Combined oral contraceptives. Introduced in 1960, "the Pill" has played an instrumental role in family planning for decades. Family planning methods Family planning services are “ the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. ” Family planning may involve consideration of the number of children a woman wishes to have, including the choice to have no children and the age at which she wishes to have them. These matters are influenced by external factors such as marital situation, career considerations, financial position, and any disabilities that may affect their ability to have children and raise them. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction. The World Health Organization (WHO) and World Bank estimate that $3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections. Coercive interference with family planning Forced sterilization Compulsory or forced sterilization programs or government policy attempt to force people to undergo surgical sterilization without their freely given consent. People from marginalized communities are at most risk of forced URL Forced sterilization has occurred in recent years in Eastern Europe (against Roma URL and in Peru (during the 1990s against indigenous women). China's one-child policy was intended to limit the rise in population numbers, but in some situations involved forced sterilisation. Sexual violence Rape can result in a pregnancy. Rape can occur in a variety of situations, including war rape, forced prostitution and marital rape. In Rwanda, the National Population Office has estimated that between 2,000 and 5,000 children were born as a result of sexual violence perpetrated during the genocide, but victims' groups gave a higher estimated number of over 10,000 children. Human rights, development and climate 240x240px|Countries by 2019 GDP (nominal) per capita.Data from the United Nations is used. Some consider access to safe, voluntary family planning to be a human right and to be central to gender equality, women's empowerment and poverty reduction. Over the past 50 years, right-based family planning has enabled the cycle of poverty to be broken resulting in millions of women and children's lives being saved. The United Nations Population Fund (UNFPA) says that “Some 225 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities.” Choices not chance UNFPA The UNFPA says that “Most of these women with an unmet need for contraceptives live in 69 of the poorest countries on earth.” The UNFPA says, 190px|Global carbon dioxide emissions by jurisdiction As part of the United Nations Millennium Development Goals (MDGs) universal access to family planning is one of the key factors contributing to development and reducing poverty. Family planning creates benefits in areas such as, gender quality and women's health, access to sexual education and higher education, and improvements in maternal and child health. Note that the Millennium Development Goals have been superseded by the Sustainable Development Goals. UNFPA and the Guttmacher Institute say, Since climate change is directly proportional to the number of humans, family planning has a significant impact on climate change. The research project Drawdown estimates that family planning is the seventh most efficient action against climate change (ahead of solar farms, nuclear power, afforestation and many other actions). Quality-quantity trade-off Having children produces a quality-quantity trade-off: parents need to decide how many children to have and how much to invest in the future of each child.Gregory Casey and Oded Galor, "Population and Demography Perspective Paper" Copenhagen Consensus Center, Post-2015 Consensus, October 3, 2014. URL The increasing marginal cost of quality (child outcome) with respect to quantity (number of children) creates a trade-off between quantity and quality. The quantity-quality trade-off means that policies that raise benefits of investing in child quality will generate higher levels of human capital, and policies that lower the costs of having children may have unintended adverse consequences on long-run economic growth. When deciding how many children, parents are influenced by their income level, perceived return to human capital investment, and cultural norms related to gender equality. Controlling birth rates allows families to raise the future earnings power of the next generation. Many empirical studies have tested the quantity-quality trade-off and either observed a negative correlation between family size and child quality or did not find a correlation. Most studies treat family size as an exogenous variable because parents choose childbearing and child outcome and therefore cannot establish causality. They are both influenced by typically non-observable parental preferences and household characteristics, but some studies observe proxy variables such as investment in education. Developing countries upright=1.35|Map of countries by fertility rate (2020), according to the Population Reference Bureau High fertility countries have 18\% of the world's population but contribute 38\% of the population growth. In order to become rich, resources must be re-appropriated to increase income per person rather than supporting larger populations. As populations increase, governments must accommodate increasing investments in health and human capital and institutional reforms to address demographic divides. Reducing the cost of human capital can be implemented by subsidizing education, which raises the earning power of women and the opportunity cost of having children, consequently lowering fertility. Access to contraceptives may also yield lower fertility rates: having more children than expected constrains the individual from attaining their desired level of investment in child quantity and quality. In high fertility contexts, reduced fertility may contribute to economic development by improving child outcomes, reducing maternal mortality and increasing female human capital. Dang and Rogers (2015) show that in Vietnam, family planning services increased investment in education by lowering the relative cost of child quality and encouraging families to invest in quality. By observing the distance to the nearest family planning center and the general education expenditure on each child, Dang and Rogers provide evidence that parents in Vietnam are making a child quality-quantity trade-off. Demand for Private Tutoring with and without access to family planning Developed countries Currently, developed countries have experienced rising economic growth and falling fertility. As a result of the demographic transition that takes place when countries become rich, developed countries have an increasing proportion of retired people which raises the burden on the workforce population to support pensions and social programs. Encouraging higher fertility as a solution may risk reversing the benefits for increased child investment and female labor force participation have had on economic growth. Increasing high skill migration may be an effective way to increase the return to education leading to lower fertility and a greater supply of highly skilled individuals. Demand for family planning upright=1.6|Demand for family planning satisfied by modern methods as of 2017. United Nations Department of Economic and Social Affairs, Population Division, "Trends in Contraceptive Use Worldwide 2015", New York: United Nations, 2015 214 million women of reproductive age in developing countries who do not want to become pregnant are not using a modern contraceptive method. This could be a result of a limited choice of methods, limited access to contraception, fear of side-effects, cultural or religious opposition, poor quality of available services, user or provider bias, or gender-based barriers. In Africa, 24.2\% of women of reproductive age do not have access to modern contraction. In Asia, Latin America, and the Caribbean, the unmet need is 10–11\%. Meeting the unmet need for contraception could prevent 104,000 maternal deaths per year, a 29\% reduction of women dying from postpartum hemorrhage or unsafe abortions. According to the United Nations Department of Economic and Social Affairs: Population Division, 64\% of the world uses contraceptives, 12\% of the world population's need for contraceptives is unmet. In the least developed countries, 22\% of the population do not have access to contraceptives, and 40\% use contraceptives.United Nations Department of Economic and Social Affairs: Population Division, "Trends in Contraceptive Use Worldwide 2015" New York: United Nations, 2015. URL The unmet need for modern contraceptives is very high in sub-Saharan Africa, south Asia, and western Asia. Africa has the lowest rate of contraceptive use (33\%) and highest rate of unmet need (22\%). Northern America has the highest rate of contraceptive use (73\%) and the lowest unmet need (7\%). Latin America and the Caribbean follows closely behind with 73\% contraceptive use and 11\% unmet need. Europe and Asia are on par: Europe has a 69\% contraceptive use rate and 10\% unmet need, Asia has a 68\% contraceptive use and 10\% unmet need. Although unmet need is lower in Asia because of the large population in this region, the number of women with unmet need is 443 million, compared to 74 million in Europe Oceania has a 59\% contraceptive use rate and 15\% unmet need. When comparing the regions within these continents, Eastern Asia ranks the highest rate of contraceptive use (82\%) and lowest unmet need (5\%). Western Africa ranks the lowest rate of contraceptive use (17\%). Middle Africa ranks the highest unmet need (26\%). Unmet need is higher among poorer women; in Bolivia and Ethiopa unmet need is tripled and doubled among poor populations. However, in the Democratic Republic of Congo and Liberia the rates of unmet need are different by 1–2 percentage points. This suggests that as wealthier women begin to want smaller families, they will increasingly seek out family planning methods. Substantial unmet need has provoked family planning programs by governments and donors, but the impact of family planning programs on fertility and contraceptive use remains somewhat unsettled. "Demand theory" argues that in traditional agricultural societies, fertility rates are driven by the desire to offset high mortality, thus as society modernizes, the costs of raising children increases, reducing their economic value, and resulting in a decline in desired number of children. Under this theory, family planning programs will have a marginal impact. Bongaarts (2014) shows that using a country case study approach, both stronger and weaker family programs reduce the unmet need for contraceptives and increases use by making modern contraceptives more widely available and removing obstacles to use. Also, the demand that is satisfied and the proportion of women using modern methods increased. The programs may have an additional effect of diffusing the ideas related to family planning and thus raising the demand for contraception. As a result, a small decrease in unmet need may be offset by a rise in demand. Nonetheless, even in countries where it is assumed that family programs will make a marginal impact, Bongaarts shows that family planning programs can potentially increase contraceptive use and increase/decrease demand depending on the