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Many of the policies and spending priorities aimed at curbing population growth have been based on a combination of inadequate data, wishful thinking and faulty logic. To resolve some of the misconceptions about population issues, there is a need for expanded scientific research using experimental designs to gather conclusive evidence about the relative effects of various approaches to curbing population growth.
If population growth is one of the world’s most serious problems, you wouldn’t know it from the relatively small investment of money and strategic thinking provided by the nations of the world. Altogether, the developed nations of the world contribute less than a billion dollars a year toward family planning assistance in developing countries. This is less than four days’ budget of the U.S. Department of Agriculture. It is less than half the cost of one stealth bomber. If we really want to accelerate the solution to the population problem, we will need to invest collectively far more now. For there is little doubt that a population doubling from 5.5 billion to 11 billion will have far greater impact than the doubling we have just experienced in the last 40 years.
Many population myths are based on unverifiable or imaginary relationships. Often, however, beliefs about population are based on interesting and plausible-sounding correlations (yet unproven) that may provide hints of possible relationships.
Someone once said, "Hell is truth, seen too late." Many policy makers and funders have been reluctant to recognize overwhelming evidence that some of their pet beliefs are countered by impressive evidence.
The predominant myths about population include:
…. Misconceptions about the nature of the problem;
…. The belief that population growth poses no threat;
…. The belief we cannot do anything about population growth; and
…. Beliefs about simple approaches that are mistakenly believed to hold promise of a quick fix to the population problem.
In the list above, the fourth area (interventions intended to solve the population problem) is the most important for those concerned with population policies. How should the world spend its limited resources in order to most rapidly bring about diminution of population growth and ultimate stabilization of numbers? While there are important and widely held myths even among population professionals, there is also good news that is not widely known. There are interventions that have been shown to rapidly bring about reductions in desired family size and actual fertility. Some of these interventions are described at the end of this paper.
Misunderstanding The Nature of The Problem
Population growth of the magnitude we are experiencing now is a phenomenon of the second half of the 20th century. As recently as 1925, India and many other developing countries were at zero population growth. While birth rates and death rates were both high in these countries, they were at the same level, so that population growth rates (the net of birth rates minus death rates) were zero or close to zero.
The following table, adapted from Measuring Mortality, Fertility, and Natural Increase by James Palmore and Robert Gardner, gives a quick historical look at world population growth rates:
Annual Crude Rate of
Natural Increase (Per 100)
Birth rates (number of births per 1000 population) and total fertility rates (the number of children a woman would theoretically have in her life span if she followed the current fertility patterns of each age group in the population) have both been dropping on a worldwide basis during most of the latter half of the 20th century. The decline has been particularly notable since 1970.
Instead, the very high rates of growth of the world’s population result primarily from declining mortality levels, particularly among infants and children, most especially among developing countries. For example, in 1920, just over 56 percent of male babies survived to adulthood in Sri Lanka. By 1967, this had changed to over 90 percent (Palmore and Gardner, 1983; Palmore and Gardner did not include similar data on females). The same is true in country after country: declines in mortality were so much faster than declines in fertility that the result was unprecedented net rates of population increase.
The potential exists in some countries for further reduction in infant and child mortality rates. In addition, throughout the world there is increasing life expectancy for adults. Some gerontologists believe it is possible that, within the next 50 years, medical science will find a way to slow the aging process by interrupting the genetic signals that cause age-related deterioration. If this occurs, the rate of population growth could increase.
Rapid population growth in the second half of the 20th century is the result of widespread inoculation programs and other public health measures that have led to declining death rates and a consequent gap between traditionally high birth rates and recently low death rates. The only way population growth can stop is if the birth rate and death rate reach the same level. Since removing public health measures or otherwise allowing the death rate to rise once again to the level of the birth rate would cause great human suffering, most of the efforts at population stabilization have been focused on reducing birth rates. Various approaches to reducing birth rates will be discussed later in this paper.
“We should not worry about population growth.”
Generally, political leaders have not talked much about population issues, both because of their own misunderstandings of the problems population growth is causing and because of the sensitive nature of population issues. Furthermore, the time frame in which population growth occurs is much greater than the election cycles of most democracies. Political leaders are most likely to talk about immediate crises and not address long range problems.
The assertion that rapid rates of population growth somehow stimulate economic growth has been made by economists for a long time but achieved prominence during the Reagan Administration. As advocated by Julian Simon, Malcolm Forbes Jr. (in an editorial in Forbes magazine) and others, the contention is that rapid rates of population growth stimulate consumerism and that the added demand fuels economic growth.
The opposite may well be true. As explained by Ansley Coale (1963) of Princeton University, there is a direct relationship between rapid rates of population growth and declining economic conditions in underdeveloped countries. The economies of many developing countries, such as those in Africa and Latin America, are being retarded by the fact that a high percentage of personal and national income is spent on the immediate consumption needs of food, housing and clothing–because there are too many children dependent on each working adult–leaving little income at the personal or national level available to form investment capital. Lack of investment capital depresses growth of productivity of industry and leads to high unemployment (which is exacerbated by rapid growth in the numbers seeking employment). Lack of capital also contributes to a country’s inability to invest in education, government, infrastructure, environmental needs and other areas that can contribute to the long-term productivity of the economy and living standards of the people.
In the 20th century, no nation has made much progress in the transition from "developing" to "developed" until it first brought its population growth under control. For example, in Japan, Korea, Taiwan, Hong Kong, Singapore, The Bahamas and Barbados, rapid economic development, as measured in gross national product per capita, occurred only after the country had achieved a rate of natural increase of its population below 1.5 percent per year and an average number of children per woman of 2.3 or less. Herman Daly, Senior Economist at the World Bank, believes that similar criteria probably hold for other countries (personal communication). Simply put, if the assertions by Simon and Forbes were true, the slow growing countries of Europe and North America would have weak economies, while the economies of sub-Saharan Africa and the high-growth countries of Asia and Latin America would be robust.
The real measure of economic welfare is not gross national product or national income, but the median income on a per capita basis. Stimulating gross national product by having more and more people buying fewer and fewer necessities does not enhance economic welfare. It may be true that a few people profit from population growth, but the mass of the people do not.
The logical extension of the saying "Necessity is the mother of invention" is that deprivation is good because it stimulates innovation. Ben Wattenberg and similar authors point to the fact that various innovations have averted disaster and that technological progress has enabled many people to lead lives of relative comfort compared to a few decades ago.
On the other hand, population professionals point out that the greatest causes of problems are solutions. Indeed, the population problem is the result of technological innovation in the field of medicine, as well as the humanitarian distribution of medical services throughout the world, thus lowering the death rates and increasing average life expectancy.
Whether necessity is the driving force behind technological development is questionable. People living in the 14th century were in desperate need of the medicines that have been invented since World War II. But human knowledge had not progressed to the point where that was possible.
People living in Bangladesh are in great need of technology to control typhoons, but to say that their suffering is good because it might stimulate such development would be both cruel and ludicrous.
Technological innovations are mostly driven by an economic system that allows for investment in basic and applied research and consumer-funded demand for products and services. Regions with severe overpopulation and related poverty and starvation may not have the luxury of time and energy for invention.
