Sub-Saharan Africa: population pressures on development

The population of sub-Saharan Africa, estimated at 434 million in 1984, is expected to reach 1.4 billion by 2025. The birth rate, currently 48/1000 population, continues to increase, and the death rate, 17/1000, is declining. Rapid population growth has curtailed government efforts to provide adequate nutrition, preserve the land base essential for future development, meet the demand for jobs, education, and health services, and address overcrowding in urban areas. Low education, rural residence, and low incomes are key contributors to the area's high fertility. Other factors include women's restricted roles, early age at marriage, a need for children as a source of security and support in old age, and limited knowledge of and access to modern methods of contraception. Average desired family size, which is higher than actual family size in most countries, is 6-9 children. Although government leaders have expressed ambivalence toward development of population policies and family planning programs as a result of the identification of such programs with Western aid donors, the policy climat is gradually changing. By mid-1984, at least 13 of the 42 countries in the region had indicated that they consider current fertility rates too high and support government and/or private family planning programs to reduce fertility. In addition, 26 countries in the region provide some government family planning services, usually integrated with maternal and child health programs. However, 10 countries in the region do not support family planning services for any reason. Unfortunately, sub-Saharan Africa has not yet produced a family planning program with a measurable effect on fertility that could serve as a model for other countries in the region. Social and economic change is central to any hope of fertility reduction in sub-Saharan Africa. Lower infant and child mortality rates, rising incomes, higher education, greater economic and social opportunities for women, and increased security would provide a climate more conducive to fertility decline. Given the limited demand, great sensitivity must be shown in implementing family planning programs.     

Thinking about several problems of the research of our family planning strategy]

On the basis of 1982 census data, it is estimated that from 1987-1997 13 million women will enter the age of marriage and child-bearing each year. The tasks of keeping the population size around 1.2 billion by the year 2000 is arduous. Great efforts have to be made to continue encouraging one child/couple, and to pursue the current plans and policies and maintain strict control over fertility. Keeping population growth in pace with economic growth, environment, ecological balance, availability of per capita resources, education programs, employment capability, health services, maternal and child care, social welfare and social security should be a component of the long term development strategy of the country. Family planning is a comprehensive program which involves long cycles and complicated factors, viewpoints of expediency in guiding policy and program formulation for short term benefits are inappropriate. The emphasis of family planning program strategy should be placed on the rural areas where the majority of population reside. Specifically, the major aspects of strategic thrusts should be the linkage between policy implementation and reception, between family planning publicity and changes of ideation on fertility; the integrated urban and rural program management relating to migration and differentiation of policy towards minority population and areas in different economic development stages. In order to achieve the above strategies, several measures are proposed. (1) strengthening family planning program and organization structure; (2) providing information on population and contraception; (3) establishing family planning program network for infiltration effects; (4) using government financing, taxation, loan, social welfare and penalty to regulate fertility motivations; (5) improving the system of target allocation and data reporting to facilitate program implementation; (6) strengthening population projection and policy research; (7) and strengthening training of family planning personnel to improve program efficiency.     

Increasing contraceptive use in Bangladesh: The role of demand and supply factors

This article analyzes the determinants of contraceptive use in Bangladesh, focusing on the roles of demand for additional children and of family planning service supply. Data from the Matlab Family Planning Health Services Project are used to examine the contributions of these factors to the difference in prevalence of modern contraceptive use between the project area and a control area served by the government family planning and health programs. Results of multivariate analysis deriving from the Easterlin synthesis framework show the importance of family planning supply factors in reducing psychic and resource costs of fertility regulation and in activating latent demand for contraception. Demand for birth limiting and for birth spacing emerge as important explanatory factors; demand for birth spacing is greater in the project area, and both demand measures exert a stronger effect on contraceptive behavior in that area.     

Community-level determinants of contraceptive use in the Philippines: A structural analysis

We use household and community data from the Philippines to estimate a multilevel model of contraceptive use. We go beyond previous efforts in this field by developing a structural model that recognizes joint endogeneity and the temporal ordering of variables, by considering a wider range of community influences on fertility behavior, and by employing an econometric procedure allowing for a multilevel error structure. The results suggest that there are significant effects on fertility behavior of community-level family planning services, labor-market conditions, and infrastructure development. These results provide insights regarding the structural determinants of contraceptive use and fertility that are useful for drawing policy implications.     

