New strategies for slowing population growth

Growth of world population over the next 100 years, until the year 2100, will produce an estimated 11.5 billion people. The past focus on reducing rapid population growth exclusively through family planning has not been sufficient. Population policy needs to be broadened to include health care, education, and poverty reduction. The population policy recommendations of Population Council Vice-President John Bongaarts and Senior Associate Judith Bruce were to reduce unwanted pregnancies by expanding services that promote reproductive choice and better health, to reduce the demand for large families by creating favorable conditions for small families, and to invest in adolescents. The Population Council 1994 publication "Population Growth and Our Caring Capacity" outlined these issues. Another similar article by John Bongaarts appeared in the journal "Science" in 1994. In developing countries, excluding China, about 25% of all births are unwanted; 25 million abortions are performed for unwanted pregnancies. The provision of comprehensive family planning programs will go a long way toward achieving a reduction in unwanted pregnancies. In addition, changes are needed in male control over female sexuality and fertility and in cultural beliefs that are obstacles to use of contraception. Stabilization of population at 2 children per family will not occur unless there is a desire for small families. In most less developed countries, large family sizes are preferred. Governments have an opportunity to adopt policies that reduce economic and social risks of having small families. This can be accomplished through the widespread education of children, a reduction in infant and child mortality, improvement in the economic and social and legal status of women, and provision of equitable gender relations in marriage and child rearing. The rights of children to be wanted, planned, and adequately cared for need to be supported. These aforementioned measures will help to reduce fertility, provide support for small families, and justify investment in social development. Population momentum will keep population growing for some time even with replacement level fertility. Investment in adolescents through enhancement of self-esteem and promotion of later childbearing can lengthen the span between generations and slow population momentum. Population policies will be more effective when human rights are protected.     

Prospects for fertility reduction and projections for future population growth in Kenya

In 1979 Kenya's annual rate of natural population growth was 3.8%. Data from the1989 Kenya Demographic and Health Survey indicate that significant decreases in fertility levels were experienced during the 1980s. Factors associated with conditions supportive of high fertility in Kenya are discussed, and progress toward attaining significant fertility reduction thresholds during the 1980s is assessed. Findings from recent fertility surveys are presented, and 1969–1989 national level family planning data are evaluated. Four population projections for 1985–2025 are presented and analyzed. One projection is based on official government growth targets; two are based on estimates provided by the United Nations and the Population Reference Bureau, and a fourth projection is based on the assumption that Kenya will attain an annual natural population growth rate of less than 1% by the year 2025. Each projection assumes that fertility declines will be experienced. Kenya's prospects for reducing the annual population growth rate to 1% within the next sixty years and a cost-sharing development policy are addressed briefly in the concluding section. Recent data suggest that Kenya will probably not complete the demographic transition before the year 2050, but Kenya should continue to move through the transition stage.     

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.     

Do family planning programs enhance children's health?

The findings of the 1993 National Demographic Survey (NDS) in the Philippines provide implications for child health of family size and whether a child was wanted at the time of conception. About 15% of the more than 8000 births considered in the NDS were classified as unwanted. In 1995, the East-West Center's Program on Population has helped research centers in the Philippines to conduct an extended analysis of NDS results. Children under age 5 who had been unwanted at the time of conception (unwanted children) were almost 25% and 15% more likely to have had diarrhea or respiratory infections, respectively, in the last two weeks than those who were wanted at the time of conception (wanted children). Unwantedness had little effect on the likelihood of treatment once the child was ill, however. When the researchers controlled all other variables, including unwantedness, family size did not have a direct influence on the likelihood that a child would become ill, but it did have a significant influence on whether or not an ill child would receive treatment. Each additional sibling reduced the likelihood that an ill child would receive treatment by about 5% for diarrhea and by about 4% for respiratory infection. Another factor that influenced disease incidence was age (at 18 months, most likely to be ill with respiratory infection or diarrhea). Older children were more likely to receive treatment than younger children. Other factors influencing treatment and disease incidence were socioeconomic status and maternal educational status. These findings further justify family planning programs based on child health. They demonstrate that children suffer when they are born into a household where they are not wanted. Since about 33% of all child deaths are caused by diarrhea or respiratory infections in the Philippines, unwantedness affects the incidence of these infections, and family size has a direct effect on the likelihood an ill child will receive treatment. A policy intervention that would greatly reduce child mortality would be extremely beneficial.     