Indeed, technological growth may ease us through some of the potential crises of the future, but there is little about the current magnitude or nature of world population growth that will accelerate technological progress, and in the meantime, many people are bound to suffer needlessly.
The technology cure argument is in part a reflection of a certain fatalism–that we can’t do anything about population growth so we might as well put a positive spin on it. It also reflects a mind set that favors the "greatest good for the greatest number of people," which for some means "large numbers are good." It is a very different mind set to favor planning for the number of people that are sustainable for the long-term future under reasonable expectations regarding technology. Even if changing technologies allow for some expansion of population numbers in the future, the limits of social institutions and the needs of other species for habitat make it imperative that we question the desirability of adding more and more people to the population.
It often seems as if opposition to population planning is motivated by a fear that curbing population growth will involve some great evil rather than a humanitarian process of planning the number of the human species that can be sustained within the current environment. In a sense, population growth in the face of inadequate current technology to sustain the people is akin to borrowing money with no prospect of being able to pay it back. It is a risky gamble which puts the burden on future generations who will suffer the consequences.
In recent decades, arguments that population growth is not really a problem, including those from the "boundless technology and resources" school, have been put forward by certain opponents of legal and accessible abortion. Some anti-choice advocates have recognized that concern with world population growth might lead to greater support for freedom of choice on abortion and have therefore set out to remove this pressure by attempting to prove that population growth is not a problem. The abortion issue may well have been a motivating factor for many of those making such arguments who were connected with the Reagan and Bush Administrations.
Some of the more outlandish claims of the "technology fix" advocates–for example, that we could ship our excess people to other planets–have almost been forgotten (imagine sending aloft 90 million people per year). Yet, while extraterrestrial migration is no longer taken seriously by most people, many of the unsubstantiated claims of new technologies that will "save the day" are still seen by many as a reason not to worry about population growth.
Particularly prominent in the 1970s during the discussion of the new international economic order, the idea has been promoted that there is enough food and other resources to support all the people currently on Earth.
While, indeed, there may be enough food grown each year to feed all the people currently alive, in demography, trends are everything. Even if we don’t consider global environmental consequences of population growth, some of the trends in agriculture are disturbing. The per capita production of grain products, which comprise the bulk of the human diet, has been declining since 1984, despite continued conversion of forest land into crop production and the Green Revolution of high-yield grains. Looking 10 to 20 years down the road, many countries face massive starvation; even today, 30,000 to 40,000 children die each day, mostly from the effects of malnutrition.
Some scientists believe that lack of drinkable water will kill more people over the next 20 years than lack of food. In China, 50 major cities face acute water shortages now; in India, Mexico, Egypt, the former Soviet Union and vast areas of the United States, water is being drained from lakes and aquifers at a rate from two to 20 times as fast as it can be replenished. Nearly a third of the world’s population is located in countries with severe water shortages, including many with the highest rates of population growth (Falkenmark and Widstrand, 1992). Because of the expense of desalinization, use of ocean water is currently limited to a few wealthy countries.
While it is certainly true that more equitable distribution of the world’s wealth and resources is possible, it is probably fanciful to imagine that the wealthy countries of the world will materially cut their standard of living by voluntarily giving a major portion of their wealth and resources to the world’s poor. If mal-distribution of resources is aggravating the population problem, is it responsible to do little to stop population growth? Would it not be better to slow growth as rapidly as possible while working on the distribution issue?
Whether massive redistribution of wealth and resources would lead to slower rates of population growth is not known. Virginia Abernethy, Professor of Psychiatry (Anthropology) at Vanderbilt Medical School and editor of the journal Population and Environment, points to a number of examples in which redistribution of wealth led to higher fertility rates (1993). In Cuba, after Fidel Castro replaced the unpopular dictator Fulgencio Batista in 1959, fertility climbed in every age group, suggesting that couples viewed the future as more promising as the result of the redistribution measures of the revolutionary government. They were inclined to believe that their greater wealth would enable them to afford more children.
According to Abernethy, "Algerian independence from France in 1962 had a similar effect on fertility."
Despite the above examples, there is widespread belief that economic development has a cause-and-effect relationship with reduced fertility levels and slower rates of population growth. The effect of redistribution of wealth and resources on population growth rates, however, could vary by country, depending on other factors that more directly affect fertility levels.
In the long run, however, redistribution of wealth and resources and changing power relationships among countries would not solve the problem of poverty and environmental degradation associated with high population growth rates, if population growth rates remain high.
The final answer has not been determined as to whether or to what extent economic conditions in developing countries may stimulate or retard population growth, but there is little doubt that slowing population growth throughout the world will make it easier to meet the basic needs of all the people.
Argued extensively at the Earth Summit at Rio in 1992, the exchange over whether the problem was with population growth or resource consumption masked the fact that we have both kinds of problems.
Those with only an environmental perspective can argue persuasively that consumption and waste in the developed world is the driving factor behind many global environmental problems, such as ozone depletion, acid rain and climate change. For example, industrialized countries, with less than one-fourth of the world’s population, currently account for about two-thirds of the world’s carbon dioxide emissions. The higher per capita consumption and waste production in the industrialized world has led some to conclude that all that is necessary is to reduce the per capita consumption in the West. This is, of course, part of the solution. But with populations of many Western countries continuing to grow (especially in the United States), reduction of total emissions of greenhouse gases is made more difficult. On top of this, the burgeoning populations of developing and industrializing countries want access to the automobiles, furnaces, manufactured goods and other items that are major contributors of greenhouse gases. And often these poorer countries reject the technologies to reduce emissions as too expensive. In order to improve the standard of living, some poor countries are trying to increase the ability of their people to consume resources.
As a result of very rapid growth rates of population and of energy use by developing countries, the U.N. panel on climate change projects that, by 2025, developing countries could be emitting four times as much carbon dioxide as the industrialized countries do today. Reducing population growth rates in the developing world would make a major difference in this problem.
A maximum sustainable population at any given level of standard of living would be one that would have no effect on the earth’s long-term carrying capacity. As per capita rates of consumption and waste production reach critical levels, the carrying capacity of the earth, in terms of numbers, diminishes. Combining rapid population growth with growth in per capita consumption is a sure formula for disaster.
There are no environmental threats that would not be alleviated by rapid stabilization and perhaps ultimate reduction in human numbers. Continued and accelerating population growth is making all the environmental problems more severe, if not insolvable.
In 1990, Prince Philip of the United Kingdom stated in a speech at the U.N.:
The population explosion, sustained by human science and technology, is causing almost insolvable problems for future generations. It is responsible for the degradation of the environment through the pollution of the air and the water; it is consuming essential as well as non-essential resources at a rate that cannot be sustained. Above all, it is condemning thousands of our fellow living organisms to extinction.
In February 1992, the presidents of the U.S. National Academy of Sciences and the British Royal Society issued a joint statement on population growth and resource consumption that included the following sentence:
If current predictions of population growth prove accurate and patterns of human activity on the planet remain unchanged, science and technology may not be able to prevent irreversible degradation of the environment or continued poverty for much of the world.
Proponents of this view point out that many family planning provider agencies and contraceptive research institutions are male dominated and that most methods of contraception (each with its own side effects) are intended for female use.
