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I shall end by talking about the unmet need for modern contraceptives in the developing world,which is now estimated by UNFPA to run at about 137 million women, with an additional 64 million women using ineffective traditional methods. It is a paradox that, as contraceptive use rises, so does the unmet need among the rest of the population, until it reaches quite a high level. These women appreciate the benefits that contraceptive users in their communities gain only after they have seen it in operation. These gains include more time to engage in income-generating activities; ability to devote more time to each child; and more money to go round generally. It is then that the desired family size comes down. The provision of mother-and-child health services with better chances of child survival, together with the education of girls, helps to lower the size of families that communities feel is the ideal.
In summing up, the point that seems most important to me is that there is no single way to slow down Africa’s population explosion. It must be tackled from both ends. There is actually room for more people in many parts of Africa, if the population were better distributed, but such expansion must go together with, or after, economic development, and not before it. Meanwhile, there is an urgent need for a holding operation to help women achieve their desired family size, to go hand in glove with the achievement of the better child survival rates that are part of the millennium development goals.
7.20 pm
Baroness Tonge: My Lords, I congratulate my noble friend on bringing this important matter to the attention of the House. Almost everything was said in the two previous speeches, but I will find something different to say, I hope.
A few figures first of all: we should remind ourselves that the estimated population of Africa is about 800 million, but by 2050 it will be 1.8 billion, because the fertility rate in that continent is about38 per 1,000 and the mortality rate is 14 per 1,000. HIV/AIDS has been mentioned. Many people think that it will decimate the African population; we know that it is having a huge economic impact in some countries. If you do your sums, however, you will find that if all the 24.5 million people who it is reckoned are AIDS sufferers in Africa at the moment died tomorrow, a population growth of 2.4 per cent per annum means that in less than 18 months those people would be replaced. That is the scale of the problem and of the huge growth of population in Africa.
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As we have heard, the All-Party Group on Population, Development and Reproductive Health has in the last few months held hearings on the effect of world population growth on the millennium development goals. The group has been chaired brilliantly and very ably by Richard Ottaway MP in the other place, and our report will be published soon. I do not want to pre-empt the report, as it is not quite ready yet, but I beg noble Lords to read it. It is important for our future development policies in Africa and elsewhere.
We have heard about the Cairo conference in 1994. I want to remind your Lordships that that was in the good times when family planning, as my noble friend said, was popular and forging ahead. The 1994 programme of action said that we must meet the family planning needs of the populations of the world as soon as possible, and should,
- “in all cases by the year 2015, seek to provide universal access to a full range of safe and reliable family-planning methods”.
But, as we have heard, little happened in Africa. Nothing has changed. There is still a huge unmet need. We used to think that education and economic prosperity were the only way forward to get small family sizes, but we know from surveys all over Africa that if women are given the opportunity and shown how to use methods of contraception, they will leap at the chance. They know instinctively that it improves their health and the health of their family, and allows them to be more productive.
Why has nothing happened? “Control” has become a dirty word since the 1970s and 1980s, when there were countries that employed coercive techniques, but the funds that were pledged at Cairo either did not materialise or were diverted into the great fight against AIDS. Sadly, although this did not apply to our own Department for International Development, the treatment of and funding for AIDS from much of the international community have concentrated on drugs, which has meant that that very useful little commodity, the simple condom, which is such a good way of preventing the spread of HIV/AIDS, has not been properly funded—as I said, the money hasgone into drugs instead. Only 1 per cent of the development budget is now spent on family planning.
The simple, time-honoured male condom—a wonderful thing—can prevent AIDS and unwanted pregnancies. It has an availability in Africa of between 1 and 4 per man per annum. I suggest that that would not be adequate even in this House—sorry—let alone Africa, where nearly everyone is under 40. It is a shocking statistic. It is not funny; it is appalling. The female condom is not popular here. It is very difficult to obtain in Africa but is very popular with women there, once they are introduced to it. Hormonal methods of contraception, especially injectables, which are so convenient, are rarely used except in the wonderful work done in clinics by NGOs such as Marie Stopes International. I name that body as I have seen so much of its work, which is very good indeed.
