Some of the primary obstacles to family planning in various areas are: insecurity and conservatism of families owing to high levels of mortality, particularly infant mortality; socio-cultural traditions and values whereby the status of women is determined by their fertility; high values placed on the birth of sons or on large families so as to ensure support and security in illness and old age; and deficiency or lack of health care and other supportive social services, limited family resources, and related socio-economic and educational considerations.
Many efforts in family planning have started not as health programmes but as population control programmes focused on goals and targets expressed as numbers of 'acceptors' rather than on providing family planning care as a vital health measure within the context of health services. In addition, in some areas the methods included in family planning services are too difficult or unpleasant for regular use by individuals who are not highly interested in or concerned about planning their families; and the major and minor side effects of many methods discourage regular use. Inadequate provision of easily accessible health service of good quality for follow-up of these conditions has served as a deterrent to increased participation by the people concerned, particularly in rural areas.
Many cultural beliefs, values, and traditional practices are antithetical to family planning practices. In a society where a wife may be returned to her family if she does not bear several children, couples are not likely to adopt measures to space their children. Likewise, in a society where marriage occurs at an early age and the birth of a child within a reasonable period after marriage determines the suitability of the wife, or where demands to produce male offspring are paramount, measures to delay the birth of the first child or to adopt measures for child spacing before one or more male children are born are not readily accepted and practised.
Closely allied to the cultural barriers are various beliefs and feelings of morality relative to sexual behaviour and interference with the procreative function. For example, in situations where pregnancy outside wedlock is considered immoral but many unmarried women, especially teenagers, are becoming pregnant, education in ways to prevent such pregnancies is unusually complicated and delicate or even forbidden.
The whole subject of family planning is surrounded by emotional overtones. In almost all societies, sex, pregnancy, and reproduction are associated with certain taboos. Males may discuss certain aspects with males, and females with females, but there are certain subjects in almost all cultures that cannot be discussed in mixed groups or even at all. Individuals who are influenced by these taboos may not feel free to discuss family planning with their spouse or their children. They are likely to be even more reticent in discussing the subject with a health worker who is a stranger, particularly one of the opposite sex.
There may also be resistance or indifference on the part of both professional and auxiliary health workers. While many obstetricians and gynaecologists are helpful, there are some who insist that their duty is to bring children into the world and not to engage in family planning care service, and this makes the educational task more difficult. Similarly, midwives and birth attendants may in some instances perceive child spacing as reducing the need for their services and the amount of their income. A closely allied factor is the confusing advice that may emanate from different programme sources or from different physicians. Because of the rapid developments in the field of family planning, particularly during the past 10-15 years, and the new contraceptives being produced, different organizations as well as different physicians may recommend different action. Such divergent advice can easily discourage individuals in need of family planning care services from taking and implementing decisions.
There is often confusion regarding the purposes for which family planning care services are offered. The health reasons for delay and spacing of conception may be obscured when the services are seen as measures to limit the size of families. This confusion is reinforced further when family planning is not viewed in the context of maternal and child health and other health services, such as education for family life and responsible parenthood, genetic and premarital counselling, nutrition, prevention of illegally induced abortions, and management of infertility.
In some countries, people have avoided family planning services because they perceived them as an impersonal governmental programme with little or no concern for the people's health and welfare. Health workers whose religion forbids certain forms of interference with conception are often in conflict when their tasks include family planning care services and counselling of individuals.
2. The population issue is fixable. We have the technology. We have the knowledge. We have the ability. We can do it without doing what China did, or any other programmes that tend to be coercive. Yet we've bound ourselves up with all of these excuses about why we don't need to do it, or don't want to do it.