The politics of contraception: policies lost and regained

Abstract

SummaryDemography, health, human rights and morality have been important perspectives in the formulation of policies for the provision of contraceptive services. By addressing unmet need, implementation of the right to contraception leads to decreases in fertility and population growth, thereby promoting attainment of the Millennium Development Goals and poverty reduction in the context of international development. With demographic considerations having received short shrift for a long time, it is most appropriate that the issue of population growth is returning to the fore. ParadoxTwenty-five years ago, management issues were at the forefront of health services and family planning was not exempt, special attention being paid to the efficient utilisation of resources. Kurji explored the feasibility of using routinely collected data for comparing the performance of clinics 1 whilst Black demonstrated the cost-effectiveness of day-surgery female sterilisation in a family planning clinic as an alternative to overnight stay in a hospital setting. 2 The long-term viability of some family planning services was threatened because some district health authorities had attempted to save money by closing clinics. The resulting shift of the workload to general practitioners would actually be more expensive, but would be charged to a different budget. 3,4 Family planning clinics had numerous advantages with their convenient hours, accessibility for certain groups of hard-to-reach individuals with the greatest need and with a specialist service providing a wide range of contraceptive methods. Training schedules were being discussed for the proposed specialty of medical gynaecology, which would strengthen the family planning clinics. 5 In a detailed analysis of the fight for family planning in Britain, which "has been a long one and is by no means over", Leathard pointed out the paradox whereby the government had lately been "ignoring demographic input as distinct from outcome" when rationalising expenditures between individuals and the state. 4Premise Demographic perspectives had long been prominent in the provision of family planning services in Britain. 4 The independent pioneering efforts of Marie Stopes and the Malthusian League that led to the opening of birth control clinics in London in 1921 were initially opposed on demographic grounds that were linked to social class, gender, religion, medical profession and morality. With the "erosion of lingering Victorian taboos", "support of socially respected women" and "contributions of eminent medical men", there was increasing support for contraception by the end of the 1920s, when government