Dr. Nafis Sadik

The UN’s Prescription for Family Planning

As Hillary Rodham Clinton opened her remarks at the Hague International Forum conference on population and women’s reproductive health last February, she turned to the woman who had introduced her, Dr. Nafis Sadik, executive director of the United Nations Population Fund (UNFPA). “I believe that the world owes her a debt of gratitude,” Clinton told the audience, “for all she has done over the years to place women at the very center of development.”

Dr. Sadik, who studied medicine in her native Pakistan and in the U.S., has had a lifelong commitment to family planning. Her first hands-on experience, between 1954 and 1963, was spent running the women’s and children’s wards of Pakistani hospitals, after which she helped shape the country’s five-year family planning program. She was made Director-General of the Pakistan Central Family Planning Council in 1970, but left to join UNFPA the following year. In 1976, Dr. Sadik won the Hugo Moore Award for her work alerting the world to the international population crisis, followed by many other prizes and honorary degrees. She became UNFPA executive director in 1987.

Dr. Sadik’s office in a New York City skyscraper, decorated with photos of her meetings with world dignitaries, offers a commanding view of the East River and the United Nations building which, during E’s visit, was hosting a population meeting that is part of the five-year review of the Cairo conference.

E: The United Nations projects three different world population scenarios for the year 2050. The low figure is eight billion, the middle 9.5 billion and the high 12 billion. What do you think will happen?

Sadik: The most likely outcome is a population level somewhere near nine billion, but that can change depending on what we do in the next five years. You need to have the fertility levels down now for the effect to be apparent in the year 2050. And this is very unlikely to happen in some of the countries that have very large populations, like Nigeria and Pakistan.

There are a number of factors working to keep world population moving up, even though fertility is going down, and among them are the aging of the population on the one hand and the large number of youth on the other.

The most significant reason for the population increase is the very large base, almost six billion people. The base population 12 years ago was five billion, and 13 years before that it was only four billion. The base makes a big difference, because it has increased dramatically in developing countries. The industrialized countries’ populations are more or less stable at about 1.2 billion, but the developing countries could have a population of more than eight billion in 50 years.

Because of that, is it likely we will see a more economically polarized world, with sharper divisions between the haves and the have-nots?

I think the realization is gathering that there cannot be any isolated part of the world, that we’re all connected. With that realization, there is interest in doing more on a global level. The environment is one area of concern, but there are others, such as the fact that AIDS and other epidemics have spread to industrialized countries. It was a bit of a shock to some of these countries when they suddenly realized that diseases don’t know any boundaries. There’s also the realization that their economic growth is not going to be very high if they lose their markets in the developing world.

It’s a question of finite resources and how those resources are distributed. You cannot continue to have an unequal society in which 1.2 billion people are comfortable and the rest live at some bare level of existence. An increasingly polarized world leads to more conflict, and that leads to confrontation at many levels. The environmental issues are really becoming serious. Water, for instance, is emerging as a source of conflict around the world.

Do you think the Earth has a “carrying capacity”? If so, what is it?

We are asked that all the time, and it is not an easy question to answer. It depends on what you mean by carrying capacity. Some countries will have a population they are not able to support, but the people will still exist with a minimal or sub-minimal standard of living. The level of misery and the lack of services in those societies will simply increase. There might be higher mortality levels, more violence. But I can’t really give a specific number for the carrying capacity of the Earth. Many environmentalists think it’s four billion, maximum. But now we have six billion people.

The issue of family planning has become somewhat politicized in the U.S., with some elected officials linking it to abortion. But it seems plain to me that cutting down on international family planning aid leads to more abortions. Even so, that linkage has had serious consequences for U.S. family planning support.

It is very unfortunate that the people who are supposedly against abortion try to criminalize the institutions that promote family planning. They use all kinds of excuses to say why they oppose contraceptives. But if you are really against abortion, you should support family planning. I was looking at some material that a Catholic group was circulating recently in the U.N. It said that fertility is declining so rapidly that the world is going to have no people, that there will be a serious labor shortage, that there will only be old people left. They’re trying to spread doomsday scenarios.

In fact, there’s no possibility of a population shortage. And we need to do more to provide information and services, in part because exercising choice is a basic human right. Surveys today show that women in all regions of the world have more children than they want. This means that they either don’t have access to information and contraceptives, or they aren’t able to make decisions for themselves, an unfortunate fact in many societies. We still have a lot of abortions—not just a few, but 60 or 70 million a year—that are the result of unwanted pregnancies. It will take much more access to information and family planning services for us to eliminate these unwanted pregnancies and reduce the abortion rate.

I think the political targeting of family planning is very misguided, and I hope it will be reversed. The Clinton administration supports UNFPA and U.S. Aid for International Development (USAID) population programs, but the U.S. Congress has just a few members who are able to hold the majority hostage to their views. I was encouraged to hear that a congresswoman from New York, Carolyn Maloney (D-NY), has introduced a bill asking for the restoration of UNFPA’s $25 million annual funding, and the bill has 46 cosponsors in the House, including many Republicans.