A look at Asia's changing youth population

This report summarizes findings from a recent East-West Center study on demographic and social changes among young people aged 15-24 years in 17 countries in East, Southeast, and South Asia. Nearly every country in Asia has experienced fertility decline. Decline began in Japan and Singapore during the 1950s, followed by declines in Hong Kong, South Korea, Sri Lanka, the Philippines, Brunei, Taiwan, Malaysia, Thailand, and China during the 1960s. Declines occurred during the 1970s in Indonesia, India, and Myanmar. A "youth bulge" occurred about 20 years later due to declines in infant and child mortality. This bulge varies by country with the timing and magnitude of population growth and subsequent fertility decline. The proportion of youth population rises from 16% to 18% about 20 years after the beginning of fertility decline and declines to a much lower stable level after several decades. The bulge is large in countries with rapid fertility decline, such as China. Governments can minimize the effects of bulge on population growth by raising the legal age at marriage, lengthening the interval between first marriage and first birth, and increasing birth intervals. School enrollments among adolescents are rising. In South Korea, the population aged 15-24 years increased from 3.8 to 8.8 million during 1950-90, a rise of 132% compared to a rise of 653% among school enrollments. It is expected that the number of out-of-school youths will decline from 5.1 to 3.6 million during 1990-2025. Youth employment varies by gender. Policies/programs in family planning and reproductive health will need to address the changing needs of youth population.     

Understanding the population dimension in development planning

In the Philippines initial efforts to adopt population policies focused on reducing rapid population growth through fertility control. The history of the national population welfare congress, which started in 1978, reflects this emphasis on family planning as a major deterrent to rapid population growth. It was only in recent years that the 2-way relationship between population and development came to be better appreciated. The 6th National Populaton Welfare Congress was a response to this need to broaden the scope of population concerns and integrate the population dimension into development planning. This viewpoint regards population not as a demand variable but as a factor that can be influenced by economic and social development. Dr. Mercedes B. Concepcion, dean of the University of the Philippines Population Institute (UPPI), discussed population trends, prospects, and problems in a paper presented before the 6th congress. In 1980, she said, the Philippine population was 48.1 million persons, up by 11.4 million persons or 31%, over the3l.7 million enumerated in 1970. While the rate of populated growth remains high, data indicate a decreasing post-World War II trend, from 3.06% in 1948-60 to 2.68% in 1975-80. The proportion of the population below 15 has dropped by 2 percentage points, while the number of persons in the working ages 15-64 has increased. In 1 of the 3 group sessions during the congress, the participants tried to define the Philippines' population distribution goals, the requirement of an urban-rural balance, and priority intervention areas. In that session 2 main papers were presented -- one on human settlements and urbanization and the other on macroeconomic policies and their spatial implications. In another sessionplanners and researchers examined the socioeconomic and demographic impact of development programs, specifically the impact of rural electrification on fertility change in Misamis Oriental, a province in Southern Philippines. In the main paper presented in that session, Dr. Herrin indicated that the most rapid decline in marital fertility in the Philippines occurred among highly educated parents with high incomes and living in the urbanized areas of Metro Manila, Southern Luzon, and Central Luzon. The 3rd group session discussed mortality trends and prospects as well as the present forms of government intervention to reverse these trends. Generally, a declining trend has been observed in the crude death rate and in infant mortality.     