There is resentment over target-setting and coercive policies in some countries that emphasize birth control rather than comprehensive reproductive health care.
There is growing fear that women will be blamed for the world’s environmental crises.
It is certainly true that women are less the cause of the population problem than they are its victims. This does not negate the existence of a population growth problem nor the need to curb population growth rates. It does, however, point out the importance of adopting strategies that respect human nature and recognize the humanity and dignity of each individual, female and male.
There are growing numbers of population organizations, such as the United Nations Population Fund and the Population Council, that are headed by women. Generally, these organizations promote family planning as vigorously as male-headed population groups. Furthermore, surveys of women in many developing countries indicate that many want to limit their childbearing and want access to contraception. In fact, women who live in societies where they have power over their own lives tend to use family planning much more frequently than in countries where they are relatively powerless.
People are justifiably concerned about the spread of HIV infection and the growing number of deaths from AIDS. The alarm over this disease has caused some people to reach the conclusion that it has or will reduce population growth to zero worldwide or in some regions.
The World Health Organization (WHO) estimates that, as of 1993, about 14 million individuals in the world were infected with the HIV virus. The spread of this disease is already causing severe personal and economic hardship and may well have significant demographic impact in some countries.
Over the next decade, an average of approximately one million people may die from AIDS each year. This is a relatively small number contrasted with the current annual growth of the world’s population of approximately 90 million per year.
It is hard to predict what will happen with the spread of the HIV virus in the long run. In some places, information and motivation campaigns have helped to change people’s behavior and greatly slow the spread of the disease. Such programs may be successful in many more places around the world.
In addition, there are almost weekly reports of progress being made in medical technology, both to prolong the lives of those already infected and in research to develop a vaccine to prevent infection. How fast this work will progress is speculative, but already in the last few years, the survival period of those infected with the HIV virus has doubled.
Further, the virus itself is evolving. The history of many diseases indicates that it is possible that the evolution of the virus will be in the direction of being less virulent. An example of this is the bubonic plague of the 14th century, which killed about a third of the population of Europe before it subsided. The bubonic plague still exists, but is not the killer it once was. Some evolutionary biologists believe that natural selection favors viruses that take longer to kill their host, because it gives them a greater period of time in which to reproduce and spread to other host organisms. Already, we are seeing new strains of HIV evolve. Whether HIV will evolve in the direction of being less virulent remains to be seen.
“Even if we should worry about population growth rates, we cannot limit population growth.”
I constantly encounter people who believe that it is impossible to reduce fertility rates in many countries of Latin America or the Middle East because of religious opposition to family planning. What is not understood is that the Catholic Church and Islam do not oppose family planning in their teachings. The Catholic Church supports and provides broad-based sexuality education and encourages couples to limit the number of their offspring to those they can afford and nurture. However, the Church opposes the use of certain means (which it considers artificial) to achieve those ends.
The Koran teaches that women should breast-feed their infants for at least two years. According to some Islamic scholars, this inherently favors child spacing at a minimum.
Clearly, family size limitation and curbing population growth rates are possible in Catholic and Islamic countries. Italy has achieved zero population growth and has, along with Spain, among the lowest fertility rates in the world. Indonesia, an Islamic nation, has achieved remarkable progress in promoting family planning. The average woman there has three children compared to a four-child average in Asia outside of China.
Worldwide, in fact, there is no country where people are reproducing anywhere near the biological limit, and this was also true in pre-modern days. Clearly, people have some level of motivation to limit fertility rates and are acting on those motivations.
It may be true that cheap child labor is an incentive for some farm families to have many children. Whether this is a predominant view among rural families in the developing world is not known. To what extent this factor serves as an incentive for large families compared to other factors is also not known.
The logic of having children merely to provide cheap labor is open to question. Children require several years of sustenance and care before they are capable of productive work that is of greater value than what they consume.
It’s also clear that the "cheap child labor" factor can be overcome. The farm families of Sri Lanka and Indonesia have, on average, far fewer children than the farm families of sub-Saharan Africa. Mandatory education and child labor laws may add to the relative "cost" of having children. The world needs a better understanding of what it is that motivates some farm families to have large numbers of children and what factors have convinced others to limit their reproduction.
Old age security may be a motivator for childbearing and, in some countries like India, is clearly related to the preference for male children.
Nevertheless, how much do we really know about the extent to which economic security in old age is a motivating factor in childbearing?
Progress has been achieved in reducing fertility rates in many countries that have not instituted old-age security programs. That is not to say that such programs should not be put in place. Where they are established, however, it would be useful to carry out studies that attempt to measure the effect of such programs on family size preferences. It would also be valuable to conduct studies of the motivations that have reduced family size in countries where there are no old age security programs.
For many couples, the strategy of having a large family to provide old age security can be questioned effectively. If large family size leads to a division of land into very small plots, poverty and resulting rural-urban migration may make adult children unable to care for their parents and their own children. Many couples can find better security by having fewer children and educating those children so they can become gainfully
employed. One child with education and a job can provide more old age security than 10 children who are, themselves, starving.
Various people fill in the blank space above with a variety of answers, depending on their favorite cause and perspective on world issues. I will discuss four that are commonly raised in international population meetings: lowering infant and child mortality rates; economic development; elevating the status of women; and meeting the "unmet need" for contraceptive services.
The assumption behind this view is that people have large numbers of children out of fear that some of their children will die before reaching maturity. It is also assumed that, if infant and child mortality rates are reduced, people will quickly understand the reduced risk and adjust their fertility patterns accordingly.
The extent to which there may be a time lag between the actual reduction in mortality rates and popular understanding of the reduction of risk clearly is a function of both the mass media and the popular culture. Whether such understanding actually reduces family size preferences is not known.
As mentioned earlier, reduction in infant and child mortality rates since the early part of this century is a major cause of rapid population growth rates. While very significant progress in reducing infant and child mortality has occurred, it is clearly possible that further progress can be made in many countries. Whether the effect on attitudes regarding family size of such additional marginal reductions would be greater than that achieved already is questionable.
It is also possible to point to countries with high infant mortality rates (such as Sierra Leone, with infant mortality of 148 deaths per 1000 live births and fertility of 6.5 children per woman) where fertility rates are lower than in nearby countries with much lower infant mortality rates (such as Nigeria, with infant mortality of 84 per 1000 and fertility of 6.6 children per woman).
History shows that reductions in infant mortality have been only partially offset by reductions in births. Reducing infant mortality should be done for humanitarian reasons, but we should
expect it to cause an increase in population growth, at least in the short term.
