rose to ask Her Majesty’s Government what steps they are taking to contribute to the stabilisation of population growth in Africa.
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 Before I develop the argument, I should acknowledge my debt to a yet unpublished paper by Professor John Cleland and others.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 belief—indeed, it has almost become part of conventional wisdom—that 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 births—less than 18 months is common in the absence of family planning—not only have a devastating effect on mortality rates among children under five but increase the incidence of low birth weight and premature births. They make it impossible for mothers to pursue non-domestic activities. In fact, reducing the birth rate from six—of whom several may die—to two or three is possibly one of the most important steps we can take towards liberating women. Contraception is a vital element in women’s rights.
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 1,000—that 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 sterility—not an obvious problem—and 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 erosion, more overgrazing and even greater pressure to produce more food from less productive agricultural land. In Africa, the ratio of the number of people in farming to the amount of available arable land is rising steeply and will get far worse in the next few decades as a result of population pressure. There will also be an ever-increasing demand for an ever-decreasing amount of water.
Africa is the continent most likely to suffer most grievously from global warming, yet adaptation to the effects of climate change will become even more difficult with population growth.
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.
My Lords, like some of the other speakers this evening, I have been concerned about women’s 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 published—unfortunately, this debate came a week or two too soon for that—but 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 its income per caput when there are more and more young capita to feed, house, clothe, immunise and educate every year.
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 exceptions—winners, if you like—are 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 million—about one-third of the total sub-Saharan population—in 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 governance—always part of government policy—should 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 health—especially reproductive health—is 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 Lord, Lord Taverne, for more secure funding, particularly for UNFPA, and that the donor countries and international financial institutions will increase their support of that vital work. I am not forgetting the important contribution of the international NGOs in this field.
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.
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.
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.
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 ruling on that. But, on the ground, Catholic NGOs perform much good work and tend to turn a blind eye to what is going on. Nevertheless, a word from on high would be hugely helpful in that regard, if we could only get it.
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 and for the sake of the millennium development goals, which, as we have heard, will never be achieved unless we deal with population growth.
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 absolutely no coercion, but there is evidence that sub-Saharan Africa could eventually have the benefit of the demographic dividend in the distant future, but there is much to be put in place to achieve that.
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,
“to achieve universal access to reproductive health by 2015”.
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 sufficient resources are made available, both financial and tangible. One problem that arose during the evidence that was heard for the all-party group's report was that some donor countries made the allocation of resources under a very wide and general heading and it was increasingly difficult to identify for what purpose some funds were actually being used.
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”.
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 total projected population increase are in Africa—Nigeria, the DRC, Uganda and Ethiopia—and each of those will add more people to the planet than the world’s most populous nation, China.
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 each infected person live longer. However, the UN says that the country's population is slowly reducing.
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.
So what can the UK Government do about Africa's problem of increasing population? Education is certainly one part of the answer. Encouraging a better role for women so that they are not seen just as baby-making machines is another. Reinstating family planning in our development programme is vital, as my noble friend said. We need to achieve worldwide trade agreements which will drive up average incomes in Africa to see whether there is a direct link between improving incomes and reducing fertility rates.
In their book Limits to Growth: The 30-Year Update, D. H. Meadows et al paint a picture of how, under certain circumstances, population growth slows then levels off at less than 8 billion wordwide; pollution peaks, then falls before it causes irreversible damage; by the end of the current century there is enough food for everyone; and the sustainable society has been ushered in. Here are some of the circumstances which must be fulfilled to reach that goal: all people must be assured by their societies of acceptance, respect, material security, and care in their old age, no matter how few children they have; all couples must have access to effective birth control technologies; and all couples must decide to limit their family size to two children. Unfortunately, the authors say that the last two of these conditions needed to be achieved by 2002, the year of the simulation. Those are not the only conditions. The book also says that the world must develop powerful technologies for pollution abatement, land yield enhancement, land protection, and conservation of non-renewable resources, all at once.