The propaganda against family planning being put out by bodies such as the Roman Catholic Church is damaging and we would love the Pope to issue a new
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The USA has stopped funding UNFPA programmes because of their links with safe abortion—which is so essential—and abortion counselling, which means that all over the world reproductive health programmes have had to be cut. Have the Government made any progress in that regard recently?
As a doctor, I know that myths and stories about different family planning techniques abound. Even in this country people tell you the most incredible stories about what the pill does to you and how dangerous it is, and claim that condoms cause AIDS rather than prevent it. In African countries where people receive little education, these stories are very much worse.
So what must we do? We must increase the proportion of aid dedicated to this matter. We must do something about the supply chain to get contraceptives out there. Everywhere you go in Africa, you can get Coca-Cola and Fanta. I can never understand why you cannot get condoms just as easily. Why is there not liaison between Coca-Cola and Durex to supply condoms taped to every bottle? It might be a good idea to do that in this country as well. Why do those commodities get everywhere whereas something as essential as condoms do not appear? We must have positive propaganda. We must ensure that people understand that even the most dangerous contraceptive methods, such as the very high dose pill that we used in the old days, would be hundreds of times safer than pregnancy.
I just have time to tell noble Lords about the Roman Catholic Bishop of Mozambique who has tried to get round the laws of the Roman Catholic Church and promote the use of condoms. He said in a sermon in the past couple of years that if you are HIV positive and have unprotected sex, you are committing murder, and that is a sin in the eyes of God. He also said that if you are a healthy individual but have unprotected sex with someone who may be HIV positive, you are committing suicide, which is also a sin in the eyes of God. Therefore, he argues that not using a condom is a sin in the eyes of God. That is a nice argument.
Finally, we must set up chains of health workers. Family planning techniques do not need doctors or nurses to deliver. I have seen wonderful schemes in Uganda, where HIV patients and village workers have delivered the message, delivered the condoms and taught the people. I have been to Senegal, where there is a marvellous organisation called Tostan, which is based on villagers being educated by villagers and spreading that out in their area. It includes not just contraception, because that would be too offensive, but messages about clean water, education and how to feed your family. I ask DfID to look carefully at its very excellent programmes and to make absolutely sure that in the future family planning is given a much higher priority, for the sake of all the people of Africa
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7.31 pm
Viscount Craigavon: My Lords, I am grateful to the noble Lord, Lord Taverne, and I particularly congratulate him on his very ambitious tour d’horizon of the whole subject in exactly 10 minutes. It was quite an achievement. I am afraid that I am not going to offer as much practical advice as the noble Baroness, Lady Tonge. For more than 20 years, I have been a vice-chair of the All-Party Group on Population, Development and Reproductive Health, and I happen to think that this is one of the most important subjects that we can discuss. My interest in that group is clearly shown on the register.
As the noble Lord, Lord Rea, and the noble Baroness, Lady Tonge, said, we have been compiling a report based on population and the MDGs. Naturally enough, the MDGs provide the framework of the consideration of the committee, which is producing the report. I have been sitting on the committee to hear the evidence with, as the noble Baroness, Lady Tonge, says, Richard Ottaway as our chair. We are only at second draft stage at present, so people might have to wait a bit for the final report. I know that it is keenly awaited with much interest, and I am sure that what I say here will benefit from the evidence that we have heard.
As we know, the achievement of the MDGs will be extremely difficult, and in many cases impossible, in the time scale envisaged. In addition, it will be very much more difficult to achieve almost all thosegoals without the assistance of some input from the field of reproductive health and considerations of population. As part of this, some of us are trying to reassert the good intentions of the ICPD Cairo conference agreement of 1994, which has already been referred to. I will frame some of my following remarks around some of the MDGs, and I hope to show how Africa, and the agreed aim of poverty reduction, would benefit from a substantially increased regard to reproductive health.
