§ 5.40 p.m.
§ Baroness Lockwood rose to ask Her Majesty's Government to what extent health and family planning are considered as part of development projects, bearing in mind the high rate of maternal and infant mortality in developing countries.
§ The noble Baroness said: My Lords, in asking this Question I am conscious of the fact that the time is not quite what we had anticipated and as a consequence I apologise on behalf of the noble Baroness, Lady Robson of Kiddington, who is chairing an important meeting which she originally expected to be concluded before this debate began.
§ The linked subjects of health and family planning in the third world arc not, regrettably, items to arouse a great deal of interest. It seems that it is only when an issue can be dramatised that our imaginations and consciences are aroused. For example, witness the magnificent response during the past two years or so to the efforts inspired largely by Bob Geldof in order to bring relief to the famine-stricken areas of Africa. Yet the more pervasive problems of infant and maternal mortality do not of themselves evoke such a response.
At a conference of European parliamentarians at The Hague earlier this year, sponsored jointly by the United Nations Fund for Population Activities, the World Health Organisation, and the United Nations Children's Fund, Doctor Inayatullah, Pakistan's Minister of State for Population, said:
Every year some 17 million children die from simple preventable diseases—more than those dying from the famines which have been brought to many of us so vividly on our screens over the past year".
She said that in some African countries infant mortality rates reach over 200 per 1,000 live births. She then went on to deal with maternal mortality. Again, I quote:
The maternal mortality rate in Sweden is near one per 100,000 live births; in the developing world as a whole it is around 400 for every 100,000 live births, and as high as 1,000 per 100,000 in some
sub-Saharan African countries where a woman has a one in 50 lifetime chance of surviving her six successive child births".
§ Those are appalling figures, and they represent human lives. Imagine, for example, if every six hours, day in day out, a jumbo jet crashed killing its 250 passengers, who were all women, who were all pregnant or who had just delivered a baby. That is how the World Health Organisation described the situation in the poorest countries of the world at its first international conference on the prevention of maternal mortality in November of last year. What horrifying pictures would fill our television screens if that were how these women died. What an immediate response there would be both from governments and from individuals. As it is, these women and their babies die unseen and largely unnoticed by the rest of the world.
§ The immediate cause of the disastrous famine in Africa was drought. But, as we all know, that is only part of the problem. Another and perhaps more fundamental cause is the pressure of the growth of population on the resources and on the environment of the region. In many of the African countries the population is set to double in the next 20 years. Dr. Fred Sai, senior population adviser to the World Bank, said to a recent meeting of the British Parliamentary Group on Population and Development that there was nothing that we could do to prevent a doubling of the population of Africa over the next 20 years. The problem was whether we could prevent it quadrupling thereafter.
§ On 15th May this year the Herald, a daily newspaper in Harare, described the situation as "Africa's time bomb". The paper referred to figures which indicate that, for example, Zimbabwe's population of 9 million is growing at 3.5 per cent. per annum and is likely to be 14.9 million by the year 2000 and 38.3 million by the year 2100. Kenya, with a population of 21 million, growing at the rate of 4.2 per cent. per annum, will have 35.8 million people by the year 2000 and 116.4 million by the year 2100. In Nigeria the population of 105.4 million, growing at 3 per cent. per annum, will reach 159.2 million by the year 2000 and 508.8 million by the year 2100. Those are horrifying figures.
§ But, one might ask, what is that to do with maternal and infant mortality rates? The two problems are integrated. On the one hand are the economic and social problems—that is, malnutrition, lack of water, lack of sanitation and hygiene, inadequate health care, inadequate housing, inadequate education, bad farming and forestry methods. Those represent one side of the problem. The other side is population growth. This population growth involves, in particular, infant mortality and maternal mortality rates in high risk areas. The high risk areas are usually described as those areas which include women who are too young, too old or who have too many children too close together; that is, pregnancies before the age of 18 or after the age of 35, pregnancies after four births and pregnancies less than two years apart. The greatest risk of infant deaths is found among those high risk pregnancy groups. Some of those groups are prevalent in the developed countries, too, and they were certainly prevalent during the Industrial Revolution, just as they are prevalent in the developing countries today.759
§ Among the factors influencing these high risk groups is the age of marriage. Girls who marry before the age of 18 and have babies before that age are at very high risk, and so are their babies. Another factor is education and literacy. This is particularly important for women, because women's education is an important factor in their status in society, and their status in society often influences the state of their health. The third influence is the use and knowledge of family planning. Here I would say that it is important that women should know of, and have available to them, family planning services. It is important, too, that men should be aware of the services and be aware of their importance, in particular when they are linked to the health of their wives and babies; so there is a great need for more to be done in that area.
§ Family planning is a difficult and delicate issue for us in the West, with our different culture. Yet family planning is not new to African countries. Especially is it not new in the sense of spacing the birth of children, which is a most crucial element in the health of mothers and babies. But the cultures in Africa and in developing countries which very often led to the spacing of children are now crumbling and one is left with a new situation.
§ However, all is not entirely gloom. It is encouraging to note that there are changes in the attitudes of government. For example, there is a growing political realisation that the health and wellbeing of families, and thus of communities, rests not on the number of children that a woman bears but on their healthy survival and on the ability of couples to choose the number of children that they will have and can support. In other words, it is increasingly recognised that family planning must be part of development. International conferences throughout the world have indicated this and the United Nations Women's Conference in Nairobi this year added its weight to this commitment. In May this year, too, an All-African Parliamentary Conference held in Harare was described by Charles Morrison, MP, who is chairman of the British population and development group, as one of the most encouraging that he had attended.
§ So we are not dealing with a situation in which the developed countries are foisting unwanted policies on developing countries. As I say, there is a growing recognition in these countries themselves that uncontrolled population growth is disastrous. Therefore I think it is more than ever appropriate that a family planning component linked to primary health care should be an integral part of Britain's aid to developing countries, and I should like to ask the Minister a number of specific questions on this subject.
§ First, what is the Government's policy on integrating family planning into all appropriate development projects? I understand that the Government issued guidelines on this matter in 1979. In view of the increased awareness of the relationship of family planning to the health of mothers and children, will it be possible to review those guidelines, which may now not be so relevant as perhaps they were then?
Secondly, the Government have generously increased support for multilateral agencies such as IPPF, UNFPA and WHO, but it is a fact that within 760 the whole of the overseas aid budget only about 1 per cent. is spent on population activities. I ask the Minister: is this enough? Thirdly, I understand that the ODA offers expert technical advice and assistance on health and population matters to those countries lacking a proper health infrastructure. Again, I ask the Minister: is this technical expertise adequate to meet the growing needs of developing countries?