The model used to develop this scenario does not take into account possible wars, labour strikes, corruption, drug addiction, crime and terrorism, many of which have plagued and continue to plague Africa. So, we must all work to help Africa stabilise its population. It will not be easy.
My Lords, this is a very timely debate. I would go further than making the usual genuflection towards congratulating the noble Lord, Lord Taverne. He has hit a lot of nails on the head and, without any collusion, I shall make many of the same points. I declare an interest as cofounder and vice-chair of the All-Party Group on Africa, although what I am about to say does not purport in any way to be a collective view.
My central theme is why Africa does not fit what I shall call the rather benign DfID model. Poverty is clearly a function of GDP per head and income distribution. To cure it, we must increase the sustainable GDP rate of growth and achieve better distribution. Everybody ought to be able to agree on that. In passing, I wish that all NGOs were as economically literate as my noble friend Lord Rea. The questions are: what creates economic development, and what explains African exceptionalism compared with the globalisation from which it seems to have excluded itself?
There is another side to the coin, of course. Some things make growth less likely—excessive population growth, in particular. There have been hugely impressive technical studies. Attention has already been drawn to Population and Poverty, published by the United Nations Population Fund in 2003, which quotes a study by Eastwood and Lipton showing that a reduction of 5 per 1,000 in the net birth rate can increase GDP by 1.36 per cent for a country with a median GDP per capita.
So we come to the puzzle—it is not too much of a puzzle, but DfID finds it so: the reasons for African exceptionalism. What creates the virtuous circle of east Asia—which is not a global virtuous circle which everyone can get to via some inevitable Darwinian process—whereby the number of births per woman reduces and the GDP per head rises sustainably? How on earth do countries such as Niger, Mali and Uganda get there? They have six, seven or eight births per woman whereas the replacement rate, as in the UK, is nearer two. There is a close correlation, if you look at the statistics for all 190-odd countries, between births per woman and the scatter diagram of GDP per head and its growth.
I am not making a fetish of two births per woman. That is a long way off, given the social and anthropological reasons for many people, particularly in sub-Saharan Africa, wanting to have a lot of children—leaving aside those who do not want to have children and do not have access to birth control. Declining fertility via family planning programmes makes a dramatic improvement. Sexual mores are unfortunately changing for the worse among many young people. We all have to use the euphemism “family planning”, but we ought to get beyond euphemisms. There is no sign of “family” with precocious sexual behaviour from the age of six, seven or eight in many parts of Africa.
If we are going to do anything to improve African living standards, we must clearly proclaim the importance of reducing births per woman as central to our development strategy. That is why I am sorry to say that I find it little short of scandalous that chapter 5 of the White Paper Making Governance Work for the Poor—which was published in May 2006 and does not have a narrow scope; it has an excellent chapter on climate change, for example—contains not one word on the question of excessive population growth. Why is that? The noble Lord, Lord Taverne, has come up with two ideas. He mentioned religion, I think, and I would add to that the fear of neo-colonialism. Those may be explanations. If my facts are wrong, I hope that my noble friend—to whom I have given notice of my line of argument and the sources I am citing—will correct me. If I am accurate, however, the next question is why we are so silent and mealy-mouthed in our profile on this. I am not talking about the Government making erudite submissions in obscure seminars but about the fact that nothing is said loud and clear in the central reports published by DfID on behalf of Her Majesty’s Government or, as the noble Lord, Lord Taverne, mentioned, in the report of the Commission for Africa.
If the reason is religious sensitivity, we should tell the truth on the basis of rigorous economic analysis. We should render unto Caesar the things that are Caesar’s and unto God the things that are God’s. We should be as robust in dealing with pseudo-religious claims as we are in dealing with false claims of neo-colonialism. I am not anti-religious—I am a member of the Church of England—but I am appalled by the way in which we seem to be censoring ourselves and not saying what needs to be said on this subject.