preexisting attitudes of the community. Regional variations A family planning facility in Kuala Terengganu, Malaysia Africa Most of the countries with lowest rates of contraceptive use, highest maternal, infant, and child mortality rates, and highest fertility rates are in Africa. Only about 30\% of all women use birth control, although over half of all African women would like to use birth control if it was available to them. The main problems that preventing access to and use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. The most available type of birth control is condoms. A rapidly growing population coupled with an increase in preventable diseases means countries in Sub-Saharan Africa face an increasingly younger population. China China's Family planning policy forced couples to have no more than one child. Beginning in 1979 and being officially phased out in 2015, the policy was instated to control the rapid population growth that was occurring in the nation at that time. With the rapid change in population, China was facing many impacts, including poverty and homelessness. As a developing nation, the Chinese government was concerned that a continuation of the rapid population growth that had been occurring would hinder their development as a nation. The process of family planning varied throughout China, as people differed in their responsiveness to the one-child policy, based on location and socioeconomic status. For example, many families in the cities accepted the policy more readily based on the lack of space, money, and resources that often occurs in the cities. Another example can be found in the enforcement of this rule; people living in rural areas of China were, in some cases, permitted to have more than one child, but had to wait several years after the birth of the first one. However, the people in rural areas of China were more hesitant in accepting this policy. China's population policy has been credited with a very significant slowing of China's population growth which had been higher before the policy was implemented. However, the policy has come under criticism that it has resulted in the abuse of women. Often implementation of the policy has involved forced abortions, forced sterilization, and infanticides. That families desired a male child had a part to play in the number of infanticides. The number of girls that die within their first year of birth is twice that of boys. Another drawback of the policy is that China's elderly population is now increasing rapidly. However, while the punishment of "unplanned" pregnancy is a large fine, both forced abortion and forced sterilization can be charged with intentional assault, which is punished with up to ten years' imprisonment. Another issue that is raised in the one-child policy in China is the information in regards to naturally giving birth to twins or triplets. If this situation arises, the family is allowed to keep the children because of the natural causes of this impregnation. 240px|Map of population density by country, per square kilometer Family planning in China had its benefits, and its drawbacks. For example, it helped reduce the population by about 300 million people in its first 20 years. A drawback is that there are now millions of people, and in China siblings are very important. Once the parent generation gets older, the children help take care of them, and the work is usually equally split among the siblings. Another benefit of the implementation of the one-child law is that it reduced the fertility rate from about 2.75 children born per woman, to about 1.8 children born per woman in the 1979. According to an investigative report by The Associated Press published at the 28 June 2020, the Chinese government is taking draconian measures to slash birth rates among Uighurs and other minorities as part of a sweeping campaign to curb its Muslim population, even as it encourages some of the country's Han majority to have more children. While individual women have spoken out before about forced birth control, the practice is far more widespread and systematic than previously known, according to an AP investigation based on government statistics, state documents and interviews with 30 ex-detainees, family members and a former detention camp instructor. The campaign over the past four years in the far west region of Xinjiang is leading to what some experts are calling a form of "demographic genocide." Hong Kong In Hong Kong, the Eugenics League was founded in 1936, which became The Family Planning Association of Hong Kong in 1950. The organisation provides family planning advice, sex education, birth control services to the general public of Hong Kong. In the 1970s, due to the rapidly rising population, it launched the "Two Is Enough" campaign, which reduced the general birth rate through educational means. The Family Planning Association of Hong Kong, Hong Kong's national family planning association,History of International Planned Parenthood Federation founded the International Planned Parenthood Federation with its counterparts in seven other countries. India Family planning in India is based on efforts largely sponsored by the Indian government. In the 1965–2009 period, contraceptive usage has more than tripled (from 13\% of married women in 1970 to 48\% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.6 in 2009), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 15 days. Indonesia The number of children in a family that is considered ideal is two. This movement was launched in the late 1970s. A song about family planning was composed that was often sung during the New Order era. This song is known as the KB song. Iran While Iran's population grew at a rate of more than 3\% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000.MSN Encarta Encyclopedia entry on Iran - People and Society , CIA World factbook 2007 . Archived 2009-10-31. Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN's Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran's 2005 to 2010 birth rate is fewer than two.Iran tops world in birth control, payvand.com 04/17/09, accessdate = 2010-03-23 In late July 2012, Supreme Leader Ali Khamenei described Iran's contraceptive services as "wrong," and Iranian authorities are slashing birth-control programs in what one Western newspaper (USA Today) describes as a "major reversal" of its long standing policy. Whether program cuts and high-level appeals for bigger families will be successful is still unclear.Iran urges baby boom, slashes birth-control programs usatoday.com 30 July 2012 Ireland The sale of contraceptives was illegal in Ireland from 1935 until 1980, when it was legalized with strong restrictions, later loosened. It has been argued that the resulting demographic dividend played a role in the economic boom in Ireland that began in the 1990s and ended abruptly in 2008 (the Celtic tiger) was in part due to the legalisation of contraception in 1979 and subsequent decline in the fertility rate. In Ireland the ratio of workers to dependents increased due to lower fertility — the reality of which has been questioned — but was raised further by increased female labor market participation. Pakistan In agreement with the 1994 International Conference on Population and Development in Cairo, Pakistan pledged that by 2010 it would provide universal access to family planning. Additionally, Pakistan's Poverty Reduction Strategy Paper has set specific national goals for increases in family planning and contraceptive use. In 2011 just one in five Pakistani women ages 15 to 49 uses modern birth control. Contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength. Philippines In the Philippines, the Responsible Parenthood and Reproductive Health Act of 2012 guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care. While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, and IUDs, as the government continues to disseminate information on their use through all health care centers. Russia According to a 2004 study, current pregnancies were termed "desired and timely" by 58\% of respondents, while 23\% described them as "desired, but untimely", and 19\% said they were "undesired". As of 2004, the share of women of reproductive age using hormonal or intrauterine birth control methods was about 46\% (29\% intrauterine, 17\% hormonal).National Human Development Report Russian Federation 2008, UNDP,pages 47–49, Retrieved on 10 October 2009 During the Soviet era high quality contraceptives were difficult to obtain, and abortion became the most common way of preventing unwanted births. Since the dissolution of the Soviet Union abortion rates have fallen considerably, but they are still higher than rates in many developed countries. Singapore Population control in Singapore spans two distinct phases: first to slow and reverse the boom in births that started after World War II; and then, from the 1980s onwards, to encourage parents to have more children because birth numbers had fallen below replacement levels. Thailand In 1970, Thailand's government declared a population policy that would battle the country's rapid population growth rate. This policy set a 5-year goal to reduce Thailand's population growth rate from 3 percent to 2.5 percent through methods such as spreading family planning awareness to rural families, or integrating family planning activities into maternal and child healthcare education. Public figures such as Mechai Viravaidya helped spread family planning awareness through public speakings and charitable activities. United Kingdom Contraception has been available for free under the National Health Service since 1974, and 74\% of reproductive-age women use some form of contraception. The levonorgestrel intrauterine system has been massively popular. Sterilization is popular in older age groups, among those 45–49, 29\% of men and 21\% of women have been sterilized. Female sterilization has been declining since 1996, when the intrauterine system was introduced. Emergency contraception has been available since the 1970s, a product was specifically licensed for emergency contraception in 1984, and emergency contraceptives became available over the counter in 2001. Since becoming available over the counter it has not reduced the use of other forms of contraception, as some moralists feared it might. In any year only 5\% of women of childbearing age use emergency hormonal contraception. Despite widespread availability of contraceptives, almost half of pregnancies were unintended in 2005. Abortion was legalized in 1967. United States Despite the availability of highly effective contraceptives, about half of U.S. pregnancies are unintended. Highly effective contraceptives, such as IUD, are underused in the United States. Increasing use of highly effective contraceptives could help meet the goal set forward in Healthy People 2020 to decrease unintended pregnancy by 10\%. Cost to the user is one factor preventing many American women from using more effective contraceptives. Making contraceptives available without a copay increases use of highly effective methods, reduces unintended pregnancies, and may be instrumental in achieving the Healthy People 2020 goal. In the United States, contraceptive use saves about $ 19 billion in direct medical costs each year. Title X of the Public Health Service Act,U.S. Office of Population Affairs — Legislation is a U.S. government program dedicated to providing family planning services for those in need. But funding for Title X as a percentage of total public funding to family planning client services has steadily declined from 44\% of total expenditures in 1980 to 12\% in 2006. Current funding for Title X is less than 40\% of what is needed to meet the need for publicly funded family planning. Title X would need $737 million annually to meet the need for family planning services. Only 6.2 million women accessed publicly funded services from 10,700 clinics in 2015, despite an estimated 20 million women who could benefit.