An analysis of major proximate determinants of our fertility]

The sample survey of fertility, in Shanghai city and Shanxi and Hebei provinces of China in 1985, provided plentiful data about fertility, marriage, contraceptive usage and breastfeeding in terms of The World Fertility Survey Model. The data, along with Bongaarts' model, was utilized to analyze the relation between several proximate determinants and fertility changes. When comparing these three geographic areas, the largest difference was breastfeeding and the smallest one was non- contraceptive usage. It was very different from the results of The World Fertility Survey in developing countries in 1977. The difference of marriage indexes among three areas was close to that of breastfeeding; but for the effects on induction of fertility, marriage index surpassed breastfeeding. There were two models showing effective efficacy on fertility decline. One was the Shanghai model, in which much more effect came from marriage delay, accounting for 71%; another was the Hebei model, induction of fertility was caused by contraceptive usage, about 53%. Both indicated that the major factor affecting fertility decline was the family planning program. Otherwise, it seemed to indicate that different factors such as social, economic development indirectly decreased fertility through family planning programs.     

Rethinking the effectiveness of family planning in Africa

For the past 50 years there has been a near global consensus that the demands of development necessitate that couples reduce their fertility as a critical act which would jump start economic growth. This consensus heralded the era of the One Child policy and over 90% of least developed states continue to run programs which seek to induce lower fertility rates in their populations. However, a growing body of literature is questioning both the validity and utility of these interventions. This article seeks to contribute to the rethinking of family planning programs. Using new data on family planning scores from forty two African states this article shows that rates of fertility are unlikely to be affected by the strength of family planning programs at lower levels of development. However, at moderate levels of development, family planning programs may contribute to accelerating the decline in fertility initiated by exogenous factors. These findings offer a fresh perspective on the wide spread adoption of family planning policy that permeates the developing world.     

Public policy and the total fertility rate: cross-sectional evidence from the LDCs

A framework developed by Easterlin for the analysis of fertility in developing societies is modified and then tested using a sample of 65 less-developed countries. The focus is on assessing the impact of public policy on the national fertility rate. Public policy is reflected in the average levels of education and health in the population and in the condition of the national family planning program. To test for threshold effects with respect to socioeconomic development, the sample is divided on the basis of the infant mortality rate. Fertility rates in those nations characterized by high infant mortality are likely to be determined more by conditions of natural fertility. Those nations with lower infant mortality, and hence greater socioeconomic development, are more likely to exhibit deliberate fertility control. The results of the regression analysis do suggest that different factors influence the national fertility rate depending upon the stage of development. For the least-developed nations, the secondary school enrollment rate, an indicator of the extent of economic mobility, and the ratio of school age children to teachers, a proxy for the national commitment to human capital formation, are important. For the more advanced of the LDCs, adult literacy and the infant mortality rate seem to predominate. For all the developing nations, however, the results confirm the importance of strong family planning programs. The paper concludes with a discussion of the policy implications of the research.     

低生育水平下我国生育率转变影响机制的地区差异——来自90年代省级面板数据的经验研究

本文利用我国1990—2000年各地区总和生育率、社会经济发展水平和计划生育执行力度的面板数据，分别对东部特大城市、东部地区、中部地区和西部地区进行了实证分析。发现：计划生育政策对各地区生育率的降低都起到了重要的作用；同时，东部地区（包括特大城市）较高的经济、社会发展水平显著的降低了总和生育率，而经济较为落后的中、西部地区，这种作用不明显。     

Backing seen of population policy in AID

Congress is almost certain to agree to use of U.S. funds to motivate reduced population growth in developing countries but funding for sterilization abroad emerged as a political issue in the House. In the proposed U.S. AID budget, which in the past has been about 10% funded for direct population programs, a total concern with literacy for women, higher educational levels, and other developmental programs which increase motivation for family planning has been proposed. Zero Population Growth has sent telegrams to Congress supporting this basic development policy. The controversy over sterilization is the result of India's compulsory sterilization legislation. An amendment refusing to allow any U.S. funds to be used for sterilization programs was rejected, but in rejecting it, the members of the House of Representatives expressed their concern that any and all sterilization programs be completely voluntary. In a letter, AID Deputy Administrator Robert Nooter assured Congress that AID has no goals to sterilize any certain number of women around the world and it is not the main purpose of the AID program to to emphasize sterilization as a method of family planning.     

