nDEVELOPMENT: CHOICES FOR A BETTER LIFEn Address As Prepared for Delivery by Barber B. Conable President The World Bank Group to the International Planned Parenthood Federation Ottawa, Canada November 7, 1989 Sharon Coleman, Honorable Ministers, President Wadia, Ladies and Gentlemen: It is a pleasure to Join my friend, Dr. Halfdan Mahler, on this occasion. I congratulate him publicly ·for accepting the challenge to lead the IPPF. I am pleased to have this opportunity to meet with representatives of so many family planning associations, whose work around the world I have admired for many years. A special thanks also to our Canadian hosts, for their warm welcome. The Population Issue It is humbling to realize, at the end of each day, how difficult it is to transform the lives of the more than four billion people in the developing world, given how many live in abject poverty; how constrained the available resources are; and how urgent the need for progress is. Yet that is the task before us. Persistent high fertility rates, and rapid population growth frustrate our task in two ways: o First, they increase the pressure on scarce resources and our natural environment. o Second, they limit the options available to families, making it harder to break the bonds of poverty. Poverty is our colIDllon enemy. Reducing poverty is the World Bank's central mission, but it must be done in ways which are sensitive to the environment. But there is absolutely no doubt that to achieve this environmental goal we must come firmly to grips with the population issue. Of course, pressure on scarce resources reflects not only the growth of population, but also the pursuit of wasteful and self-indulgent lifestyles -- especially in industrial countries -- lifestyles which threaten our natural heritage and our dream of sustainable development. Industrial countries must show bolder leadership on the environment. - 2 - Environmental Strains First, I want to talk to you about population pressures and the environment. Two-hundred and fifty years ago Reverend Malthus gave his contemporaries a vision of population outrunning its resource base. The sense of urgency I have about population pressures and the environment is not based on his grim calculation, however, because we have learned how to frustrate his simple arithmetic. The evidence is clear that economic growth rates in excess of population growth rates can be achieved and maintained, by both developed and developing countries. My sense of urgency about this derives, inste~d, from concern about the serious strains that more billions of people will impose on the earth's environment. Our lands can be made to feed our populations, but at what cost to the earth's ability to sustain the livelihood of future generations? Our cities may be able to accommodate added millions, but at what cost to the quality of urban life? Our political, social and legal institutions can be adapted to accommodate increasing population density, but at what cost to privacy, to personal freedom, to the rights of individuals? These are not easy issues. There are no great philosophic ponderings about th1s, no timeless chemistry, no historical precedents to guide how we shape our future. We can, however, pull together some examples of what we should avoid. We must slow down the massive decline in the capacity of the overflowing cities of the Third World to meet the elemental needs of their populations. We must prevent the deterioration of the tropical soils that underpin slash and burn agriculture. We must end the breakdown of personal privacy and collective discipline that accompany overcrowding. These are just a few examples; there are many more. In too many developing nations, the growth of rural population.has exceeded the capacity to create non-rural employment.opportunities. The pressure on land has increased with more intensive cultivation, fragmentation of holdings and, often, a resulting loss in productivity through soil erosion, a decline in soil structure and soil-plant nutrients. The number of rural people who are landless has increased, adding to problems of poverty and aggravating social tensions. Those who can no longer be accommodated on family holdings extend their farming into marginal lands unsuited to intensive cultivation. This hastens the degradation of both the farm economy and the resource base upon which it rests. Sustainable agriculture, that is, agriculture that can be practiced from one generation to the next, is impossible in this environment of expanding human population. - 3 - I have drawn your attention to rural realities because the agrarian nature of developing countries makes the agricultural sector the first to feel the impact of population growth. But I could have chosen the urban view of the increase in farm-to-urban migration, of the rise of urban slums, of the costs of extending urban services to new migrants, and so on. The rural and urban environments are stretched, folded and made vulnerable by the rapid growth of population. Improvement of People's Lives -- Increasing Choices My second point is that high fertility limits the options available to families -- and especially to women -- making it harder to break the bonds of poverty. Making choices available to individual women and men is the key to improvement for themselves, their families, their communities and their nations. Development is not a statistical exercise. The whole puruose of development is to improve the quality of people's lives -- increasing their options. Having too many children, too close together, forecloses those options, particularly for women. In the developing world, many women spend 15-20 years bearing children. In industrial countries, most women bear their children in 5-10 years. It is difficult for mothers of young children to seek work or training outside the home. The cumulative effects of many pregnancies may damage the health of women. In many developing nations where populations double every generation, there may be no practical way to provide the basics of education, health care, or even decent food. Hard-won savings go largely to sustain more people at living standards barely above subsistence. Sir Dugald Baird, a British obstetrician, stated in 1965 that freedom from excessive fertility is the fifth