I welcome and echo what my noble friend Lord Rea said about the alarming connection between population growth and desertification and the destruction of habitat. In Madagascar, where I was this summer, 80 per cent of the rainforest has been slashed and burnt in the past 40 years. There is now bare rock in many places and the habitat of animals such as lemurs is shrinking. I shall come back in a second to the problem of disaffected youths—the young men who hang around the streets of Antananarivo. A compelling study by an academic offshoot of the UN demonstrates very vividly how the conflict in Darfur arose essentially from the destruction of habitat in the nomadic areas, which led to migration and inevitable clashes over land at the most sensitive junction of so many ethnic and religious traditions, leaving aside the odd legacy of straight lines on the map from the colonial era in Sudan and other places.
As noble Lords have said, getting Africa to change is not easy. The recipe is all too reminiscent of the famous recipe for jugged hare that begins, “First, catch your hare”. That is very difficult. There has to be dialogue with the African Union and with all parts of Africa, and it will have to be robust. Unemployment may be one way into it, and it is absolutely necessary to consider that, but the other way may be to look at migration, given that a state governor in Nigeria said that if more aid did not come there, more people would come to Europe. People are putting that on the agenda and we must be honest and robust in addressing it.
My Lords, I echo the congratulations expressed to my noble friend Lord Taverne on his brilliant speech, in which he argued most effectively that a reduction in the rate of population growth is an effective means of promoting development in Africa. That sentiment has been echoed by every other noble Lord who has spoken.
Last year, the UN report on population challenges and development goals concluded that reduction of birth rates led to a “demographic bonus” whereby the number of people of working age increased relative to those of the children and the elderly, contributing significantly to economic growth and poverty reduction. But the UN study of world population prospects in 2004 showed that, over the last 30 years, the lowest reductions in fertility occurred in 12 African high-fertility countries, as has been mentioned. These countries are forecast to have the highest population growth, coupled with the lowest chance of reaching the millennium development goals, particularly as regards infant and maternal mortality and universal primary education.
The Africa Commission said that Africa's population is exploding and that millions are migrating to the slums of cities, where the young are unemployed and disaffected. Yet it fails to link the population explosion with Africa’s underdevelopment or to emphasise the negative feedback between high rates of growth and the acute environmental risks affecting the continent. That point was mentioned by several noble Lords. The commission recommends that donors should do all that they can to ensure universal access to sexual and reproductive services, including the provision of an extra $300 million in commodity requirements. But it offers no suggestions about how to overcome the inertia or obstruction by Governments and religious organisations to these programmes, a matter to which my noble friend Lord Taverne referred.
There have been shortages of condoms in Africa. Last year, there was a particular shortage in Uganda, to which my noble friend referred. I think that that shortage was partly caused by the American plan for AIDS relief driven by the religious right, which emphasises abstinence. The DfID profile on Uganda rightly praises the Government of President Museveni for reducing the prevalence of HIV and AIDS from 18 per cent to 6 per cent in a decade. But many women are still unable to exercise freedom of choice over their own fertility. One-third of Ugandan women say that they would like to stop or postpone having children if they could. They are among the100 million to 200 million whom the noble Viscount, Lord Craigavon, referred to who want to control their fertility but who do not have the means of doing so.
According to UN estimates—and this was also referred to by my noble friend—Uganda's population may treble from 42 million in 2005 to 127 million in 2050. With similar increases in other countries in that region, climate change—which is linked to population increase, as the noble Lord, Lord Jones, remarked, and is likely to reduce agricultural production because of extended desertification, lack of water, loss of soil fertility and reduction of crop yields—could bring about conflicts over resources, mass starvation and large-scale emigration long before the mid-century arrives. Droughts have increased in frequency in the Horn from one in eight years to one in three, and there are too many cattle for the carrying capacity of the people, but too few to feed the increasing number of mouths. In Somalia, the desperation of people living on the edge of survival is already reinforcing the growth of radical Islam. Even war-torn Somalia, without a functioning Government or health service, is estimated to have a population increase from8 million in 2005 to 21 million in 2050, while the combined populations of Kenya and Tanzania will double over the same period to 150 million. It is inconceivable that east Africa can sustain increases of this order.