Papua New Guinea: first population policy declared

In its 2nd year after achieving political independence, Papua New Guinea declared a general population policy in October 1976, and inaugurated a population research program to guide policy formulation. Population affairs of the country, which has a population of 2.75 million, have been vested with the Ministry of Environment and Conservation. The research program will be implemented in cooperation primarily with the Institute of Applied Social and Economic Research (IASER) and the University of Papua New Guinea, as well as the Central Planning Office, Department of Public Health, Bureau of Statistics, and Office of Information, among other agencies. The priorities for research will initially fall under 5 main concerns: 1) fertility and population growth, and the causes of local differentials; 2) socioeconomic influences on growth trends; 3) interrelation between population and land resources; 4) internal migration; and 5) individual attitudes regarding family planning practice. The research program is designed to become an integral part of national development planning. However, the Government has declared that both policy and research programs must concur with the needs and desires of the people, to pave the way for successful implementation of development plans.     

The determinants of fertility in rural Peru: Program effects in the early years of the national family planning program

Using data from the 1991 Peru Demographic Health Survey, a linked Situation Analysis, and a unique region-level data set, this paper examines the determinants of fertility in rural Peru before and after the 1985 enactment of its National Policy on Population. The empirical framework combines a model of the timing and spacing of conceptions with a model of the timing of the placement of family planning services in communities in order to control for non-random placement of services. Results show the program helped reduce fertility post 1985. The magnitude of the effects is quantified with simulations. All correspondence to David Guilkey.We thank the editor and two referees for detailed comments on an earlier draft of this paper. Funding support for this project was provided by the MEASURE Evaluation Project under a Cooperative Agreement between the U.S. Agency for International Development and the Carolina Population Center (Number HRN-A-00-97-0018-00). The views expressed herein are those of the authors and not the sponsoring agency. Responsible editor: Junsen Zhang.     

How economic development and family planning programs combined to reduce indonesian fertility

This paper examines the contributions of family planning programs, economic development, and women’s status to Indonesian fertility decline from 1982 to 1987. Methodologically we unify seemingly conflicting demographic and economic frameworks into a single “structural” proximate-cause model as well as controlling statistically for the targeted (nonrandom) placement of family planning program inputs. The results are consistent with both frameworks: 75% of the fertility decline resulted from increased contraceptive use, but was induced primarily through economic development and improved education and economic opportunities for females. Even so, the dramatic impact of the changes in demand-side factors (education and economic development) on contraceptive use was possible only because there already existed a highly responsive contraceptive supply delivery system.     

A note on measuring the independent impact of family planning programs on fertility Declines

This note critically evaluates recent cross-national studies that estimate the independent effect of family planning programs on the fertility of the developing world. The evaluation demonstrates that past research is biased to produce overestimates of net program impact. A new estimate is derived to account more completely for the effects of the social context and socioeconomic development on fertility. This estimate indicates that 5 percent of the variation in crude birth rate decline for 89 developing countries is due to family planning programs. This is substantially less than past estimates.     

Using operations research to guide family planning program development and policy formulation in sub-Saharan Africa

The process by which a population policy and family planning program evolve in a given country is influenced by many factors that combine to make each country's experience unique. One of the most influential factors among these is the role played by external technical assistance, normally provided through donor-supported mechanisms. One donor-supported mechanism that seeks to guide the operational policy and program development process is technical assistance through operations research. Many questions are raised during the design of family planning programs that are often best answered with reference to empirical evidence collected through applied, or operations research (OR). This paper provides a review of the three main OR approaches currently being used in sub-Saharan Africa: diagnostic or needs assessment studies; experimental pilot studies; and intensive technical assistance for problem-solving and institutional development. The extent to which these OR approaches can play a role in family planning program development to improve and expand service delivery activities is discussed, and examples where these approaches have been used are given.     

