Contraception is not a panacea

The UK Government/Gates Foundation summit on family planning is a good thing, but we can't be fooled into thinking it can solve all our problems.

Every day around the world 1,000 women die from complications related to pregnancy or childbirth. Think about it: that’s 365,000 women every year – almost as many as the total population of Bristol.

In many of the world’s poorest countries early marriage, overstretched healthcare services and low adoption of modern contraception methods together create a situation where pregnancy can be a cause for real concern as well as celebration.

So it is great news that the prime minister will tomorrow host a joint UK Government/Gates Foundation summit on family planning intended to provide 120 million women with access to contraception over the next eight years at a cost of £2.6bn.

David Cameron and International Development Secretary Andrew Mitchell certainly deserve real credit for putting the issue of family planning firmly on the development agenda. Giving millions more women the means to choose when and whether to start families will not only save lives, it will also help families who are struggling to feed their existing children avoid unwanted pregnancies. And it could play a role in helping younger brides delay pregnancy until they are ready to have children.

But the government needs to avoid the misconception that contraception is a panacea. Girls forced into early marriage, for example, often have less control over the choice about when to start a family. Handing out contraceptives is necessary but not enough. These efforts need to be backed up by education and support services that empower women to assert their rights. And women who choose to get pregnant will still die unnecessarily unless there are good quality health services to take care of them.

Alongside the provision of contraception we need more programmes like the one Oxfam runs in Hadrahmout Governate in Yemen where only a quarter of the population has access to primary healthcare.  There we are building health facilities, distributing home delivery kits and supporting health education and awareness raising programmes. We are also training midwives, a process which not only improves healthcare but can also raise the status of women in society.
These issues may not get much airtime at the summit, to be held on July 11, World Population Day, which is planned as the government’s latest effort to communicate to the British public the benefits our aid brings. In these tough economic times, ministers deserve a loud cheer for its unwavering commitment to keeping Britain’s promises to the poorest in the face of some significant opposition on their own backbenches and beyond.

There are potentially two reasons why ministers find family planning an attractive topic for such an event. Firstly, giving women a chance to gain control of their own reproductive health is something that can save lives, and that we can all understand.

Critics opposed to aid or who believe that our concern for the poorest should begin and end at home have two simple questions to answer: do you believe that it is right that women in Sierra Leone, for example, are more than 70 times more likely to die as a result of pregnancy or childbirth than those in the UK? If not, what would you do about it?

The second attraction of family planning is potentially more problematic. Population growth is the public’s number one concern about development– yes, higher than corruption. This goes beyond simple prejudice about growing numbers of Africans or Asians (although that doubtless does exist) - it is also fuelled by concerns that population growth is responsible for climate change and other environmental problems.

This is based on a fallacy. It is consumption in the rich rather than the poor world that is primarily responsible for the pressure on our planet. In the 25 years to 2005, for example, Sub-Saharan Africa accounted for almost a fifth of the growth in the world’s population but only 2.4 per cent of the increase in CO2 emissions. By contrast, North America was responsible for four per cent of population growth but a staggering 13.9 per cent of the rise in emissions.

These facts did not stop the Optimum Population Trust deciding a couple of years ago, ahead of the Copenhagen climate summit, to launch a carbon off-setting scheme where instead of planting forests your money was used to fund family planning in poor countries.

It is the government’s job to challenge public prejudice which is not based on fact. It needs to find ways to ensure that tomorrow’s summit avoids reinforcing such lazy and (for us high consumers) convenient thinking.

Barbara Stocking is Chief Executive of Oxfam

Indian programme officer G. Shilpa poses with a female condom at an awareness camp in Hyderabad. Photograph: Getty Images
Photo: Getty Images
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The twelve tricks in George Osborne's spending review

All Chancellors use chicanery, and George Osborne is no exception.

There is no great shame to a wheeze: George Osborne is no more or less partial to them than other Chancellors before him. Politicians have been wheezing away since history began. Wheezes aren’t even necessarily bad policy: sometimes they’re sensible as well as slightly sneaky. And we shouldn’t overstate their significance: the biggest changes announced yesterday were described in a clear, honest and non-wheezy way.

But it’s fun to try to spot the wheezes. Here are some we’ve found so far.


  1. Give people less time to pay their tax bills. Yesterday the Chancellor announced tax rises that will raise, in total, a net £5.5bn in 2019-20. A sixth of that total – £900m – results from the announcement that, from April 2019, anyone paying Capital Gains Tax (CGT) on the sale of a house will have to cough up within 30 days. Has the Chancellor made a strategic decision to increase taxes to pay for public services? Not really – he’s just moved some tax forward from the subsequent year to help his numbers stack up, at the price of bigger hassle for people who are selling houses. Not necessarily a bad thing – but a classic wheeze.


  1. Dress up a spending cut as a minor bureaucratic change. The Treasury yesterday announced what sounds like a sensible administrative change to the Government’s scheme for automatically enrolling people into pensions: “to simplify the administration of automatic enrolment for the smallest employers in particular, the next two phases of minimum contribution rate increases will be aligned to the tax years”. Nice of them to reduce bureaucratic hassle for the smallest employers. This also happens to save the Government £450m in 2018-19, because instead of paying an increased subsidy into people’s pensions from January 2018, it will do it from April 2018.