The question is: what can the countries themselves and the donor community do to avert the looming catastrophe? A far greater emphasis on the MDG of promoting gender equality and empowering women would be an essential part of any strategy, because if women controlled their own fertility they would not have very large families. Bill Gates wrote in the Independent the other day:
“Abstinence is not an option for some poor men and girls who have no choice but to marry at an early age ... And using condoms is not a decision that a woman can make by herself; it depends on a man”.
I would argue that abstinence is in any case an unworkable policy and contrary to human nature, but if women themselves decided when to get married and could decide on whether contraceptives should be used, both population growth and HIV/AIDS infections would be reduced, as has been remarked, and women liberated from the burden and health risks of constant childbearing would be able to make a far greater contribution to the economy, especially in agriculture.
In fact, 120 million women in sub-Saharan Africa are illiterate and most African women have less access to land and education than ever before. Elizabeth Chacko of George Washington University points out that Kerala in India has a low fertility rate compared with that of India as a whole because the women of Kerala have a relatively high status, are well educated and are integrated into the workforce. She says that whether a woman can read, can understand what methods of contraception are available to her and is empowered to use them can have a great impact on fertility rates.
DfID says that one of its key priorities is to get more girls into school, leading to greater economic growth, less poverty and reduced fertility, and that is an important contribution towards attaining the MDG of promoting gender equality. But six years ago DfID also said in an excellent report on poverty and women's empowerment that education alone would not be enough—inequalities needed to be tackled across the board in economic, political, social and cultural life. The Beijing World Conference on Women of 1995 identified 12 critical areas of concern, of which one was unequal access to education and training—one very important one, but not the only one. So I suggest to the Minister that it is time for DfID to review the strategy for poverty elimination and the empowerment of women and to upgrade accordingly its country programmes for Africa. That is not only the right policy for its own sake, but the best way to harness the talent and energies of half the population of Africa and to prevent a Malthusian catastrophe from overwhelming the continent within two generations.
My Lords, I must apologise to the House for not being here at the start of the debate. I had to attend a funeral and, needless to say, the train was late. I pray your Lordships’ indulgence. As the time for this debate has also changed, I asked my noble friend Lady Seccombe to come to my rescue. I am most grateful to her for agreeing and for filling me in on the very impressive introduction from the noble Lord, Lord Taverne.
I add my thanks to the noble Lord, Lord Taverne, for giving us the opportunity to debate this very important Question. Current population projections suggest that Africa's population will double again within a generation—as it did during the previous generation—while the figures in some individual sub-Saharan countries are even more dramatic. Despite high mortality rates, there is no evidence that points to the rate of population growth slowing.
Such sharp demographic change brings with it many problems and prevents solutions being found to existing problems—not least, economic ones. As long as population growth continues at the current rate, it will be very hard to achieve economic growth in real terms. Even where countries are seeing GDP growth, that is more often than not offset by even greater population expansion. Rapid population growth therefore potentially represents one of the biggest barriers to tackling poverty. Continuing to throw money and aid at the problem, while admirable in sentiment, will struggle to have any lasting effect unless the population explosion ends.
There are equally marked demographic links to hunger and starvation. Population growth is leading to over-exploitation of farmland. More than 80 per cent of farmland in sub-Saharan Africa is now severely degraded, as we heard from the noble Lord, Lord Jones. Nutrients are disappearing from the soil because of overuse due to the pressure of feeding an ever-increasing number of people. As the cycle continues, African farmland will become incapable of sustaining its already undernourished people.
Many noble Lords have rightly stressed that the pressure on the land also causes other problems, such as deforestation, inadequate supplies of fresh water and, inevitably, climate change, as the noble Lords, Lord Rea and Lord Lea, mentioned. In Ethiopia, for example, nearly half the country was forested only a century ago. Now only 4 per cent of the country is covered with trees, as the land is required to help feed the population. As the population grows, it will also create new difficulties. It will become increasingly difficult to maintain adequate numbers of schools and hospitals and to improve these and other basic services.
