The existence of an official policy or statement of government support, however, does not guarantee effective action (210, 250, 254). For example, Pakistan has had a national population policy since 1960, but frequent changes in government personnel and a lack of high-level support for family planning have held back the program (110 ). Despite substantial international donor support, family planning has received low priority from the government, and thus it has been difficult to operate an effective national program (226).

In some countries where political leaders have not actively supported family planning, they have given tacit approval and created a climate of tolerance, enabling nongovernmental organizations, international donor agencies, and the private sector to meet the rising popular demand for family planning (240, 263). For example, in some Latin American countries contraceptive use has become widespread without strong population policies or government family planning programs (214, 270). While the governments of Costa Rica and Mexico have provided strong support for family planning, governments in Argentina, Brazil, Chile, and Colombia have been reluctant to provide contraception, partly because of opposition from the Catholic Church. In these countries the impetus for providing family planning came first from the medical profession and then from family planning associations (110 ).