To have or not to have: the critical importance of reproductive rights to the paradox of population policies in the 21st century.

Reproductive rights continue to be under threat, even some 15 years after the landmark International Conference on Population and Development in Cairo declared the importance of a satisfying and safe sex life, the capability to have children, and the right to decide on the timing, number, and spacing. The right to choose whether and when to have children is at risk both from some who seek to increase birth rates through pronatalist policies and from some who seek a return to "population control" as a response to global climate change, environmental degradation, endemic poverty, global recession, and food shortages. This paper argues the success of the rights-based approach to family planning, reproductive health and health education, and outlines issues and policy responses related to low fertility. This is contrasted with the unmet need for family planning in the poorest countries. It calls for health providers to advocate for reproductive rights, affirming that the freedom of women to control their fertility is the basis for other essential freedoms.