The 1980s will go into history as a decade of lost opportunities to increase contraceptive prevalence and improve reproductive health worldwide. As the decade closes, 500 million couples still have no access to fertility regulation, there are 30-50 million induced abortions each year, 15 million infant and child deaths (30% of all deaths worldwide), an estimated 250 million new cases of sexually transmitted diseases and 60-80 million infertile couples. One of the major problems is that many policy makers are still unimpressed with the global demographic reality. World population was less than 300 million 1991 years ago. It took some 1500 years to double this number by the time of the voyages of columbus to America. The first billion was reached at the beginning of the last century and the second in the lifetime of the author, in 1927. Then it took less than 50 years to double this number to 4 billion by 1976. Global population is 5.3 billion today. In view of such figures, it is understandable that, historically, it was this demographic concern that in the 1960s persuaded many governments to support family planning programmes. During the subsequent decades, it was gradually recognized by developing country governments that family planning lowers infant, child and maternal mortality and morbidity and reduces the number of illegal abortions and their health hazards. Today, 52 developing country governments support family planning programmes for the demographic rationale, but 65 for the reproductive health and human rights rationale. Where do we go from here? That will mainly depend on the number of years it will take to reach replacement level of fertility (around 2.1 children per couple) worldwide. If the level is reached in 2010 (the low projection of the United Nations), global population will stabilize by the end of the 21st century at 8 billion; if it is reached in 2035 (medium projection), population will stabilize around 10 billion; however, if it is reached only in 2065 (high projection), the global population in 2100 will consist of more than 14 billion people, with major consequences on every walk of life. To restrict the final population to 10 billion, contraceptive prevalence must increase from 51% to 58% of married women of reproductive age before the year 2000 and to 71% by 2020, implying an increase from the present 350 million users to 500 and 800 million, respectively. Whether or not these ambitious targets can be reached will depend not only on the availability of a wider choice of safe, acceptable and affordable contraceptives and greatly increased international and national funding, but also on fundamental changes in a number of behavioural, educational, sociocultural, economic and, last but not least, political factors. The perception of many governments must also change; they must realize that contraceptive prevalence represents the key not only to improved reproductive and environmental health, but also to demographic and economic development.
