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.

An unchallenged fixture of many news stories about population aging and decline in developed countries today is the idea that “replacement fertility”-the number of children women must have, on average, over their childbearing years to produce a stationary population-is 2.1 children. The extra tenth of a child is needed, the explanation often goes, to make up for the children who don't themselves survive to parenting age.

Donor assistance for population, reproductive health and HIV/AIDS programs continues to increase, but the benchmarks used to assess performance have not changed since 1994. Those who monitor donor performance say that current assistance is not sufficient and that the benchmarks need to move upwards. This review of recent efforts to revise cost estimates for reproductive health and HIV/AIDS services concludes that $35 billion to $45 billion annually will be needed from all sources over the next few years. At the same time, further research is needed to improve the accuracy of such estimates.

New foreign assistance strategies that aim to encourage ownership by recipients while still effectively reducing poverty are laudable. They offer the hope of increased financial support to overall global development-a bigger pie-but they also pose significant challenges to the family planning field: Will it be able to keep a slice of that pie?

Over the last two years, the architecture of U.S. foreign assistance has undergone an unprecedented restructuring. At the same time, a congressionally-mandated commission on poverty-focused development has issued its report; a Senate staff delegation has conducted an extensive overseas fact-finding mission; and numerous nongovernmental organizations, think tanks, and presidential campaigns have issued policy prescriptions on the future of U.S. foreign aid. In all of these efforts, insufficient attention has been paid to the implications of actual and proposed changes in the U.S. foreign assistance program to the future priority and funding of family planning and reproductive health (FP/RH) care overseas-highly successful and cost-effective programs that have received U.S. government funding since the 1960s.

Whatever one's view about population as an issue, few people fervently wish the world were home to a lot more human beings than it is. Some may wonder if another Mahatma Gandhi or an Albert Einstein or a Mother Theresa missed out on being born due to the declining global birthrates of the past few decades. But most know that such a question is fundamentally unanswerable and don't stay awake at night thinking about it.