Human rights have been central to the family planning movement for well over half a century, although family planning programs have not always lived up to the human rights commitments that governments publicly subscribe to. The right of couples to control their fertility was first codified in the 1968 Tehran Declaration, which noted that:

“Parents have a basic human right to determine freely and responsibly the number and spacing of their children.”

However, 1968 also brought us the book, The Population Bomb, which stoked fears of widespread famine and social unrest due to rapidly rising human populations, particularly in the Global South. In the wake of such alarmist rhetoric about the economic and environmental impacts of rapid population growth, many countries adopted coercive family planning programs with an aim of sharply lowering fertility. These policies often resulted in human rights violations, including forced sterilizations and abortions.  

Partly as a result of these abuses, the family planning community recommitted to rights-based approaches at the 1994 International Conference on Population and Development (ICPD). The ICPD Program of Action (PoA) reaffirmed the rights of couples to choose the number and spacing of children first articulated in Tehran, while also noting that these rights belong to individuals as well. Additionally, the ICPD PoA called on governments to provide high-quality reproductive health programs that respect human rights.

Principle 8 of the ICPD PoA reads (in part):

“Reproductive health-care programs should provide the widest range of services without any form of coercion. All couples and individuals have the basic right to decide freely and responsibly the number and spacing of their children and to have the information, education and means to do so.”

This Principle, and the broader ICPD PoA, have been integral in shaping international family planning policy for the last quarter century.

Sub-Replacement Fertility is Becoming More Widespread

As a result of economic development, changing social norms, and improvements in access to, and the quality of, reproductive healthcare, global total fertility rates (TFR) have fallen considerably since ICPD, from around three children per woman in the early 1990s to 2.3 today. Moreover, many countries have passed through the demographic transition, with fertility often falling below the replacement rate (roughly 2.1 children per woman). Over 90 jurisdictions worldwide had fertility rates below 2.1 in 2021, including the United States, China, Russia, Japan, Brazil, Germany, France, the United Kingdom, and Turkey.  

While the world’s population will continue to grow for the next several decades due to population momentum and continued high fertility rates in sub-Saharan Africa, depopulation is beginning to replace overpopulation as a dominant paradigm in global demography and is a phenomenon that the family planning community needs to prepare for. In a sign of the changing times, this past November, the Wittgenstein Center, a leading demographic research consortium, held its first—but almost certainly not its last—conference on depopulation.

Governments are increasingly taking note of these fertility trends, particularly throughout the Americas, Europe, and Asia where many countries are experiencing sub-replacement fertility. To combat low fertility, many governments are adopting public policies with the aim of raising birth rates, often referred to as pronatalist policies. These reforms include: increased parental leave, childcare subsidies, one-time or recurring cash bonuses, subsidized housing or loans, and tax abatements. While many of these policies can increase fertility, they are usually insufficient on their own to raise fertility to the replacement rate or to the number of children that couples desire. Moreover, as many of these policies have been implemented relatively recently, it is unknown whether they will be able to sustain increases in fertility over the long run.  

Will Human Rights be Protected as Governments Grapple with Depopulation?

Some governments that are dissatisfied with the results provided by pronatalist economic and labor policies are restricting access to family planning services, which directly conflicts with the commitments made at ICPD to provide a wide range of methods free of coercion. In 2021, Iran passed a law drastically curtailing its family planning program, which was once widely celebrated for its impacts on development and gender equality. The new law bans public health care providers from providing no-cost contraceptives, as well as voluntary sterilization. In China, some local governments are limiting access to vasectomies—a very common birth control method for Chinese couples—in response to central government concerns about population decline. Crackdowns on access to family planning services with pronatalist aims can even be found in Europe. In 2017, Poland initiated a requirement for women to receive a prescription in order to access emergency contraception—a policy out of step with its European Union counterparts. This reform was adopted as part of a broader pronatalist push by the Polish government, which included cash bonuses to parents.

Efforts to limit contraceptive access are not universal—on New Year’s Day, France expanded a program to provide free contraceptives to women and girls less than 25 years of age. However, France—with a TFR of roughly 1.8 and net in-migration—faces fewer immediate challenges related to population decline than many of its European peers.

As population decline replaces population growth as the central demographic concern vexing policymakers throughout many high- and middle-income countries, more governments are likely to adopt pronatalist policies. But given the evidence suggesting the limited effectiveness of fiscal or labor reforms to yield significant or lasting increases in fertility rates, policies that restrict access to family planning services may become increasingly tempting.

ICPD enshrined the ability of individuals and couples to freely choose the number and spacing of their children as a core right, along with instilling the obligation on states to provide high-quality, rights-based family planning services. Without efforts to reassert the centrality of human rights in family planning, the painful lessons of the past, where demographic targets were prioritized over the preferences of couples and individuals, are at risk of being repeated.