dialogue on population issues in these countries needs to be attuned to their particular nteds and circumstances.

- In almost all countries, irrespective of the magnitude of the "population' problem, the potential i' -onsiderable for improving the lives of the poor directly by increasing<sup>their</sup> access to fawily planning, thereby reducing their own high fertility and improving the lives of their children. In all these countries, the nature and content of the Bank's dialogue on population and family planning policy, and its advice and lending for family planning programs, aeeds to be at ied to the particular problems they face. These vary greatly, from limited access to family planning in rural areas because health infrastructure is lacking (in much of Africa); regulatory barrin;rs to the use of low-cost paramedicals to deliver simple