§ We know from the world fertility survey and other research that women would like more family planning services and that they will use appropriately offered and accessible services. We know too that governments in developing countries are increasingly committed politically to population policies. Therefore, as I have said, it is not a question of imposing our values on them but of assisting them to overcome those gigantic problems.
§ This is a moral question. The morality lies in protecting the health of women and children. The question of the right to life arises here. It is the right of women to continue to live and not face death through continued childbearing, and it is the right of children to survive and to live a healthy life.
§ 5.57 p.m.
§ Lord Bauer
My Lords, I wish to thank the noble Baroness, Lady Lockwood, for her Question and for her eloquent speech. My remarks will focus on the linking of aid to birth control.
The heavy toll of infant, child and maternal mortality in LDCs must arouse compassion and concern. But we should be wary of trying to influence people to limit their families. The reason for this was epitomised in this House by the notably compassionate noble Baroness, Lady Gaitskell, exactly two years ago to the day, on 29th October 1984. Rebuking other speakers, the noble Baroness said:What right have they to tell other people how exactly they are going to have their families—whether large or small?".This is the heart of the matter. Do we have the right to press people in their most vital private decisions? People in the third world do not procreate heedless of consequences. They know about birth control. Traditional methods of birth control were widely practised in societies that were far more backward than the high-fertility contemporary LDCs, where moreover, people have access to cheap Western contraceptives and where for many years now cheap Western-style goods—hardware, cosmetics, soft drinks and cameras—have been ubiquitous. Yet the use of condoms, the Pill and interuterine devices has spread only slowly, even when they are subsidised. Western-style contraceptives are often absent when sophisticated articles of feminine hygiene are on sale, as in Nigeria. All this suggests that people do not want to restrict their families or prefer other methods.
In LDCs, as in the West, the great majority of people want the children that they have. Children give satisfaction; they provide an outlet for affection; they enable people to project themselves into the future; and much more than in this country, they contribute significantly to family income and serve as a support for old age. They often also bring prestige and influence. In all these contexts, the benefits to the parents outweigh the cost and the benefits from one 761 highly successful child exceed the cost of the others. Most of these benefits are not registered in the national income, which, though useful as an accounting concept, does not measure welfare.
Thus in the third world the children who are born are generally desired. They are certainly avoidable. To deny this amounts to saying that third world parents are both ignorant and driven by uncontrollable sexual urges. This treats people with unwarranted condescension or even contempt. Intense pressure against prevailing mores induces insecurity and tension. Morevover, in LDCs more than in the West, advice, education and persuasion shade readily into coercion. The notorious compulsory sterilisation campaign in India in the 1970s and the brutal forcible abortions in China are only extreme cases. In India, allocation of trading and taxi licences, access to subsidised housing and promotion in the civil service have all been used to force people to limit their families.
It is often said—it was clearly suggested by the noble Baroness, Lady Lockwood, and had been said here in reply to the noble Baroness, Lady Gaitskell—that without pressure by the West the population in LDCs would be unmanageable by the year 2000. This is unwarranted. To begin with, these forecasts are normally wildly out. In the 1930s, the population scare meant the prospective depopulation of the world. If the numbers really threatened people's welfare in LDCs, they would modify their reproductive habits as people have done in the West.
The linking of foreign aid to birth control also arouses political suspicions. I was told repreatedly in Africa that Western insistence on birth control there reflects Western fears that larger numbers inevitably bring greater political influence. Such suspicions are understandable, even if unfounded.
Genuinely voluntary family limitation will, however, come about through external commercial contacts for people at large. These bring about uncoerced changes in attitudes. They have already resulted in voluntary family limitation in much of the third world, and will result in more if they are extended. On this ground, as well as on others, the aid programme, while and where it operates, should be directed towards governments who foster economic advance through humane leadership, effective limitation and personal freedom. Linking age to birth control works in the opposite direction.
§ 6.3 p.m.
§ Viscount Craigavon
My Lords, I am glad to support the Question which the noble Baroness, Lady Lockwood, has tabled and the way in which she presented it.
The subject of the Question is similar to and partly stems from a conference that I attended in February this year organised by the United Nations in The Hague for parliamentarians in Europe. This has been mentioned by the noble Baroness, Lady Lockwood.
The full title of the conference was "European Parliamentarians' Forum on Child Survival, Women and Population: Integrated Strategies". The reference to integration was to emphasise the connected aspects of those subjects as well as being a reminder of the 762 integrated efforts of the three arms of the United Nations, which had joined together to organise this forum—the WHO, UNICEF and UNFPA, the United Nations Fund for Population Activities.
As well as the conference being addressed by the heads of those organisations, the main speakers were mostly from developing countries offering their own experience and feedbacks, on the basis of which discussions took place in groups consisting mainly of European MPs. From those groups recommendations emerged for political action and progress in terms that politicians use and can understand.
Needless to say, there was no one simple or unitary solution to the problems posed in these varied fields, but it was a most useful and successful conference, and one which concentrated on the need for the integration of efforts in these fields of child and maternal health, and population.
While being mindful of this relatedness, I should say that my particular field of interest is population, as I am vice-chairman of the all-party group on population and development, a group that was originally conceived and nurtured into existence by the noble Lord, Lord Houghton of Sowerby, who is currently its president.
The report of the forum is now available from any of the sponsoring UN agencies, and I recommend it to the Government and to anyone else interested in this subject. There is also a copy in the Library of the House of Lords and in the Library of the House of Commons.
I should say that the report is not some manifesto imposed by the UN, but a practical attempt by working politicians to suggest how parliamentarians can contribute in these areas. The report of the conference is far too detailed even to begin to sum up here, but part of what I will be saying tonight derives from my experiences there.
I hope that the Government will support the integrated approach advocated at the conference as well as encouraging UN agencies, in particular UNFPA, by their wholehearted support—support not least to UNFPA financially—following pressures and effective withdrawal of funding by the American Government. Perhaps the noble Baroness the Minister can comment on this. I would hope that we could now increase our funding to UNFPA as soon as possible, not only to give a lead to other countries, but to show that we do not share the reasoning of the United States in this. I believe that the Netherlands and, indeed, Finland have already given a substantial lead in that direction.
I would also advocate increased funding, if I may say so at this point, for the IPPF—the International Planned Parenthood Federation—which, following similar American vicissitudes, has been extremely energetic in trying to obtain alternative funding. Again we should continue to recognise those increased efforts and encourage its excellent work financially even more.
