13 private sector programs have increased the use of contraception which in turn has led to reduced fertility and population growth." They go on to say, in much the same manner as the 1984 WDR, that "...[the amount ofl fertility reduction that can be achieved with a given program effort in a particular country depends on the level of development of that country.' They then estimate the effect of family planning programs in terms of the fertility rates that could be expected to have occurred in the developing world in the absence of organized family planning programs, and conclude that such programs reduced actual fertility by 1.2 births per woman during the period 1980-85. Cumulatively, between 1965 and 1990, there were an estimated 412 million fewer births than would otherwise have occurred. Projecting forward on the basis of current information about unwanted births (i.e., 21 percent of current births reported to be unwanted), they calculate that by simply averting unwanted births through effective family planning programs, the global population in 2100 could be 7.8 billion rather than the 10 billion estimated in the Bank's own projections. (In the absence of any organized family planning programs, they estimate that global population would grow to 14.6 billion by 2100.) Of course, it will not be possible to prevent all of the unwanted births, but, according to this analysis, even partially effective programs could produce significant declines in fertility and a much smaller population by the end of the next century than would otherwise be the case.

# Lessons Learned from Family Planning Program Experience

33. As is noted above, a great deal has been learned about the design and implementation of effective population projects in recent years. The vast literature which has accumulated on family planning program effectiveness will soon be available in summary form through the family planning effectiveness study referred to in footnote 1. Also, the recent OED study of Bank performance in several countries will soon be available. What follows is a brief overview of some of the most important lessons learned, which can guide the design of an enhanced Bank effort in the population field.

34. The quality of family planning services is crucial. Simply providing contraceptives is not enough. The more closely such services are linked to maternal and child health and nutrition programs, and the more care is taken in training administrators, supervisors, and field workers to respond to clients' perceptions and needs, the more acceptable and effective family planning services will be. The most successful programs in the longer term are those which emphasize comprehensive counselling on contraceptive methods and which assure informed choice among a reasonably broad range of methods in a completely non-coercive atmosphere.

35. Government commitment, both as stated in public pronouncements and as manifested in allocation of administrative and financial resources, is important. This commitment becomes more important the less capable the private sector is of catering to the demand for family planning services. Bank projects have tended to be most successful in countries whose governments were fully committed to effective programs. In many countries, the Bank has played an important role in encouraging such commitment. Examples are Rwanda, Kenya, Zimbabwe, Bangladesh, Nigeria and Mexico.

36. While the Bank has a comparative advantage in such infrastructure components of population programs as the construction of physical facilities, the most successful projects have been those where Bank resources have also financed such "software" and recurrent costs as training, transport, management information systems, and contraceptive supply. The recently completed OED reviews of the Bank's contributions to the population programs in Indonesia, Bangladesh, and Kenya strongly support this conclusion.

37. It is generally better to attempt to strengthen existing institutions than to try to bypass them by creating new ones. Even a weak Ministry of Health can do a great deal to undermine the effectiveness of a new agency that is established to administer family planning services. The slower s.art-up of a program