Family planning dramatically improves the health and chances of survival of both women and their children. At the same time, when parents are more confident their children will survive, they are more likely to have fewer children and plan the size of their families. U.S. international development and humanitarian assistance should support both child health and family planning programs as complementary initiatives.

Sexual and reproductive health services, including family planning, are among the most important elements of the global effort to contain the HIV/AIDS pandemic. Through a well-established infrastructure, they help provide the supplies, education and information that are known to be effective in preventing the spread of infection.

Reproductive illnesses and unintended pregnancies undermine economic development by weakening and killing adults in the prime of their working lives, by disrupting and cutting short the lives of their children, and by placing heavy financial and social burdens on families. In most developing-country settings, much of the loss of life and human productivity that is due to poor reproductive health could be prevented with affordable and cost-effective programs.

The West African nation of Niger was propelled to the headlines several months ago over reports of starving and dying children amid denials by its government that the country was enduring a sustained food emergency (seasonal fluctuations in the availability of food are not unusual in the arid Sahel region, they argued). Niger is perhaps better known as the country falsely accused by the Bush Administration of selling uranium to Iraq – an issue that later became the object of the Valerie Plame scandal. But Niger is confronting a genuine scandal: one-quarter of its people are facing yearly food shortages. Meanwhile, its population is set to double in less than 20 years and contraceptive use among Niger's men and women remains at one of the lowest levels of any country in the world.

Across the globe, adults wring their hands over the behavior of young people, yet are often unable to communicate effectively with them about their sexual and reproductive lives. Parents, teachers and other adults widely fail to prepare young people with the information, skills and resources needed to chart a steady, healthy course through the transition to adulthood. Parents' difficulties in managing their own sexuality, combined with cultural beliefs about parenting, sexuality, and gender all constrain their ability to prepare young people. Failing to provide critical information, skills and support to young people sends them out into the world inadequately prepared for life.

In this era of tight financial resources for international family planning – as evidenced by the recent budget cuts proposed by President Bush in the United States – are the world's donated contraceptives reaching the women and men who need them most? A review shows that while donors of such supplies often focus their resources on countries with high need, they could do so even more effectively.

Shortages of critical reproductive health supplies (RH supplies) around the world are undermining progress towards achieving the Programme of Action established at the International Conference on Population and Development in Cairo and the poverty reduction targets included in the Millennium Development Goals. Without supplies, no health or poverty reduction program can be successful.

HIV prevention has long been approached at the level of individual behaviors, operating to some extent under the assumption that behavior is determined by a person's conscious decisions. However, a paradigm shift toward considering the physical and social environments in which individual HIV risk behavior takes place is gradually gaining momentum. These structural factors-whether political, economic or cultural-may directly or indirectly affect an individual's ability to avoid exposure to HIV.1 The Dominican Republic offers an example of this progression from successful individual HIV behavioral interventions among sex workers, toward broader community approaches and policy initiatives.

Weak infrastructure and limited distribution systems in low-income countries complicate access to health services, especially in rural areas. Government health outlets may be relatively few and widely dispersed, and private-sector sources often favor wealthier urban areas, resulting in uneven service availability within a country. In the absence of a solid heath infrastructure, strengthening primary health care and innovative community-based health service delivery systems help provide more equitable access to health services.

Few outsiders are likely aware of the stagnation of Pakistan's family planning program, which provides key services and affects the country's larger demographic trajectory....Pakistan was among the vanguard countries in Asia in starting a family planning program more than five decades ago, with intermittent support from international donors including the United States. Yet fertility has declined more slowly in Pakistan than in most other Asian countries.