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Baroness Anelay of St Johns: My Lords, when the Bill began, it was perceived in the media as being rather dull but large, and one that might not interest many people. This House has proved the media wrong. It takes its role very seriously in scrutinising government legislation, even those parts of itand there were some parts like that in the Billthat we agree with. Today we saw a change in respect of the inspectorate which was most welcome. I recognise there, as I do elsewhere, the work of the noble Baroness throughout. I say that because I know that she has also been handling other significant Bills that have excited far more interest in the media than this. We send the Bill to another place having shown the views of Members here not only on Her Majestys Chief Inspector of Prisons, but also on police force mergers, extradition, the Secretary of States directions to chief officers of police and conditional cautions. We give the other place much to think about, but as ever our regret may be that they will not be given much time to consider it.
Baroness Harris of Richmond: My Lords, with the noble Baroness, I wish to express the grateful thanks of Members on these Benches to the Minister who has, with her usual courtesy and encouragement, helped us through a difficult Bill. It is quite technical and many changes have been made to it, not least taking out the provision to merge police forces at the very beginning. That was a significant achievement and one that we trust will be maintained in the other place. Perhaps I may put on the record my thanks and those of Members on these Benches to the noble Baroness and the noble Lord who have led us through with courtesy and charm.
Baroness Scotland of Asthal: My Lords, flushed as I am with such embarrassing compliments, I thank noble Lords for them. But I also thank this House for its good humour, its passion and its devotion to duty. I wish the Bill very well indeed in another place.
The noble Lord said: My Lords, my purpose in this debate is to urge the Government to restore family planning and concern about population to a central role in their policy to reduce poverty in Africa. Before I develop the argument, I should acknowledge my debt to a yet unpublished paper by Professor John Cleland and others. He is Professor of Medical Demography at the London School of Tropical Medicine and Hygiene and an eminent authority on population and fertility.
Family planning used to occupy a central role. Until the time of the Cairo conference on population in 1994, it had been extremely successful. In developing countries, between 1960 and 2000 the average number of births per woman fell from six to about three, and the number of women who used contraception rose from fewer than 10 per cent to about 60 per cent. That was a huge achievement. Success was not confined to Asia and Latin America, but was also beginning to happen in sub-Saharan Africa. In Asia, it included some of the poorest countries such as Bangladesh and Nepal. What we saw at the time was a substantial increase in international funding. During the period between 1971 and 1985, funding rose from $168 million to $512 million.
Family planning and concern with population now appear to be out of fashion. Partly this may be due to a reaction against the draconian policies pursued by the Chinese, and earlier by Mrs Indira Gandhi, but more recently family planning has suffered from religious influences in the United States. Anyway, for a number of reasons, some of which I will develop later, between 1995 and 2003 international funding declined from $560 million to $460 million. The millennium development goals set by the United Nations in 2000 ignored the problem of rapid population growth. The Commission for Africa also ignored population growth and the need for family planning. No mention is made of either in the recent White Paper on international development issuedby DfID. The new priorities are HIV/AIDS, international migration, ageing and good governance. I am not arguing that these are unimportant, but I do argue that the decline of interest in family planning is already having adverse results and could be calamitous if it is not reversed.
Leaving aside for the moment the influence of religious dogma, there is a widespread beliefindeed, it has almost become part of conventional wisdomthat family planning will look after itself if we reduce poverty, because the poor need lots of children as a substitute for social security to support them in old age. Once poverty is reduced, runs the argument, and people are wealthier, they will have fewer children. Further, it is often asserted that family planning cannot be effective in the poorest nations. Neither belief is supported by evidence.
Many factors affect poverty but it is clear that large families make poverty worse and make it more difficult for the poor to become better off. There is less food to go round; children are less likely to be educated; and large families increase unemployment. Short intervals between birthsless than 18 months
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It is argued that one of the most important measures for eradicating poverty is improving education. Of course it is. One aim of the millennium development goals is universal primary education for both sexes. But rapid population growth undermines that goal. It means that the number of teachers will have to double every 20 to 25 years; the supply of school equipment and the number of classrooms will have to double, and the cost of all that will be enormous. What will happen is that spending per pupil will fall and the quality of education suffer if population growth continues uncontrolled.
As to the second misconception that family planning is not effective in poor countries, in fact there is strong evidence of the benefits of reduced fertility and reduced population growth. To cite one recent study of 45 countries, it was estimated that in the 1980s the number of people living in poverty could have been reduced by a third if the birth rate had fallen by five in 1,000that is, by one-half of1 per cent. Reduced fertility means that after 20 years or so the productive part of the population aged 15 to 65 starts to grow faster than the number of under 15s and over 65s. This could have a dramatic effect on economic growth in the least developed countries.
I have already mentioned that when family planning was central to development policy it proved effective in very poor countries such as Nepal and Bangladesh. Most governments in the poorest countries have policies in place for birth control, but today they lack the encouragement and funds to make them effective and the funds are now drying up.
