Dr. Frederick Sai: Family planning reduces abortions

At the end of October, the world's population will cross the 7 billion mark and continue to climb. Over the next five weeks, Global Pulse interviews several world leaders about how to slow this explosive growth.

Dr. Frederick T. Sai, a medical doctor, was born in Ghana. He started working on global nutrition issues in 1963 – 48 years ago – as an advisor to the FAO regional office in Africa. He went on to become an internationally known authority on health, nutrition, population, and family planning, and among his various posts were president of International Planned Parenthood Federation, and Director of Population at the World Bank. He is a member of Aspen’s Global Leaders Council for Reproductive Health. Sai spoke about what first got him interested in reproductive health rights issues, why African leaders don’t want to talk about family planning, and how his days as a doctor-coroner uncovered evidence that changed him.

In the 1960s, near the start of your career, the world population was 3 billion. In about a month, it will reach 7 billion. What happened?

What happened is the world knew how to care for mankind better. After World War II, the developing country populations started growing faster than the northern countries. It was due to a range of biomedical interventions, including introduction of antibiotics, and vaccinations. Death rates were coming down. Our ability to develop and to tackle diseases was much better. If it were not for efforts being made in the West and North with development and women’s education that made families smaller, our population would be much larger than 7 billion.

What’s the best strategy to slow down the rate of population?

The rate of population increase is coming down. Much of Europe and North America are at replacement level or less. Sub-Saharan Africa or South Asia are the major population areas, and even in those countries, fertility rates of women have come down from six, seven, or eight children per women to four now. My country, Ghana, is at about four, but it was six some 20 years ago.

But we don’t have another 50 years to go from four children per women to two. The numbers will grow too big. We need to hammer these points home. If you look, for instance, at the quality of schools and the quality of teachers in high-fertility areas, we are not succeeding. If you look at the job markets today and look at areas of over-population, we have serious issues with underemployment or unemployment. We have very serious population problems right now.

You sit on a council of current and former leaders. What can the Global Leaders Council do?

What it is doing is talking to the leadership of the countries that have the fertility problems, where the number of children per women is still so high. It is necessary for those leaders to do something about it because of what they themselves want to achieve. If Ghana, for instance, wanted to see all of its children in good grade schools and all of its university graduates in good employment, it must do something because even those university graduates today don’t have enough employment. What does the future hold if we keep on growing?

Still, funding for family planning has gone down over the years. How do you increase funding in tight economic times?

Since the AIDS epidemic, and particularly recently, family planning has lost its priority from both the donors and recipients. In the US, those on the right unfairly equate family planning with abortion. That has taken away the courage to speak on this from many of our African leaders. They think the subject is too politicized. So they don’t talk about it. Family planning does not mean abortion. Family planning means preventing births when you don’t want them. Family planning actually reduces abortions.

You’ve been working on health and reproductive health issues for more than a half-century. What is your motivation to stay with it for so long?

I started as a doctor and I found one of the largest issues was poor nutrition. Poor nutrition is the stage for bad outcomes for infectious diseases. I found quite a high proportion of malnourished children, especially at a time when their mothers were pregnant, or had stopped breast feeding them. So I started advocating that the mothers start spacing these children better, to not have them so close together.

Then, in cases where there were fevers and I did post mortem of young women, I saw young women dying of fevers of unknown origin.

You became a coroner?

No, I was a doctor. But there were so few doctors that some of us had to do autopsies in addition to our own work.

What did you find in those autopsies?

It turns out that most of them had an abortion two or three weeks previously. I found abscesses in their liver, in their lungs, even one in a woman’s brain. With better spacing of children, with fewer unplanned pregnancies, I realized that many of these deaths wouldn’t have happened.