Michael Teitelbaum of the Alfred P. Sloan Foundation points out:
In 1800, life expectancy at birth averaged less than 40 years for the world as a whole; by 1990 it had risen to 65 years globally (to 62 years in developing countries and 74 years in the industrialized nations). The key declines in mortality rates were among infants and children in the developing countries of Asia, Latin America and Africa, principally in the period since World War II. At the same time, however, there was no contemporaneous drop on the fertility side; for decades after mortality had declined greatly, many nations of Asia, Africa and Latin America continued to sustain very high fertility. (p. 64)
Abernethy (1993) cites a couple of examples that put in doubt any immediate causal link between reduced child mortality and fertility rates:
In Haiti, Save the Children Fund set out to learn if women who had lost children compensated by increasing their total number of births. The exactly opposite effect was found: women who had never lost children had the most births; women who had an infant die were least likely to continue childbearing. Indeed, studies in several continents fail to find that high child mortality leads to more births. Comparison of Indian women who had lost young children with those whose family was intact showed no increased childbearing among the former. Research in Guatemala yielded similar results: women who had lost children did not desire additional births as replacements…
Still stronger evidence that declining mortality was not a cause of lower fertility comes from France, the country which led Europe into the fertility transition. Catherine Rollet-Echalier (1990) finds that small family size was established by 1850, but the decline in infant mortality was not recognizable until the 20th century.
While the above example indicates that fertility levels can be reduced in the absence of reduced infant and child mortality rates, more research is needed to determine whether reducing infant/child mortality alone can cause reduced fertility levels in the long term.
A cause and effect relationship between child mortality and fertility appears to run in the opposite direction. That is to say that one of the best ways to lower child mortality rates is child spacing and reduced family size. Modern medicine can only do so much in the face of people having more children than they can afford to feed or care for.
At the 1974 World Population Conference, the phrase "Development is the best contraceptive" was on the lips of many delegates from developing countries. The example of the naturally-occurring reduction in fertility rates in Europe and North America over the last two centuries was proposed as evidence that improved economic welfare would lead automatically to such a demographic transition in the developing countries.
If one looks at the Demographic and Health Survey reports on 18 countries, it is clear that desired and actual levels of fertility are higher in countries with low levels of economic development and lower in countries with high levels of development. To what extent each is cause and effect, however, is open to question. As mentioned earlier in this paper, there is strong reason to believe that lower fertility rates lead to improved economic development.
Abernethy (1993 correspondence) points out a number of cases that cast doubt on the theory of an orderly demographic transition:
Land redistribution in Turkey promoted a doubling in family size (to six children) among formerly landless peasants. In the United States and much of Western Europe, a baby boom coincided with the broad-based prosperity of the 1950s. More water wells for the pastoralists of the African Sahel promoted larger herd size, earlier marriage and much higher fertility. The introduction of the potato into Ireland in about 1745 increased agricultural productivity and caused a baby boom.
Some further examples from Abernethy include the 17 percent drop in Sudan’s fertility rate during the late 1980s at a time of extreme deterioration of the economy and a similar correlation of
falling fertility rates and declining economic conditions in Brazil in the 1980s.
It is also true that the United States had its lowest fertility rate in history prior to 1970 during the Great Depression.
Robley, Rutstein, and Morris (1993) cite Bangladesh as a perfect example of how the theory that economic development must precede fertility declines has been disproved:
It is one of the world’s poorest and most traditional agrarian countries. Infant mortality is high, women have low social status and most families depend on children for economic security. Nevertheless, fertility rates there declined 21 percent between 1970 and 1991…During this period, the use of contraception among married women of reproductive age rose from 3 to 40 percent.
The above indicate that economic prosperity may lead to higher fertility levels and that economically depressed conditions may motivate people to limit family size. The theory that prosperity causes fertility declines cannot explain many situations in both developed and developing countries.
Despite the above examples, improved economic conditions in many societies may actually lead to reductions in fertility levels. As mentioned above, there is a strong inverse correlation between levels of economic development and levels of fertility in many countries of the world. While there is a link between industrialization and lower fertility levels, the nature of the relationship is not well understood. But few would take the position that poverty is a solution to high rates of population growth.
In general, the evidence would lead us to conclude that not only will people’s lives be improved through economic development, but that, in most cases, such development is likely to be associated with smaller family size.
The point of this section is that economic development by itself, without other measures that affect family size desires or the ability to achieve those desires, is not necessarily a cure-all for the population problem. Nor is there any clear understanding of the length of time that may elapse in various societies between achieving higher standards of living and reduction in fertility levels.
Countries with similar levels of economic development may have markedly different fertility levels, indicating that factors other than economic welfare, such as access to family planning services and cultural norms regarding childbearing, may be far more important in determining completed family size.
Delaying the establishment of family planning programs until economic development occurs may well have the effect of ensuring that economic development will never occur.
If development does work as a contraceptive, it appears to have a high failure rate. Where it does work to lower fertility, the effect may be indirect: the growing economy may include opportunities for women’s employment outside the home, thus giving childbearing a greater opportunity cost. On the other hand, while improvement in the standard of living in developing countries is desirable, economic development does not appear to be a necessary precursor to lowered fertility.
I use the word "myth" cautiously here, for I happen to believe that much of what is behind this statement is true. In fact, in many countries there is a strong inverse correlation between the level of education of women and their fertility level. In addition, as Kenya has experienced, keeping girls in school longer can have a demographic impact in countries with high teenage pregnancy rates.
On the other hand, achieving high rates of female literacy, without any other interventions, may not lead to fertility decline. Tanzania is an example of a country with high rates of female literacy (88 percent, according to the government) where the fertility rate has not declined markedly (as of 1993, at 6.4 children per woman). As with the issue of economic development, other factors, such as access to family planning services and cultural norms regarding childbearing, cannot be ignored by those concerned with population growth.
There is a need for more research on the relationship between various aspects of women’s status and fertility rates. In his 1991 study of comparative reproductive preferences, Charles Westoff of Princeton University’s Office of Population Research found,
The relationship between education and the percentage of women who want no more children is positive in several of the countries, but weak or non-existent in many others. In fact, [the data] give the general impression that the intention to terminate childbearing is similar across educational levels…There is little evidence to support any strong pattern of diffusion or differential penetration of norms of family limitation across educational levels or from urban to rural areas. (pp. 5-6)
Abernethy (1993 correspondence) raises some interesting issues:
Raising women’s legal, health, and social status, and providing women with educational opportunity are very worthwhile objectives in themselves. Nevertheless, only correlational data link these factors to fertility decline. On the contrary, participation in the labor market, particularly if a woman’s earnings make a significant contribution to family income, appears to significantly affect family size targets: Penn Handwerker and Diane Macunovich have found in Third World countries and the United States, respectively, that women prefer and have fewer children when child rearing carries an opportunity cost.
If overpopulation is a threat to women’s well-being (as Abernethy points out), jobs for women deserve high priority. Particularly effective in reducing fertility rates may be income-producing jobs outside of the home, which create a situation where children carry a higher opportunity cost. It is reasonable to believe that education and training programs that prepare women for such jobs are an important element of a women’s employment strategy. This implies providing far more than literacy training, as important as that may be.
For obvious humanitarian reasons, job creation for women should be combined with broad-scale programs to elevate the status of women–both in law and in practice. The evidence to date suggests all such efforts will be useful.
Clearly more research is needed. But in general, it is safe to conclude that if women lack the right or practical ability to make decisions about family planning and family size, reducing fertility rates will be much more difficult.
This is an extreme statement of the view that "the top priority in the population field should be focused on providing family planning medical services because lack of access to these services still is the major barrier to fertility reduction." It is true that over the last 30 years increasing access to contraceptive services has helped reduce fertility rates to the current levels. The view of those who subscribe to the "medical model" of solving the population problem is that additional family planning services will complete the job.