freedom. How true! When we talk of excessive fertility, we are not just talking about numbers -- we all know the statistics. What we are talking about is improving the quality of life for individual men and women. We are talking of sick and dying mothers, and neglected and abandoned children. We are talking of poverty, disease, ignorance, and hunger. We are talking of slums, pollution, and decay in our environment. We are talking of social and political instability. While rapid population growth may not directly cause all of these problems, it makes solution of them far more difficult, if not impossible. Signs of Progress But there are signs of progress and hope. Through international efforts over the past 20 years -- from the U.N. conference in Tehran in 1968 to the international conference on population in Mexico in 1984 -- the world coIImlunity has forged consensus on the importance of population issues to national progress. - 4 - These population conferences and the U.N. conferences on the Decade for Women recognized that having the information and means to plan families is a basic human right. These principles have been given practical expression in the policies and actions of many countries -- a real step forward. We have new evidence of progress in family planning during the 1980s. This is particularly welcome because, for the developing world, the 1980s have been marked by an increasing burden of debt and the challenges of economic adjustment. For example, in Asia, population growth is slowing in Korea, Thailand, Indonesia, parts of India and even Bangladesh. In Latin America, Colombia and Mexico are important examples. In Africa, population continues to grow at ov~r 3 percent annually -- enough to double in less than 20 years. No continent has ever developed successfully in the face of such rapid population growth. But the situation in Africa is changing. Today more than 25 percent of couples in.Botswana and Kenya are practicing family planning, and in Zimbabwe the figure has reached 40 percent. The lesson is clear: given the opportunity, many couples all over the world will choose family planning. Yet too often rhetoric still outpaces action. Sadly, despite the international consensus on family planning as a human right, between 300 and 400 million couples worldwide still lack convenient access to the information and services needed to plan their families. A two-pronged approach is necessary to reduce fertility and slow population growth. We need to: o first, ensure that men and women actually desire smaller families; and o second, supply family planning information and services to both men and wome~ so that they can achieve their preferred family size in ways acceptable to them. Desire for Smaller Families We all know that today's population growth will make it harder for future generations to escape poverty and that high fertility limits women's options. Despite these basic facts, many poor couples still feel obliged to have large families. For the poor, children are their surest hope -- sometimes their only hope -- of reliable labor, physic Gl protection, and old- age support. Yet, with economic progress and accompanying opportunity, couples find they no longer need so many children and often prefer smaller -- but healthier and better educated -- families. The key, again, is to open up options, especially for women. Everywhere in the Third World women are forced by circumstance to be the primary nurturers, educators, and farmers -- they must have the opportunity to make wider choices about the purposes of their lives. - 5 - We must increase education and employment opportunities, especially for women, so that they can depend less on their children and more on themselves. As women's horizons expand, so do their aspirations for themselves and their children. A woman who knows how to expand her horizons, because she can read and write, is better able to care for and teach her children. In the 1920's, an African leader said, "You educate a man and you educate an individual; you educate a woman and you educate the whole nation." We must improve the health and nutrition of children so that parents no longer must accept the expectation that some of their children will die. Where infant mortality rates fall to 50 per 1,000 or less, more couples choose to practice family planning. I do not wish to downplay the importance and crucial influence of men in economic, social and cultural change. But my emphasis on women is based on persuasive facts: a Making more options available to women affects family size more than similar efforts for men. Clearly, women's income-earning activities compete with childbearing. Indeed, research shows that as men's incomes increase, they want more children; as women's incomes increase, they want fewer. o Women's education and income also have more influence than men's education and income on the health and welfare of children. Again the explanation is that women give greater attention to their children's up-bringing and individual development. Of course, what makes people want many or few children varies from one culture to another. But access to education and productiv~ resources are almost universal forces for good, in their own right. Our task is to help make available to women and to men the ability to make decisions which will meet the needs of families and serve well society as a whole. In millions of families now, there is no choice; given the choices development creates, many will choose smaller families and a better quality of life. Meeting the Demand for Family Planning Many more couples today wish to start families later, space births more widely, and end childbearing sooner. They demand -- and they deserve -- the means to satisfy that wish in safe, effective, affordable and acceptable ways. We have an obligation to help provide the information and means for family planning. It would be irresponsible not to do so. Today's contraceptive technologies meet these requirements ~ asonably well. But we still need better methods, more suited to the needs of the poor and the deprived who live in scattered, rural connnunities and teeming ghettos. The World Bank supports the research efforts of the World Health Organization Human Reproduction Program -- to find better, safer and more