A theoretical framework of collective action for the evaluation of family planning programs

Typically, a family planning program seeks to alter individuals' fertility behavior. The very necessity for the existence of a family planning program presumes that individuals' fertility expectations and behavior are not yet consistent with the objectives of the program. Therefore, some individuals may choose not to cooperate. In this article I establish a theoretical framework for the evaluation of family planning programs by synthesizing the literature on the theory of collective action. Because of the characteristics of collective action — indivisibility and externality — noncooperation (free riding) is bound to occur. Faced with the problem of free riding, a good family planning program should ideally apply selective incentives, localize the costs and benefits, and invest in social capital. The relations among these three factors, cooperation, and fertility are also spelled out.An earlier version of this article was presented at the annual meeting of the American Sociological Association, Washington, DC, 11–15 August 1990.     

Unmet Need for Family Planning in Developing Countries and Implications for Population Policy

Unmet need for family planning has been a core concept in international population discourse for several decades. This article reviews the history of unmet need and the development of increasingly refined methods of its empirical measurement and delineates the main questions that have been raised about unmet need during the past decade, some of which concern the validity of the concept and others its role in policy debates. The discussion draws heavily on empirical research conducted during the 1990s, much of it localized, in‐depth studies combining quantitative and qualitative methodologies. Of the causes of unmet need other than those related to access to services, three emerge as especially salient: lack of necessary knowledge about contraceptive methods, social opposition to their use, and health concerns about possible side effects. The article argues that the concept of unmet need for family planning, by joining together contraceptive behavior and fertility preferences, encourages an integration of family planning programs and broader development approaches to population policy. By focusing on the fulfillment of individual aspirations, unmet need remains a defensible rationale for the formulation of population policy and a sensible guide to the design of family planning programs.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.     

Declining world fertility: trends,causes, implications

This Bulletin examines the evidence that the world's fertility has declined in recent years, the factors that appear to have accounted for the decline, and the implications for fertility and population growth rates to the end of the century. On the basis of a compilation of estimates available for all nations of the world, the authors derive estimates which indicate that the world's total fertility rate dropped from 4.6 to 4.1 births per woman between 1968 and 1975, thanks largely to an earlier and more rapid and universal decline in the fertility of less developed countries (LDCs) than had been anticipated. Statistical analysis of available data suggests that the socioeconomic progress made by LDCs in this period was not great enough to account for more than a proportion of the fertility decline and that organized family planning programs were a major contributing factor. The authors' projections, which are compared to similar projections from the World Bank, the United Nations, and the U.S. Bureau of the Census, indicate that, by the year 2000, less than 1/5 of the world's population will be in the "red danger" circle of explosive population growth (2.1% or more annually); most LDCs will be in a phase of fertility decline; and many of them -- along with most now developed countries -- will be at or near replacement level of fertility. The authors warn that "our optimistic prediction is premised upon a big IF -- if (organized) family planning (in LDCs) continues. It remains imperative that all of the developed nations of the world continue their contribution to this program undiminished."     

Toward a U.S. population policy

The gratifying media results from a concerted national and local publicity effort when Zero Population Growth (ZPG) released its recommendations for a national population policy are reported. Support was received from 10 members of Congress and local leaders. 8 ZPG chapters and the Washington office held press conferences casting the meaning of increased population growth in regional terms. In Cincinnati, ZPG focused on the shortage of landfill space, in San Francisco the water shortage, and in Massachusetts the rapid urbanization of prime farmland. The Congressmen emphasized that the U.S. must have a comprehensive population policy before it can tell other countries they must. Among the ZPG policies recommended are: zero population growth by 2008, increased funding for family planning services and education, special programs for teenagers, greater public education on population dynamics, increased funding for contraceptive research, enforcement of existing immigration laws, comprehensive review of immigration policy, equal rights for women, and more equitable income tax policy.     

A review of the studies on fertility transition in China]

This article is a summary of papers and analysis in recent years on fertility transition and the association between fertility decline and socioeconomic development in China. These papers discuss the causes of fertility decline and the role of family planning programs in demographic transition. The major points are: 1. The demographic transition in China has the same characteristics as in the countries that have completed the transition. The transition had already started in the more developed areas or completed in a few large cities before family planning programs were implemented. 2. The role of family planning programs is to lead and to accelerate the demographic transition, which is the key idea of the "induced fertility transition". 3. The socioeconomic development and family planning programs worked together to affect the fertility decline, however socioeconomic development is the fundamental factor. Without the existence of the socioeconomic development, which included the changes in the function of family, traditional ideas on fertility, increased level of education, the status of women and social security system; the family planning program is not likely to make an impact.