This is perhaps the most important issue within the population field. Of the $4.5 billion spent by developing and developed countries for population-related work in the developing world, the largest share has gone to providing family planning medical services to individuals and couples. Inherent in this approach is the belief that a large portion of births are unwanted and that contraceptive availability will solve this problem.
In Kenya, which until recently was the fastest growing country in the world, contraceptives were within reach of nearly 90 percent of the population by the late 1980s (Hammerslough, 1991). Yet currently only about a third of the women use them (Kenya Demographic and Health Survey, 1993).
Where did the idea come from that merely making contraceptives available would solve the population problem? Since the late 1960’s and throughout the 1970’s, studies were conducted in numerous countries measuring women’s knowledge of, attitudes toward, and practice of birth control as well as their family size desires. These knowledge, attitude and practice (or KAP) studies resulted in a term "KAP-gap"–or "unmet need"–to describe those women who wanted to delay their next pregnancy by at least two years but were not using a modern method of contraception. In the minds of many policy makers and funders, "unmet need" became confused with "lack of access" to contraceptive services. However, Charles Westoff and Luis Hernando Ochoa of the Demographic and Health Surveys determined in 1991 that about half the women categorized as having an "unmet need" have no intention of using contraceptives even if they are made freely available. In other words, it is probably not theoretically possible to "meet" more than half of the remaining "unmet need" in the developing world.
The World Health Organization (WHO) in 1986 estimated that "300 million couples are not practicing contraception despite a stated desire to stop childbearing." In a recent (1991) analysis of unmet need, demographer John Bongaarts of the Population Council stated that WHO did not describe the methodology used to arrive at its estimate. Earlier estimates from the 1970’s indicated that there might be 500 million women whose actions differed from their stated desires to delay or stop childbearing.
The term "unmet need" is really a misnomer that has misled many people in leadership positions. Many world figures assume that "unmet need" means "unmet demand" and that such demand can be overcome by improving family planning services and contraceptive distribution.
The reasoning of these policy makers has been that, if there was a gap between what people wanted and what they were doing, improving access to contraceptives would close that gap. The problem is that the discrepancy between attitudes and behavior has had less and less to do with availability in recent years.
Interestingly, in his 1991 analysis, John Bongaarts concluded that total "unmet need" was between 87 and 100 million women in the developing world outside of China. He also concluded that many factors account for the gap, of which lack of access is only one.
The report of the 1989 Kenya Demographic and Health Survey is illustrative of findings in numerous countries recently. Ninety percent of currently married women and 91 percent of the husbands know where they can obtain a modern contraceptive. Among the reasons given for not using contraception by women who are not pregnant and do not want to become pregnant, only one percent cited lack of availability of contraceptives. The top four reasons? 1) Lack of knowledge (23%); 2) infrequent sex (12%); 3) concern with the medical side effects of contraceptives (11%); and 4) opposition from the husbands (10%). These are all issues that are best responded to by information and motivational communications.
Country by country, the Demographic and Health Surveys show a similar pattern. Lack of access is cited infrequently by those who are categorized as having an unmet need for family planning. The following chart illustrates that reasons having to do with information and cultural attitudes are predominant.
A 1992 paper by Etienne van de Walle showed that another factor is at play for many women and men–fatalism. Many people have simply not reached the realization that reproductive decisions are a matter of conscious choice. Many who did not particularly want another pregnancy in the near future still reasoned that God had determined since the beginning of the universe how many children they would have and that it did not matter what they thought or whether they might use a contraceptive, because they could not overcome God’s will. The 1990 Demographic and Health Survey found that in Nigeria, Africa’s largest country, over half the women questioned about their ideal family size responded by saying, "It is up to God." Overcoming this situation takes more than access to contraceptive services. It requires helping people understand that they are responsible for their own life experiences and that they have the power to effect changes in their life situation.
A 1992 publication of UNICEF carried the following statement: "If all women were able to decide how many children to have and when to have them, the rate of population growth would fall about 30%."
If this statement is true, the stunning significance of it is that–if all women everywhere had full access to contraceptives and used them to have only the children they
want–the rate of world population growth would drop only 30 percent. A large share of the money and effort worldwide is going into solving 30 percent of the problem.
The above statement should not be interpreted as suggesting that the level of effort in providing contraceptive services be reduced. High quality, low cost reproductive health care services are an essential element of fertility planning. I happen to believe that both quality and quantity of contraceptive choices and services are in dire need of improvement throughout much of the developing world. But access to family planning methods is not sufficient if men prevent their partners from using them, if women don’t understand the relative safety of contraception compared with early and repeated childbearing throughout the reproductive years, or if women feel they cannot take control of their own lives.
Many population planners measure progress on the basis of contraceptive prevalence rates. Use of effective family planning methods is critical, but will not result in population stabilization if desired family size is five, six or seven children. The contraceptive prevalence rate in Brazil is higher than it is in Spain (66 percent vs. 59 percent), but the total fertility rate in Brazil is twice that of Spain.
Delaying the first pregnancy and spacing children is important to the health of women and children–and to slowing population growth rates. But spacing seven children will still lead to a high growth rate.
Having talked about myths through most of this paper, I do not want to leave the reader depressed with the thought that the population problem will be difficult or impossible to solve. There are some steps that can be taken now to bring about accelerated progress in reducing population growth. Many of these steps have to do with addressing personal beliefs and cultural norms with regard to the status of women, ideal family size and age of initiating childbearing. Many of these issues revolve around the concept of personal motivation.
Motivation to use family planning and to limit family size has been a missing piece of the strategy for population stabilization. While the percentage of non-users of contraceptives has declined, various studies indicate that the number of adults not using contraceptives remains roughly the same as it was in 1960, a fact stemming from the enormous increase in world population over the past 30 years. Approximately half of the three billion people of reproductive age use no contraception at all. It’s time to focus some significant effort on motivating this group to use contraception for the purpose of achieving small family size.
Nearly as important are the desired family sizes of the users of contraception. In many countries, those who do use contraceptives still want more than enough children to replace themselves. Their goals, if achieved, will lead to continued high rates of growth.
A rapid reduction in fertility rates is happening in Kenya, once the world’s fastest growing country. Desired family size dropped from 6.3 children in 1984 to 4.8 children per woman in 1989, and actual fertility rates dropped from 7.7 children in 1984 to 5.4 children in 1993 (Demographic and Health Surveys).
According to a 1991 study by Charles Hammerslough of the University of Michigan, his data support "the hypothesis that the rise of [family planning] services has accelerated the fertility transition, but is inconsistent with the notion that service availability initiated the transition." That is to say, desired family size dropped before the rapid increase in contraceptive usage occurred.
Kenya is but one of many examples. Virginia Abernethy (1993) states, "Historical and cross-cultural data confirm that motivation (rather than differential access to modern contraception) is the primary determinant of fertility." Japan has achieved below-replacement-level fertility (1.5 children per woman) in a country where the oral contraceptive pill is still illegal. As mentioned earlier, the United States achieved below-replacement-level fertility in the Great Depression, before the invention of most modern contraceptives. Similarly, a demographic transition in Western Europe and the United States reduced fertility to near-replacement level even earlier, in the 19th century.