The fertility rates in Africa are astonishing. In the rest of the world, including developing nations in Latin America and Asia, birth rates have steadily declined to an average of 2.3 children per mother. Most nations will experience only modest population growth in the next few decades. Yet, in large portions of Africa, the position is very different. In Uganda, as the noble Lord, Lord Taverne, mentioned, the average mother gives birth to seven children. This remarkable fertility rate has been constant for more than 30 years. Are the Government aware of these birth rates, and do they accept that the continent simply cannot support the numbers? Given that the population of Africa is set to increase from around 750 million today to nearly 1.7 billion people by 2050, does the Minister agree with the noble Lord, Lord Rea, that such a development would place a huge strain on natural resources and the environment?
Fewer than one in five married women in Uganda have access to contraception. This is a very typical cross-section. What practical steps are the Government taking to improve the awareness of birth control in Africa? Can we expect any increase in the availability of contraception? Does the Minister agree that it is often the poorest and less educated women who have the least access to family-planning services? As the poorest and less educated women have larger families, unlike the educated women in Kerala, whom the noble Lord, Lord Avebury, mentioned, what can the Government do to tackle this problem?
I recently returned from South Africa, where I had the opportunity to study the Anglo-American programme which raises awareness of, and provides treatment for, AIDS for all its employees. Run by the very enlightened Dr Brian Brink, this excellent programme has been in place for several years, and works in various ways. It focuses on prevention, which is so important. The programme ranges from practical measures, such as the distribution of contraception, to behaviour-based education and targeting young audiences. Does the Minister accept that the frightening spread of HIV shares many roots with uncontrolled population growth, and that there can and should be a similar approach to both? Will the Government look into the impressive Anglo-American programme developed by Dr Brian Brink and encourage others to follow?
Some of the figures relating to population growth that we have heard from many noble Lords today are so striking that there must be an appreciation of the fact that urgent measures are needed. Without the stabilisation of its population, Africa will find it impossible to address and to resolve many of the issues that noble Lords have clearly identified today. This is especially true of the economic problems that have attracted so much recent popular interest all over the world.
My Lords, I, too, am grateful to the noble Lord, Lord Taverne, for securing this debate and to other noble Lords for their valuable contributions. I also welcome the recent series of parliamentary hearings by the APPG on population, development and reproductive health which have helped to raise the profile of this issue. I pay tribute to the noble Viscount, Lord Craigavon, for his sterling work in the APPG, and for the group’s work for many years to ensure that this important issue does not slip down the political agenda.
Population—people—are at the centre of the Government’s business. The biggest obstacles to population stabilisation in Africa are poverty, lack of sexual and reproductive health rights and lack of access to basic services. We are certainly aware of the birth rates. I assure the noble Lord, Lord Taverne, that sexual and reproductive health are an important part of this Government’s international development policy. However, discussion about limiting population growth has to be firmly based in a rights context. Underlying high levels of population growth is deep-rooted gender inequality. Women’s low status, lack of decision-making power and control, poor access to information and care, restricted mobility, early age of marriage, and low political priority and resources all contribute to high fertility rates by limiting their ability to make informed choices to ensure healthy sexual and reproductive lives. As the noble Baroness, Lady Rawlings, said, it is the poorest women who have the fewest choices. The attainment of universal sexual and reproductive health rights underpins the achievement of the millennium development goals on poverty reduction, maternal and child mortality, gender empowerment and prevention of HIV/AIDS. The noble Viscount is right that we have to create conditions and means whereby sexual and reproductive health can thrive.