Combined oral contraceptives. Introduced in 1960, "the Pill" has played an instrumental role in family planning for decades. Family planning methods Family planning services are " the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. " Family planning may involve consideration of the number of children a woman wishes to have, including the choice to have no children and the age at which she wishes to have them. These matters are influenced by external factors such as marital situation, career considerations, financial position, and any disabilities that may affect their ability to have children and raise them. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction. The World Health Organization (WHO) and World Bank estimate that $3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections. Coercive interference with family planning Forced sterilization Compulsory or forced sterilization programs or government policy attempt to force people to undergo surgical sterilization without their freely given consent. People from marginalized communities are at most risk of forced URL Forced sterilization has occurred in recent years in Eastern Europe (against Roma URL and in Peru (during the 1990s against indigenous women). China's one-child policy was intended to limit the rise in population numbers, but in some situations involved forced sterilisation. Sexual violence Rape can result in a pregnancy. Rape can occur in a variety of situations, including war rape, forced prostitution and marital rape. In Rwanda, the National Population Office has estimated that between 2,000 and 5,000 children were born as a result of sexual violence perpetrated during the genocide, but victims' groups gave a higher estimated number of over 10,000 children. Human rights, development and climate 240x240px|Countries by 2019 GDP (nominal) per capita.Data from the United Nations is used. Some consider access to safe, voluntary family planning to be a human right and to be central to gender equality, women's empowerment and poverty reduction. Over the past 50 years, right-based family planning has enabled the cycle of poverty to be broken resulting in millions of women and children's lives being saved. The United Nations Population Fund (UNFPA) says that “Some 225 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities.” Choices not chance UNFPA The UNFPA says that “Most of these women with an unmet need for contraceptives live in 69 of the poorest countries on earth.” The UNFPA says, 190px|Global carbon dioxide emissions by jurisdiction As part of the United Nations Millennium Development Goals (MDGs) universal access to family planning is one of the key factors contributing to development and reducing poverty. Family planning creates benefits in areas such as, gender quality and women's health, access to sexual education and higher education, and improvements in maternal and child health. Note that the Millennium Development Goals have been superseded by the Sustainable Development Goals. UNFPA and the Guttmacher Institute say, Since climate change is directly proportional to the number of humans, family planning has a significant impact on climate change. The research project Drawdown estimates that family planning is the seventh most efficient action against climate change (ahead of solar farms, nuclear power, afforestation and many other actions). Quality-quantity trade-off Having children produces a quality-quantity trade-off: parents need to decide how many children to have and how much to invest in the future of each child.Gregory Casey and Oded Galor, "Population and Demography Perspective Paper" Copenhagen Consensus Center, Post-2015 Consensus, October 3, 2014. URL The increasing marginal cost of quality (child outcome) with respect to quantity (number of children) creates a trade-off between quantity and quality. The quantity-quality trade-off means that policies that raise benefits of investing in child quality will generate higher levels of human capital, and policies that lower the costs of having children may have unintended adverse consequences on long-run economic growth. When deciding how many children, parents are influenced by their income level, perceived return to human capital investment, and cultural norms related to gender equality. Controlling birth rates allows families to raise the future earnings power of the next generation. Many empirical studies have tested the quantity-quality trade-off and either observed a negative correlation between family size and child quality or did not find a correlation. Most studies treat family size as an exogenous variable because parents choose childbearing and child outcome and therefore cannot establish causality. They are both influenced by typically non-observable parental preferences and household characteristics, but some studies observe proxy variables such as investment in education. Developing countries upright=1.35|Map of countries by fertility rate (2020), according to the Population Reference Bureau High fertility countries have 18\% of the world's population but contribute 38\% of the population growth. In order to become rich, resources must be re-appropriated to increase income per person rather than supporting larger populations. As populations increase, governments must accommodate increasing investments in health and human capital and institutional reforms to address demographic divides. Reducing the cost of human capital can be implemented by subsidizing education, which raises the earning power of women and the opportunity cost of having children, consequently lowering fertility. Access to contraceptives may also yield lower fertility rates: having more children than expected constrains the individual from attaining their desired level of investment in child quantity and quality. In high fertility contexts, reduced fertility may contribute to economic development by improving child outcomes, reducing maternal mortality and increasing female human capital. Dang and Rogers (2015) show that in Vietnam, family planning services increased investment in education by lowering the relative cost of child quality and encouraging families to invest in quality. By observing the distance to the nearest family planning center and the general education expenditure on each child, Dang and Rogers provide evidence that parents in Vietnam are making a child quality-quantity trade-off. Demand for Private Tutoring with and without access to family planning Developed countries Currently, developed countries have experienced rising economic growth and falling fertility. As a result of the demographic transition that takes place when countries become rich, developed countries have an increasing proportion of retired people which raises the burden on the workforce population to support pensions and social programs. Encouraging higher fertility as a solution may risk reversing the benefits for increased child investment and female labor force participation have had on economic growth. Increasing high skill migration may be an effective way to increase the return to education leading to lower fertility and a greater supply of highly skilled individuals. Demand for family planning upright=1.6|Demand for family planning satisfied by modern methods as of 2017. United Nations Department of Economic and Social Affairs, Population Division, "Trends in Contraceptive Use Worldwide 2015", New York: United Nations, 2015 214 million women of reproductive age in developing countries who do not want to become pregnant are not using a modern contraceptive method. This could be a result of a limited choice of methods, limited access to contraception, fear of side-effects, cultural or religious opposition, poor quality of available services, user or provider bias, or gender-based barriers. In Africa, 24.2\% of women of reproductive age do not have access to modern contraction. In Asia, Latin America, and the Caribbean, the unmet need is 10–11\%. Meeting the unmet need for contraception could prevent 104,000 maternal deaths per year, a 29\% reduction of women dying from postpartum hemorrhage or unsafe abortions. According to the United Nations Department of Economic and Social Affairs: Population Division, 64\% of the world uses contraceptives, 12\% of the world population's need for contraceptives is unmet. In the least developed countries, 22\% of the population do not have access to contraceptives, and 40\% use contraceptives.United Nations Department of Economic and Social Affairs: Population Division, "Trends in Contraceptive Use Worldwide 2015" New York: United Nations, 2015. URL The unmet need for modern contraceptives is very high in sub-Saharan Africa, south Asia, and western Asia. Africa has the lowest rate of contraceptive use (33\%) and highest rate of unmet need (22\%). Northern America has the highest rate of contraceptive use (73\%) and the lowest unmet need (7\%). Latin America and the Caribbean follows closely behind with 73\% contraceptive use and 11\% unmet need. Europe and Asia are on par: Europe has a 69\% contraceptive use rate and 10\% unmet need, Asia has a 68\% contraceptive use and 10\% unmet need. Although unmet need is lower in Asia because of the large population in this region, the number of women with unmet need is 443 million, compared to 74 million in Europe Oceania has a 59\% contraceptive use rate and 15\% unmet need. When comparing the regions within these continents, Eastern Asia ranks the highest rate of contraceptive use (82\%) and lowest unmet need (5\%). Western Africa ranks the lowest rate of contraceptive use (17\%). Middle Africa ranks the highest unmet need (26\%). Unmet need is higher among poorer women; in Bolivia and Ethiopa unmet need is tripled and doubled among poor populations. However, in the Democratic Republic of Congo and Liberia the rates of unmet need are different by 1–2 percentage points. This suggests that as wealthier women begin to want smaller families, they will increasingly seek out family planning methods. Substantial unmet need has provoked family planning programs by governments and donors, but the impact of family planning programs on fertility and contraceptive use remains somewhat unsettled. "Demand theory" argues that in traditional agricultural societies, fertility rates are driven by the desire to offset high mortality, thus as society modernizes, the costs of raising children increases, reducing their economic value, and resulting in a decline in desired number of children. Under this theory, family planning programs will have a marginal impact. Bongaarts (2014) shows that using a country case study approach, both stronger and weaker family programs reduce the unmet need for contraceptives and increases