To return more directly to the question on the Order Paper, one thing particularly that became clearer to me at the European conference was the scandalous level of maternal and infant mortality, much of which 763 could be prevented at minimal cost by the right integrated approach and organisation.
Family planning elements can form part of that approach, and are extremely cost-effective in reducing mortality. This is particularly so in contributing to effective child spacing, which allows the mother and children time to become stronger, and for the mother to avoid pregnancy at times in her life when she is most at risk. Family life must be enhanced by strong mothers with strong children.
It has been estimated that in the developing countries today 5.6 million infant deaths and 200,000 maternal deaths could be avoided if women were able to choose to have their children within the safest years of their lives, and with adequate spacing between births and completed families of moderate size. This represents half of all infant and maternal deaths now occurring.
For detailed argument on this very important area, which is central to Lady Lockwood's Question, may I refer anyone interested to just one remarkable paper given at this European forum, and mentioned by the noble Baroness, Lady Lockwood, that by Dr. Attiya Inayatullah, who is Minister of State for Population in Pakistan. It is printed in the report and is entitled, "Child Spacing, Child Survival and Maternal Health".
If understanding and appreciation of the problems referred to in the Question is increasing, as I believe it is, slowly and inexorably, what can we in this country do, and what can the Government do? The noble Baroness, Lady Young, will note that I am not here asking for more money, but for a redistribution in emphasis to this area, particularly family planning components. By that I mean within the ODA and the effect that department has on its development projects.
Without expecting answers tonight, and in view of the increasing importance of population matters, I ask whether there are enough staff within the department allocated to that area? Do staff generally have training so that they are aware of the population aspects of whatever they are doing?
Externally, the ODA obviously has great experience in responding to and assessing requests from other countries. It clearly would not push family planning and health components in inappropriate circumstances. With the often desperate needs of today's developing world, many requests must be for projects showing immediate or short-term results. I believe that we have a duty also to encourage the longer term thinking and benefits involved in some health and family planning projects. We should find ways of encouraging countries to come forward for funding in this area.
We know that the world fertility survey has shown the massive unmet need for modern contraceptive methods in the developing world. That is from those who have said that they would want to use such methods if they were available.
We are now, for example, aware of the desperate and immediate problems in Africa. Last June, The Times, in a leading editorial entitled "Africa: Help for Self-Help" used the words "frantic" and "frightening" to describe Africa's population growth. That was 764 echoed during the same week in a letter to The Times from the chairman of the all-party group on population and development as he had recently returned from a conference in Zimbabwe. I shall quote three sentences from the letter where, after giving some examples of stresses caused by rapid population growth, he said:There is keen awareness among African parliamentarians of the stresses that rapid population growth places on national development and a growing recognition of the part that family planning services can play in reducing some of these stresses. These perceptions were very much in evidence at the All-Africa Parliamentarian Conference on Population and Development held in Harare last month and attended by parliamentarians from 31 countries in Africa. It is vital for developed nations to respond positively to help the Africans to help themselves in the long-term task of slowing down population growth.Finally, it has always struck me as a poignant paradox that so much of the thought in this area has been about numbers: numbers surviving or merely existing—the quantity of population. We should always bear in mind that in the long run the quality of life that people lead is also important. I hope that what I have said ultimately points in that direction.
§ 6.13 p.m.
§ Lord Rea
My Lords, my noble friend has chosen one of the most important topics in the modern world today. She should be congratulated on that. She is right to link the problems of rapid population growth in the developing world with the problem of excessive child and maternity mortality. I have been interested in this topic for a number of years. Last year I was fortunate enough to be the United Kingdom observer at a IPU-WHO conference in Thailand on health and development.
For many hears it was thought that where there was a problem of a rapidly expanding population, equalling or outstripping the growth in national income, it was illogical to spend resources on lowering the mortality rate of children, as increasing the chances of child survival would only exacerbate the problem. Some of us who were concerned with lowering excessively high child mortality and suffering in the third world feared that we might not be helping the problem in the long term but might even be exacerbating it by increasing the population.
In fact, experience over the years has shown that those countries that have been the most successful in improving the position of women and children and in lowering their mortality rate have shown the greatest progress in reducing their fertility rate. It is not difficult to see why that has been the case. Countries which have high child and maternal mortality rates are, paradoxically, the ones in which at present the population increase is the greatest. That applies especially to Africa, south of the Sahara, South Asia and parts of Latin America. In those countries it makes economic sense for families, as the noble Lord, Lord Bauer, pointed out, to have as many children as possible for several reasons. Where there is no social security system parents expect children to provide for them in their old age. They are an economic asset to them even in childhood.
In one study it has been calculated that a child can, by the age of 15, have repaid all the expenditure on it until that age. In such an economy, from the age of 765 seven a child can start to be useful around the house and on the farm by, for example, caring for younger children; by the age of nine, by fetching water, caring for goats and cattle, cutting crops and harvesting or transplanting rice; by the age of 12, if there are jobs available, children are capable of working for wages and adding to the family income; by the age of 13, they may be useful tilling the land. Those activities have been observed in a study in Java. That is paralleled in many other countries.
Where one child in four dies on average, there will be many families where two, three or even all the children in a family die and so for insurance the desired family size will be over four and perhaps six, seven or even more children. However, in those countries which have succeeded in reducing the number of child deaths, there is a decline in the birth rate within one generation. Once parents have confidence that their children will survive, the need to have many children declines. The Oxfam field directors' handbook puts that well:Most people will choose to have small, well-spaced families only when they have sufficient economic and emotional security not to have to depend on their offspring".Until the second half of this century, it took one or two generations for the birth rate to fall after the fall of the child death rate. Now it takes less than a generation. A fall in child deaths has been found time and again to come before a fall in the birth rate. Paradoxically, if more children survive now, the world population will eventually be lower; in other words, a stable state such as the industrialised countries now enjoy with low mortality will be reached earlier.
Demographic trends over the past few hundred years have had three phases. First, there is a stable phase with a high birth rate and a high mortality rate. That existed all over the world until the Industrial Revolution. It still exists in some of the most remote communities. In Europe, slowly during the 19th century, with increasing prosperity, mortality rates began to fall and the population began to rise quite dramatically. We had our own population explosion in the last century. The population more than trebled in Britain between 1800 and 1900.
