The State of the Union Address That Kickstarted International Family Planning Programs

As President Obama prepares to deliver his annual State of the Union address to a joint session of Congress this evening, advocates of the U.S. government’s investments in international family planning and reproductive health programs need to be reminded of an important milestone in the history of U.S. leadership on population issues that occurred 50 years ago this month.

In his second State of the Union on January 4, 1965, President Lyndon Johnson uttered these words:

“I will seek new ways to use our knowledge to help deal with the explosion in world population and the growing scarcity in world resources.”

Only 25 words out of several thousand, yet with those words President Johnson gave greater encouragement to the birth control movement than any of his White House predecessors.  Although his statement was rooted in concern about overpopulation and natural resource scarcity, the president’s statement gave new and deliberate priority to family planning as an issue worthy of the U.S. government’s attention and action.

According to former PAI Executive Director Phyllis Tilson Piotrow’s definitive 1973 history of the origins of U.S. government involvement in family planning, World Population Crisis:  The United States Response, “It was undoubtedly the most-quoted sentence in the message.”

This brief mention in the State of the Union address was the culmination of accelerating behind-the-scenes government activity that had been building since the beginning of the 1960s. But the willingness of a President to risk his own prestige and influence by talking about population—an issue previously deemed too politically controversial to take on—bolstered activists within the U.S. Agency for International Development, the State Department, and the former Department of Health, Education, and Welfare.

Among the leading external activists encouraging President Johnson to have the United States lead the world community in addressing population issues after the 1964 election were prominent individuals like William H. Draper, Jr. and Cass Canfield, two of the founders of PAI.  As we commemorate the silver anniversary of President Johnson’s bold words, it is no coincidence that PAI is also celebrating its 50^th anniversary this year.

In the wake of LBJ’s January address, USAID launched its first population and family planning program in 1965. By 1969, USAID had established an Office of Population to provide technical leadership and coordination in developing and implementing population and family planning programs. In reading a fascinating history of USAID’s global health program, 50 Years of Global Health: Saving Lives and Building Priorities, it’s striking to see all of the strategies developed by the population and family planning program that have been applied to solving other public health problems in more cost-effective and impactful ways.

Although the contributions of what is now known as the Office of Population and Reproductive Health deserve a much longer and exhaustive treatment, here is a list of just a few:

• Creation of the Demographic and Health Survey (DHS) which collects accurate data on health indicators in developing countries for use in program planning, budgeting, and service delivery;
• Use of interactive computer modeling to help developing country policymakers visualize the impact of policy and funding decisions, in a program known at RAPID;
• Demonstrating that community-based distribution (CBD) of health information and supplies could be successfully delivered by well-trained laypersons from the local community;
• Understanding how to efficiently organize commodity procurement and to develop a system for supply chain management and logistics that has expanded beyond contraceptives and condoms; and
• Social marketing to increase health product availability by employing market-based principles for development.

In many respects, the world in 2015 is vastly different than that which existed in 1965. The rationale and justification for providing family planning and contraception has shifted from an emphasis on overpopulation to a priority on sexual and reproductive health. But the necessity of providing women and couples around the world the services and information to prevent unintended pregnancies and space births remains no less vital.  While there is no expectation that President Obama will elect to devote any time in tonight’s address to demographic challenges or to expanding sexual and reproductive health and rights, that does not diminish the fact that these issues are as critical as ever, 50 years hence.