Like the noble Lord, Lord Rea, and the noble Viscount, Lord Craigavon, I warmly welcomethe new target in the MDG framework to includethe International Conference on Population and Development goal of universal access to reproductive health by 2015. Indeed, the UK worked very hard to achieve that outcome and strongly supports inclusion of this target. One indicator for consideration of the new target was the unmet need for family planning. The Secretary-General recommended inclusion of this in his report that was noted by the UN General Assembly in October. Sadly, the Holy See and USA raised some last minute objections, and negotiations to ensure inclusion of the target and to agree appropriate monitoring indicators are continuing. However, we are committed to work on this diligently because we want to ensure the appropriate outcome.
The noble Lord, Lord Taverne, and others have rightly mentioned that the US and parts of the Church heavily promote abstinence-only programmes as a response to preventing the spread of HIV/AIDS. DfID does not promote abstinence-only messages as a strategy for HIV prevention and pregnancy reduction for young people. The noble Lord, Lord Jones of Cheltenham, mentioned ABC—abstinence, be faithful, correct and consistent condom use. DfID promotes the full ABC message as a balanced strategy for HIV prevention and pregnancy reduction for young people, but I fully agree with the noble Lord, Lord Avebury, that for many women abstinence is not an option. I deeply regret that in Ethiopia, for example, the loss of nearly US$500,000 per year of US funding to the Ethiopian Family Guidance Association, is equivalent to the loss of reproductive health services to 500,000 men and women in urban areas every year.
Marie Stopes International lost $60,000 and hadto close several health posts. Funding cuts have caused cutbacks or discontinuations in emergency contraceptive programmes, outreach services, voluntary counselling and testing for HIV. However, DfID is actively addressing that through increased attention to improving funding for abortion and sexual and reproductive health, including family planning and male and female condoms.
Better sexual and reproductive health and poverty reduction is a virtuous circle. Education, better health and greater rights for women and girls enhance choice and opportunity. Fewer and better spaced births improve maternal and child health. Families can invest more in their children. Slower population growth means that countries can invest more per head in basic services. All this helps to reduce poverty. Efforts to slow population growth and reduce poverty are mutually reinforcing.
On the White Paper, I am pleased to inform noble Lords that the All-Party Parliamentary Group on Population Development and Reproductive Health took part in the consultation process. However, I believe they recognised that not every subject that was raised in the consultation process could be dealt with fully. The White Paper takes account of population changes as part of its wider review of environmental and economic pressures, and a key part of the White Paper is about the delivery of basic services, including health and education to poor people. Better sexual and reproductive health is and will remain an essential element of this. I can assure noble Lords that the Government, in the words of my noble friend Lord Lea, are not mealy-mouthed or secretive about population or about sexual and reproductive health. Indeed, we have a very loud voice in the UN and the EU, as well as in our bilateral discussions with countries in Africa, as I will seek to demonstrate. The African Union itself recently held a meeting of health Ministers on sexual health and reproduction, and those Ministers are determined to keep these issues high on the political agenda.
In Africa, as elsewhere, DfID is keen to contribute to poverty reduction by supporting country-ledand country-owned policies and strategies. Where appropriate, our preferred way of supporting development in Africa is to provide budgetary support to national governments’ overall plans and budgets. Within that context we can then support governments as they define and deliver their own priorities, including basic health and education services, and reduce barriers to accessing those services. Prioritising issues such as sexual and reproductive health in national planning processes such as poverty reduction strategies is critical. That is why in countries like Sierra Leone we are helping donors and the Government to include performance indicators for sexual and reproductive health at the highest level. In addition, in a number of African countries we are directly supporting long-term investments to rebuild and strengthen health systems. In Malawi, for example, DfID’s emergency human resources programme is improving incentives for the recruitment and retention of health staff and enabling a significant expansion of domestic training capacity. We are also supporting a Marie Stopes International partner which is delivering services to such women, precisely because we understand the importance of family planning.
