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.     

Determinants of national family planning effort

In light of recent research demonstrating a substantial impact of family planning programs on fertility, we develop and estimate a multivariate model of the determinants of national differences in family planning program effort (FPPE). The framework that guides the specification of this model identifies three broad classes of factors—those that create demand for family planning, those that facilitate the initiation and expansion of family planning programs, and finally those that encourage or inhibit program development. The results from multiple regression using 84 less developed countries indicate that demand for family planning, facilitating infrastructure, and certain demographic and geographic factors are important determinants of program effort. These results suggest that popular demand for family planning is helpful, but that policy makers must perceive the adverse consequences of high fertility and have the infrastructure necessary to develop an effective organized family planning program. Current U.S. policies relevant to reducing birth rates are discussed and found to reflect quite well research on determinants of fertility declines among LDCs. U.S. policy also balances the often competing claims of family planners and their opponents by encouraging support to both developmental projects as well as direct aid to family planning program activities.     

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.     

Case study: fertility decline in Iran

Iran has experienced one of the most successful family planning programs in the developing world, with 64 percent decline in total fertility rate (TFR) between 1986 and 2000. This paper focuses on Iranians’ unique experience with implementation of a national family planning program. Recognition of sensitive moral and ethical aspects of population issues resulted in successful collaboration of technical experts and religious leaders. Involvement of local health workers, women health volunteers and rural midwives led to great community participation. Demographic and Health Survey (DHS) data in 2000 indicated a TFR of 2.0 births per women and 74 percent contraceptive use among married women. This case study will help policy makers and researchers in Moslem countries and other developing countries with high fertility rate to consider a successful family program as a realistic concept with positive impacts on nation’s health and human development.     

鼓励生育政策能否提高生育率? ——基于生育成本缺口递增的视角

中国总和生育率的下降引发调整生育政策的讨论,但鲜有对鼓励生育政策的效果评估与理论解释.通过马斯洛需求层次理论构建生育成本缺口递增假说,并基于世界人口政策数据库与OECD家庭数据库对基于转移支付的鼓励生育政策进行了效果评估,得出如下结论:第一,生育成本是一种动态结构,需求跃迁导致生育成本缺口增速快于收入增速,进而决定鼓励...     

Another Child? Fertility Ideals,Resources and Opportunities

Low fertility in most developed countries has prompted policy concern in relation to labour market supply, pensions, and expenditure on health and welfare services as well as policy debate about both the cost of children and the opportunity costs of parenthood. The extent to which family policy interventions can be effective in slowing or reversing fertility decline is much debated. This paper, based on a fertility module of the Scottish Social Attitudes Survey 2005, examines the current fertility, and ideal and expected fertility of a nationally representative sample of 455 parents of reproductive age and focuses on whether they plan to have another child. It compares the characteristics of those who intend to have another child with those who do not, and how parents with one child differ from those with more children. It addresses three questions about family size: (1) fertility ideals, (2) resources and the economic implications of childbearing, and (3) opportunities for childbearing and the effects of a late start on fertility expectations. It concludes that, despite a sustained period of low fertility in Scotland, childbearing ideals are robust and explanations of low fertility must derive from difficulties in realising those ideals. Difficulties in realising fertility aspirations are associated less with resources than with opportunities for childbearing, especially the timing of first birth. Those who delay their first birth are less likely to realise their ideal family size, and their lower fertility is associated with the opportunity costs of childbearing in terms of foregone qualifications, careers and earnings.     

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.     

The demographic assessment of family planning programs: a bibliographic essay

Over the past 15-20 years a substantial literature has accumulated in the area of determining the effect of family planning programs upon fertility, and a selected bibliography is provided. The development of modern contraceptive techniques coincided with the development of large national programs designed to reduce the fertility of the general population, and literature is presented on each of the several evaluation methods that have been used to examine program-induced changes in 1 or more fertility measures. 2 methods deal with data on individuals - births averted among acceptors and individual matching; the latter compares the fertility experience of acceptors and matched non-acceptors. A different class of methods is aggregated methods. Either areas and areal variables are the focus of the analysis proceeds with measures on general subgroups identified by such factors as residence, age, or marital status. The aggregate methods are multiple regression, program experiemnts, matching of areas, correspondence between program activity and fertility change, decomposition, and simulation. The disparity in methods has conspired with large differences in programs, data sets, and investigator interests to produce serious problems of non-comparability in results.     