Charles Westoff, in a 1988 paper, concludes that, "By and large, contraceptive behavior…is not grossly inconsistent with reproductive intention." Only one to two percent of the women failed to use contraception in a manner consistent with their family size preference in Brazil, the Dominican Republic, Peru, and Liberia. According to Westoff, "The overwhelming majority of women who want no more children or want to postpone fertility, at least in the four countries discussed here, are behaving in a manner consistent with that goal."
Lant Pritchett, Senior Economist at the World Bank, in a 1994 article in Population and Development Review, concluded that family size desire is the overwhelming determinant of actual fertility rates. "The conclusion that follows from the evidence and analysis we presented," he wrote, "is that because fertility is principally determined by the desires for children, contraceptive access (or cost) or family planning effort more generally is not a dominant, or typically even a major, factor in determining fertility differences." According to Pritchett, desired levels of fertility account for roughly 90 percent of differences among countries in total fertility rates. He argues that reducing the demand for children–for instance, by giving girls more education–is vastly more important to reducing fertility than providing more contraceptives or family planning services.
Not enough is known about family size preferences of the men and women of the world–particularly among those who are not using any method of contraception. Recent papers on family size preferences by John Bongaarts (1990), Charles Westoff (1991), and Warren Miller and David Pasta (1993) point to the need for much more in-depth, interdisciplinary research on the relationships among ideal family size as viewed by men and women at each age level, fertility intentions and actual achieved fertility.
More research is needed to measure the effects of non-medical interventions, such as efforts to raise women’s status, mandatory education for children and mass media communications designed to affect desired family size.
According to a 1993 study by Charles Westoff and German Rodriguez, mass media in Kenya may well have played a key role in bringing about the changes in desired and actual fertility rates mentioned earlier. In their concluding sentence, they state, "We are disposed to believe that the mass media can have an important effect on reproductive behavior."
In the United States and throughout much of the world, people get their information and form many of their opinions from the mass media–particularly radio and television. Worldwide, the biggest audiences are to be found during evening (prime-time) hours, tuned into entertainment programs. Throughout much of the world, the most popular format by far is prime-time serial dramas –called telenovelas (television novels)in Latin America–or soap operas. Unlike American soap operas, telenovelas have a beginning, middle and end–and run for a limited period of time.
Entertainment programs can reach large numbers of people very cost effectively. Serial dramas are especially well-suited to showing an evolution of key characters from traditional attitudes towards modern attitudes regarding such issues as the role of women, family size decisions and the use of family planning (Nariman, 1993).
A growing body of evidence bears this out. In 1977, Miguel Sabido, then Vice President for Research of the Mexican network, Televisa, developed a new family planning communication model, using a telenovela. Based on an earlier telenovela that promoted literacy (and which led to a 700 percent increase in registrations at adult education centers in Mexico), the first telenovela to promote family planning, named Acompaname (Accompany Me), showed in dramatic terms over the course of the nine-month series (five days a week at prime time during 1977-78) the personal benefits of planning one’s family, by focusing on the issue of family harmony.
Briefly, the results of Acompaname, as described in a report by the Mexican Institute for Communication Research (1981), were:
a) Phone calls to Mexico’s national family planning office requesting family planning information increased from zero to an average of 500 a month. Many people calling mentioned that they were encouraged to do so by the television soap opera.
b) More than 2,000 women registered as voluntary workers in the National Program of Family Planning. This was an idea suggested in the television soap opera.
c) Contraceptive sales increased 23 percent in one year, compared to a seven percent increase the preceding year.
d) More than 560,000 women enrolled in family planning clinics, an increase of 33 percent (compared to a one percent decrease the previous year).
Following Acompaname, Televisa developed four additional family planning soap operas. All produced by Miguel Sabido, they were Vamos Juntos (We Go Together), Caminemos (Let’s Walk), Nosotros las Mujeres (We the Women), and Por Amor (For Love).
During the decade 1977-1986, while the five family planning programs were on the air, Mexico underwent a 34 percent decline in its population growth rate. As a result, in May 1986 the United Nations’ Population Award was presented to Mexico as the foremost population success story in the world.
The role of the soap operas in this success was significant. Thomas Donnelly, with the United States Agency for International Development (USAID) in Mexico until 1983, wrote, "Throughout Mexico, wherever one travels, when people are asked where they heard about family planning, or what made them decide to practice family planning, the response is universally attributed to one of the soap operas that Televisa has done." Donnelly also stated, "The Televisa family planning soap operas have made the single most powerful contribution to the Mexican population success story."
Following a meeting David Poindexter (at that time with The Population Institute and now honorary chair of Population Media Center), and Miguel Sabido held with Indira Ghandi, and training by Miguel Sabido, Doordarshan (Indian Television) went on the air in July 1984 with India’s first social-content soap opera, Hum Log (We People). The program included promotion of family planning and elevation of the status of women, through the words and actions of the key characters.
Over 17 months of broadcast, the programs achieved ratings of 60 to 90 percent of the viewing audience. Research conducted by Professor Everett M. Rogers and Arvind Singhal, then of the Annenberg School of Communications of the University of Southern California, found, through a sample survey, that 70 percent of the viewers indicated they had learned from Hum Log that women should have equal opportunities; 68 percent had learned women should have the freedom to make their personal decisions in life; and 71 percent had learned that family size should be limited. Among other things, the program stimulated over 400,000 people to write letters to the Indian Television Authority and to various characters in the program, stating their views on the issues being dealt with or asking for help and advice.
A second Indian soap opera, Humraahi (Come Along With Me), went on the air on January 14, 1992, airing at 9:00 p.m. on Tuesdays. The focus of the first 52 episodes was on the status of women, with particular attention to age of marriage, age of first pregnancy, gender bias in childbearing and child-rearing, equal educational opportunity, and the right of women to choose their own husbands.
In the series, a young girl who wanted to be educated and to become an attorney, instead is forced into an arranged marriage at age 14 by her father. Despite her pleas to her husband to delay consummating her marriage, she becomes pregnant and dies in childbirth. Following that key episode, the other characters lament what is happening to the young women of India and the tragedy of early marriage and pregnancy. A study of viewer response by the Annenberg School of Communications of the University of Southern California found many interviewees stating that after seeing the death of this character, they had decided not to marry their own daughters off at puberty, but to send them to be educated.
A study of over 3,000 people in the Hindi-speaking region of India, carried out by Marketing Research Private Group, Ltd., of Bombay, identified numerous significant shifts in attitudes while Humraahi was on the air, particularly related to the ideal age of marriage for women. The shifts in pro-social directions were dramatically greater for viewers than non-viewers.
A similar story occurred in Kenya. After training Kenyan television and radio personnel in Mexico, David Poindexter helped in the development of two programs: a television series, Tushauriane (Let’s Talk About It), and a radio series, Ushikwapo Shikamana (If Assisted, Assist Yourself). Both programs went on the air in 1987. The programs were aimed at opening the minds of men to allowing their wives to seek family planning. The programs also effectively linked family size with land inheritance and the resulting ability or inability of children to support their parents in their old age.
