High fertility and population growth have been framed as villains in global health and development. Inspired by neo-Malthusian concerns around resource depletion, scholars have argued that fertility reduction through increased contraceptive use is necessary to protect maternal health, prevent environmental disaster, and promote economic prosperity throughout the Global South. Despite substantial critique from feminist and anticolonial scholars, the scientific evidence behind these arguments has often been treated as established fact. This ostensible scientific consensus on the instrumental benefits of contraceptive use has been marshalled by the global family planning establishment in the wake of the 1994 International Conference on Population and Development to justify continued efforts to maximize contraceptive uptake in the Global South. Here, we critically examine the evidence linking high fertility to adverse maternal health, environmental, and economic outcomes and evaluate whether reducing fertility through increased contraceptive use offers an effective strategy to address these challenges. We find the state of the evidence weaker and more conflicted than commonly acknowledged, with many claims relying on small effect sizes and/or unjustified assumptions. While increasing contraceptive uptake and reducing fertility may offer limited, marginal advantages, we argue that family planning cannot effectively address the multidimensional challenges of global poverty, ill health, and environmental degradation. Instead, global health and development should address root causes of these phenomena, while family planning programs must radically refocus on reproductive autonomy.

高生育率和人口增长被认为是全球健康和发展的罪魁祸首。受新马尔萨斯主义对资源枯竭担忧的启发，学者们认为，通过增加避孕药具的使用来降低生育率对于保护孕产妇健康、防止环境灾难和促进整个南方国家的经济繁荣是必要的。尽管女权主义和反殖民学者提出了大量批评，但这些论点背后的科学证据往往被视为既定事实。1994 年国际人口与发展会议之后，全球计划生育机构就使用避孕药具的益处达成了表面上的科学共识，以证明继续努力在全球南方最大限度地提高避孕药具的采用率是合理的。在这里，我们批判性地研究了高生育率与不良孕产妇健康、环境和经济结果之间的联系，并评估通过增加避孕药具的使用来降低生育率是否是应对这些挑战的有效策略。我们发现证据的状态比普遍承认的更弱、更矛盾，许多主张依赖于较小的效应规模和/或不合理的假设。虽然提高避孕药具的采用率和降低生育率可能会带来有限的边际优势，但我们认为，计划生育无法有效应对全球贫困、健康状况不佳和环境退化等多层面的挑战。相反，全球健康和发展应该解决这些现象的根本原因，而计划生育方案必须从根本上重新关注生殖自主权。