That is the unstable phase, with decreasing mortality but persistently high birth rates. It is the phase through which the developing world is passing today. Even after the birth rate comes down, there is still an increase of population because of the large proportion of young people after a rapid population increase. Even if we were able to bring the birth rate down to two children per couple, there would be a continuing increase in the world population well into the 21st century.
Until the third or stable phase is reached, with low birth and death rates balancing each other, the increase in the population of parts of the third world, especially Africa, is occurring now at a much more rapid rate than in the industrial North a century ago. Equally, and luckily, there are signs that a decrease in birth rate is occurring more rapidly in some countries than it did in Britain, Europe and the United States. I would emphasise that the situation is far from hopeless. We have seen quite dramatic decreases in fertility in some countries over the past two decades, with China leading the way and Cuba in second place. 766 Many other countries, particularly in South East Asia, have also been quite successful in reducing their fertility rates. In parts of some countries success in reducing the birth rate has been greater than in the country as a whole. In the State of Kerala in South India, for instance, total fertility fell from 4.1 per 1000 in 1972 to 2.1 in 1978—after only six years—despite that state being very poor.
It is worth looking at those three places—China, Cuba and the State of Kerala—and asking why they have been more successful than some other countries, particularly in Africa south of the Sahara. In all three there has been a positive policy on the part of the government to upgrade the state of the rural peasantry by actively promoting community development and particularly by encouraging literacy among girls as well as boys. One of the most striking correlations throughout the third world is between female literacy and both a low infant mortality rate and a decreasing birth rate.
The better educated a woman becomes the less is she content to spend the best years of her life raising a very large family. She is more able to see the possibility of other activities, such as engaging in small cottage industries, thus increasing her income, and she is better able to understand any health or contraceptive advice which is given to her through her primary health care clinic or health post. That applies both in the rural situation and in the many urban shanty town conglomerates. In the rural areas lack of such facilities may result in a continuing high birth rate but in the cities it is quite likely to lead to a high abortion rate. In those circumstances that will lead to hight mortality among women because of the complications of illegal back-street abortion.
Because there are signs of some success in certain countries, it does not mean that the situation is not urgent in a large part of the developing world, where child mortality rates are still alarmingly high and half of all deaths may occur in children under 15. Most governments in developing countries now recognise the need to do something about this, but the will, I would suggest, is not enough. There is a tremendous amount of experience and expertise throughout the world, but especially in this country, on how to tackle this problem both tactfully and effectively. Family planning activities are nothing like as effective if they are sporadic and not part of a continuing primary health care coverage. That is what the World Health Organisation's call for "Health for all by the year 2000" really means.
Aid from the industrial north, if it is to be effective in this area, should be channelled so that it reaches the very poorest people in every country—the majority. If it reaches only a few the demographic impact will be minimal. Primary health care provision is much more effective if it can be simultaneously linked to programmes which increase education and encourage small communities to become more self-sufficient and self-directing by the provision, for instance, of help with improving agriculture, developing local water resources and in marketing of agricultural or industrial products. The setting up of rural industries with appropriate technology should be part of these schemes.
767 Some of these activities are as applicable to the shanty towns as they are in rural areas. I think that many noble Lords are aware that much excellent work is being done throughout the world and much of it through non-governmental agencies. I would encourage the Government to collaborate closely with these non-governmental organisations and to help them perhaps by even more than the "pound for pound" assistance which they now give. I also feel that this country's expertise could be used far more in bilateral assistance programmes than it is at the moment. It is often easier to see that money is well spent in this way. Our expertise in this country, which has been developed over decades, needs to be used. It is rather disappointing to see that the proportion of government aid that is devoted to population activities seems not to have changed over the years.
Perhaps I have over-simplified the case. It is enormously complex. My basic point is that the measures which are most effective' in reducing infant, child and maternal mortality rates are the very same as those which lead parents to aim for smaller families. I echo the noble Lord, Lord Bauer. It is the wish of parents to reduce the birth rate which matters, rather than the wish of governments. The measures necessary in order of importance are these: education, especially of women; the provision of basic health care and improved nutritional education; and a degree of economic stability and progress. Many of these measures depend upon a new deal for third world countries, such as lifting or limiting the debt burden, stable prices for commodities and some protection for and investment in local industry and agriculture for local consumption. This is a small price to pay for averting the kind of disastrous situation we see in parts of Africa today.
Over many years of involvement in the development of tropical countries this country has built up an impressive battery of expertise. But we hear at present of staff cuts and the closing down of units financed by the Overseas Development Administration across the whole range of technical assistance. We have the most enterprising publishing houses in the world in the United Kingdom. What are the Government doing to aid and encourage the flow of books, for instance, and teaching materials to satisfy the tremendous thirst for knowledge which exists in the third world? I think that this, as much as the provision of contraceptives, would help the world to reach the third and stable demographic state which I mentioned earlier.
The Government should take the long-term view and not penny pinch now. The kind of investment that I have outlined would reap benefits of good will, and later of trade, which would greatly ontweigh the small extra [...] that it may incur at the moment.
§ 6.28 p.m.
§ Lord Henderson of Brompton
My Lords, I want to approach this important subject from a slightly different point of view from that of those who have already spoken, though our objectives are no doubt much the same, except for the views and objectives of the noble Lord, Lord Bauer, who seems, when he hears 768 the words "development" to salivate like Pavlov's dog and becomes almost rabid. The truth is, I think that the noble Lord would have addressed Dr. Jenner in the 18th century in much the same terms as he addressed the House this afternoon. I think that is probably the short answer to the noble Lord, though I shall refer to him later in my speech.
My point of view is that which was taken in the debate in this House on 14th May on the importance of the prevention of disability. Thus the ill-health associated with ill-planned or unplanned pregnancies and the disease and disability of children born as a result of those pregnancies should, in my view be looked at as preventable and avoidable disabilities. In those developing countries that have proved unresponsive to family planning, perhaps the most persuasive way of winning acceptance and consent is to present it as an essential part of any primary health service which includes, as a matter of course, preventive medicine. We have been pioneers in preventive medicine in this country. The rest of the world has benefited accordingly. One cannot promote health without taking steps to avoid disability by the prevention and by the alleviation of disabling conditions.