use by making modern contraceptives more widely available and removing obstacles to use. Also, the demand that is satisfied and the proportion of women using modern methods increased. The programs may have an additional effect of diffusing the ideas related to family planning and thus raising the demand for contraception. As a result, a small decrease in unmet need may be offset by a rise in demand. Nonetheless, even in countries where it is assumed that family programs will make a marginal impact, Bongaarts shows that family planning programs can potentially increase contraceptive use and increase/decrease demand depending on the preexisting attitudes of the community. Regional variations A family planning facility in Kuala Terengganu, Malaysia Africa Most of the countries with lowest rates of contraceptive use, highest maternal, infant, and child mortality rates, and highest fertility rates are in Africa. Only about 30\% of all women use birth control, although over half of all African women would like to use birth control if it was available to them. The main problems that preventing access to and use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. The most available type of birth control is condoms. A rapidly growing population coupled with an increase in preventable diseases means countries in Sub-Saharan Africa face an increasingly younger population. China China's Family planning policy forced couples to have no more than one child. Beginning in 1979 and being officially phased out in 2015, the policy was instated to control the rapid population growth that was occurring in the nation at that time. With the rapid change in population, China was facing many impacts, including poverty and homelessness. As a developing nation, the Chinese government was concerned that a continuation of the rapid population growth that had been occurring would hinder their development as a nation. The process of family planning varied throughout China, as people differed in their responsiveness to the one-child policy, based on location and socioeconomic status. For example, many families in the cities accepted the policy more readily based on the lack of space, money, and resources that often occurs in the cities. Another example can be found in the enforcement of this rule; people living in rural areas of China were, in some cases, permitted to have more than one child, but had to wait several years after the birth of the first one. However, the people in rural areas of China were more hesitant in accepting this policy. China's population policy has been credited with a very significant slowing of China's population growth which had been higher before the policy was implemented. However, the policy has come under criticism that it has resulted in the abuse of women. Often implementation of the policy has involved forced abortions, forced sterilization, and infanticides. That families desired a male child had a part to play in the number of infanticides. The number of girls that die within their first year of birth is twice that of boys. Another drawback of the policy is that China's elderly population is now increasing rapidly. However, while the punishment of "unplanned" pregnancy is a large fine, both forced abortion and forced sterilization can be charged with intentional assault, which is punished with up to ten years' imprisonment. Another issue that is raised in the one-child policy in China is the information in regards to naturally giving birth to twins or triplets. If this situation arises, the family is allowed to keep the children because of the natural causes of this impregnation. 240px|Map of population density by country, per square kilometer Family planning in China had its benefits, and its drawbacks. For example, it helped reduce the population by about 300 million people in its first 20 years. A drawback is that there are now millions of people, and in China siblings are very important. Once the parent generation gets older, the children help take care of them, and the work is usually equally split among the siblings. Another benefit of the implementation of the one-child law is that it reduced the fertility rate from about 2.75 children born per woman, to about 1.8 children born per woman in the 1979. According to an investigative report by The Associated Press published at the 28 June 2020, the Chinese government is taking draconian measures to slash birth rates among Uighurs and other minorities as part of a sweeping campaign to curb its Muslim population, even as it encourages some of the country's Han majority to have more children. While individual women have spoken out before about forced birth control, the practice is far more widespread and systematic than previously known, according to an AP investigation based on government statistics, state documents and interviews with 30 ex-detainees, family members and a former detention camp instructor. The campaign over the past four years in the far west region of Xinjiang is leading to what some experts are calling a form of "demographic genocide." Hong Kong In Hong Kong, the Eugenics League was founded in 1936, which became The Family Planning Association of Hong Kong in 1950. The organisation provides family planning advice, sex education, birth control services to the general public of Hong Kong. In the 1970s, due to the rapidly rising population, it launched the "Two Is Enough" campaign, which reduced the general birth rate through educational means. The Family Planning Association of Hong Kong, Hong Kong's national family planning association,History of International Planned Parenthood Federation founded the International Planned Parenthood Federation with its counterparts in seven other countries. India Family planning in India is based on efforts largely sponsored by the Indian government. In the 1965–2009 period, contraceptive usage has more than tripled (from 13\% of married women in 1970 to 48\% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.6 in 2009), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 15 days. Iran While Iran's population grew at a rate of more than 3\% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000.MSN Encarta Encyclopedia entry on Iran - People and Society , CIA World factbook 2007 . Archived 2009-10-31. Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN's Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran's 2005 to 2010 birth rate is fewer than two.Iran tops world in birth control, payvand.com 04/17/09, accessdate = 2010-03-23 In late July 2012, Supreme Leader Ali Khamenei described Iran's contraceptive services as "wrong," and Iranian authorities are slashing birth-control programs in what one Western newspaper (USA Today) describes as a "major reversal" of its long standing policy. Whether program cuts and high-level appeals for bigger families will be successful is still unclear.Iran urges baby boom, slashes birth-control programs usatoday.com 30 July 2012 Ireland The sale of contraceptives was illegal in Ireland from 1935 until 1980, when it was legalized with strong restrictions, later loosened. It has been argued that the resulting demographic dividend played a role in the economic boom in Ireland that began in the 1990s and ended abruptly in 2008 (the Celtic tiger) was in part due to the legalisation of contraception in 1979 and subsequent decline in the fertility rate. In Ireland the ratio of workers to dependents increased due to lower fertility — the reality of which has been questioned — but was raised further by increased female labor market participation. Pakistan In agreement with the 1994 International Conference on Population and Development in Cairo, Pakistan pledged that by 2010 it would provide universal access to family planning. Additionally, Pakistan's Poverty Reduction Strategy Paper has set specific national goals for increases in family planning and contraceptive use. In 2011 just one in five Pakistani women ages 15 to 49 uses modern birth control. Contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength. Philippines In the Philippines, the Responsible Parenthood and Reproductive Health Act of 2012 guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care. While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, and IUDs, as the government continues to disseminate information on their use through all health care centers. Russia According to a 2004 study, current pregnancies were termed "desired and timely" by 58\% of respondents, while 23\% described them as "desired, but untimely", and 19\% said they were "undesired". As of 2004, the share of women of reproductive age using hormonal or intrauterine birth control methods was about 46\% (29\% intrauterine, 17\% hormonal).National Human Development Report Russian Federation 2008, UNDP,pages 47–49, Retrieved on 10 October 2009 During the Soviet era high quality contraceptives were difficult to obtain, and abortion became the most common way of preventing unwanted births. Since the dissolution of the Soviet Union abortion rates have fallen considerably, but they are still higher than rates in many developed countries. Singapore Population control in Singapore spans two distinct phases: first to slow and reverse the boom in births that started after World War II; and then, from the 1980s onwards, to encourage parents to have more children because birth numbers had fallen below replacement levels. Thailand In 1970, Thailand's government declared a population policy that would battle the country's rapid population growth rate. This policy set a 5-year goal to reduce Thailand's population growth rate from 3 percent to 2.5 percent through methods such as spreading family planning awareness to rural families, or integrating family planning activities into maternal and child healthcare education. Public figures such as Mechai Viravaidya helped spread family planning awareness through public speakings and charitable activities. United Kingdom Contraception has been available for free under the National Health Service since 1974, and 74\% of reproductive-age women use some form of contraception. The levonorgestrel intrauterine system has been massively popular. Sterilization is popular in older age groups, among those 45–49, 29\% of men and 21\% of women have been sterilized. Female sterilization has been declining since 1996, when the intrauterine system was introduced. Emergency contraception has been available since the 1970s, a product was specifically licensed for emergency contraception in 1984, and emergency contraceptives became available over the counter in 2001. Since becoming available over the counter it has not reduced the use of other forms of contraception, as some moralists feared it might. In any year only 5\% of women of childbearing age use emergency hormonal contraception. Despite widespread availability of contraceptives, almost half of pregnancies were unintended in 2005. Abortion was legalized in 1967. United States Despite the availability of highly effective contraceptives, about half of U.S. pregnancies are unintended. Highly effective contraceptives, such as IUD, are underused in the United States. Increasing use of highly effective contraceptives could help meet the goal set forward in Healthy People 2020 to decrease unintended pregnancy by 10\%. Cost to the user is one factor preventing many American women from using more effective contraceptives. Making contraceptives available without a copay increases use of highly effective methods, reduces unintended pregnancies, and may be instrumental in achieving the Healthy People 2020 goal. In the United States, contraceptive use saves about $ 19 billion in direct medical costs each year. Title X of the Public Health Service Act,U.S. Office of Population Affairs — Legislation is a U.S. government program dedicated to providing family planning services for those in need. But funding for Title X as a percentage of total public funding to family planning client services has steadily declined from 44\% of total expenditures in 1980 to 12\% in 2006. Current funding for Title X is less than 40\% of what is needed to meet the need for publicly funded family planning. Title X would need $737 million annually to meet the need for family planning services. Only 6.2 million women accessed publicly funded services from 10,700 clinics in 2015, despite an estimated 20 million women who could benefit.
