Population growth and the Millennium Development Goals.

354 www.thelancet.com Vol 369 February 3, 2007 Return of the Population Growth Factor: its impact on the Millennium Development Goals, a report of hearings held in the UK Parliament in 2006, focuses on the devastating impact of population growth on the Millennium Dev elopment Goals (MDGs). The report was released on Jan 31. The Inquiry Chairman, Richard Ottaway, Mem ber of Parliament (MP), concludes: “The evidence is overwhelming: the MDGs are diffi cult or impossible to achieve with the current levels of population growth in the least developed countries and regions.” Experts from around the world who testifi ed to the hearings described the benefi cial eff ects of slowing rapid population growth, as did Cleland and colleagues recently in The Lancet. Slower population growth permits greater investment in education and health, helping to lift nations out of poverty (MDG 1). By contrast, high birth rates in sub-Saharan Africa have helped increase the number living in extreme poverty from 231 million in 1990 to 318 million in 2001. In Ethiopia, 8 million people already live on permanent food aid, and the projected population growth from 75 million today to 145 million in 2050 presents an insurmountable challenge. Rapid population growth has a detrimental eff ect on the hope of achieving universal primary education by 2015 (MDG 2). Girls in large families are less likely to begin school and more likely to drop out early. The UK Department for International Development (DfID) sees “The ability of women to control their own fertility [as] absolutely fundamental to women’s empowerment and equality” (MDG 3). Given the same level of health care, a child born less than 18 months after an older sibling has three times the death rate of a baby born after an interval of 36 months (MDG 4). An estimated 35% of all maternal deaths could be forestalled by simply preventing unintended births (MDG 5). For HIV/AIDS (MDG 6), many unintended pregnancies occur in women who are HIV-positive, and improved access to family planning is the most cost-eff ective way of preventing vertical transmission. Rapid population growth is a counterforce against environmental conservation (MDG 7). Consumption in the developed world contributes enormously to global ecological problems, but rapid population growth in developing countries also leads directly to deforestation, land degradation, and threats to water quality. Some past population policies were coercive and Christine McCaff erty, MP, Chair of the All Party Parliamentary Group on Population, Development and Reproductive Health, which sponsored the hearings, emphasises that possible solutions must be framed in a “human rights perspective”. The need for family planning must be met among the estimated 125–200 million women around the world who would like to limit or space their childbearing but are not using contraception. Return of the Population Growth Factor calls for much greater investment in international family planning, and stresses the critical importance of breaking down the many barriers to contraceptive use that are based not on medical evidence but on cultural beliefs, prejudices, and assumptions. In Kenya, for example, the poorest economic quintile has more than twice the total fertility rate. However, while this quintile have less than one-third of the contraceptive use of the richest, it also has almost three times the unmet need for family planning, which suggests that this group fi nds it diffi cult to access modern contraception (fi gure). Currently, there are serious shortages of contraceptives and Parliamentarians at the hearing were interested to hear Dr Baige Zhao, Vice Minister of China’s National Population and Family Planning Commission, mention China’s willingness to share contraceptive commodities with developing countries. In the next 50 years, global population will grow by another 1·5–4·5 billion people. In 1994, the Cairo Pro gramme of Action concluded that “even the 50