effective contraceptives. We are also seeking more culturally appropriate ways to deliver family planning services to the people who need and want them. - 6 - We must listen to the people who will use family planning services, especially the poor and those who live in remote areas. Thus far, we have learned several lessons. We must: o make available a variety of methods to meet and satisfy the needs of people in different cultural and economic circumstances; o provide as much information as possible on family planning on how to use the various methods and their possible side effects; o lower the cost of family planning to the user -- not only the financial cost, but the time cost, the transportation cost, the social embarrassment cost. We need ~o bring services as close as possible to the community, not only geographically, but socially and culturally . . o improve the management of family planning and related health programs, to lower costs, increase reliability, reduce the risk of problems and improve the capacity to handle them; o use multiple channels for distributing family planning information and services -- government primary health care programs, non-governmental organizations, such as the family planning associations represented here, private physicians, the commercial sector, women's organizations, radio, television, traditional media; o and, finally, we must educate the public on the health risks to women of not practicing family planning. In many developing countries today, maternal mortality accounts for over one-fourth of all deaths of women of childbearing age. Through family planning -- and better care during pregnancy and childbirth -- we can sharply reduce the maternal death toll. The World Bank joined with WHO, IPPF, and others to launch the international Safe Motherhood Initiative. I am pleased at the response to this effort by the international community -- and by women around the world. Certainly, the active involvement of political and other leaders makes an enormous difference -- as we have seen recently in Kenya and Zimbabwe. The programs of Bangladesh, Indonesia, and Thailand attest to the importance of political leadership. The Role of NGOs IPPF should be justly proud of its achievements over the last 37 years, as the largest non-governmental organization dealing with population and responsible parenthood. NGOs and the private sector provide more than half the health care in many countries. NGOs can often try new approaches that governments will not or cannot do, and develop models that are cost-effective. - 7 - Within the field of family planning and population, IPPF deserves its reputation for being, in its biographer's words, ~brave and angryn. IPPF was on the front line in the struggle to make family planning the right of every individual and couple. Historically, IPPF has earned the world's respect. You will retain that respect by asking yourselves these questions, ye·ar after year: o Are you still on the front line? o Are you still prepared to try new things? o On major current issues, where do you stand? o Are you in the vanguard of work with young people? o Are you helping with adolescent pregnancy in culturally acceptable ways? o Are you prepared to help governments see the need to extend family planning and take more interest in population issues? o What goals and targets are you setting for yourselves in the 1990s? The World Bank is glad to be working with IPPF, supporting programs and projects that will help your organizations work better with their governments. These efforts have borne fruit. About one-fifth of our projects in population, health and nutrition now involve NGOs. The World Bank's Role The World Bank has a long-standing commitment to population. We will not forget this commitment, even when new i~itiatives clamor for our attention. What is more, we have under way a number of supporting thrusts: o renewed emphasis on poverty, both a cause and a consequence of rapid population growth (Poverty will be the main topic of our World Development Report next summer.); o concern with the environment and its close relationship with population; and o attention to women in development. In fact, more than one-fifth of the number of projects will include components that specifically address women's needs. These include major efforts in agriculture, education, family planning, health and nutrition. - 8 - I pledge today to renew the Bank's commitment to issues of excessive population growth and to help make family planning accessible to all. We will increase substantially our lending, first, for the delivery of effective family planning services and, second, for investments which will improve opportunities for women. For population, health and nutrition alone, we are increasing our lending to $800 million for the next three years, compared to $500 million for the past five years. I will personally monitor our performance on both quantity and quality. We will enhance our dialogue with policymakers and political leaders, especially on reducing poverty and expanding opportunities for women. To this end, we will step up our efforts to discover and disseminate information about what works in different economic and cultural environments. We will work with others in the family planning field, including both bilateral and multilateral donors and NGOs such as IPPF, to de.sign ways to forge greater cooperation. It is not enough for us to meet at international gatherings and talk about what we want to do. We need goals. Family planning should be an accepted practice for at least half the couples of the developing world by the year 2000. The action, of course, is at the national level. An individual can make a difference; leadership matters. I need not remind you of the shining examples of leaders, particularly women leaders, that illuminate your history -- Margaret Sanger, Ottesen Jensen, Lady Rama Rao, Beth Jacobs, Aziza Hussain, Avabai Wadia, just to name a few. You are the leaders in this field, and you should be aware of the resources available to you. We at the Bank stand ready to help as one of those resources. Will you join forces with us in the next decade to ensure that family planning is not only a theoretical right, but a practical possibility for men and women everywhere? Thank you. /