  1. “Tuck under”.  The phrase “tucking under” is a Whitehall term of art, best illustrated with an example. We learnt yesterday that “DfID [the Department for International Development] will remain the UK’s primary channel for aid, but to respond to the changing world, more aid will be administered by other government departments, drawing on their complementary skills.” That sounds like great joined-up government. It also, conveniently, means that the Government can continue to meet its target of keeping overseas aid at 0.7% of Gross National Income, without having to increase DfID’s budget at the same rate as GNI: instead, other departments pick up the slack. Those bits of other departments’ budgets have thus been “tucked under” the ODA protection. See also: the Government is “protecting” the schools budget in real terms, while slashing around £600m from the funding it gives to local authorities to support schools, so that schools will now have to buy those services from their “protected” funding – thus “tucking” the £600m “under” the protected schools budget. (See also: in the last Parliament, the Government asked the NHS to contribute to social care funding, thus “tucking” some social care “under” the protected health budget.)


  1. Cumulative numbers. Most of the figures used in the Spending Review are “in-year” figures: when the Government says it is giving £10bn more to the NHS, it means that the NHS will get £10bn more in 2019-20 than it got in 2015-16. Then you read something like: “The Spending Review and Autumn Statement provides investment of over £1.3 billion up to 2019-20 to attract new teachers into the profession.” That’s not £1.3bn per year – it’s the cumulative figure over four years.


  1. Deploy weasel words. The government is protecting “the national base rate per student for 16-19 year olds”. Sounds great – and it will be written up in many places as “Government protects 16-19 education”. But the word “base” is doing a lot of work here. Schools and colleges that educate 16-19 year olds currently get a lot of funding on top of the “base rate” – such as extra funding for disadvantaged students. Plans for that funding have not yet been revealed.


  1. Pretend to hypothecate a tax. The Chancellor announced yesterday that – because the EU won’t allow him to reduce the ‘tampon tax’ – he’ll instead use the proceeds of that tax to pay for grants to women’s charities. This sounds great – but all he’s really saying is that, among all the many other millions of pounds of grants issued by the government to various causes, £15m will be given to some women’s charities, which might have got that funding anyway. It’s not real hypothecation: it’s not as if women’s charities will get more if there’s a spike in tampon sales. See also: announcing that local authorities can raise council tax so long as they use it to pay for social care – LAs would probably have spent just as much on social care anyway (and other services would have suffered).


  1. Shave away a small fraction of a big commitment. The Conservative party made great play in the election campaign of its commitment to provide 30 hours of free childcare to 3 and 4 year olds in working families. In the July Budget, it made more great play of re-committing to this. Yesterday, it announced that “working families” excluded any parent working less than the equivalent of 16 hours at the minimum wage, or more than £100,000. That sounds like a fairly small change – but it saves the Government £125m in 2020.


  1. Turn a grant into a loan. If government gives someone a grant, that is counted as spending and increases the public sector deficit. If instead the government gives someone a loan, that doesn’t count against the deficit, because it’s assumed that the loan will be paid back (so the loan is like an asset which the Government is holding). Recently we’ve seen a lot of government grants turning into loans – in the July Budget it was student maintenance grants; yesterday it was bursaries for trainee nurses.


  1. “Reverse” a decision that hasn’t happened yet. In 2012 the Government announced that, from April 2016, it would remove the 3% “diesel supplement” that puts a higher tax on company cars that use diesel than on others. Yesterday, it cancelled this, saving over £265m per year for the rest of the Parliament. People complain less about you cancelling a tax cut when you haven’t done the tax cut yet. (Perhaps this doesn’t qualify as a full wheeze, but there’s something wheezy about it.)


  1. “Protect” things in cash terms. If you really want to protect an area of spending, you should at least increase it in line with inflation, so that it can still buy the same amount of stuff. This government – like the Coalition before it – enjoys protecting things only in cash terms. Examples yesterday included the basic rate of funding per 16-19 year old in education, and the entire children’s services budget.


  1. Freeze things in cash terms. Yesterday the government announced that the repayment threshold on student loans – the level above which ex-students must start paying back their loans – will remain frozen in cash terms for 5 years, instead of increasing with earnings (which is what has happened to date). This saves the Government £200m in 2019-20. In a particularly bold move, the Government has even applied this rule to loans that have already been issued – changing the terms on which students took out the loans in the first place.


  1. Hide all these wheezes in sweeping statements. The first chapter of the Spending Review tells us that “£3 billion [of reduction in the deficit] is being delivered through reforms such as Making Tax Digital and further measures to tackle tax avoidance.” The innocuous phrase “reforms such as” covers the bringing forward of £900m in Capital Gains Tax (see number 1 above) and the £450m saved by delaying automatic enrolment into pensions (see number 2 above).

Catherine Colebrook is chief economist at the Institute for Public Policy Research