Despite widespread reductions in average family size, the populations of most developing countries are still growing at an annual rate of 2% to 3%. Populations in countries that grow by 2% each year double every 35 years. Improving women’s ability to achieve their childbearing goals and reducing the number of unwanted births will slow down the pace of population increase.

As couples increasingly want and value smaller families, women still bear the primary burden of trying to avoid unplanned or unwanted pregnancies and suffer the risks of pregnancy, childbirth and unsafe abortion. The gap between reproductive hopes and reproductive realities persists, because millions of women who are at risk of pregnancy and say they do not want to be pregnant are not using an effective method of family planning; because men in most countries play only a small part in family planning and often do not support their partners’ reproductive decision-making; and because some women who are using effective contraceptive methods fail to use them correctly or consistently. Many of these women lack access to methods or to contraceptives suitable for them, especially if governments or service centres concentrate on providing a single method.

Clearly, if a woman is to succeed in having children when she wants them, she needs access to effective methods of birth control. Indeed, she needs contraceptive protection for a very long part of her fertile life. For example, a woman who marries or becomes sexually active at age 20 remains in a sexual relationship throughout her reproductive years and wants to have only two children will need to use birth control for approximately 21 years. If she wants four children, she will need protection for about 16 years and if she wants six children, for almost 12 years.

Because women’s control over childbearing is closely related to many areas of their lives besides access to contraception, major improvements are necessary in these areas, too: educational achievement, the age at which women marry, their role within the family, their likelihood of being subjected to domestic violence and the degree to which husbands or partners endorse their family-size and contraceptive-use goals. There is no shortage of initiatives that could strengthen women’s capacities in these areas. These include social legislation, policies, programmes and services that will reduce discrimination against girls and women, improve health services, provide better educational opportunities for girls and promote greater equity in the labour force.

Progress in these areas not only is a function of a country’s economic development, but also reflects the priority individual governments attach to education, health and social services. Given further improvements in women’s economic and social conditions, in their ability to act upon their own decisions and in the provision of family planning services, there is little reason to believe that women cannot achieve better control over their childbearing.

Most people would argue that as a matter of simple justice and equity, women should have access to education; a choice of whom and when to marry; more equitable sharing of childbearing responsibilities with their partners; access to gainful employment; and the right to have, or not to have, children. Furthermore, improvements in the status and reproductive health of women also have important benefits for society: Education enables women to contribute to the overall growth and welfare of society; improved prospects for paid work decrease women’s likelihood of being exploited (economically or sexually); and having few adequately spaced births without having to resort to unsafe abortion makes women healthier and stronger. As a result, children born into smaller families and to women with increased health, economic and social resources to invest in their development are more likely to thrive than are children who do not have these advantages.

Financial support from national governments and the international community has played an important role in meeting the rapidly increasing contraceptive needs of women in developing countries. But nowhere in the world has this assistance been sufficiently comprehensive, intensive or sustained to meet the needs of all segments of society, particularly rural populations, the poor, the uneducated and the young.

The cost of providing all women in the developing world with the broad range of reproductive health services they need is substantial. The United Nations estimates that the cost of relevant programmes—including those addressing family planning, maternal health and prevention of sexually transmitted diseases—will reach $17 billion by the year 2000. Assuming that contraceptive prevalence in developing countries will rise to about 60% among women of reproductive age, and recognizing that the number of women in this age-group will continue to grow, the United Nations has concluded that the cost of family planning services alone will be $10 billion of that total.

Currently, about $3 billion of the roughly $4 billion being spent to provide family planning services in developing countries is borne by the countries’ own governments and by the women and men who use these services; the other $1 billion is contributed by governments and nongovernmental organizations in developed countries. Some international policy-makers and financial experts consider it unlikely that developing countries can continue to bear most of these costs. Should this supposition prove true, international support will need to grow considerably if couples in developing countries are to succeed in reaching their reproductive goals.

Achieving the family size that women and their partners want is a very complicated business, and no one approach is appropriate for all couples or all societies. Yet, women the world over seem to be remarkably creative in the strategies they use to avoid unwanted childbearing, often acting in the absence of established alternatives. Future efforts should build on women’s strengths, courage and ingenuity by providing them with wider and more effective options that will serve their reproductive needs, protect their health and the health of their families, and broaden their ability to gain control of their lives.

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