Talking about contraception puts Apio Christine Peace, a Ugandan health worker, in a pessimistic mood. Peace, who is currently working for Care International in a refugee camp in the war ravaged north of her country, would like more Ugandan women to be given the means to control their fertility, not least because Uganda has one of the world’s fastest growing populations, projected to triple by 2050 to about 103 million citizens.1 She highlights her concern about Uganda’s ability to sustain such a rapid growth in population by pointing out the gradual loss of the country’s natural forests. Poor agricultural practices and overpopulation are causing the erosion.

“Part of the forest reserve was recently given over to a soft drinks plant. I just think the government isn’t committed to the environment. There is poor provision of family planning services, and so the population is on the increase. Women do want control over their fertility, but many are in circumstances where they don’t have a choice. It is still a highly patriarchal society where men dictate how many children a wife has.” The average number of children per mother is 6.6 in Uganda, and there are 550 maternal deaths per 100 000 live births. Use of modern contraception remains low, at 18%.2

Peace’s perspective—that the lack of access to sexual and reproductive health services is a major spur to population growth—is unfortunately not one that attracts the big international aid dollars. In fact, international aid to family planning schemes has shrunk dramatically over the past 15 years. Between 1994 and 2008, funding for reproductive health as a proportion of global health aid dropped from 30% …