Guatemala, Indonesia, and Nigeria.<sup>10</sup> The key question is whether family planning programs can advance the timing of reproductive change and accelerate it once underway.

In a highly influential paper, Pritchett (1994a) argued that family planning programs have little impact on fertility: ‘Ninety percent of the differences across countries in total fertility rates are accounted for solely by differences in women's reported desired fertility.... The results contradict theories that assert a large causal role for expansion of contraceptive use in the reductions of fertility’ Pritchett (1994: abstract).

Many have taken Pritchett’s study as indicating that effort on family planning programs is ill-spent, but he later concludes that his estimates imply that strengthening a family planning program substantially (by 50 points out of a scale of 0-100) would reduce fertility by one birth (Pritchett 1994b: 626). Bongaarts (1997) estimates the corresponding fertility reduction at 1.4 births, but even Pritchett’s lower estimate amounts to a very large difference in population momentum and size. If one birth less per woman was sustained in sub-Saharan Africa over the period 2010-2100, the region would have an estimated 2.6 billion fewer people in 2100 – more than halving the estimated total population at the end of this century (Figure 4).

A crucial gap in Pritchett’s argument is that he assumes that family planning programs work only on the supply side, and overlooks their important role in reducing desired family size. He conducts cross-country regressions of Total Fertility Rates against contraceptive prevalence and against family planning effort, but in both cases he _controls for desired fertility_ (Pritchett 1994: Table 3). Yet mass media outreach to reduce desired family size is a major component of family planning programs. Studies have shown that the mass media are very effective at increasing contraceptive use and reducing fertility (see below).

# **_4.1  What do family planning programs seek to do?_**

Family planning programs seek to boost use of contraceptive methods by expanding their supply and accessibility, thus enabling couples to postpone or limit childbearing. This is especially important for the poor, who typically have higher numbers of unwanted children than the rich except in settings with very effective programs, such as Indonesia (Figure 5).

Family planning programs also typically seek to reduce desired family size by disseminating information on new opportunities for altering living standards through new strategies for bearing and investing in children. Parents – especially poorer parents – have imperfect information on these issues. Households also appear to face difficulties in making optimal choices that involve long-term planning horizons (see for example Cronqvist and Thaler 2004 on pension decisions). Offering simple information on contraception ― or more complex messages through radio or television, such as soap operas that portray the lives of people with small families and how they access new opportunities ― helps reduce imperfect information.

Media outreach has been found effective at increasing contraceptive use and lowering fertility. This has been found in many studies using cross-sectional survey data on access to media (e.g. Bhat 1996). The few quasi-randomized evaluations have found it effective at altering fertility and contraceptive use in Tanzania (Rogers et al 1999) and reducing fertility in Brazil and India (La Ferrara et al 2008; Jensen and Oster 2009).

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