Children in large families

A summary was provided of issues presented by Dr. Cynthia Lloyd in her chapter on investing in children from the 1994 volume "Population and Development: Old Debates, New Conclusions." Children in large families may miss the opportunities offered in a modernizing society. The possibilities for adverse consequences because of a large size of families include a smaller share of resources (time, income, and/or nutrition) among family members, limited access to public resources (health care and education), unequal distribution of resources among family members, and gender defined roles. Dr. Lloyd's review of the literature exposed the lack of emphasis on the impact of opportunity, equity, and intergenerational transfers on child welfare. Children's smaller share of resources had less impact on child welfare. Later-born and unwanted children were particularly vulnerable in large families. Unwanted children were usually later born or girls. The lack of investments in girl's education not only affected the limited earning power and opportunity to escape from gender restricting roles but also contributed to the perpetuation of the cycle of high fertility and gender discrimination. Family decisions about fertility and investments in children's education and nutrition can not be separated from the social context of culture, class, social custom, and level of socioeconomic development. Disadvantage is not assured in large families, but statistically more probable. Fewer children are more likely to be wanted and to receive better care. Societies should provide high quality family planning services, safe abortion services, and enforcement of primary school education requirements. Measures need to be adopted for promotion of schooling for girls that is sensitive to cultural norms. Laws must protect children's rights to economic support from both biological parents. Gender discrimination against women must be eliminated.     

Adolescent sexuality in Asia: new focus for population policy

As the age at marriage continues to rise in East and Southeast Asia, the fertility behavior of unmarried teenagers is receiving more attention from population policymakers. In addition to fertility reduction through family planning, Asian societies today consider population planning strategies in relation to national needs and social goals, including such matters as the population's growth rate, age structure, educational quality and skills. The number of single youth in Asia is growing much more rapidly than the total youth population. By the year 2010, for example, India is projected to have nearly 70 million single teenagers, aged 15-19, 188% more than in 1980. In many developing countries today, such as the Philippines and Korea, the rising age at marriage has combined with rapid urbanization, improved status for women, and more educational opportunity to alter both the behavioral norms of young people and the traditional means of social control over youth. Studies of contemporary adolescent sexuality have been conducted in 4 Asian countries. In the Philippines an overt independent youth homosexual culture was found to exist in urban and to some extent rural areas. In Thailand research revealed little conservative resistance to family planning or to contraceptives for young unmarried people. Surveys in Taiwan indicate that behavior related to dating and choice of spouse has become more liberal, and a survey in Hong Kong revealed a higher level of premarital sex and use of prostitutes among Chinese men than expected. Population policy perspectives that need to be considered in these changing times include: 1) issues of access to family planning services by unmarried people below the legal age of maturity; 2) the development of social institutions, such as exist in Thailand and the Philippines, to guide adolescents' behavior; 3) more extensive study of adolescent sexuality; 4) establishment of the scope of family policy.     

Gender inequalities and demographic behavior

A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.     

Sex preference and fertility: what is the link?

It is argued that investment in programs for changing attitudes toward sex preference may not have the greatest impact on reducing fertility or increasing fertility control. Arnold's new method of analysis of determining sex preference was applied to data from a 1977 Egyptian survey of 36,000 rural households in Menoufia Governorate. Findings indicated that couples increased their use of modern contraceptives in direct proportion to an increase in the number of sons. Arnold determined that a large majority of all couples would have at least one boy early in their childbearing years. Thus sex preference would not have a large effect on fertility. Arnold's analysis among 27 countries found that without any sex preference, contraceptive usage would increase by an average of less than 3.7 percentage points. Arnold found that sex preference was strongest in Asia, particularly in South Korea and Taiwan that already have reduced fertility levels. In Africa, where fertility is high, the total elimination of sex preference would have only a 2.9 percentage point difference in contraceptive use. Sex preference had small effects on the percent of women who practice contraception, the percent who desire no more children, and the average number of additional children wanted. For example, in Bangladesh having no sex preference would show a percentage difference of 1.6 percentage points for contraceptive use, 4.7 percentage points difference for women desiring no more children, and -0.1 percentage point difference for the average number of additional children wanted. The effect of having no sex preference was strongest in India compared with Bangladesh, Indonesia, Nepal, the Philippines, Thailand, Ghana, Kenya, Costa Rica, Haiti, Paraguay, and Peru. The effect of no sex preference in India would have the respective percentage point effect of 3.7, 8.9, and -0.2. Public policy should be directed to information, education, and communication with other social goals.     

Completing the fertility transition in the developing world: The role of educational differences and fertility preferences

This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition. The data are from Demographic and Health Surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in developed and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This conclusion implies that the educational composition of the population remains a key predictor of overall fertility in late transitional countries and that low levels of schooling can be a cause of stalling fertility.     

