By William N. Ryerson | 2001
Population Media Center
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.
1. Myth: Population growth has occurred at current levels over many centuries
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:
2. Myth: The population problem is the result of a recent surge in birth rates.
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.
3. Myth: Population is not a problem, or our leaders would tell us.
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.
4. Myth: Population growth stimulates economic growth.
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.
5. Myth: Technology will solve all problems.
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.
6. Myth: There is no population problem, but instead, a food (or resource) distribution problem.
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.
7. Myth: What we have is not a population problem but a consumption and waste problem.
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.
8. Myth: The population issue is used as a ploy for controlling women.
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.
9. Myth: The AIDS virus will solve the population problem.
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.
10. Myth: Religious objections will prevent the use of family planning.
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.
11. Myth: Farmers want many children to work in the field.
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.
12. Myth: As long as there is no social security system, people will have many children to support them in their old age.
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.
“Take care of __________ (fill in the blank)
and population will take care of itself.”
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.
13. Myth: Reduce infant/child mortality rates and fertility rates are certain to follow.
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.
14. Myth: Economic development will lead automatically to a demographic transition.
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.
15. Myth: Educate women, and fertility rates will automatically drop.
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.
16. Myth: Meeting all “unmet need” for contraceptive services will essentially solve the population problem.
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.
Reasons Cited For Non-Use of Contraception By Non-Pregnant Women Who Are Sexually Active, Not Using Any Contraceptive Method and Who Would Be Unhappy If They Became Pregnant
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.
Vatican control of World Health Organization population policy: An interview with Milton P. Siegel
Al Bartlett – Democracy Cannot Survive Overpopulation
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