Bangladesh: programs geared to meet population goals; communication as a major factor in UNFPA funded projects

The population policy of Bangladesh is aiming for a zero population growth rate at a suitable level of equilibrium. It is hoped that a net reproductive rate of 1.0 will be achieved by 1990, and that by 1985 fertility will be reduced to replacement level. Various measures to attain these goals have been suggested and they include such ones as the integration of family planning programs with other development efforts through a multisectoral approach and the introduction of incentives and disincentives for acceptance of the idea of the small family. Communications by radio and television play a critical role in the program to reduce fertility. UNFPA-funded projects emphasize education, motivation, and communication with the hope of creating a favorable attitude towards family planning and the concept of the small family. Numerous projects in progress are mentioned with regard to their current status. These projects include: rural development cooperatives and population education; pilot projects for family planning motivation and services in industry and on plantations; population education in agricultural extension; strengthening (IEM) information, education, and motivation and training; population awareness for out-of-school youth; a population education program for the Ministry of Education; and a national population information service.     

Demographic change and response: Social context and the practice of birth control in six countries

This paper expands on Kingsley Davis’s demographic thesis of change and response. Specifically, we consider the social context that accounts for the primacy of particular birth control methods that bring about fertility change during specific time periods. We examine the relevance of state policy (including national family planning programs), the international population establishment, the medical profession, organized religion, and women’s groups using case studies from Japan, Russia, Puerto Rico, China, India, and Cameroon. Some of these countries are undergoing the second demographic transition, others the first. Despite variations in context, heavy reliance on sterilization and/or, abortion as a means of birth control is a major response in most of these countries. The key roles of the medical profession and state policy are discussed, along with the general lack of influence of religion and of women’s groups in these countries.     

独生子女伤残状况及对计生扶助政策的需求分析

利用苏州市吴中区独生子女伤残家庭的问卷调查和小组访谈资料,对独生子女伤残状况及这些家庭对计生扶助政策的需求进行实证分析。结果表明：近七成独生子女伤残时的年龄在15岁以下,其中先天残疾占51．3％;重度残疾比例超过五分之二;智力残疾和精神残疾独生子女合计占比近六成;残疾后生活难以自理者比重接近三成。进一步分析发现,独生子女伤残家庭最需得到的帮扶依次为：为独生子女伤残家庭提供生活补助、为伤残独生子女父母提供养老保险补贴、提高独生子女家庭的医疗救助水平。基于以上结论．提出相关对策建议。     

Fertility and endogenous gender bargaining power

We develop an intra-household bargaining model to examine the feedback effect of household fertility decisions on gender bargaining power. In our model, the household balance of power is endogenously determined reflecting social interactions, i.e., the fertility choices by the other couples in society. We show the presence of multiple equilibria in fertility outcome: one equilibrium characterized by patriarchal society with a high fertility rate, and another in which women are sufficiently empowered and the fertility rate is low. In other circumstances, this study also demonstrates a positive relationship between female wage rates and the fertility outcomes. Finally, we discuss its policy implications, comparing the effects of two family policies: the child allowance and the subsidies for market childcare.     

Social change,population policies,and fertility decline in Colombia and Venezuela

This paper takes a comparative case-study approach to examine the social and policy correlates of fertility decline. The analysis compares fertility behavior across a mature and young cohort of women in Colombia and Venezuela, two countries that experienced rapid demographic change under dissimilar socioeconomic and population policy conditions. Based on the distinction between birth-spacing and birth-stopping behavior the analysis tests several propositions derived from the adaptation and innovation explanations of fertility decline. Results show that fertility regulation at low parities was largely absent among mature women in both countries, representing an innovative behavior among younger women. The introduction of fertility control, however, was highly dependent on women's socioeconomic position, particularly their educational and occupational characteristics. The strong family planning programs in Colombia resulted in a more rapid extension of contraceptive use, particularly female sterilization, and stopping behavior after two children relative to Venezuela. Results highlight the diversity of conditions under which fertility can decline in developing countries and the importance of family planning and other policy initiatives to understanding the different pathways towards lower fertility.     

The Bangladesh fertility decline: an interpretation

The claim has been made, notably in a 1994 World Bank report, that the Bangladesh fertility decline shows that efficient national family planning programs can achieve major fertility declines even in countries that are very poor, and even if females have a low status and significant socioeconomic change has not occurred. This article challenges this claim on the grounds that Bangladesh did experience major social and economic change, real and perceived, over the last two decades. This proposition is supported by official data and by findings of the authors' 1997 field study in rural southeast Bangladesh. That study demonstrates that most Bangladeshis believe that conditions are very different from the situation a generation ago and that on balance there has been improvement. Most also believe that more decisions must now be made by individuals, and these include decisions to have fewer children. In helping to achieve these new fertility aims, however, the services provided by the family planning program constituted an important input.     