AIDS in Africa is now top of the agenda, but I would suggest that stabilisation of population growth is even more important than reducing AIDS. In Ghana, more women are likely to die from unsafe abortions than from AIDS, and yet funds are being diverted from family planning to the fight against AIDS. Many African countries, despite AIDS, will double or treble in size in the next few decades. In Uganda, where AIDS is a moderately severe epidemic, the population is expected to grow from30 million to over 60 million by 2025 and to some120 million by the middle of this century. There is no official concern about population growth in Uganda and yet its impact on poverty is likely to be immense. Niger is facing a catastrophe, partly as a result of overpopulation. But in Niger there are more meetings about sterilitynot an obvious problemand sex among the elderly than there are about population growth or family planning.
I should also mention the effect on the environment. Uncontrolled population growth will mean more depletion of soil fertility, more soil
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Why has concern about population dropped out of fashion? One important reason is religious dogma. There is an unholy alliance between the Bush Administration, which opposes contraception, the Pope and the Catholic Church, which preaches that contraception is a sin, and Islam. This alliance hits the developing world with a double whammy: it prevents UN organisations distributing condoms in Africa, thereby condemning hundreds of thousands of Africans to death from AIDS. Even more seriously, it has cut back funding for family planning by international organisation.
Only Europe can give a lead. Within Europe, the UK could play a major part, but only if we face reality and recognise the problem. I hope to hear from the Minister that the Government recognise that what is needed is old-fashioned family planning to stabilise population growth. Apart, perhaps, from climate change, there is no bigger issue we face today than world poverty. There can be few more important moral issues and few, if any, that have such grave social and economic consequences for us all.
Lord Rea: My Lords, like some of the other speakers this evening, I have been concerned about womens right to reproductive health and contraceptive services for many years, so I am grateful to the noble Lord for asking this Question, and for concentrating on Africa, where population growth remains at such a high level. In fact, some of us consider that population growth is of equal importance to the very topical question of climate change. If, like most of the scientific community, we consider that the rapidly increasing levels of atmospheric carbon dioxide and global warming are largely due to human activity, the two are inextricably linked.
The All-Party Group on Population, Development and Reproductive Health, of which I am a member, has recently completed a series of hearings on the link between poverty and rapid population growth. The report is not yet publishedunfortunately, this debate came a week or two too soon for thatbut those of us who attended some of the hearings are in little doubt about the link between poverty and rapid population growth. Although it is not so easy to attribute causation to one or the other, most of our witnesses emphasised that it is more difficult for a poor country to climb out of its poverty and increase
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If you look at the fertility map of the world, with high-fertility countries coloured dark red, shading down to off-white for low-fertility countries, it is striking how clearly Africa stands out, with nearly every sub-Saharan country at or near the deepest shade, corresponding to a fertility rate of over four children per woman, with several over six, compared with the world average of only 2.7. Niger, Mali and Uganda are at the top of the league, with 7.4, 7.1 and 7.1 respectively. The exceptionswinners, if you likeare Ghana, South Africa and its neighbouring countries, Namibia, Zimbabwe and Botswana, all with rates under four. All are countries with a rising or reasonably high girls literacy rate and, except Ghana, a per capita income above the sub-Saharan average.
Although we are mainly considering Africa, it is worth looking at other countries which have not experienced the fall in fertility that has occurred in most countries in the past few decades. Afghanistan and Iraq stand out in western Asia, as does Pakistan and Laos further east, with Haiti and Guatemala in the western hemisphere. All except Iraq are very poor countries and most have experienced war or internal conflict. The birth rate frequently goes up during or after conflict involving loss of life or civil disruption. You could say that this is a kind of natural demographic insurance policy. But conflict makes it difficult to carry out any public health measures, which may include reproductive health provision and may in itself contribute to the high post-conflict fertility rate.
In Africa, conflict and internal disruption have affected around 20 countries with a combined population of more than 250 millionabout one-third of the total sub-Saharan populationin the past couple of decades. Apart from Darfur and the uneasy situation in Zimbabwe, there seems to be a period of relative calm, although there are rumbling storm clouds on the horizon. Some might say that conflict resolution and the encouragement of good governancealways part of government policyshould be a first step and have higher priority than programmes to assist with public health, including family planning. Many noble Lords might disagree with that, however, and urge that development assistance, including healthespecially reproductive healthis in itself part of the process of building societies that are less likely to tolerate conflict and lawlessness.
I hope very much that my noble friend will giveus some encouraging information on what the Government, through DfID, are doing to assist sub-Saharan countries with reproductive health measures. I look forward to hearing the Minister on that subject. It is extremely good news that the right of all women to have access to reproductive health services has recently been included in millennium development goal 5 by a vote in the General Assembly of the United Nations. I hope that will result in an answer to some of the pleas of the noble
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It would be good if a lot of the increase in funding that we are hoping for could come from the other side of the Atlantic. We may have to wait for another election, but we are always hopeful that it will start a bit sooner than that.
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