Both programs were the most popular programs ever produced by the Voice of Kenya. The television series ran for 60 episodes and then went into reruns. The radio series ran for two years with two episodes per week, with each episode playing twice during each day for most of the broadcast series.
Work by Poindexter in Brazil led to inclusion by TV Globo of family planning in several programs, including news and information programs and six prime-time telenovelas. Between 1989, when these programs began including family planning messages, and 1998, total fertility rate in Brazil fell from 3.4 to 2.5 children. Three of the Brazilian novelas have been dubbed into Spanish and sold to numerous Spanish-speaking countries of Latin America, where they have been playing since early 1992. They have also played in other countries in Europe and the Middle East–a total of 55 countries in all.
The most extensive evaluation of the effects of a family planning serial drama occurred from 1993 to 1997 in Tanzania. There, Radio Tanzania broadcast a serial melodrama that attracted 55 percent of the population (age 15 to 45) in areas of the broadcast. In one region of the country, the area surrounding the city of Dodoma, a music program was substituted for the soap opera during the first two years of the project.
Independent research by the University of New Mexico and the Population Family Life Education Programme of the Government of Tanzania measured the effects caused by the program with regard to such issues as ideal age of marriage for women, use of family planning, and AIDS prevention behavior. Because the population of the Dodoma comparison area was more urban than the rest of the country, a multiple regression analysis eliminated the influence such differences might have accounted for. Nationwide random sample surveys of 3,000 people were conducted before, during and after the broadcast of the program.
Among the findings were a significant increase in the percentage of listeners in the broadcast area who believe that they, rather than their deity or fate, can determine how many children they will have; an increase in the belief that children in small families have better lives than children in large families; and an increase in the percentage of respondents who approve of family planning.
The study also provided evidence that the Tanzanian radio serial stimulated important behavioral changes. There was a strong positive relationship between listenership and the change in the percentage of men who were currently using any family planning method. Similar evidence was found for changes in other important behaviors, including an increase in the percentage of Tanzanians who discuss family planning with their spouses and a decrease in the number of sexual partners for both men and women.
In regions where the show was broadcast, the percentage of married women who were currently using a family planning method increased by more than one-third, from 26 percent to 33, percent in the first two years of the program, while that percentage stayed flat in the Dodoma area where the program was not broadcast. In regions where the program was broadcast, the average number of new family planning adopters per clinic, in a sample of 21 clinics, increased by 32 percent from June 1993 (the month before the show began airing) to December 1994. Over the same period, the average number of new adopters at clinics in the Dodoma area remained roughly the same.
Independent data from Ministry of Health clinics showed that 23 percent of new adopters of family planning methods cited the soap opera by name when asked why they had come to the clinic. Counting all of the costs of the radio serial, the cost per new adopter of family planning was under 80 cents (U.S.), a cost-effectiveness unmatched by any other known strategy.
The program was also effective in AIDS prevention. Over half the population of the areas where the serial was broadcast identified themselves as listeners, with more men than women in the audience. One of the key characters in the soap opera was a truck driver with many girl friends up and down the truck route. In the program he contracts AIDS. Of the male listeners, 88 percent said the program had caused them to change their own behavior to avoid HIV infection, through limiting the number of sexual partners and through condom use. Independent data from the AIDS control program of the government of Tanzania showed a 153 percent increase in condom distribution in the broadcast areas during the first year of the soap opera, while condom distribution in the Dodoma non-broadcast area increased only 16 percent in the same time period.
As a double control for any socio/economic differences between the population of the Dodoma region and the rest of the country, the program was broadcast in its entirety by the Dodoma transmitter, starting in 1995. Data collected since that time has shown that roughly the same changes occurred there as had been experienced in the rest of the country during the soap opera’s broadcast. This data is summarized in a paper by Dr. Everett M. Rogers and Dr. Peter Vaughan, et al (in print).
Because entertainment programming (radio or television, depending on the coverage of each medium in any country) attracts the largest audiences, it is particularly important to utilize entertainment media for disseminating information about family planning and family size issues. Along with that, many communications experts state that the most effective way of bringing about changes in attitudes and behavior with regard to any social issue is to utilize as many channels of communication simultaneously as possible, including print and broadcast, news and information, various formats of entertainment programs, and the communication activities of governmental and non-governmental organizations. Examples of successful media campaigns that have utilized this strategy include the designated driver campaign of Harvard University and the smoking prevention campaign carried out by a coalition of organizations in the United States. Measuring the effects of such multi-faceted efforts is made more difficult by the inability to isolate the campaign’s effects from other influences in society. But it is logical to infer that people learn and change behaviors more quickly when they are hearing consistent information from a variety of sources.
Widespread research and serious attention to motivational communications is called for, since motivation must be a key element in solving the population problem. It is not possible to say with certainty that a radio or television soap opera will move any particular country or group of people from large family size norms to small family size desires in a certain time frame. A lot depends upon the quality of the audience research used to design the programs and on the quality of the writing and acting. Programs that capture the attention of a large audience because of the entertainment quality of the drama and that create characters with whom the audience can identify have great potential to provide role models that the audience will follow as those characters evolve from traditional attitudes to modern attitudes regarding status of women, family size decision making and the use of family planning.
As the debate surrounding the 1994 United Nations International Conference on Population and Development demonstrated, no one has a monopoly on proposed solutions to the world’s massive problem of population growth. The momentum of this growth is well recognized. Because of the age structure of the population, an immediate drop to replacement level fertility would not lead to zero population growth for half a century. By that time, population would have grown to well over 8 billion, assuming no dramatic increase in the death rate.
More rapid achievement of zero population growth would require that the world quickly achieve below-replacement level fertility, that is, less than two children per couple. Because all of the potential mothers and fathers for the next 15 to 20 years have already been born, it is possible to predict various scenarios of fertility rates and the corresponding trajectory of the population. For example, there would still be growth of the world’s population with a one-child average for some time before the world reached zero population growth. But at that point, population size would start to decline.
How rapidly the world must achieve an end to population growth in order to avoid catastrophic environmental, political or economic consequences is a subject of endless debate. Some scientists believe the long-term carrying capacity of the earth is well below our current population of 5.6 billion, while others say that the world could manage to get by with as many as 8 billion people. Very few find the prospect of a doubling of the current population acceptable, and some believe that such a doubling is impossible because of natural limits like food and waste disposal capacity of the globe.
While studying these subjects is important, scientists may never fully resolve an answer to the question of carrying capacity before the earth informs the human population what its carrying capacity is through less than polite means of communication. It is important, therefore, for policy makers and activists to continue to focus on activities that hold promise of finding solutions to population growth.
The potential consequences of continued rapid population growth are too serious to merit anything but the most intense scrutiny and development of action plans based on the best data possible. As suggested above, there is an urgent need for controlled experimental designs that allow for effective measurement of proposed solutions so that their affects can be isolated from other things going on in society.
The urgency of such research cannot be overstated. As indicated throughout this paper, far too many policy and spending decisions have been made on the basis of weak cause-and-effect data. While many correlations in the population field seem to have plausible cause-and-effect relationships, the world is only slowly learning the expensive lesson that correlation does not equal causation.
