The Global Family Planning Revolution: Three Decades of Population Policies and Programs (review)

This book brings to life the remarkable story of how family planning programs developed in three continents (Asia, Latin American, and Africa) during the second half of the twentieth century. This is public health and social change on the macro-scale, and such a change never before occurred as quickly as the growth family planning did. The book includes twenty-three case studies as well as introductory and concluding chapters. Among the authors are some of the most prominent people in the family planning field. These authors document staggering successes (Korea and Thailand) as well as massive efforts that were largely ineffective (e.g., Philippines, Pakistan). As the editors, note, “The authors are senior professionals who had firsthand experience with the programs, regrettably, the gender bias of the period has resulted in a predominantly male authorship” (p. 421).

The editors point out that much of the history behind the creation of national programs has vanished and that young people entering the field are often unaware of it. This volume can definitely fill that gap and explain the unprecedented changes brought about by family planning efforts. I also recommend the volume to experienced public health managers and researchers. Not only is this history presented in interesting ways, but many chapters on specific countries conclude with lessons learned.

Unlike many edited volumes, this one is coherent, from the succinct and informative introduction by Stephen Sinding through the varied case studies to the concluding chapter in which the editors synthesize the chapters on individual countries. The country cases are organized by region: the Middle East and North Africa (Egypt, Iran, Tunisia, and Morocco), Europe and Central Asia (Turkey only), Latin America and the Caribbean (Chile, Columbia, Guatemala, and Jamaica), East Asia and the Pacific (Korea, Hong Kong, Singapore, Thailand, Indonesia, Malaysia, Philippines), South Asia (India, Bangladesh and Pakistan—presented in one chapter, Sri Lanka, Nepal, and Sub-Saharan Africa (Ghana and Kenya). Each of the case studies explains the social and historical background of the country, setting the context for an analysis of how family planning was implemented. Each country case includes a helpful time line, useful for keeping track of the country’s family planning milestones and helpful for comparing the relative experiences of different countries.

While the book’s chapters cohere, the explanation of why these particular countries were chosen occurs only in the final chapter, written by the editors: “The 23 case studies presented here were the earliest national efforts to establish organized family planning programs for entire populations” (p. 421). This explanation is not quite consistent with Steven Sinding’s introductory chapter, where a number of countries that do not appear (such as Taiwan and Botswana) are mentioned. If the editors were unable to find willing authors for some of these countries, the field would be well served by a simple acknowledgment of the fact.

I found the final chapter to be especially strong both in terms of summarizing country efforts and analyzing global trends in family planning program performance and management. Its application extends far beyond family planning and should be considered by anyone taking on the ambitious task of providing health services to an entire population, be it a country, state, or city. The detailed lessons bear repeating:

1. 1. Policy adoption is a continuing process.

2. 2. No one best pathway to policy adoption exists.

3. 3. Each new problem should not create a new administrative structure.

4. 4. Crash programs can entail dangers.

5. 5. Initial socioeconomic status levels are a good guide to program planning.

6. 6. The scale of the initial program must be realistic.

7. 7. Financial resources are not a guarantee of success.

8. 8. Consistency in program leadership and direction is important.

9. 9. No single family planning approach worked everywhere.

While I am mostly enthusiastic about The Global Family Planning Revolution, there is one glaring omission–the feminist backlash. With the exception of Sinding’s discussion...