Family Futures

The CBR has declined rapidly since 1990, from 27 to 20 in the world as a whole and from 31 to 21 in developing countries. Two strategies have been successful in reducing birth rates.

CBR Change 1990-2018

The CBR has declined in all but a handful of countries. Declines have been most rapid in Latin America and South and Southwest Asia.

Lowering CBR through Education & Health Care

One approach to lowering birth rates emphasizes the importance of improving local economic conditions. A wealthier community has more money to spend on education and health-care programs that promote lower birth rates. According to this approach:

• With more women able to attend school and to remain in school longer, they would be more likely to learn employment skills and gain more economic control over their lives.

• With better education, women would better understand their reproductive rights, make more informed reproductive choices, and select more effective methods of contraception.

• With improved health-care programs, IMRs would decline through such programs as improved prenatal care, counseling about sexually transmitted diseases, and child immunization.

• With the survival of more infants ensured, women would be more likely to choose to make more effective use of contraceptives for family-planning.

Family Planning Education

Women talk about birth control at a reproductive health clinic in Kampong Cham, Cambodia.

Pause & Reflect

Why might birth rates have declined since 1990 less rapidly in Europe and North America than in other regions?

Lowering CBR through Contraception

A second approach to lowering birth rates emphasizes the importance of rapidly diffusing modern contraceptive methods. In developing countries, demand for contraceptive devices is greater than the available supply. Therefore, the most effective way to increase their use is to distribute more of them cheaply and quickly. Even though economic development may promote lower birth rates in the long run, the world cannot wait around for that alternative to take effect. Allocating resources into family-planning programs can reduce birth rates much more rapidly.

Women Using Family Planning, 2017

More than two-thirds of couples in developed countries use a family-planning method. Family planning varies widely in developing countries. China reports the world’s highest rate of family planning while the lowest rates are in sub-Saharan Africa.

Family Planning Methods

(a) The principal family-planning methods in developed countries such as Germany are condoms and birth-control pills. (b) The principal methods in China are intrauterine devices (IUDs) and female sterilization. (c) People in sub-Saharan African countries such as Nigeria make minimal use of family planning.

Rapid growth in the acceptance of family planning in a number of developing countries is evidence that in the modern world, ideas can diffuse rapidly, even to places where people have limited access to education and modern communications. Bangladesh is an example of a country that has had little improvement in the wealth and literacy of its people, but 62 percent of married women in the country used contraceptives in 2017 compared to 6 percent in 1980. Similar growth in the use of contraceptives has occurred in other developing countries, including Colombia, Morocco, and Thailand. The percentage of women using contraceptives is especially low in sub-Saharan Africa, in part because of reluctance of men to use them. So the alternative of distributing contraceptives could have an especially strong impact there.

Many oppose birth-control programs for religious and political reasons. Adherents of several religions have convictions that prevent them from using some or all birth-control methods. Opposition is especially strong in some countries to terminating pregnancy by abortion.

Pause & Reflect

How would a difference in contraceptive choices increase or decrease birth rates?