Truman National Security Project

Women’s Health is Key to Global Health, Economic Development, Security


Women’s health and birth control access have sparked a contentious political firestorm in American politics as Republicans have unleashed a barrage of restrictive and damaging legislation. As we fight back against these historic attempts to undermine women’s health and family planning access here in the US, let’s not lose sight of our sisters around the world. Access to family planning education and contraception is one of the global keys to improving health, economic development, and security.

While fertility rates have declined dramatically in most of the world, Sub-Saharan Africa and Southeast Asia have resisted the trend toward fewer lifetime births per mother. From 1950 to 2000, the average fertility rate in developing countries was cut in half, from 6 to 3. Fertility rates, however, in many African countries have remained stubbornly high. In Nigeria, the rate is 5.5, in Chad and Uganda it’s over 6.  With a fertility rate over 7, Afghanistan has one of the highest rates of childbirth in the world.  The fact that it is also poor, uneducated and prone to extremist movements is no accident. Take a look at this list of countries by fertility rate.  A quick glance confirms that poor countries tend to have high rates and rich countries tend to have low rates. Is this simple correlation or causation? In other words, which comes first, the economic development or the declining fertility rate? It’s probably some of both but there’s good reason to believe that access to contraception, even in a poor country, can decrease fertility rates and improve economic development.

Researchers in Bangladesh studied the impact of access to birth control, in Matlab district, over the course of 20 years.  They found that in villages with family planning, every measure of well-being, including health, earnings and assets, improved. While cultural preferences for large families remain, an increasing amount of research also shows that couples in developing countries desire fewer children.  Marie Stopes International surveyed Afghan families and found that the ideal size for most Afghan families was 4 or 5 children, in other words, 2 or 3 children less than their current fertility rate would dictate.  Afghan couples also seemed to understand the benefits of limiting family size. One man commented that: “Three to five (children) is perfect in order to feed and educate them well.” Another study found that more African women said they wanted contraception but had no access than said that they actually use contraception. Most poignant however was the reaction of one woman, a mother of 17, upon receiving birth control for the first time.  The woman was reportedly so delighted that she “hugged and kissed Aziza (the provider), ripped open a package and swallowed a pill with a gulp of water.”

Increased access to contraception is not just good for families, it also contributes to a stable and sustainable world.  While the link between poverty and terrorism has been difficult to tease out, the growth for example of the deadly Boko Haram terrorist group in Nigeria appears directly tied to grievances about poverty and inequality, economic stress that is worsened by large families.  All of this is to say nothing of the burden that climate change puts on our world and the strain and conflict it creates. The Department of Defense calls climate change an “accelerant of instability” that exacerbates volatile situations. Warmer temperatures and increased incidences of severe weather lead to more natural disasters, dislocation, and disease.  This stress and hardship in turn fuels extremism. Smaller families consuming fewer resources can be a step on the road to lessening the impact of extreme weather events on global security.

Despite the obvious and demonstrated importance of birth control access, focus on the issue is limited. According to Melinda Gates whose No Controversy movement is working to build awareness and action around family planning in the developing world: “Birth control has almost completely and totally disappeared from the global health agenda.”  Family-planning is no silver bullet but it can be a vital and effective tool in saving and improving lives. If you don’t find these reasons compelling consider this: unintended pregnancy is the leading cause of death among teenage girls.  For some women contraception access can literally mean the difference between life and death.

Krystal Ball is a Truman Partner.


Additional resources:

The Economist’s take on the positive impacts of decreased fertility: Go forth and multiply a lot less

Melinda Gates’ TEDx talk on why increased access to family planning should be a non-controversial idea

New York Times article on attempts to increase birth control access in Afghanistan: Broaching Birth Control with Afghan Mullahs

Recent New York Times article on strain that rapid population growth has placed on Nigeria: Nigeria Tested by Rise in Population