want to get pregnant but are not using contraception.12 Among the reasons
for this unmet need are a lack of knowledge about contraception, difficult
access to supplies and services, the cost of contraception, fear of side effects,
and opposition from spouses and other family members. Family planning
programs have been shown to be effective in reducing these obstacles, thus
reducing unintended pregnancies and birth rates.13 For example, one of the
best known and most influential controlled family planning experiments
was undertaken in the Matlab district of Bangladesh. Matlab’s population
of 173,000 in 1977 was divided into roughly equal experimental and control
areas. Starting in 1977, the quality of family planning services (including
home visits, access to an array of contraceptive methods, and follow-up care)
were greatly improved in the experimental half of the district while no additional
services (other than much less intensive country-wide services) were
provided in the control half of the district. The impact of the new services
was large and immediate:14 contraceptive use among women of reproductive
age jumped from five to thirty-three percent in the experimental area in the
first eighteen months and remained about twenty-five percent higher than
in the control area in subsequent years. As a result, fertility declined in the
experimental area and the difference between the areas of about 1.5 births
per woman was maintained over time. The Matlab experiment convincingly
demonstrated that family planning programs can substantially reduce fertility
in a very poor country.