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$3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections. Coercive interference with family planning Forced sterilization Compulsory or forced sterilization programs or government policy attempt to force people to undergo surgical sterilization without their freely given consent. People from marginalized communities are at most risk of forced URL Forced sterilization has occurred in recent years in Eastern Europe (against Roma URL and in Peru (during the 1990s against indigenous women). China's one-child policy was intended to limit the rise in population numbers, but in some situations involved forced sterilisation. Sexual violence Rape can result in a pregnancy. Rape can occur in a variety of situations, including war rape, forced prostitution and marital rape. In Rwanda, the National Population Office has estimated that between 2,000 and 5,000 children were born as a result of sexual violence perpetrated during the genocide, but victims' groups gave a higher estimated number of over 10,000 children. Human rights, development and climate 240x240px|Countries by 2019 GDP (nominal) per capita.Data from the United Nations is used. Some consider access to safe, voluntary family planning to be a human right and to be central to gender equality, women's empowerment and poverty reduction. Over the past 50 years, right-based family planning has enabled the cycle of poverty to be broken resulting in millions of women and children's lives being saved. The United Nations Population Fund (UNFPA) says that “Some 225 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities.” Choices not chance UNFPA The UNFPA says that “Most of these women with an unmet need for contraceptives live in 69 of the poorest countries on earth.” The UNFPA says, 190px|Global carbon dioxide emissions by jurisdiction As part of the United Nations Millennium Development Goals (MDGs) universal access to family planning is one of the key factors contributing to development and reducing poverty. Family planning creates benefits in areas such as, gender quality and women's health, access to sexual education and higher education, and improvements in maternal and child health. Note that the Millennium Development Goals have been superseded by the Sustainable Development Goals. UNFPA and the Guttmacher Institute say, Since climate change is directly proportional to the number of humans, family planning has a significant impact on climate change. The research project Drawdown estimates that family planning is the seventh most efficient action against climate change (ahead of solar farms, nuclear power, afforestation and many other actions). Quality-quantity trade-off Having children produces a quality-quantity trade-off: parents need to decide how many children to have and how much to invest in the future of each child.Gregory Casey and Oded Galor, "Population and Demography Perspective Paper" Copenhagen Consensus Center, Post-2015 Consensus, October 3, 2014. URL The increasing marginal cost of quality (child outcome) with respect to quantity (number of children) creates a trade-off between quantity and quality. The quantity-quality trade-off means that policies that raise benefits of investing in child quality will generate higher levels of human capital, and policies that lower the costs of having children may have unintended adverse consequences on long-run economic growth. When deciding how many children, parents are influenced by their income level, perceived return to human capital investment, and cultural norms related to gender equality. Controlling birth rates allows families to raise the future earnings power of the next generation. Many empirical studies have tested the quantity-quality trade-off and either observed a negative correlation between family size and child quality or did not find a correlation. Most studies treat family size as an exogenous variable because parents choose childbearing and child outcome and therefore cannot establish causality. They are both influenced by typically non-observable parental preferences and household characteristics, but some studies observe proxy variables such as investment in education. Developing countries upright=1.35|Map of countries by fertility rate (2020), according to the Population Reference Bureau High fertility countries have 18\% of the world's population but contribute 38\% of the population growth. In order to become rich, resources must be re-appropriated to increase income per person rather than supporting larger populations. As populations increase, governments must accommodate increasing investments in health and human capital and institutional reforms to address demographic divides. Reducing the cost of human capital can be implemented by subsidizing education, which raises the earning power of women and the opportunity cost of having children, consequently lowering fertility. Access to contraceptives may also yield lower fertility rates: having more children than expected constrains the individual from attaining their desired level of investment in child quantity and quality. In high fertility contexts, reduced fertility may contribute to economic development by improving child outcomes, reducing maternal mortality and increasing female human capital. Dang and Rogers (2015) show that in Vietnam, family planning services increased investment in education by lowering the relative cost of child quality and encouraging families to invest in quality. By observing the distance to the nearest family planning center and the general education expenditure on each child, Dang and Rogers provide evidence that parents in Vietnam are making a child quality-quantity trade-off. Demand for Private Tutoring with and without access to family planning Developed countries Currently, developed countries have experienced rising economic growth and falling fertility. As a result of the demographic transition that takes place when countries become rich, developed countries have an increasing proportion of retired people which raises the burden on the workforce population to support pensions and social programs. Encouraging higher fertility as a solution may risk reversing the benefits for increased child investment and female labor force participation have had on economic growth. Increasing high skill migration may be an effective way to increase the return to education leading to lower fertility and a greater supply of highly skilled individuals. Demand for family planning upright=1.6|Demand for family planning satisfied by modern methods as of 2017. United Nations Department of Economic and Social Affairs, Population Division, "Trends in Contraceptive Use Worldwide 2015", New York: United Nations, 2015 214 million women of reproductive age in developing countries who do not want to become pregnant are not using a modern contraceptive method. This could be a result of a limited choice of methods, limited access to contraception, fear of side-effects, cultural or religious opposition, poor quality of available services, user or provider bias, or gender-based barriers. In Africa, 24.2\% of women of reproductive age do not have access to modern contraction. In Asia, Latin America, and the Caribbean, the unmet need is 10–11\%. Meeting the unmet need for contraception could prevent 104,000 maternal deaths per year, a 29\% reduction of women dying from postpartum hemorrhage or unsafe abortions. According to the United Nations Department of Economic and Social Affairs: Population Division, 64\% of the world uses contraceptives, 12\% of the world population's need for contraceptives is unmet. In the least developed countries, 22\% of the population do not have access to contraceptives, and 40\% use contraceptives.United Nations Department of Economic and Social Affairs: Population Division, "Trends in Contraceptive Use Worldwide 2015" New York: United Nations, 2015. URL The unmet need for modern contraceptives is very high in sub-Saharan Africa, south Asia, and western Asia. Africa has the lowest rate of contraceptive use (33\%) and highest rate of unmet need (22\%). Northern America has the highest rate of contraceptive use (73\%) and the lowest unmet need (7\%). Latin America and the Caribbean follows closely behind with 73\% contraceptive use and 11\% unmet need. Europe and Asia are on par: Europe has a 69\% contraceptive use rate and 10\% unmet need, Asia has a 68\% contraceptive use and 10\% unmet need. Although unmet need is lower in Asia because of the large population in this region, the number of women with unmet need is 443 million, compared to 74 million in Europe Oceania has a 59\% contraceptive use rate and 15\% unmet need. When comparing the regions within these continents, Eastern Asia ranks the highest rate of contraceptive use (82\%) and lowest unmet need (5\%). Western Africa ranks the lowest rate of contraceptive use (17\%). Middle Africa ranks the highest unmet need (26\%). Unmet need is higher among poorer women; in Bolivia and Ethiopa unmet need is tripled and doubled among poor populations. However, in the Democratic Republic of Congo and Liberia the rates of unmet need are different by 1–2 percentage points. This suggests that as wealthier women begin to want smaller families, they will increasingly seek out family planning methods. Substantial unmet need has provoked family planning programs by governments and donors, but the impact of family planning programs on fertility and contraceptive use remains somewhat unsettled. "Demand theory" argues that in traditional agricultural societies, fertility rates are driven by the desire to offset high mortality, thus as society modernizes, the costs of raising children increases, reducing their economic value, and resulting in a decline in desired number of children. Under this theory, family planning programs will have a marginal impact. Bongaarts (2014) shows that using a country case study approach, both stronger and weaker family programs reduce the unmet need for contraceptives and increases use by making modern contraceptives more widely available and removing obstacles to use. Also, the demand that is satisfied and the proportion of women using modern methods increased. The programs may have an additional effect of diffusing the ideas related to family planning and thus