The noble Baroness Lady Hooper, replying to the debate on 14th May, said:Developing countries in particular can now be expected to do more to prevent disabling conditions arising from, for example, poor perinatal care, malnutrition and infections. A net result should and we hope will be a reduction of new disability among children and infants".—[Official Report. 14/5/86; col. 1185.]I would add the words "among mothers as well" as, indeed, did Mr.Tim Eggar at the end of a debate in another place on 25th July. He said that,we must recognise that family planning is a key preventive health measure and that in poor countries it is a real force for improving child survival and maternal health".—[Official Report, Commons, 25/7/86; col. 848.]Those two ministerial statements, one in either of the two Houses of Parliament, are immensely encouraging. But we should press the Government to step up, if possible, the proportion of aid spent on population activities and family planning. Most of those who have spoken in this House feel, I believe, that the percentage is at present too low. The specific earmarking or dedication of funds within the total aid programme should ensure that those funds reach their intended destination.
We have all talked about developing countries. That is a useful concept. I was particularly struck by the leading article in the Economist last week entitled "Richer than you" stating that it is, in economic terms, better to think of a four-way split instead of a two-way split among the non-comunist countries. In the first category, the article put Japan alone, and, in the second category, North America and Western Europe, those categories comprising what we normally call the developed countries. The third category consisted of the NICs, or newly industrialising countries—so called because their economies are moving so fast—pre-eminently South Korea, Taiwan and Hong Kong. However, according to the Economist, most of Asia and Latin America are within that group, or soon could be. Last, there was the fourth category, the Continent of Africa, where 769 movement is hardly discernible. This concept of a four-way split can be useful when considering the distribution of resources, which are the subject of the Question.
It can be argued that the newly industrialising countries will, as they develop and grow richer, accord greater respect to women and increasingly provide Western standards of preventive medicine, including family planning and, where necessary, abortion. There is considerable evidence that as a country prospers, so also does its health improve and its population stabilise. On that argument, although the newly industrialising countries need every penny they can get now, we hope that they will increasingly be less dependent upon us. By contrast, those in the first two categories, the developed countries, should be concentrating their greatest efforts on the Continent of Africa which does not look as if it can pull itself up by its own bootstraps unaided.
A recent issue of a magazine called People, published by the IPPF, was devoted entirely to Africa, including the Francophone areas. I should like to paraphrase if not exactly quote a number of considerations put forward by black African men and women in that magazine. The first comment was that population policies must be based on specific African social and cultural features. I suspect that the noble Lord, Lord Bauer, might agree with that. Another comment was that family planning can only be introduced as a support for traditional child spacing and the other needs of the people. Here again, I would hope to carry the noble Lord, Lord Bauer, with me in respect of that statement made by an African person.
Another comment was that a particular effort should be made to integrate the anthropological dimension into research and programmes concerned with population, health and development in African societies. Again, the noble Lord, Lord Bauer, would, I hope, agree. A further comment was that we need to carry out better research into the social situations when considering the introduction of family planning. I would ask the noble Baroness, Lady Young, whether she agrees with those sentiments put so recently in People, issued under the auspices of the IPPF.
The most notable observation was made by the Togolese director of family health for the United Nations in South Africa. I recommend what she says, as an African woman, as being more important in this debate than the remarks of a European man who has contributed words to a contrary effect. She says that West African women may not be directly aware of the social and economic arguments for reducing the high fertility rate prevailing in most of the region. She is saying that they may be ignorant, to use the word of the noble Lord, Lord Bauer, of the benefits that are available. But she goes on to say that these women definitely want help in spacing their families.
If they want help in spacing their families—we are told by an African woman that they do—who are we to deny it to them? She goes on to say:Family planning in Francophone countries has usually been integrated with other developmental improvements, which lays firmer foundations for the future".That is an expression by a highly experienced African woman with which we can all agree,
770 Finally, I should like to quote from WHO's regional director for Africa, Dr. Monekosso, who is another African expert, speaking on this subject. He said:A lot of countries in Africa have shifted their approach to family planning and quite a few countries are now requesting programmes of family planning, particularly if these are integrated into maternal and child health services".Perhaps I may ask the noble Lord, Lord Bauer: if these countries are requesting such programmes for family planning who are we to deny them if we are capable of delivering what they are asking for?
In conclusion, I should like to repeat what I said at the outset: that these matters are best considered as part of a health package of aid—primary health care—which if necessary can be separated from other forms of aid such as food aid. However, in my view and the view of the Africans whom I have quoted, it is best presented as part of a total package of primary health care.
§ 6.42 p.m.
§ Lord Vernon
My Lords, like other noble Lords in this debate, I believe that the noble Baroness, Lady Lockwood, has raised some very important issues in the question that she has asked. These are issues which are all too often swept under the carpet because on the whole politicians are unwilling to face up to the implications of unrestricted population growth in the third world. This is largely because the effect of such growth will not be felt for several years, and several years is a long time in politics. Also, there is a body of opinion in this country, perhaps represented by the noble Lord, Lord Bauer, who believe that in any case the third world should be left to their own devices and we should not interfere. On the other hand, I believe that we are a single world now—
§ Lord Vernon
My Lords, I believe that we are a single world now, and we cannot escape our responsibility to help others less fortunate than ourselves, particularly as the noble Lord, Lord Henderson, has said, when they ask for it.
While I was very interested to listen to the remarks of the noble Lord, I found that I could agree with very little that he said.
Before I continue, perhaps I should declare an interest. I am the chairman of a UK charity called "Population Concern". Our aims are to raise funds for population and development programmes around the world, and also to raise awareness about the nature, size and complexity of world population, especially as it affects the social and economic development of mankind. We work in close co-operation with the IPPF, with the ODA and with the United Nations fund for population activity.
The high rate of maternal and infant mortality in developing countries is one of the more disturbing symptoms of our exploding population growth. To 771 give a single example, in Bangladesh, which is the most densely populated country in the world excluding island and city states, and where the present population of 104 million will double in 26 years, one in seven of the children will die in their first year. Eighty-one per cent. of women are illiterate. That refers back to what my noble friend Lord Rae had to say on the subject of literacy.
I sometimes wonder what people like the noble Lord, Lord Bauer, would think if we were told that the United Kingdom population of 56 million was going to double within the next 26 years. Would we do anything about it? Of course we would.
§ Lord Bauer
My Lords, it is not a question of the population of the United Kingdom, or the population of Bangladesh. The question is what parents decide about the number of children they want to have. I tried to introduce my remarks by directly referring to what the noble Baroness, Lady Gaitskell said on this subject. It is not an abstract concept such as the United Kingdom or Bangladesh. It is the decision made by parents about the size of their families. This is what matters.
