OpenForum – a blog by the Health and Human Rights community

[Editor's note: This is a guest post written by Stephanie Psaki.]

Last month, the World Bank published a review of its health, nutrition, and population programs from 1997 through 2007, totaling US$17 billion in support. The review found that a third of the projects in this portfolio did not meet their objectives, and that, “none of the projects with explicit fertility or population objectives achieved them.”

The Bank’s current (2007) Population Strategy does not promise much greater success. Amidst a general endorsement of past approaches, the report states that they will target high fertility countries, where total fertility rates (average number of children born to a woman over her lifetime) exceed 5.

However, this strategy does not appear to take into account the level of unmet need – the proportion of women who no longer want to have children but lack access to contraception – in these countries. From an economics perspective, this is analogous to trying to sell a product to a new market with no indication that anyone wants to purchase it.

In fact, there is reason to believe that most people in these high fertility “markets” do not currently want to use contraception.

In a 1994 paper, Dr. Lant Pritchett – a World Bank economist – famously pointed out that worldwide 90% of differences in total fertility rates could be explained by differences in desired fertility. In other words, in most cases women and couples are having children because they want to have children. While Pritchett’s conclusions have been the subject of heated debate, the distinction between wanted and unwanted fertility remains crucial. Read more