First, we should remind ourselves that the footprint of the developed nations is very much included in MDG 7 on environmental sustainability. For example, there are issues such as fresh water and carbon emissions which apply globally. In our group’s report, the “northern” scale of consumption and the damage that we do to the planet is acknowledged and must be borne in mind when we are talking about the problems of Africa. In MDG 8, our responsibility for being involved in global partnerships for development is set out. That includes fair trade and finance and also co-operating in many fields with developing countries.
To address the Unstarred Question directly, we should be offering parts of Africa the means—of which reproductive health is but a small part—and helping to create the conditions, background and infrastructure where countries can benefit from and use what reproductive health can offer. There is
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I will mention in more detail than the noble Lord, Lord Rea, that we are very fortunate that the work and the lobbying that have been done to get reproductive health recognised in the MDGs have recently borne fruit. The new target that has been added and adopted under the heading MDG 5 is,
The UN General Assembly took note of that in a report by the Secretary-General and implicitly endorsed that recommendation. It should be noted that after that happened the United States said from the floor that it did not agree with what had been added and noted. I understand that regardless of that, the endorsement by the UN General Assembly will enable universal access to reproductive health to be monitored within the framework of the MDGs.
Further detailed work is needed to measure progress in this particular field by framing and agreeing indicators by which monitoring of progress can meaningfully take place. Given that the theoretical deadline is 2015, I hope that agreement can be reached fairly swiftly on what those measures will be. A further two years’ delay would be unacceptable and I hope that DfID can make sure that progress continues.
Defining the age parameters, for example, for the contraceptive prevalence rate and for the unmet need for family planning will be very difficult; but when agreed, both should be invaluable international measures as to the progress that is being made. The variable of unmet need in the developing world, as the noble Lord, Lord Rea, said, of those who would like to be able to control their fertility but who are unable to do so has varying estimates, but is invariably more than 100 million, sometimes double that. It will be extremely valuable to have an internationally agreed figure.
A large proportion of that figure is estimated to be in Africa. In the report of the parliamentary group that I referred to, there will be considerable evidence from both written and oral sources on the direction of causation and the relationship of severe poverty to population size. In this short debate, it is not possible to go into too much detail.
Similarly, addressing the subject of the Question as to what steps the Government might take can be done only in general terms here. I hope that, following the report I mentioned, the Government through DfID can take an even stronger lead internationally than at present in putting the issue of population into the wider field of our concerns, where it belongs. The additional target for MDGs will provide the perfect platform. I am not forgetting that as much of the impetus for that as is possible needs to come from the developing countries—sometimes the poorest—which will understandably manifest more immediate and urgent needs.
We need to help win the argument on population, in both the long and short terms, on the basis of evidence and need; and we need to ensure that
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I usually try to avoid quoting numbers in this field, particularly in a debate such as this, but some of the sub-Saharan statistics, if the continuing rates of increase are maintained, are remarkable. The noble Lord, Lord Taverne, mentioned figures for Uganda and Niger. If the present rate of increase in population in Niger continues, from the present level of 14 million it might reach 50 million by 2050—and it is a very small country. It would be too much to expect that education services or food supply could begin to match such an increase. Similar examples could be given.
After the good intentions of the International Conference on Population and Development in 1994, the issue of population growth gradually lost prominence. That trend led to the under-appreciation of population size and growth alone. A present theme might be that numbers do count, at the same time as we are challenged to “make every person count”. I hope that when the all-party group's report on population and the MDGs is published shortly, it will be studied with keen attention by all.
Perhaps I may end with the encouraging use of the word “population” and the specific endorsement of that issue in a quotation from Mr Kofi Annan. He stated:
“The Millennium Developments Goals, particularly the eradication of extreme poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women’s rights, and greater investment in education and health, including reproductive health and family planning”.
7.40 pm
Lord Jones of Cheltenham: My Lords, I, too, congratulate my noble friend on raising this issue, which is important not only to the people of the continent of Africa but also to the viability of the human race on planet Earth.