raising the demand for contraception. As a result, a small decrease in unmet need may be offset by a rise in demand. Nonetheless, even in countries where it is assumed that family programs will make a marginal impact, Bongaarts shows that family planning programs can potentially increase contraceptive use and increase/decrease demand depending on the preexisting attitudes of the community. Regional variations A family planning facility in Kuala Terengganu, Malaysia Africa Most of the countries with lowest rates of contraceptive use, highest maternal, infant, and child mortality rates, and highest fertility rates are in Africa. Only about 30\% of all women use birth control, although over half of all African women would like to use birth control if it was available to them. The main problems that preventing access to and use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. The most available type of birth control is condoms. A rapidly growing population coupled with an increase in preventable diseases means countries in Sub-Saharan Africa face an increasingly younger population. China China's Family planning policy forced couples to have no more than one child. Beginning in 1979 and being officially phased out in 2015, the policy was instated to control the rapid population growth that was occurring in the nation at that time. With the rapid change in population, China was facing many impacts, including poverty and homelessness. As a developing nation, the Chinese government was concerned that a continuation of the rapid population growth that had been occurring would hinder their development as a nation. The process of family planning varied throughout China, as people differed in their responsiveness to the one-child policy, based on location and socioeconomic status. For example, many families in the cities accepted the policy more readily based on the lack of space, money, and resources that often occurs in the cities. Another example can be found in the enforcement of this rule; people living in rural areas of China were, in some cases, permitted to have more than one child, but had to wait several years after the birth of the first one. However, the people in rural areas of China were more hesitant in accepting this policy. China's population policy has been credited with a very significant slowing of China's population growth which had been higher before the policy was implemented. However, the policy has come under criticism that it has resulted in the abuse of women. Often implementation of the policy has involved forced abortions, forced sterilization, and infanticides. That families desired a male child had a part to play in the number of infanticides. The number of girls that die within their first year of birth is twice that of boys. Another drawback of the policy is that China's elderly population is now increasing rapidly. However, while the punishment of "unplanned" pregnancy is a large fine, both forced abortion and forced sterilization can be charged with intentional assault, which is punished with up to ten years' imprisonment. Another issue that is raised in the one-child policy in China is the information in regards to naturally giving birth to twins or triplets. If this situation arises, the family is allowed to keep the children because of the natural causes of this impregnation. 240px|Map of population density by country, per square kilometer Family planning in China had its benefits, and its drawbacks. For example, it helped reduce the population by about 300 million people in its first 20 years. A drawback is that there are now millions of people, and in China siblings are very important. Once the parent generation gets older, the children help take care of them, and the work is usually equally split among the siblings. Another benefit of the implementation of the one-child law is that it reduced the fertility rate from about 2.75 children born per woman, to about 1.8 children born per woman in the 1979. According to an investigative report by The Associated Press published at the 28 June 2020, the Chinese government is taking draconian measures to slash birth rates among Uighurs and other minorities as part of a sweeping campaign to curb its Muslim population, even as it encourages some of the country's Han majority to have more children. While individual women have spoken out before about forced birth control, the practice is far more widespread and systematic than previously known, according to an AP investigation based on government statistics, state documents and interviews with 30 ex-detainees, family members and a former detention camp instructor. The campaign over the past four years in the far west region of Xinjiang is leading to what some experts are calling a form of "demographic genocide." Hong Kong In Hong Kong, the Eugenics League was founded in 1936, which became The Family Planning Association of Hong Kong in 1950. The organisation provides family planning advice, sex education, birth control services to the general public of Hong Kong. In the 1970s, due to the rapidly rising population, it launched the "Two Is Enough" campaign, which reduced the general birth rate through educational means. The Family Planning Association of Hong Kong, Hong Kong's national family planning association,History of International Planned Parenthood Federation founded the International Planned Parenthood Federation with its counterparts in seven other countries. India Family planning in India is based on efforts largely sponsored by the Indian government. In the 1965–2009 period, contraceptive usage has more than tripled (from 13\% of married women in 1970 to 48\% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.6 in 2009), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 15 days. Indonesia The number of children in a family that is considered ideal is two. This movement was launched in the late 1970s. A song about family planning was composed that was often sung during the New Order era. This song is known as the KB song. Iran While Iran's population grew at a rate of more than 3\% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000.MSN Encarta Encyclopedia entry on Iran - People and Society , CIA World factbook 2007 . Archived 2009-10-31. Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN's Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran's 2005 to 2010 birth rate is fewer than two.Iran tops world in birth control, payvand.com 04/17/09, accessdate = 2010-03-23 In late July 2012, Supreme Leader Ali Khamenei described Iran's contraceptive services as "wrong," and Iranian authorities are slashing birth-control programs in what one Western newspaper (USA Today) describes as a "major reversal" of its long standing policy. Whether program cuts and high-level appeals for bigger families will be successful is still unclear.Iran urges baby boom, slashes birth-control programs usatoday.com 30 July 2012 Ireland The sale of contraceptives was illegal in Ireland from 1935 until 1980, when it was legalized with strong restrictions, later loosened. It has been argued that the resulting demographic dividend played a role in the economic boom in Ireland that began in the 1990s and ended abruptly in 2008 (the Celtic tiger) was in part due to the legalisation of contraception in 1979 and subsequent decline in the fertility rate. In Ireland the ratio of workers to dependents increased due to lower fertility — the reality of which has been questioned — but was raised further by increased female labor market participation. Pakistan In agreement with the 1994 International Conference on Population and Development in Cairo, Pakistan pledged that by 2010 it would provide universal access to family planning. Additionally, Pakistan's Poverty Reduction Strategy Paper has set specific national goals for increases in family planning and contraceptive use. In 2011 just one in five Pakistani women ages 15 to 49 uses modern birth control. Contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength. Philippines In the Philippines, the Responsible Parenthood and Reproductive Health Act of 2012 guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care. While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, and IUDs, as the government continues to disseminate information on their use through all health care centers. Russia According to a 2004 study, current pregnancies were termed "desired and timely" by 58\% of respondents, while 23\% described them as "desired, but untimely", and 19\% said they were "undesired". As of 2004, the share of women of reproductive age using hormonal or intrauterine birth control methods was about 46\% (29\% intrauterine, 17\% hormonal).National Human Development Report Russian Federation 2008, UNDP,pages 47–49, Retrieved on 10 October 2009 During the Soviet era high quality contraceptives were difficult to obtain, and abortion became the most common way of preventing unwanted births. Since the dissolution of the Soviet Union abortion rates have fallen considerably, but they are still higher than rates in many developed countries. Singapore Population control in Singapore spans two distinct phases: first to slow and reverse the boom in births that started after World War II; and then, from the 1980s onwards, to encourage parents to have more children because birth numbers had fallen below replacement levels. Thailand In 1970, Thailand's government declared a population policy that would battle the country's rapid population growth rate. This policy set a 5-year goal to reduce Thailand's population growth rate from 3 percent to 2.5 percent through methods such as spreading family planning awareness to rural families, or integrating family planning activities into maternal and child healthcare education. Public figures such as Mechai Viravaidya helped spread family planning awareness through public speakings and charitable activities. United Kingdom Contraception has been available for free under the National Health Service since 1974, and 74\% of reproductive-age women use some form of contraception. The levonorgestrel intrauterine system has been massively popular. Sterilization is popular in older age groups, among those 45–49, 29\% of men and 21\% of women have been sterilized. Female sterilization has been declining since 1996, when the intrauterine system was introduced. Emergency contraception has been available since the 1970s, a product was specifically licensed for emergency contraception in 1984, and emergency contraceptives became available over the counter in 2001. Since becoming available over the counter it has not reduced the use of other forms of contraception, as some moralists feared it might. In any year only 5\% of women of childbearing age use emergency hormonal contraception. Despite widespread availability of contraceptives, almost half of pregnancies were unintended in 2005. Abortion was legalized in 1967. United States Despite the availability of highly effective contraceptives, about half of U.S. pregnancies are unintended. Highly effective contraceptives, such as IUD, are underused in the United States. Increasing use of highly effective contraceptives could help meet the goal set forward in Healthy People 2020 to decrease unintended pregnancy by 10\%. Cost to the user is one factor preventing many American women from using more effective contraceptives. Making contraceptives available without a copay increases use of highly effective methods, reduces unintended pregnancies, and may be instrumental in achieving the Healthy People 2020 goal. In the United States, contraceptive use saves about $
