Meeting the world’s need for family planning is a human right and a climate imperative. Wherever women have been given information and access to family planning, birth rates have fallen – even in poor, low-literate societies like Bangladesh or conservative religious countries such as Iran.

Parts of Africa have the most rapid population growth in the world. Recent studies by climatologists suggest that, in coming decades, ecologically vulnerable areas of Africa, including the Sahel will be exposed to the harshest adverse effects of global warming. The threat hanging over parts of sub-Saharan Africa is extreme. Fortunately, there are evidence-based achievable policies which can greatly ameliorate what would otherwise be a slowly unfolding catastrophe of stunning magnitude. But to succeed such measures must be taken immediately and on a large scale.

The wide gap in maternal mortality ratios worldwide indicates major inequities in the levels of risk women face during pregnancy. Two priority strategies have emerged among safe motherhood advocates: increasing the quality of emergency obstetric care facilities and deploying skilled birth attendants. The training of traditional birth attendants, a strategy employed in the 1970s and 1980s, is no longer considered a best practice. However, inadequate access to emergency obstetric care and skilled birth attendants means women living in remote areas continue to die in large numbers from preventable maternal causes. This paper outlines an intervention to address the leading direct cause of maternal mortality, postpartum haemorrhage. The potential for saving maternal lives might increase if community-based birth attendants, women themselves, or other community members could be trained to use misoprostol to prevent postpartum haemorrhage. The growing body of evidence regarding the safety and efficacy of misoprostol for this indication raises the question: if achievement of the fifth Millennium Development Goal is truly a priority, why can policy makers and women’s health advocates not see that misoprostol distribution at the community level might have life-saving benefits that outweigh risks?

The population of the least developed countries of the Sahel will more than triple from 100 million to 340 million by 2050, and new research projects that today’s extreme temperatures will become the norm by mid-century. The region is characterized by poverty, illiteracy, weak infrastructure, failed states, widespread conflict, and an abysmal status of women. Scenarios beyond 2050 demonstrate that, without urgent and significant action today, the Sahel could become the first part of planet earth that suffers large-scale starvation and escalating conflict as a growing human population outruns diminishing natural resources. National governments and the international community can do a great deal to ameliorate this unfolding disaster if they put in place immediate policies and investments to help communities adapt to climate change, make family planning realistically available, and improve the status of girls and women. Implementing evidence-based action now will be an order of magnitude more humane and cost-effective than confronting disaster later. However, action will challenge some long held development paradigms of economists, demographers, and humanitarian organizations. If the crisis unfolding in the Sahel can help bridge the current intellectual chasm between the economic commitment to seemingly endless growth and the threat seen by some biologists and ecologists that human activity is bringing about irreversible damage to the biosphere, then it may be possible also to begin to solve this same formidable problem at a global level.

Published in Environmental & Resource Economics 2013: 55(4), 501-512.

A report following the OASIS Conference (Organizing to Advance Solutions in the Sahel) hosted by the University of California, Berkeley and African Institute for Development Policy in Berkeley on September 21, 2012.The goal of this report is to start building a network of scientists and policy makers committed to helping the Sahel address its population, environment, and food security challenges. A compelling body of evidence is needed to inform people in governments and relevant local institutions, humanitarian organizations, foreign aid agencies, philanthropic institutions, and national security agencies concerning the startling challenges facing this neglected and highly vulnerable region.

Last spring at a Technology, Entertainment, Design (TED) talk in Berlin, Melinda Gates used this phrase, “The most transformative thing you can do is to give people access to birth control.” She expressed similar sentiments at the London Summit on Family Planning on July 11, 2012, as did the British Prime Minister David Cameron, and Andrew Mitchell who was then Secretary of State for the Department for International Development, the British equivalent of United States Agency for International Development. The London Summit represented a new focus on international family planning after nearly 20 years of collapsed budgets. It set the goal of halving the number of women with an unmet need for family planning in the world’s poor counties in the next 8 years — that is, helping 120 million out of an estimated 222 million women worldwide with an unmet need for family planning. Donor governments and foundations pledged US$2625 million dollars over the next 8 years to reach this goal. Governments of the target countries, especially India, committed another US$2 billion. This renaissance in international family planning is exceedingly welcome, but if it is to succeed, it must pay particular attention to the least developed countries (LDCs).

Published in: Contraception (Article In Press)

Although fertility decline often correlates with improvements in socioeconomic conditions, many demographers have found flaws in demographic transition theories that depend on changes in distal factors such as increased wealth or education. Human beings worldwide engage in sexual intercourse much more frequently than is needed to conceive the number of children they want, and for women who do not have access to the information and means they need to separate sex from childbearing, the default position is a large family. In many societies, male patriarchal drives to control female reproduction give rise to unnecessary medical rules constraining family planning (including safe abortion) or justifying child marriage. Widespread misinformation about contraception makes women afraid to adopt modern family planning. The barriers to family planning can be so deeply infused that for many women the idea of managing their fertility is not considered an option. Conversely, there is evidence that once family planning is introduced into a society, then it is normal consumer behaviour for individuals to welcome a new technology they had not wanted until it became realistically available. We contend that in societies free from child marriage, wherever women have access to a range of contraceptive methods, along with correct information and backed up by safe abortion, family size will always fall. Education and wealth can make the adoption of family planning easier, but they are not prerequisites for fertility decline. By contrast, access to family planning itself can accelerate economic development and the spread of education.