Why should we be bothered about Africa’s population increase? After all, Africa covers 22 per cent of the world’s total land area, yet has only 13 per cent of the world’s total population. There are three basic problems. First, much of Africa’s land is unproductive—particularly the deserts, which include the Sahara and the Kalahari. Secondly, climate change means that drought conditions now occur more frequently there. Thirdly, projections showthat Africa’s population, which is currently around 800 million, is likely to double over 33 years.
According to the UN Department of Economic and Social Affairs, the populations of some countries are expected to triple by 2050: those of Burkina Faso, Burundi, Chad, Congo, the Democratic Republic of Congo, Guinea-Bissau, Liberia, Mali, Niger and Uganda. Between now and 2050, four of the nine countries expected to account for half the world’s
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This increase in population will create additional demands, particularly on water and food supplies. Let us take Ethiopia as an example. The World Resources Institute tells us that in 1950 its population was18 million; by 2002, this had risen to 66 million; and in 2025 it is likely to be 113 million—a sixfold increase in 75 years.
That creates another problem. In many parts of Africa, population growth, with more mouths to feed, is leading to soil depletion. Farmers are reducing the length of fallow periods or doing away with them altogether to make it possible to plant more crops. Also, the larger the population, the more firewood is needed for cooking and the greater the need to cut down forests to provide more land for crops. The resultant reduced firewood availability has led to animal dung being used for fuel rather than for fertiliser. Marginal lands, which are not really suitable for agriculture, have increasingly been used and protected areas encroached upon. Sharing farms between sons has led to a reduction in farm size to the point where they are inadequate, and many people become landless.
It is difficult to believe that, even if climate, agricultural and other remedial measures were successfully implemented in Ethiopia, food supplies could be secured in the face of such a massive population increase and the already incurred environmental deterioration. Even if on a global scale an effective reduction in adverse climate effects were achieved, it is doubtful whether Ethiopia or other countries south of the Sahara could achieve food security if the population continued to grow as projected.
An additional problem is that most of the countries with the fastest growing populations are poor. Indeed, that is one reason why fertility rates are so high, with each woman producing, on average, five, six or seven children. They know that, because of poor health facilities, some of their offspring are likely to die, and parents see children as the only guarantee of help as they themselves get older and more frail.
However, the news is not all bad. Some countries in Africa already have fertility rates nearing European levels. South Africa has reduced its fertility rate to2.8; Botswana to 3.0; Namibia to 3.3; and Lesotho to 3.4. Tragically, this progress towards stabilising populations has been dealt a body blow by the HIV/AIDS pandemic.
Noble Lords will know of my special interest in Botswana and of my declared interests in the register. Botswana faces a particular population challenge. The country is large—larger than France and Belgium put together—but has a population of just 1.7 million. Over 30 per cent of the population of Botswana are HIV positive. In one respect they are fortunate to live in that enlightened country because the Government have built up healthcare facilities and are able to afford to provide the medicines to help
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A few years ago, in a nationwide address, the President of Botswana, Festus Mogae, startled his people when he said, “Our country faces extinction”. The country is grappling to educate the population, particularly the younger generation, to change behaviour patterns. Like other countries in Africa, Botswana is promoting the ABC campaign to prevent more people catching HIV: A for abstinence; B for be faithful—have only one partner; and C for use condoms. Fortunately, even the Roman Catholic Church has joined in this campaign. It is to be congratulated on recognising the seriousness of the problem.
Lesotho, Swaziland and South Africa also have high rates of HIV and shrinking populations. Elsewhere on the continent the recording of HIV levels is patchy because testing is not routinely carried out. While lower rates of HIV are published for other countries in Africa, we cannot be sure of the true picture. Uganda, one of the most heavily populated countries in the continent, was thought at one time to have the highest incidence of HIV. It was one of the first countries to recognise the problem and to take steps to tackle it, even though the amount spent on healthcare per person was, and remains, very low. Unfortunately, Uganda today still has a very high fertility rate of 6.8 children per woman and the population is soaring.
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