§ Lord Vernon
My Lords, I understood that point perfectly when the noble Lord made it. However, I was talking about Bangladesh. If one allows every woman in Bangladesh to have as many children as she wants, the result is going to be absolute disaster. I quote Bangladesh as one of many similar examples because it is a country where Population Concern has helped to bring health and family planning services to 42,000 couples in the slum areas of Chittagong. We have done so partly as a result of the tireless efforts of the well known actress Susan Hampshire who has personally raised more than £30,000 for the project, but also because of the substantial grants which we have received from ODA. I should like to take this opportunity to express our appreciation for this very welcome government assistance.
The health of mothers and their babies is only one aspect of the rapid rate of population growth which is taking place in the third world. It is a little difficult to grasp the scale of the crisis in human terms with which we shall be faced within the next three decades. There will be twice as many people on the face of the globe as we have today. The increase coming almost exclusively from the poorer countries in Africa, Asia and Latin America. It is not just a question of how they will be fed—they probably can be fed—but in what conditions they will live, and how, if at all, they will be employed. It is not the fact of population growth which is so disturbing, it is the speed with which it is happening. There is an important distinction here which is often overlooked.
Then there is the effect of people on the environment. The United Nations Environmental Programme Report of 1985 stated that population growth was outpacing the capacity of a number of developing countries to provide for their economic and social well-being. The pressures thus generated were depleting natural resources faster than they could be regenerated. Some of the more visible consequences 772 of this degradation are to be seen in the deforestation, desertification, soil erosion and slum proliferation which is already taking place.
On the subject of deforestation, I should like to read something to your Lordships. This quotation is from the World Bank report. It says that in Gambia and Tanzania the population growth has made wood so scarce that each household spends 250 to 300 worker days gathering the wood it needs, that is in addition to the commercial timber which is being felled.
In a speech to the United Nations special session on Africa on 28th May this year, the Foreign Secretary said that safeguarding the environment and facing the problem of population growth were two issues where the lead has to come from government. He also said that government would give any help that they could. I should like to ask the Minister, when she comes to reply, whether, in the light of those encouraging remarks from the Foreign Secretary, the Foreign Office will reconsider—and this question has already been asked by the noble Baroness—the proportion of overseas aid allocated to population and family planning. I am not asking for more funds for overseas aid as a whole; I am merely asking that there should be a redistribution of the existing funds.
In view of the present serious situation which the Foreign Secretary himself recognises, surely the existing tiny proportion of 1 per cent. could be substantially increased. If the ODA were able to make more funds available for these purposes, then organisations like that which I represent would be able to respond positively to some of the many requests which we now have to refuse.
These are complex issues and there is no simple solution. However, we know that appropriate and accessible family planning services reduce the toll of infant and maternal mortality and slow down the destructive rate of population growth. If no further action is taken or if it is taken too late, one of two things is likely to happen: either coercive measures of an unpleasant kind to restrict population growth will have to be undertaken by the governments of the countries concerned—rather like those measures which the Government of China have already introduced, which no one would like but which are very necessary in the circumstances in which they find themselves—or more likely, the job will be done for us by nature, and nature does not always act very kindly.
§ Lord Bauer
My Lords, before the noble Lord sits down, will he consider the third possibility; namely, that people will modify their reproductive habits if numbers threaten their welfare?
§ Lord Vernon
My Lords, I am afraid that I did not quite catch the beginning of the noble Lord's remarks.
§ Lord Bauer
My Lords, I am so sorry. Has the noble Lord considered the third possibility: that if the growth in numbers genuinely threatens people's welfare, they will modify their reproductive habits in the third world in exactly the same way as they have done in the West?
§ Lord Vernon
My Lords, I think that they may do so to some extent, but evidently the Chinese, who have great experience in this matter, did not think that it would be effective.
§ 6.52 p.m.
My Lords, first, I should like to join with others who have spoken in this debate in complimenting my noble friend Lady Lockwood not only on the nature and purpose of her Unstarred Question, and, indeed, on the speech with which she introduced it, but also on her perseverance in bringing this important matter to your Lordships' attention. Your Lordships will recall that she tried to do so last June when she first tabled this Question, but unfortunately at that time she was a casualty of a very congested timetable in your Lordships' House. It is still congested, but at least we seem to have come to discuss this Question at a more reasonable hour than was possible when my noble friend first raised the subject.
My noble friend and others—notably, my noble friend Lord Rea—have dealt in detail and specifically with the problems of maternal and infant mortality in developing countries, and there is little that I need add in a statistical or analytical sense on that aspect of the matter. I should like to make some more general comments which are prompted by the nature of my noble friend's Question.
My noble friend's Question was urgent last June; it is urgent now; and unfortunately it will continue to be urgent for the foreseeable future because the interrelated problem of ill-health, on the one hand, and rapidly increasing population, on the other, needs to be constantly brought to the attention of the public. I am glad that my noble friend is taking this opportunity to do so.
Sometimes when we face this and similar problems in the third world the problems are so immense that one wonders whether debates such as this do any more than add one tiny drop in an ocean of compassion. However, I am sure that this kind of debate produces results. My mind goes back 20 years to when I had the privilege, together with my right honourable friend Barbara Castle, of establishing the Ministry of Overseas Development. I recall that my right honourable friend was very keen and very forthright in identifying the population problem as one that needed firm action from the new ministry and vastly increased resources. I also remember that when she brought up the subject she encountered quite a bit of diffidence from the officials. It was considered to be a subject of some embarrassment at that time—perhaps one that ought not to be discussed in front of the children or even in front of bashful civil servants. However, she persisted and ever since then, under governments of both complexions, it is true to say that the ODM as it was then, and the ODA as it is now, has had a good record in matters of population control.
Today the whole question of family planning is much more openly and frankly discussed in government and other circles, and, indeed, in international circles. I recall that when I went to conferences in those days, especially those in Africa, I was advised to be very cautious when raising the 774 question of family planning in the hearing of representatives of African governments.
However, we have heard this evening that that picture has considerably changed. The noble Viscount, Lord Craigavon, and, I think, my noble friend Lady Lockwood, told us about various conferences which have come under the auspices of the All-Party Parliamentary Committee on Population and Development. In particular, there was a reference to the attendance of Mr. Morrison at an African conference in that series. He reported that the conference was attended by 40 African countries. The noble Viscount mentioned the figure of 31. I think that there were 31 countries with parliamentary governments and another nine which did not have parliamentary governments, so there were 40 African governments at that recent conference.