PHOTO: Jim Motavalli

Twenty-five million is not very much money, and it represents a considerable drop from the $45 million we received from Congress in 1985. The U.S. had already retreated from being our first to our sixth-largest funder, and clearly by now the contribution should be $50 or $60 million. Japan, which was second to the U.S., now contributes $59 million. If we had had that level of support from the U.S. for the last 10 years, we could have done a lot.

Will small increases in family planning acceptance res

ult in big demographic changes?

Yes, very big changes. And there are 350 million women who would use contraceptives if they could get them. They either don’t want to get pregnant again or simply want to space the next pregnancy out. If we were able to deliver services to these women, it would make a huge difference. But, obviously, the chance of that happening is remote. The amount of money is minuscule compared to the amount spent on all kinds of wasteful things.
We have estimated that we need $5.7 billion from the international community to get family planning to everybody who wants it in developing countries. The total cost is $17 billion, with most of the money coming from the developing countries themselves. They are increasing their expenditures on reproductive health and family planning, but the international community is doing only about 50 percent of what it should be doing.

My father was from Iran, and it was a revelation for me to learn what strides the current Moslem theocracy has made in family planning. I had no idea that the government encouraged birth control there.

There is an exceptional program in Iran. In eight years, its birth rate has been cut in half. Iran is providing sex education and premarital counseling to all couples in a society that is otherwise very conservative. We use Iran as a model for other Moslem countries—there is nothing in the Koran that prohibits family planning. It is only when someone wants to misuse religion that they find ways to oppose birth control. But all the Moslem countries have programs, and many of them are very successful. Indonesia, Tunisia and Bangladesh have successful programs, and Bangladesh is very poor. Morocco and Egypt are also doing very well.

What kind of impact does population growth have on the environment?

In developing countries, the environmental impact is very serious because of the density of the population. The problem is most serious in the poorest parts of the countries, where impoverished people overcultivate the land and cut down trees for fuel. If we had a policy of meeting people’s basic needs, we could address some of the environmental issues that occur as a result of poverty. In developed, industrialized societies, there’s a different problem. When economic levels go up, consumption levels go up, too. People buy more cars and consumer goods. They use more electricity.

I understand that a New Yorker uses 120 times more of the Earth’s resources in his or her lifetime than does an inhabitant of Madagascar.

That’s true. In the U.S., every building is overheated in the winter and overcooled in the summer. People never turn off their televisions here.

But don’t most people in the developing world aspire to this level of consumption?

Of course, and it’s a big problem. That’s why we say that we need a new development paradigm. Every developing country thinks to be rich is to follow the lifestyle and the consumption of the West. It’s not just the wealth, but the cultural and social behavior patterns that are emulated. Even Europeans want American-type lifestyles, though they might say they don’t. All of the countries in the world want to be like the U.S.
One of the things you notice when you come from a developing country is that the aspirations of young people have also changed. Young people want to be rich, whereas my generation of children wanted to be somebody—a doctor or a scientist. There is a real pursuit of wealth here, and in all industrialized societies.

And in the developing world, wealth is seen in a western context because that’s what people, even very poor people, see on TV.

The visual images are centered on wealth, so everybody in Pakistan and India wants to be like the families on American TV—with the cars, the houses, the refrigerators and deep freezers.
The society which seems to have preserved more of its cultural values, while not being totally insulated, is Japan. Japanese people have the economic success of Americans, but they live in little boxes. They seem to accept that that is what they will have, and don’t spend a lot of money on large houses.

Meanwhile, in the U.S., the average size of a house keeps growing. But I’d like to get back to the funding issue. I recently heard that Microsoft’s Bill Gates had made a $2 billion contribution to a family foundation that specializes in population. In some ways, can individual grants—from people like Bill Gates and Ted Turner—make up for the loss of U.S. government funding?

We expect to get some money from the population foundation that Bill Gates has set up. The Turner Foundation gave the U.N. $1 billion, and some of that will come to the UNFPA also. But that doesn’t make up for the government’s contribution—we would have gotten that private funding in any case.

If you were able to address the American people on October 12, the Day of Six Billion, what would you say?

I would tell them that population is not someone else’s problem, it’s a global issue that needs to engage every country in the world. The U.S. played a leadership role, and it was, in fact, the catalyst that led the European countries and Japan to look at population in the late 1960s and early 1970s. Now Congress has forced the U.S. to abandon that leadership role with the false thinking that population is either over as a problem or that it doesn’t really affect the U.S. I think neither is true: it’s not over, and it certainly does affect America.

Americans consider themselves the promoters of human rights and human security, and what greater human right is there than for women and families to be able to decide the number of children they want, and for all those children to be wanted and have opportunities?