Completing the fertility transition in the developing world: The role of educational differences and fertility preferences

This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition. The data are from Demographic and Health Surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in developed and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This conclusion implies that the educational composition of the population remains a key predictor of overall fertility in late transitional countries and that low levels of schooling can be a cause of stalling fertility.     

Asian and Pacific population targets

2 population targets for the Asian and Pacific regions were established in 1981-82: 1) by the Asian Conference of Parliamentarians on Population and Development at Beijing, China to attain 1% population growth rate for the Asian region by the year 2000, and 2) by the 3rd Asian and Pacific Population Conference at Colombo, Sri Lanka, to attain replacement level of fertility by the year 2000. In an attempt to ascertain whether these targets can be achieved and/or related, the Population Division of the UN's Economic and Social Commission for Asia and the Pacific (ESCAP) prepared population projections in which the 2 targets are achieved. These projections were prepared by aggregating the total population of member countries. When net reproduction rate (NRR) equals 1 (replacement level fertility) it will lead to a stable population with a growth rate of zero. In the short-term a population with replacement level fertility will continue to increase if it has a young age structure due to previous higher levels of fertility. Some projections for the period 1980-2005 are: 1) population growth rate will decrease from 1.78% to 1.05%, 2) total fertility rate will decrease from 3.63-2.11, 3) male life expectancy will increase from 59.8-67.3, and 4) infant mortality rate will decrease from 67.3-34.5. For the ESCAP region, a target of NRR of 1 would be easier to achieve than a growth rate of 1%. The UN projects the total population of the region to be 3,382,000,000 in the year 2000. If the NRR can be lowered to 1 by then, however, the total population would be 3,342,000,000 and if the growth rate can be reduced to 1% by the end of the century the resulting population would be 3,300,000,000. Major demographic benefits will be attained in terms of the age structure of the population if a 1% growth rate is achieved; the proportion under age 15 was 37.1% in 1980 but will be 27.2% in 2000 with a dependency ratio of 48.8 compared to 70.8 for 1980.     

The momentum of mortality change

Mortality change is not usually assigned much importance as a source of population growth when future population trends are discussed. Yet it can make a significant contribution to population momentum. In populations that have experienced mortality change, cohort survivorship will continue varying for some time even if period mortality rates become constant. This continuing change in cohort survivorship can create a significant degree of mortality-induced population change, a process we call the 'momentum of mortality change'. The momentum of mortality change can be estimated by taking the ratio of e0 (the period life expectancy at birth) to CAL (the cross-sectional average length of life) for a given year. In industrialized nations, the momentum of mortality change can attenuate the negative effect on population growth of declining fertility or sustained below-replacement fertility. In India, where population momentum has a value of 1.436, the momentum of mortality change is the greatest contributor to its value.     

The momentum of mortality change

Mortality change is not usually assigned much importance as a source of population growth when future population trends are discussed. Yet it can make a significant contribution to population momentum. In populations that have experienced mortality change, cohort survivorship will continue varying for some time even if period mortality rates become constant. This continuing change in cohort survivorship can create a significant degree of mortality-induced population change, a process we call the ‘momentum of mortality change’. The momentum of mortality change can be estimated by taking the ratio of e ₀ (the period life expectancy at birth) to CAL (the cross-sectional average length of life) for a given year. In industrialized nations, the momentum of mortality change can attenuate the negative effect on population growth of declining fertility or sustained below-replacement fertility. In India, where population momentum has a value of 1.436, the momentum of mortality change is the greatest contributor to its value.     

Kenya's record population growth: a dilemma of development

The causes and implications of Kenya's 4% rate of natural increase and fertility rate of 8.1 births per woman were examined. Attention was directed to the following: pronatalist pressures; inadvertent pronatalist impact of development; women's education and employment and fertility; population growth and pressures; mortality decline and population growth; fertility levels and differentials; fertility desires; the family planning program; and family planning knowledge, attitudes, and practice. Kenya's development success has worked to push up the population growth rate. Improved health care and nutrition halved infant mortality from 160 to 87 deaths/1000 live births between 1958 and 1977 and a marked increase in primary school enrollment may be factors in the birthrate increase to 53/1000 population. At this time fertility is highest among women with 1-4 years of education. The 1977-1978 Kenya Fertility Survey showed that only 5.8% of married women were using modern contraception, indicating that the national family planning program, established in 1967, has made little progress. Program difficulties have included shortages of staff, supplies and easily accessible clinic as well as an almost universal desire on the part of Kenyans for families of at least 7 children. Children are viewed as essential to survival and status to the rural population.     