Finding a solution to the population problem will not be simple or inexpensive. Probably no one intervention will bring about rapid reductions in fertility rates; certainly none has to date. But the overall framework for population stabilization lies in the following three areas:
1. Governmental policies that ensure the right to have access to comprehensive reproductive health care, including family planning information and services; the right of women and men to determine the number and spacing of their children; the right of girls, as well as boys, to be educated; the right of women to have equal opportunity for gainful employment; and the right of women, as well as men, to live free of violence and intimidation.
2. Provision of high quality, comprehensive reproductive health care, including family planning services, to all people who want it on a voluntary basis and, more broadly, provision of maternal and child health care.
3. A social/cultural climate that brings about strong self-motivation by people toward small family size norms and desires and that enables women, as well as men, to take the steps necessary to implement those desires.
Much of the effort over the last 30 years has focused on points 1 and 2 above: development of governmental policies and family planning medical service provision. Creating a social environment that motivates and empowers people to use family planning to limit family size has been a neglected part of the picture, as discussed above. There are many creative and innovative steps that can be tried towards increasing the level of motivation, such as motivational serial dramas. But such steps should not be seen as a panacea. There are many more things that can and should be tried.
There is broad general agreement that voluntary measures are not only preferable to coercion from an ethical and human rights standpoint, but that in the long run self-motivation will be far more effective at keeping fertility rates low than government- imposed mandates that are despised by the people. Even in non-democratic societies, unpopular governments have a way of disappearing sooner or later. In addition, in countries where involuntary population measures have been enacted by the government, people find ways of skirting the law, whether it be through non-registration of births or through obtaining illegal abortions and birth control measures.
In the field of mass media communications, there is much that should be done in each country, beyond the provision of one soap opera in which characters promote family planning and small family norms. Numerous programs on radio and television can address different aspects of the same theme. News and information programs should educate people about the realities of population issues and their relationship with economic development, environmental problems and social progress. Comic books and traditional media, such as travelling road shows, can find ways to incorporate messages that people will relate to. Such messages should not dwell on family planning methods, but on the "why" of family planning. People will be much more motivated to use family planning to limit family size if they know that it can lead to happier marriages, improved family harmony, greater health and well-being, and material progress for them and the nation as a whole, than they can possibly be motivated by learning how easy it is to use condoms or pills. For many women in the developing world, a shift in consciousness needs to occur that helps them understand that they can, in theory, exert control and influence over their own lives and that this is not only acceptable but desirable. Mass media and local media have a major role to play in bringing about such changes in cultural norms. National leaders can also play a significant role in changing the social climate on these issues, by speaking out.
Changes in cultural norms and accurate information are needed in order to reduce desired family size, slow population momentum and enhance the use of contraceptive services. The following seven elements are essential:
1. opportunities for gainful employment of women, especially outside the home, and cultural acceptance of the concept of women in the workplace;
2. lowering cultural norms with regard to ideal family size as viewed by men as well as women;
3. mandatory education of girls as well as boys, going well beyond literacy training;
4. enactment and enforcement of child labor laws to prevent exploitation of children by parents and others, and changes in cultural norms with regard to the acceptability of child labor;
5. changes in cultural norms with regard to age of marriage and age of onset of childbearing;
6. overcoming misinformation about the relative safety of using contraception as opposed to early and frequent childbearing; and
7. overcoming men’s fears that contraceptive use by women will lead to infidelity.
If World Bank Senior Economist Lant Pritchett is correct that desired family size is the leading cause of differences in actual fertility rates among countries, then creative thinking is needed to arrive at interventions that reduce desired fertility and that are in harmony with voluntary and informed decision making by individuals and couples. People often raise the question of incentives as a way of enhancing motivation. Incentives can be tricky, because the recipient either can see them as a bribe to do something they would not otherwise do and resent them, or can see them as an added bonus for taking an action they are convinced is in their own interest. If, for example, a supermarket in the West offers shoppers a discount for trying a new brand of cereal, few people are offended. If, on the other hand, someone is offered money to do something they would not otherwise do for moral reasons, it can lead to deep resentment.
Similarly, in very poor countries, incentives can be subject to abuse. Women may be coerced into undergoing a sterilization by a husband who wants the monetary reward that may be the equivalent of an entire year’s wages. Desperate people may feel that they are being bribed into doing something they do not want to do, but accept the bribe in order to survive. Incentives that are out of line with the cultural and economic realities of a country are likely to backfire and cause resentment and hostility toward the whole concept of family planning.
On the other hand, there are incentives that have been tried that have provided culturally acceptable and quite successful motivations for delaying onset of first pregnancy, limiting family size or using family planning. For example, Rocky Mountain Planned Parenthood in the United States experimented with a program that offered very small monetary rewards and participation in a group program for teens in Denver who remained free of pregnancy. The program was successful, and the participants experienced lower pregnancy rates than a similar group that did not have those benefits. According to the teen participants, the real motivator was the benefit of participating in the group gatherings, which provided a social outlet they were otherwise missing in their lives. The group itself provided peer pressure for success in the program.
An organization called Population Communication (based in Pasadena, California) has successfully run small-family clubs in various developing countries. Those who join the club are provided nominal discounts on purchases from participating vendors and receive a certificate announcing their club membership.
One of the problems with large monetary incentives is that they can become very expensive when made available on a nationwide basis in a large country. If people learn that cash or other material benefits are to be made available for those who limit their family size, even those who would have done so without incentives will apply for the reward. Quite apart from the ethical issues involved, the cost of providing incentives in a country the size of India (over 900 million people) can become exorbitant. In terms of birth averted per dollar spent, mass media communications are probably far more effective. This is particularly true with entertainment broadcasting where donor dollars only play a catalytic role and where commercial sponsorship underwrites the cost of air time and production. Using the leverage of commercial sponsorship, as little as $10 million a year in donor support–if spent properly–could lead to the development of highly effective motivational programs in all of the major developing countries of the world.
In addition to mass media and local media, another important communication channel in most countries is the network of non-governmental organizations, as well as schools and other institutions that serve large numbers of people. An effective campaign to change cultural norms with regard to family size should include membership organizations, education programs in the schools, outreach to workers in factories and on farms, and outreach through neighborhoods and villages via community leaders. Many non-governmental organizations, including environmental groups and women’s organizations, are predisposed to carrying appropriate messages regarding family size and family planning. They need to be involved in developing the messages that will be sent to the people and then enlisted to help deliver those messages to their constituencies.
We don’t know whether programs like family planning soap operas and small-family clubs will be successful in achieving replacement level (or lower) fertility in a short period of time. Funding for such strategies has been woefully inadequate, and research to measure the effects of such programs is only beginning to be taken seriously. But given the massive increases in funding being talked about by donor countries for population assistance, it is critically important that a much larger share be directed towards approaches that hold the promise to reduce family size desires throughout the world.
Whether we will ultimately succeed in stopping population growth in time to avoid a global environmental disaster remains to be seen. The more we can do now to quickly reduce fertility rates, the less likely it is we will experience a global catastrophe, or, at least, whatever crises we face may not be as severe.
Those who are interested in finding solutions must recognize that we cannot afford to wait until all the answers are in before taking action. Our best hope is if everyone, every government and every institution give the population problem the attention and funding it deserves.
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(Mr. William N. Ryerson is a President of