Migration, fertility, and state policy in Hubei Province, China

Despite China s one-child family planning policy, the nation experienced a slight rise in the birth rate in the mid-1980s. Many observers attributed this rise to the heightened fertility of those rural-to-urban migrants who moved without a change in registration (temporary migrants), presumably to avoid the surveillance of family planning programs at origin and destination. Using a sequential logit analysis with life-history data from a 1988 survey of Hubei Province, we test this possibility by comparing nonmigrants, permanent migrants, and temporary migrants. While changing family planning policies have a strong impact on timing of first birth and on the likelihood of higher-order births, migrants generally do not have more children than nonmigrants. In fact, migration tends to lower the propensity to have a child. More specifically, the fertility of temporary migrants does not differ significantly from that of other women.     

The estimation of Unwanted Fertility

The estimation of unwanted fertility is a major objective of demographic surveys, including DHS surveys conducted in Asia, Africa, and Latin America. Levels and trends in unwanted fertility are important input to the formulation of population policy and the evaluation of family planning programs. Yet existing methods for estimating unwanted fertility are known to be defective, among other reasons because they rely on subjective data whose validity and reliability are questionable. In this article, we propose a new estimator of unwanted fertility-the "aggregate prospective estimator"--so named because it depends on the stated preference for another child at the time of the survey, the fertility-desires item consistently shown to possess the highest validity and reliability. Under reasonable assumptions, the aggregate prospective estimator produces less biased estimates of unwanted fertility than the most widely used existing methods. The new estimator has the limitation of generating only aggregate-level estimates, but such estimates are the primary data for policy formulation and program evaluation. The new estimator is presented in this article, along with an evaluation of its underlying assumptions and its sensitivity to several sources of error. In an illustrative application to recent DHS data from six countries, the new estimator yields substantially higher estimates of unwanted fertility than existing methods in all six countries.     

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.     

Implementation of China's population policy

On July 1, 1982 China's 3rd national population census reported the population of the 29 provinces, municipalities, and autonomous regions on the mainland at 1,008,175,288, showing a net increase of 460,000,000 or 84% over the 548,000,000 recorded at the end of 1949. At this time China's population is about 1/4 of the world. Its population policy must conform to her national conditions and will be successful only to the extent that it does so. Discussion focuses on the main features of China's population policy. In 1953 the State Council instructed the Ministry of Health to support birth control by providing contraceptives. It also ratified provisions concerning contraception and induced abortions. In 1962 the State Council issued "Instructions on Conscientious Advocacy of Family Planning." China not only advocates and publicized family planning but also takes specific measures. Special administrative organizations were established in 1964 to oversee scientific research, production, and supply of contraceptives and to provide couples of childbearing age with free contraceptives. An all round attack on family planning work in 1966 led to unchecked childbirth resulting in rapid population growth. In 1971 Premier Zhou Enlai reiterated the importance of population control in 1971 and asked that it be incorporated into the 4th Five Year Plan for the development of the national economy. Family planning was incorporated into the Constitution in 1978. China's 20 years of experiences with family planning suggest that a country's population policy becomes effective only with repeated efforts. The 10-year period of turmoil undermined the enforcement of the population policy. Recently the State Family Planning Commission organized a nationwide fertility survey which indicated tremendous successes for China's population control drive. The total fertility rate dropped from 5.29 in the 1950s to 2.63 in the 1980s. The population census shows that the momentum of China's population growth cannot be checked without strict measures because the population is characterized by a huge base figure, a young age composition, and a fertility rate much higher than a population replacement level. China's population policy is formulated in line with her national conditions. Specific provisions for family planning reflect different ways to deal with different people.     

The need for family planning

The purpose of this paper is to examine the evidence on the need for family planning. The available evidence on current levels of unmet need for contraceptives, fertility preferences, and the non-contraceptive benefits of family planning is reviewed. I argue that expansion of family planning programs is still needed. These programs provide couples with tools to reach their desired family size; can significantly impact maternal and child mortality by decreasing fertility and optimizing child spacing; and by decreasing fertility, slow population growth. It is therefore imperative to continue to expand the provision of family planning services.     

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.