Population is Personal: Reflections on Policy Communication from PopPov 2013

In the wonky worlds of economics and demography, quantitative models and regression output tables rule supreme. But with such sterile and aggregated methods, it can be all too easy to forget that those endless p-tests and robustness checks relate to the most intimate and meaningful aspects of human life. If we want population or demographic research to translate into policy significance, it’s worth asking in the most blunt and human terms: What are we really talking about when we talk about population? And relatedly, how can we best be understood by those we’re trying to reach? These issues are on my mind after attending the 7^th Annual PopPov Conference on Population, Reproductive Health, and Economic Development, held last month in lovely (albeit frigid!) Oslo, Norway. The conference was a unique opportunity to hear new and in-progress research at the nexus of population, reproductive health, and economic development. But perhaps most importantly, it offered a much-needed venue for a parallel conversation about how to communicate those ideas – all with important policy implications – to the audiences who need to hear them. Population policy presents a unique challenge in this respect, because it connects the most personal aspects of human behavior with potential macro-level consequences (i.e. demographic dividends, dependency ratios, and sustainable development). To paraphrase Hans Rosling (an invited speaker at the conference), population policy might be set at the Ministry of Health or Finance, but population decisions are ultimately happening in the bedroom. When we talk about population, we are really talking about people, and the aggregate of the most important and intimate decisions in their lives. For example, will I have a child? Or two or three or four or more? And will I have one now, next year, or never? Will I use modern contraception to control my fertility? Will I marry, or divorce? Where will I choose to deliver my babies? Where will my family live? And am I empowered to make any of these decisions in the first place? Perhaps for this reason, one recurring topic of discussion at PopPov concerned our population “glossary”, and whether it can appear insensitive to those intimate life choices described above, or at odds with the closely related (but often divergent) languages of women’s rights and maternal and child health. For example, it’s common in demography and economics to talk about the quantity-quality tradeoff for number of children – that is, the more children a woman has the more she will have to divide scarce resources (think healthcare, nutrition, and education) resulting in less human capital for each child. So – in demography terms – it makes perfect sense to promote birth spacing and voluntary contraception as one (of many) interventions to improve child health and welfare. On the other hand, you can also imagine that women might respond poorly to being told they have “low-quality” children, or a policymaker to being told that his or her country needs “higher quality” people. Likewise, it’s hard to argue with policies which allow a woman to limit her fertility – but it’s no accident that women rarely report having “unwanted” children once they arrive. Rosling himself put forth perhaps the strongest critique of some population rhetoric, charging that terms like “population bomb” and “population explosion” were at once factually incorrect, dehumanizing, and often motivated by latent racism and prejudice. These issues are not entirely semantic, nor are they new; indeed, there have been longstanding divides between those who see lower fertility as an end in itself (largely in the context of sustainable development), and those who see voluntary contraception as either a means to better health and development outcomes, or as a necessary component of women’s rights and empowerment via control of her desired fertility (or some combination of all three). These competing (though often complementary) agendas culminated in the 1994 “Cairo Consensus”, which, according to Cohen and Richards (1994), “placed the discussion of population firmly in a development context [and] identified women and their status as central to sustaining global development efforts…[In] the words of Chief Bisi Ogunley of Nigeria, ‘Our program is ‘allow people to count, do not count people.’’” While the Cairo Consensus was thus a hugely important step in uniting the women’s rights, maternal health, population, and environmentalist communities, I worry that those divides are reemerging, at least linguistically. In the week prior to the PopPov conference, I attended the 2013 Global Maternal Health Conference (GMHC) in Arusha, Tanzania, hosted by the Maternal Health Task Force.  It was striking to see a discussion of many of the same issues – for example, access to maternal health services, contraceptive prevalence, and desired fertility – but communicated using a very different language. In Arusha, these issues were framed squarely within the context of women’s rights and health, respectful care and equity, with little discussion of macro level economic or population consequences. And while all PopPov discussions remained firmly within the “Cairo Consensus” framework of people-oriented population policy, the clear contrast in language was revealing – as were signs of frustration with the women’s rights community. (Notably, to the best of my knowledge, I was the only delegate to attend both conferences). All this to say that I don’t think there’s actually that much policy space between the women’s health and rights advocates and the population community – ultimately, both are interested in women’s empowerment, access to high-quality family planning and reproductive health services, and children’s health and welfare. But in the spirit of “policy communication,” I think that there’s work to be done in speaking each other’s languages, and thus realizing the natural alliance between their respective agendas. Language matters, particularly when you’re talking about the most intimate and personal choices in a woman’s life, and when you’re trying to convince policymakers of the relevance of your work. PopPov offered a wonderful opportunity to start that conversation – I hope others will work to continue it and move it forward.