The Commission on Population Growth and the American Future: its origins,operations, and aftermath

The origins, organization, and operation of the Commission on Population Growth and the American Future and the response to its report are described. The origins of the Commission are traced to a concern with the consequences of U.S. population growth on the part of such key individuals as John D. Rockefeller 3rd and Paul Ehrlich. Because the Commission was a statutory creation of Congress, its membership included 4 Congressmen in addition to 20 distinguished citizens representing a spectrum of groups and views. The evaluation of the consequences of growth, as opposed to the means of reducing fertility, became the major concern of the research effort. Several issues led to differences within the Commission: 1) A narrow versus a broad definition of the scope of the report; 2) differing perceptions of the population problem as manifested by the ecological view, the "unwanted fertility" school, and the social justice view. The social science work contracted by the Commission had a significant impact on the final report's substance: 1) the demographic work on population projections was crucial to the analysis of the consequences of growth; 2) evaluating the demographic capability of national "growth center strategy" had an influence; and 3) the need to eliminate unwanted fertility was confirmed as a necessary priority. The basic thrust of the Commission's report was to recomment slowing growth in order to maximize the quality of life.     

Completing the Demographic Transition

Despite ongoing declines in fertility in many countries, the population of the world is experiencing a period of rapid expansion, and its size is expected to reach 10 billion by the end of the demographic transition. Three causes of this growth are identified and quantified: 1) fertility above the replacement level of two surviving children per woman, 2) continuing declines in mortality, and 3) population momentum resulting from a young age structure. A set of simple analytic expressions is proposed for estimating these factors from standard demographic indicators. Population momentum is shown to be the main cause of future growth in most countries and regions.     

Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries

This paper investigates whether children later reported as having been unwanted or mistimed at conception will, when compared with children reported as wanted, show adverse effects when the following criteria are applied: receipt of antenatal care before the sixth month of gestation, supervised delivery, full vaccination of the child, and child growth (stunting). The study uses data from five recent Demographic and Health Survey enquiries in Bolivia, Egypt, Kenya, Peru, and the Philippines. In Peru, children unwanted at conception were found to have significantly worse outcomes than other children, but in the other countries, a systematic effect was found only for receipt of antenatal care. Weak measurement of the complex concept of wantedness may have contributed to these results. Birth order of the child, with which wantedness is inextricably linked, has more powerful and pervasive effects, with first-born and second-born children being much less likely to show adverse effects.     

Population pressures in Latin America

In 1950 Latin America's population of 165 million was on a par with the 166 million of North America. 2 decades of growth at nearly 3% a year pushed the total to 405 million in 1985, vs. 264 million in North America. Despite substantial fertility declines since the 1960s, continued growth is ensured by the demographic momentum built into the region's large and youthful population bases. UN medium projections put the 2025 total at 779 million, compared to 345 million in North America. This Bulletin examines the main demographic changes in Latin America since World War II and their links to economic and social changes in the region as well as their implications for international and social relations. The post World War II population surge was accompanied by massive rural-ruban and international migration, rapid urbanization, large labor shifts out of agriculture into industry and services, increased education for both men and women, and higher labor force participation for females. The rural exodus was spurred by extreme land tenure inequalities and the urban bias of postwar industrialization. The labor-saving bias of this industrialization forced exploding city populations to turn to the informal sector for jobs. Population pressures on city services and housing as well as jobs have been further exacerbated by overconcentration in a few large cities and economic downturns of the 1980s. Recent fertility declines seem to be the result of both increased access to family planning and the economic and social pressures posed by the gap between young adults' aspirations and their ability to realize them. Population and economic pressures could induce faster fertility declines than now projected but in the short run are likely to mean more employment problems, continued rapid urban growth, and even larger international immigration flows within the hemisphere, particularly to the US.