At the turn of this century, in a rare burst of feel-good solidarity at the United Nations, member governments signed on to a very ambitious set of measures to combat just about everything wrong on the planet: poverty, disease, inequality, environmental degradation and imbalanced international finance and trade. They called the plan the Millennium Development Goals. This month, halfway to a 2015 finish line, comes the first big reckoning.
On September 25, in a summit-style gathering at the UN to which all 192 member nations are invited, successes and failures will be parsed, region by region, country by country. Then, predictably, the conversation will turn to money, the perennial quick fix prescribed for soul-destroying underdevelopment in the world's poorest places. Money is always needed, but there is more to ensuring development than that.
Missing from these diplomatic extravaganzas are the voices of suffering people themselves, the billion or two (depending on what cutoff point you chose) who live on sums so small that hours of whatever work can be found after a scant breakfast will determine whether there will be another meal of any kind that day. Absent most of all will be the women who go to sleep exhausted and hungry, or weep when a sick or starving child cries for something the family cannot provide.
UN member nations have a poor record on keeping promises to women, even as UN officials insist repeatedly that the Millennium Goals won't be met unless governments pay more attention to those who make up half their populations. At another summit in 2005, countries agreed to create a new under secretary-general position for women's issues. Three years later there have been only more meetings and the inevitable position papers. Opposition comes from some large developing countries with most to gain from an empowered female population, from the Vatican, influential Arab states and the current US Administration.
Of the world's 6.7 billion people, only 1.2 billion live in developed countries and their numbers are stabilizing or shrinking in some places. Almost all the new people in this century will be born trapped in cycles of high fertility and poverty, as Kofi Annan has said. But if women already in that trap were to address the coming summit, they would use words no longer heard much in polite diplomatic society, words like contraception, safe abortion, family planning, population pressure.
Neither the liberal left, professing cultural sensitivity, nor the conservative right, preaching abstinence and other unworkable ideas, want to hear the word "population," which evokes the horror of forced abortion in China or involuntary sterilization in India decades ago. The long shadow of "population control" still hovers over the conversation.
Money for family planning has dropped precipitously since the 1994 Cairo conference on population and development  agreed that women should take charge of their reproductive health and rights. Dependent entirely on donations, the United Nations Population Fund , known as UNFPA, struggles but can never keep up with huge demands for life-saving contraceptives, including condoms. The Administration of President George W. Bush cut off all US funding to the agency, accusing it of aiding abortion. Though other countries filled the hole in UNFPA's income, American hostility has had a chilling effect internationally, according to officials involved in reproductive health. A McCain-Palin White House would make the situation much worse.
Much more money now goes to fight HIV/AIDS, a shift justifiably related to the continuing spread of the still-incurable disease. But people in the reproductive health field are distressed by the widening gap between AIDS and family planning campaigns and the bizarre tendency to treat these as separate issues. Effective reproductive health services for women and men should be part of the arsenal against HIV/AIDS, now becoming a women's disease in sub-Saharan Africa and other regions. At least half a million women already die annually of pregnancy-related causes. Add AIDS and that's two lethal strikes against them, two terrible and often unnecessary vulnerabilities.
People who work in family planning in the UN system and in voluntary organizations see another inexplicable divide between feminist campaigns for women's rights and drives to expand access to contraception in developing nations. Women's rights and family planning should also be natural allies, linked inextricably where the most deprived and undervalued of women live. Yet, argues Robert Engelman, author of a new book, More: Population, Nature and what Women Want  (Island Press), too many rich-world feminists think family planning turns women into instruments of that old bugbear, population control.
Poor families in the global South know that without the most fundamental rights, women in the villages of Ghana or Laos or in the brothels of Kinshasa or Calcutta cannot assert themselves against demands for unprotected sex or a preference for sons that leads to unwanted pregnancy or female feticide. They also know that without available contraception and the freedom to use it, women's rights, good on paper, can be pretty meaningless day to day. Without both enhanced rights and the means to control their bodies, they cannot hope for even that small measure of economic independence that allows them to feed their children better and send them to school.
Buoyed by popular books that purport to show that there is no population "problem" in the world, current opinion in rich donor nations has fostered the myopic view that there are not too many people, and that the global population needs only some redistribution of resources, better and more equitable management of food and water and properly organized migration. Population growth, in other words, is not killing development. In a macro sense, that's one argument. On the micro-level, it looks different from the perspective of an anemic woman in rural Afghanistan who may bear seven or more children, only half of whom may live, in a resource-poor country where birth rates, infant mortality and maternal deaths are among the world's highest. No time for macro policies to kick in there.
If the nations meeting at the UN this fall cannot do more than just repeat the mantra that the role of women is essential to development, most of the Millennium Development Goals will be dead on arrival in 2015. People out there in the developing world say so.
In the Philippines, where a former president, Fidel Ramos, has called population growth a "ticking time bomb," another bill has been introduced in Congress--after almost a dozen failures--to establish a national family planning program over the objections of the powerful Roman Catholic Church, which threatens to excommunicate legislators who vote for it. Surveys show that the poorest Filipinos want family planning, but it is often nonexistent. Benjamin Dioko, a Filipino economist, recently told Agence France-Presse that "the incidence of poverty is less than 10 percent in a family with one child compared to 57 percent for a family of nine or more children."
In Nigeria, contraception has also met religious and cultural opposition and exposed the shaky status of women in society, health officials report. In Uganda, a national survey showed that women who thought that two to four children would be ideal were having, on average, more than six.
In Africa, the fourteen-nation Southern African Development Community has just adopted a landmark Protocol on Gender and Development , which calls for a wide range of rights and services for women, including access to reproductive health services for young girls, an end to harmful cultural practices and emergency contraception for victims of sexual violence.
Worldwide, it has been shown that culture and religion do not have to be insurmountable obstacles to women's reproductive health. All over the once-conservative Roman Catholic universe--in Italy, Spain, Portugal, Brazil, Colombia, Mexico to name just a few places--advocates for sexual freedom and better reproductive health services have made great gains. Among nations with Islamic majorities, notably Indonesia and Iran, extensive family planning programs have contributed to freeing women for economic activity. Bangladesh, poor and prone to calamitous natural disasters, has reduced fertility voluntarily in recent decades from seven children for each woman to three, and has already met the Millennium goal for parity between boys and girls in primary education.
Surely women of the industrial countries, with an array of lifestyle and reproductive options, don't really want to deny the same choices to the poor. Surely European and American feminists who once railed against the "barefoot and pregnant" mentality do not want to be found among those politicians or religious leaders who repress poor women by refusing them the most basic tool for taking charge of their lives: contraception.
Joseph Chamie, a demographer and former director of the UN's population division, likes to say that women prove again and again that they are wise about their needs, if only the world would listen. Given the chance to choose smaller families and join the population debate where they live, they will "talk fertility down" of their own accord, not because anyone is forcing them to have fewer children. If poverty reduction can start within families, if children are healthier, mothers live longer, food goes farther and the environment benefits from declining population pressures, surely those coincidental consequences can't be bad for the world. They would certainly help achieve the Millennium Development Goals.