As I recall, he reported in a debate in another place that those African governments were now quite forthright in having a strong commitment on matters of population control. The opinions which the noble Lord, Lord Henderson of Brompton, has brought forward from African spokesmen seem effectively to contradict the views which the noble Lord, Lord Bauer, said he picked up from contacts in Africa. Certainly there is a real change in the atmosphere in which these matters are discussed and dealt with.
I very much welcome the way in which in her Question my noble friend links concern for health and family planning with economic development. In that connection I was delighted that the noble Lord, Lord Vernon, took part in the debate this evening not only because of the effective speech to which we have just listened, but because he will recall that he and I were together a decade ago at a conference held at St. Ermin's Hotel which initiated this series of all-party parliamentary groups on population and development. I recall, as I am sure the noble Lord does, that at that conference and in Berlin a few days later we insisted that it was not enough just to direct our attention to family planning and population questions, but we should indicate the essential link between health, education and other development matters and the question of size of family and other family planning questions. That is why I was pleased to find in my noble friend's Question stress put upon the interaction between population programmes and development.
But I should like to point to a danger which can emerge from this stress on economic development. The danger was highlighted only a few minutes ago by the intervention of the noble Lord, Lord Bauer, during the speech of the noble Lord, Lord Vernon. The emphasis on the need for development is seized upon by opponents of programmes of population control who say that the special provision of contraceptives and family planning advice is not necessary. They say that we should simply concern ourselves with development, with uplifting the living standards of the people of the third world, and then the population problem will go away much as it did, so it is asserted, in the European and North American scenes. They point to Western economies where increasing standards of living have brought about smaller families and slower increases in population.
775 That thesis I believe to be entirely misguided. In the present world, in the present situation in the third world, it is the staggering pace of population increases and the way in which resources are being outstripped that is so devastating. We are faced with rapid increases in population in many third world countries which are far exceeding the resources available for feeding those populations.
For example, if we can, as I think we should, take the African scene as of crucial importance in these matters, the growth in Africa's food supply compares favourably with that in the world as a whole, but its increase in human numbers is far more rapid. Plagued as Africa is by the fastest population growth of any continent in history, as well as by widespread soil erosion and the spread of deserts, Africa's food production per person has fallen by 11 per cent. since 1970.
That is the sad illustration. But fortunately recent experience has shown that countries with broad-based but inexpensive health care systems, and well-designed family planning programmes that encourage small families, can bring fertility down even without a widespread economic gain similar to that in industrial societies. The outstanding example, which has been referred to by a number of speakers, is China. As part of the post-Mao reassessment Chinese leaders projected future population size based on the assumption that couples would have only two children. Even under that assumption, given the country's youthful age—and I have been to China a number of times recently and the youthfulness of their population strikes one—China would add another 300 million or 400 million people before growth of population ceased.
Therefore, the leaders in China, after relating these projections to the availability of economic resources, concluded that they had no choice but to go further than the two-child family. They went to the one-child family, and through that means over the last decade they have reduced the birthrate by 41 per cent. All that in one decade. But it shows that direct family planning programmes are necessary and that it is not sufficient to reply solely on the indirect effect of economic development.
This brings me to the point that it is necessary for us to do all that we can, as others have said, to back up the work of such organisations as the International Planned Parenthood Federation and the United Nations Fund For Population Activities. I am sure that the Minister when she replies will be able to give us information of the good record of the Government in support of those two organisations. As I think my noble friend Lord Henderson, or another speaker, said that is particularly welcome in view of the contrary policy that was pursued by the United States in respect of financial support for those two organisations. We were glad that the British Government resisted the example and the advice of the United States in these matters, and I feel confident that having resisted that advice from the United States the Government will resist the advice coming from the noble Lord, Lord Bauer, in these matters.
776 I nevertheless point out—and here I echo my noble friend Lord Henderson of Brompton—that though we are glad about what has been done, the resources in relation to the size of the problem are inadequate. I hope that the Minister has been listening to the pleas from speakers in this debate that more should be done and more resources should be made available. In that connection I repeat what I think my noble friend Lady Lockwood said. I hope that the Minister can assure the House that the ODA continues to implement, and indeed update, the undertakings given some years ago now that all its development projects would be vetted to ensure that, wherever possible, population control methods should be linked with development projects in an integrated way.
The great value, as I see it, of the wording in my noble friend's Question is to put stress on that point. The provision of family planning advice and the physical resources for contraception need to be seen not as projects in isolation. They need to be integrated with other programmes, particularly in relation, as the Question suggests, to health and the care of mothers and children.
On that note, perhaps I may quote again from the publication that my noble friend Lord Henderson of Brompton quoted from, although from a different edition, because I came across a pertinent illustration of this at the grass roots. It was a question being asked of a Chinese family planning worker. She was asked what changes she had seen recently. She replied:Because maternal and child health care and family planning came to be carried on side by side, the attitude of the residents towards us softened and today they greet us with a smile".That I believe to be the most important aspect—that integrated projects have a much better reception from those to whom the message is directed. I hope that the Government agree with this, as I feel sure they do, and that they will do all that they can to ensure that that is the way our population programmes are implemented.
§ 7.10 p.m.
§ Baroness Young
My Lords, I am sure that we are all grateful to the noble Baroness, Lady Lockwood, for raising this important issue this evening. The link between health and family planning is an important one. Family planning raises fundamental questions about family life. Large families are customary throughout the developing world, especially in rural areas where a person's status is often measured by the size of his family. In Africa, the population is rising particularly fast. The tragedy of Africa's immense human and economic problems has undoubtedly made population growth an important part of the development agenda. In the past decade governments have increased support for family planning programmes, particularly in Africa. Zimbabwe, Kenya and Botswana have already put programmes in place to provide family planning services to all couples and individuals. Other governments are following, often with help from aid donors such as ourselves.
We certainly recognise that family planning is of particular significance as a preventive health measure. High levels of infant mortality are a major factor in the desire of many people in developing countries to have large families. Each year more than 15 million 777 children die for simple and often preventable causes such as poor nutrition, pneumonia of measles. Children born into large, closely-spaced families are at particular risk. Yet parents will not want smaller families until they are confident that their children will survive. Maternal mortality is also influenced by the number of children a woman has had. Family planning is therefore acknowledged as being a major force for improving child survival and maternal health. The Hague Conference, mentioned by the noble Baroness, Lady Lockwood and by the noble Viscount, Lord Craigavon, highlighted these issues. I have read the report with great interest.