$3 per person per year would provide basic family planning, maternal and neonatal health care to women in developing countries. This would include contraception, prenatal, delivery, and post-natal care in addition to postpartum family planning and the promotion of condoms to prevent sexually transmitted infections. Coercive interference with family planning Forced sterilization Compulsory or forced sterilization programs or government policy attempt to force people to undergo surgical sterilization without their freely given consent. People from marginalized communities are at most risk of forced URL Forced sterilization has occurred in recent years in Eastern Europe (against Roma URL and in Peru (during the 1990s against indigenous women). China's one-child policy was intended to limit the rise in population numbers, but in some situations involved forced sterilisation. Sexual violence Rape can result in a pregnancy. Rape can occur in a variety of situations, including war rape, forced prostitution and marital rape. In Rwanda, the National Population Office has estimated that between 2,000 and 5,000 children were born as a result of sexual violence perpetrated during the genocide, but victims' groups gave a higher estimated number of over 10,000 children. Human rights, development and climate 240x240px|Countries by 2019 GDP (nominal) per capita.Data from the United Nations is used. Some consider access to safe, voluntary family planning to be a human right and to be central to gender equality, women's empowerment and poverty reduction. Over the past 50 years, right-based family planning has enabled the cycle of poverty to be broken resulting in millions of women and children's lives being saved. The United Nations Population Fund (UNFPA) says that “Some 225 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities.” Choices not chance UNFPA The UNFPA says that “Most of these women with an unmet need for contraceptives live in 69 of the poorest countries on earth.” The UNFPA says, 190px|Global carbon dioxide emissions by jurisdiction As part of the United Nations Millennium Development Goals (MDGs) universal access to family planning is one of the key factors contributing to development and reducing poverty. Family planning creates benefits in areas such as, gender quality and women's health, access to sexual education and higher education, and improvements in maternal and child health. Note that the Millennium Development Goals have been superseded by the Sustainable Development Goals. UNFPA and the Guttmacher Institute say, Since climate change is directly proportional to the number of humans, family planning has a significant impact on climate change. The research project Drawdown estimates that family planning is the seventh most efficient action against climate change (ahead of solar farms, nuclear power, afforestation and many other actions). Quality-quantity trade-off Having children produces a quality-quantity trade-off: parents need to decide how many children to have and how much to invest in the future of each child.Gregory Casey and Oded Galor, "Population and Demography Perspective Paper" Copenhagen Consensus Center, Post-2015 Consensus, October 3, 2014. URL The increasing marginal cost of quality (child outcome) with respect to quantity (number of children) creates a trade-off between quantity and quality. The quantity-quality trade-off means that policies that raise benefits of investing in child quality will generate higher levels of human capital, and policies that lower the costs of having children may have unintended adverse consequences on long-run economic growth. When deciding how many children, parents are influenced by their income level, perceived return to human capital investment, and cultural norms related to gender equality. Controlling birth rates allows families to raise the future earnings power of the next generation. Many empirical studies have tested the quantity-quality trade-off and either observed a negative correlation between family size and child quality or did not find a correlation. Most studies treat family size as an exogenous variable because parents choose childbearing and child outcome and therefore cannot establish causality. They are both influenced by typically non-observable parental preferences and household characteristics, but some studies observe proxy variables such as investment in education. Developing countries upright=1.35|Map of countries by fertility rate (2020), according to the Population Reference Bureau High fertility countries have 18\% of the world's population but contribute 38\% of the population growth. In order to become rich, resources must be re-appropriated to increase income per person rather than supporting larger populations. As populations increase, governments must accommodate increasing investments in health and human capital and institutional reforms to address demographic divides. Reducing the cost of human capital can be implemented by subsidizing education, which raises the earning power of women and the opportunity cost of having children, consequently lowering fertility. Access to contraceptives may also yield lower fertility rates: having more children than expected constrains the individual from attaining their desired level of investment in child quantity and quality. In high fertility contexts, reduced fertility may contribute to economic development by improving child outcomes, reducing maternal mortality and increasing female human capital. Dang and Rogers (2015) show that in Vietnam, family planning services increased investment in education by lowering the relative cost of child quality and encouraging families to invest in quality. By observing the distance to the nearest family planning center and the general education expenditure on each child, Dang and Rogers provide evidence that parents in Vietnam are making a child quality-quantity trade-off. Demand for Private Tutoring with and without access to family planning Developed countries Currently, developed countries have experienced rising economic growth and falling fertility. As a result of the demographic transition that takes place when countries become rich, developed countries have an increasing proportion of retired people which raises the burden on the workforce population to support pensions and social programs. Encouraging higher fertility as a solution may risk reversing the benefits for increased child investment and female labor force participation have had on economic growth. Increasing high skill migration may be an effective way to increase the return to education leading to lower fertility and a greater supply of highly skilled individuals. Demand for family planning upright=1.6|Demand for family planning satisfied by modern methods as of 2017. United Nations Department of Economic and Social Affairs, Population Division, "Trends in Contraceptive Use Worldwide 2015", New York: United Nations, 2015 214 million women of reproductive age in developing countries who do not want to become pregnant are not using a modern contraceptive method. This could be a result of a limited choice of methods, limited access to contraception, fear of side-effects, cultural or religious opposition, poor quality of available services, user or provider bias, or gender-based barriers. In Africa, 24.2\% of women of reproductive age do not have access to modern contraction. In Asia, Latin America, and the Caribbean, the unmet need is 10–11\%. Meeting the unmet need for contraception could prevent 104,000 maternal deaths per year, a 29\% reduction of women dying from postpartum hemorrhage or unsafe abortions. According to the United Nations Department of Economic and Social Affairs: Population Division, 64\% of the world uses contraceptives, 12\% of the world population's need for contraceptives is unmet. In the least developed countries, 22\% of the population do not have access to contraceptives, and 40\% use contraceptives.United Nations Department of Economic and Social Affairs: Population Division, "Trends in Contraceptive Use Worldwide 2015" New York: United Nations, 2015. URL The unmet need for modern contraceptives is very high in sub-Saharan Africa, south Asia, and western Asia. Africa has the lowest rate of contraceptive use (33\%) and highest rate of unmet need (22\%). Northern America has the highest rate of contraceptive use (73\%) and the lowest unmet need (7\%). Latin America and the Caribbean follows closely behind with 73\% contraceptive use and 11\% unmet need. Europe and Asia are on par: Europe has a 69\% contraceptive use rate and 10\% unmet need, Asia has a 68\% contraceptive use and 10\% unmet need. Although unmet need is lower in Asia because of the large population in this region, the number of women with unmet need is 443 million, compared to 74 million in Europe Oceania has a 59\% contraceptive use rate and 15\% unmet need. When comparing the regions within these continents, Eastern Asia ranks the highest rate of contraceptive use (82\%) and lowest unmet need (5\%). Western Africa ranks the lowest rate of contraceptive use (17\%). Middle Africa ranks the highest unmet need (26\%). Unmet need is higher among poorer women; in Bolivia and Ethiopa unmet need is tripled and doubled among poor populations. However, in the Democratic Republic of Congo and Liberia the rates of unmet need are different by 1–2 percentage points. This suggests that as wealthier women begin to want smaller families, they will increasingly seek out family planning methods. Substantial unmet need has provoked family planning programs by governments and donors, but the impact of family planning programs on fertility and contraceptive use remains somewhat unsettled. "Demand theory" argues that in traditional agricultural societies, fertility rates are driven by the desire to offset high mortality, thus as society modernizes, the costs of raising children increases, reducing their economic value, and resulting in a decline in desired number of children. Under this theory, family planning programs will have a marginal impact. Bongaarts (2014) shows that using a country case study approach, both stronger and weaker family programs reduce the unmet need for contraceptives and increases use by making modern contraceptives more widely available and removing obstacles to use. Also, the demand that is satisfied and the proportion of women using modern methods increased. The programs may have an additional effect of diffusing the ideas related to family planning and thus raising the demand for contraception. As a result, a small decrease in unmet need may be offset by a rise in demand. Nonetheless, even in countries where it is assumed that family programs will make a marginal impact, Bongaarts shows that family planning programs can potentially increase contraceptive use and increase/decrease demand depending on the preexisting attitudes of the community. Regional variations A family planning facility in Kuala Terengganu, Malaysia Africa Most of the countries with lowest rates of contraceptive use, highest maternal, infant, and child mortality rates, and highest