Access to good quality sexual and reproductive health information, services and supplies, including family planning, is central to giving people more choice over family spacing and size. These help both to stabilise population growth and to tackle AIDS. I must say that I rather like the idea of a free condom with every bottle of Coke. In Mozambique, DfID is investing over £13 million to increase access to reproductive and sexual health services. In Sierra Leone, DfID is considering a joint programme with the World Bank to improve sexual, reproductive and child health. Improving access to family planning will be a key component from the outset. The noble Baroness, Lady Tonge, asked about the simple but important condom. For the past 10 years, DfID has been the fourth largest provider of condoms to developing countries, supporting the distribution of around 150 million condoms annually. DfID has provided nearly £4 million for condoms and hormonal contraceptives in Ethiopia, £500,000 for a social marketing programme to maintain family planning services in DRC, and nearly £2 million for maintaining access to family planning services for women with HIV and AIDS in Zimbabwe. DfID is providing the vast majority of condoms for distribution through the public sector and social marketing in Ghana, and 80 per cent of the condoms in Nigeria. In addition to our direct support for partner governments, DfID supports the global efforts of UNFPA and the International Planned Parenthood Federation. We are currently providing £80 million over four years to UNFPA and£19.5 million to IPPF between 2004 and 2006.
Noble Lords have clearly demonstrated in their remarks that the unmet need for family planning is enormous. Some 137 million women who have expressed a desire to space or limit their family size are not using any form of contraception. This year alone an estimated 19 million women and girls will face an unintended and unwanted pregnancy. Many will suffer the deadly consequences of unsafe abortion, from which nearly 70,000 will die and many others will be left with long-term debilitating injuries. The UK has therefore taken the lead and, in February 2006, the Government committed an initial £3 million to the safe abortion action fund developed by the IPPF, which aims to reduce the 13 per cent of maternal deaths which result from unsafe abortion.
The noble Lord, Lord Avebury, referred to the DfID publication of 2000. Last year there was an evaluation across all DfID work looking at gender and the empowerment of women in relation to the achievement of the MDGs. One of the outcomes is that a senior management team is working to ensure that empowerment of women and gender are mainstreamed. Yes, an evaluation of the 2000 strategy would be interesting, but DfID believes that it is much more important to ensure that we are doing the job and empowering women. I will write to the noble Lord with further information about the evaluation.
My noble friend Lord Lea is absolutely right—it is important that data and analysis about population dynamics and their consequences are made available, disseminated and taken into account in the development of policy. DfID is currently working with the William and Flora Hewlitt Foundation and the Population Reference Bureau to convene an October seminar at DfID on poverty reduction and economic growth, the role of population dynamics and reproductive health. Earlier this year my honourable friend Gareth Thomas attended the population conference in Paris, which highlighted many of the links between demographic change and poverty reduction.
As the noble Lord, Lord Jones, and the noble Baroness, Lady Rawlings, demonstrated, population growth in Africa, the environment and climate change are inextricably linked and they are clearly adversely affected by poverty. This was recognised by the Commission for Africa, which clearly considered both population and sexual and reproductive health, although I recognise that it was not considered as fully as noble Lords might have wished. But that is precisely why the focus of DfID’s policy is the elimination of poverty. It is also clear that when women have full sexual and reproductive health and rights they are able to participate more fully in education, sustainable livelihoods, markets and the economy, decision-making and the political processes.
As mentioned by my noble friend, increased migration is also a result of both poverty and population growth. In September, I participatedin the UN high-level dialogue on international migration and development and there is now real recognition that development plays an important role in tackling the causes which compel people to migrate and that migration could be a positive force for development.
The UK Government remain firmly committed to the stabilisation of population in Africa. We will seek to ensure that the achievements we have seen to date are consolidated and continued. We will work with others to ensure that critical constraints, both at the global policy level and at the country level, are overcome. I understand that the Germans, in both their EU and G8 presidencies, will focus on Africa, so there may be room there to develop this work.
But although we will continue to play our part, it is also the responsibility of African Governments to take leadership to address this issue. That is why we are putting our resources into their development plans and channelling them through their systems. The UK has shown continuous leadership and lobbied at the highest level for full attention to sexual and reproductive health and rights, including family planning. I can assure the House that we will continue to do so.
House adjourned at twenty-nine minutes past eight o’clock.