The Overseas Development Administration is taking positive measures in this area. Bilateral and multilateral contributions in the health, population and nutrition fields, have risen from £20 million in 1981 to over £30 million in 1985. ODA officials make special efforts to ensure that all new aid projects take into account population implications wherever possible and appropriate. I hope that that answers the first of the questions put to me by the noble Baroness, Lady Lockwood, and confirms the point that the noble Lord, Lord Oram, made in his winding-up speech. Clearly there are some areas such as engineering or transport projects that do not by their nature accommodate population components, but I can assure the noble Baroness and the noble Lord that social and environmental factors are taken into account in bilateral aid projects. The noble Baroness went on to ask me whether expert advice that is given is enough.
Professional advice on health and population is vital and the ODA use both in-house specialists and outside sources for advice and expertise. However, it must be remembered that such programmes can only be implemented with the co-operation of third world governments backed by their own health professionals. Moreover, basic decisions on the focus of programmes must be left to the recipient governments. I was also asked a number of questions about resources. The noble Viscount, Lord Craigavon, and the noble Lord, Lord Oram, asked me about multilateral population activities, in particular, the support for the IPPF and the United Nations Fund for Population Activities. I can confirm to the noble Lord, Lord Oram, that the United States Government decision to withdraw support to the IPPF and the United Nations Fund for Population Activities reflects a domestic decision to withdraw from all programmes in which abortion or abortion-related activities take place. Our understanding is that the decision does not reflect an assessment of the ethics or value of the work of either organisation. The ODA intends to continue its support for both programmes. Indeed, we have substantially increased our contributions to both organisations in recent years, and we shall take account of this loss of income in planning our contributions for 1987.
I should also comment at the same time on the point raised by the noble Viscount, Lord Craigavon, about staff and say that ODA has an agreed complement of a chief medical and health services adviser, two medical advisers, two nursing advisers, two population advisers and a part-time nutrition adviser, all at headquarters in London. There are a number of 778 vacancies at present although all except the senior posts are being filled on a temporary and, in some cases, a part-time basis. We are currently recruiting new nursing and medical advisers and we hope that the posts will be filled early this next year.
On this point on resources, finally, may I comment on the point raised by both the noble Baroness, Lady Lockwood, and the noble Lord, Lord Vernon, on the percentage of aid spent on family planning. In recent years, spending on population activities; that is, family planning, maternal and child health, has represented about 1 per cent. of gross total public expenditure on aid and we are hoping to increase this figure.
Our bilateral health assistance programmes attach particular importance to maternal and child health. For example, in Kenya, a country which is estimated to have the world's fastest-growing population, we are working with other donors on a project which integrates rural health and family planning. This is designed to create an interest in family planning services as well as improving the availability and quality of services offered at rural health and family planning clinics. In India, we are helping to improve the health of members in a dairy co-operative in Gujarat through mobile teams and by training a woman from each village to provide basic health care to mothers and children. We have developed health and population activities as part of other projects such as slum improvements, sewage disposal and water supply. We are currently evaluating the health impact of these improvements and working with local authorities to provide basic health services including mother-and-child health and family planning. These programmes will become more important as people in the developing world drift from the villages to the cities.
We are financing a number of multilateral programmes in both the health and population sectors. Much of this assistance is channelled through multilateral organisations to which I have referred, such as the United Nations Fund for Population Activities and the International Planned Parenthood Federation. These contributions have more than doubled from £5.5 million in 1980 to just over £12 million in 1986.
In addition, about 40 per cent. of our total aid programme is channelled through the major multilateral agencies such as the World Bank, the European Community and the United Nations. All these organisations fund health and population projects. Under the European Community, health and population programmes are at an early stage of development and my right honourable friend the Minister for Overseas Developments intends to take this forward when he chairs a meeting of the Development Council next month.
The ODA also tries to improve financial and management practices by placing emphasis on increasing the effectiveness of health services in poor countries. This depends on two main factors. First, an ability to make widespread services affordable; and, second, to provide enough trained staff to run them. In response to shortages of health service staff, we finance a programme designed to strengthen health services, policies and strategies in poor countries. This is 779 complemented by a British training programme under which trainees can undertake courses either in this country or elsewhere.
The noble Lord, Lord Rea, in his speech and the noble Lord, Lord Vernon, referred to non-governmental organisations and I was grateful for the acknowledgement that the noble Lord, Lord Vernon, paid to ODA help over the project in Bangladesh. But we value the role of NGOs in improving the wellbeing of mothers and children and encouraging them to take responsibility for their own health. We provide a considerable level of support for these organisations; £7.7 million will be given this year, which will help to fund the over-1,000 volunteers working in developing countries. Assistance to the poorer sections of the community is very effectively achieved through the joint funding scheme under which the ODA provides matching contributions to projects run by 24 charitable agencies. This scheme involves £5.5 million this year, the bulk of which is dispersed through Oxfam, the Save the Children Fund, CAFOD and Christian Aid. Current projects include a corrective surgery and rehabilitation and vocational training for handicapped children in India by the Save the Children fund, a rural health population project in Nigeria by CAFOD and a project devoted to the training and education of women in Tanzania by Oxfam.
In answer to the point raised by the noble Lord, Lord Vernon, perhaps I may say that the ODA would certainly be prepared to consider requests from Population Concern for new activities. We are in a position to influence our multilateral expenditure, which takes the form of voluntary contributions to various multilaterial health and population programmes. Our record is good in this area. In 1985, we increased our contributions to multilateral population organisations by almost 50 per cent. over the 1984 levels, and in 1986 by a further 10 per cent. Spending on the bilateral programme is variable because the pattern of ODA's aid is broadly shaped by the demands from aid recipients.
We recognise that programmes under all these schemes must be implemented with care. Here I agree with the point made by the noble Lord, Lord Bauer, that individuals, couples and communities must not feel coerced. The links between child spacing, child survival and maternal health are now relatively well known in the third world. We must therefore educate people about maternal and child health and family planning and we must reassure them about its relevance to their lives and the lives of their families. In this respect, it is also important to remember the broad aims of our overseas aid programme. We want to help relieve poverty, raise living standards, improve the status of women and raise the standard and number of effective managers.
Finally, I say to my noble friend Lord Henderson, to whom I listened with great interest, that yes, we agree with the points that he read out. I hope he will accept, from the figures that I have given and the points we have made, that we agree with the general thread of his argument on the correlation between family planning and maternity and child health.
780 Achieving the objectives which the noble Baroness, Lady Lockwood, outlined in her remarks and the objectives of our overseas aid programme will of course have a significant impact not only on the health of individuals but also on families and communities and will also lead to smaller, well-spaced families.