fertility rates are in Africa. Only about 30\% of all women use birth control, although over half of all African women would like to use birth control if it was available to them. The main problems that preventing access to and use of birth control are unavailability, poor health care services, spousal disapproval, religious concerns, and misinformation about the effects of birth control. The most available type of birth control is condoms. A rapidly growing population coupled with an increase in preventable diseases means countries in Sub-Saharan Africa face an increasingly younger population. China China's Family planning policy forced couples to have no more than one child. Beginning in 1979 and being officially phased out in 2015, the policy was instated to control the rapid population growth that was occurring in the nation at that time. With the rapid change in population, China was facing many impacts, including poverty and homelessness. As a developing nation, the Chinese government was concerned that a continuation of the rapid population growth that had been occurring would hinder their development as a nation. The process of family planning varied throughout China, as people differed in their responsiveness to the one-child policy, based on location and socioeconomic status. For example, many families in the cities accepted the policy more readily based on the lack of space, money, and resources that often occurs in the cities. Another example can be found in the enforcement of this rule; people living in rural areas of China were, in some cases, permitted to have more than one child, but had to wait several years after the birth of the first one. However, the people in rural areas of China were more hesitant in accepting this policy. China's population policy has been credited with a very significant slowing of China's population growth which had been higher before the policy was implemented. However, the policy has come under criticism that it has resulted in the abuse of women. Often implementation of the policy has involved forced abortions, forced sterilization, and infanticides. That families desired a male child had a part to play in the number of infanticides. The number of girls that die within their first year of birth is twice that of boys. Another drawback of the policy is that China's elderly population is now increasing rapidly. However, while the punishment of "unplanned" pregnancy is a large fine, both forced abortion and forced sterilization can be charged with intentional assault, which is punished with up to ten years' imprisonment. Another issue that is raised in the one-child policy in China is the information in regards to naturally giving birth to twins or triplets. If this situation arises, the family is allowed to keep the children because of the natural causes of this impregnation. 240px|Map of population density by country, per square kilometer Family planning in China had its benefits, and its drawbacks. For example, it helped reduce the population by about 300 million people in its first 20 years. A drawback is that there are now millions of people, and in China siblings are very important. Once the parent generation gets older, the children help take care of them, and the work is usually equally split among the siblings. Another benefit of the implementation of the one-child law is that it reduced the fertility rate from about 2.75 children born per woman, to about 1.8 children born per woman in the 1979. According to an investigative report by The Associated Press published at the 28 June 2020, the Chinese government is taking draconian measures to slash birth rates among Uighurs and other minorities as part of a sweeping campaign to curb its Muslim population, even as it encourages some of the country's Han majority to have more children. While individual women have spoken out before about forced birth control, the practice is far more widespread and systematic than previously known, according to an AP investigation based on government statistics, state documents and interviews with 30 ex-detainees, family members and a former detention camp instructor. The campaign over the past four years in the far west region of Xinjiang is leading to what some experts are calling a form of "demographic genocide." Hong Kong In Hong Kong, the Eugenics League was founded in 1936, which became The Family Planning Association of Hong Kong in 1950. The organisation provides family planning advice, sex education, birth control services to the general public of Hong Kong. In the 1970s, due to the rapidly rising population, it launched the "Two Is Enough" campaign, which reduced the general birth rate through educational means. The Family Planning Association of Hong Kong, Hong Kong's national family planning association,History of International Planned Parenthood Federation founded the International Planned Parenthood Federation with its counterparts in seven other countries. India Family planning in India is based on efforts largely sponsored by the Indian government. In the 1965–2009 period, contraceptive usage has more than tripled (from 13\% of married women in 1970 to 48\% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.6 in 2009), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 15 days. Iran While Iran's population grew at a rate of more than 3\% per year between 1956 and 1986, the growth rate began to decline in the late 1980s and early 1990s after the government initiated a major population control program. By 2007 the growth rate had declined to 0.7 percent per year, with a birth rate of 17 per 1,000 persons and a death rate of 6 per 1,000.MSN Encarta Encyclopedia entry on Iran - People and Society , CIA World factbook 2007 . Archived 2009-10-31. Reports by the UN show birth control policies in Iran to be effective with the country topping the list of greatest fertility decreases. UN's Population Division of the Department of Economic and Social Affairs says that between 1975 and 1980, the total fertility number was 6.5. The projected level for Iran's 2005 to 2010 birth rate is fewer than two.Iran tops world in birth control, payvand.com 04/17/09, accessdate = 2010-03-23 In late July 2012, Supreme Leader Ali Khamenei described Iran's contraceptive services as "wrong," and Iranian authorities are slashing birth-control programs in what one Western newspaper (USA Today) describes as a "major reversal" of its long standing policy. Whether program cuts and high-level appeals for bigger families will be successful is still unclear.Iran urges baby boom, slashes birth-control programs usatoday.com 30 July 2012 Ireland The sale of contraceptives was illegal in Ireland from 1935 until 1980, when it was legalized with strong restrictions, later loosened. It has been argued that the resulting demographic dividend played a role in the economic boom in Ireland that began in the 1990s and ended abruptly in 2008 (the Celtic tiger) was in part due to the legalisation of contraception in 1979 and subsequent decline in the fertility rate. In Ireland the ratio of workers to dependents increased due to lower fertility — the reality of which has been questioned — but was raised further by increased female labor market participation. Pakistan In agreement with the 1994 International Conference on Population and Development in Cairo, Pakistan pledged that by 2010 it would provide universal access to family planning. Additionally, Pakistan's Poverty Reduction Strategy Paper has set specific national goals for increases in family planning and contraceptive use. In 2011 just one in five Pakistani women ages 15 to 49 uses modern birth control. Contraception is shunned under traditional social mores that are fiercely defended as fundamentalist Islam gains strength. Philippines In the Philippines, the Responsible Parenthood and Reproductive Health Act of 2012 guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care. While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, and IUDs, as the government continues to disseminate information on their use through all health care centers. Russia According to a 2004 study, current pregnancies were termed "desired and timely" by 58\% of respondents, while 23\% described them as "desired, but untimely", and 19\% said they were "undesired". As of 2004, the share of women of reproductive age using hormonal or intrauterine birth control methods was about 46\% (29\% intrauterine, 17\% hormonal).National Human Development Report Russian Federation 2008, UNDP,pages 47–49, Retrieved on 10 October 2009 During the Soviet era high quality contraceptives were difficult to obtain, and abortion became the most common way of preventing unwanted births. Since the dissolution of the Soviet Union abortion rates have fallen considerably, but they are still higher than rates in many developed countries. Singapore Population control in Singapore spans two distinct phases: first to slow and reverse the boom in births that started after World War II; and then, from the 1980s onwards, to encourage parents to have more children because birth numbers had fallen below replacement levels. Thailand In 1970, Thailand's government declared a population policy that would battle the country's rapid population growth rate. This policy set a 5-year goal to reduce Thailand's population growth rate from 3 percent to 2.5 percent through methods such as spreading family planning awareness to rural families, or integrating family planning activities into maternal and child healthcare education. Public figures such as Mechai Viravaidya helped spread family planning awareness through public speakings and charitable activities. United Kingdom Contraception has been available for free under the National Health Service since 1974, and 74\% of reproductive-age women use some form of contraception. The levonorgestrel intrauterine system has been massively popular. Sterilization is popular in older age groups, among those 45–49, 29\% of men and 21\% of women have been sterilized. Female sterilization has been declining since 1996, when the intrauterine system was introduced. Emergency contraception has been available since the 1970s, a product was specifically licensed for emergency contraception in 1984, and emergency contraceptives became available over the counter in 2001. Since becoming available over the counter it has not reduced the use of other forms of contraception, as some moralists feared it might. In any year only 5\% of women of childbearing age use emergency hormonal contraception. Despite widespread availability of contraceptives, almost half of pregnancies were unintended in 2005. Abortion was legalized in 1967. United States Despite the availability of highly effective contraceptives, about half of U.S. pregnancies are unintended. Highly effective contraceptives, such as IUD, are underused in the United States. Increasing use of highly effective contraceptives could help meet the goal set forward in Healthy People 2020 to decrease unintended pregnancy by 10\%. Cost to the user is one factor preventing many American women from using more effective contraceptives. Making contraceptives available without a copay increases use of highly effective methods, reduces unintended pregnancies, and may be instrumental in achieving the Healthy People 2020 goal. In the United States, contraceptive use saves about $