We must pay attention to the difference between the original intention and the current status of family planning]

Due to imperfections in the current family planning (FP) policy, and the differences un program implementation in urban and rural areas, the fertility of the urban population with higher IQ scores is under control but this is not the case for the rural population. Among rural couples, one child is rare and two or three are commonplace, while in cities over 70% of couples are having one child. In the metropolitan cities, this figure is about 90%. In the rural areas, provision of education is a serious problem because of insufficient resources, a lack of qualified teachers and inadequate facilities. At the present, at least 3 million school age children in rural areas can not go to primary school. Besides there is a big contrast in FP practice between Han nationality and minorities. Population growth is basically under control among the more advanced Han nationally but not among the less advances minority nationalities. This growth rate among the minority population was about 50.27/1000 in the past five years, which is alarming. Furthermore, the couples given opportunity to have a second child are often those whose first child had birth defects or is mentally retarded, whereas couples with a normal child can have only one child. This has become a vicious circle, since subsequent children are more likely to have the same birth defects. It was discovered from a 1983-85 survey that the prevalence of birth defects was 12.8/1000. The current situation is that the fertility of urban, educated, and healthy people is restricted while the less educated, those living in less developed areas, and those with health defects are having more children. The outcome of this situation is the decline of national population quality, which greatly deviates from the original intention of the FP.     

India's population in transition

This demographic profile of India addresses fertility, family planning, and economic issues. India is described as a country shifting from economic policies of self-reliance to active involvement in international trade. Wealth has increased, particularly at higher educational levels, yet 25% still live below the official poverty line and almost 66% of Indian women are illiterate. The government program in family planning, which was instituted during the early 1950s, did not change the rate of natural increase, which remained stable at 2.2% over the past 30 years. 1993 marked the first time the growth rate decline to under 2%. The growth rate in 1995 was 1.9%. The total population is expected double in 36 years. Only Nigeria, Pakistan, and Bangladesh had a higher growth rate and higher fertility in 1995. India is geographically diverse (with the northern Himalayan mountain zone, the central alluvial plains, the western desert region, and the southern peninsula with forest, mountains, and plains). There are regional differences in the fertility rates, which range from replacement level in Kerala and Goa to 5.5 children in Uttar Pradesh. Fertility is expected to decline throughout India due to the slower pace of childbearing among women over the age of 35 years, the increase in contraceptive use, and increases in marriage age. Increased educational levels in India and its state variations are related to lower fertility. Literacy campaigns are considered to be effective means of increasing the educational levels of women. Urbanization is not expected to markedly affect fertility levels. Urban population, which is concentrated in a few large cities, remains a small proportion of total population. Greater shifts are evident in the transition from agriculture to other wage labor. Fertility is expected to decline as women's share of labor force activity increases. The major determinant of fertility decline in India is use of family planning, which has improved in access and use during the 1980s. If India is to keep a stable population under 1.6 billion in the future, Indians may have to accept only one child per family.     

Characteristics of fertility transition in China]

Since 1949 and in particular the 1970s, China's fertility rate has undergone rapid and continuous change. This is a direct reflection of China's success in population control. The decline in China's fertility rate regulated the speed of population growth, altered the population structure, and brought population development to be in line with economic development. Data used in this article are from the National 1/1000 Random Sample of Fertility (1982), the 10% Sample of the 1982 Population Census, 1981, 1983 and 1984 statistical yearbooks, and other data from the Statistics Bureau. China's fertility rate dropped an annual average of 2.5/1000 from 1950-81. However, this time, the fertility rate fluctuated, depending on political, social and economic factors. As the nation prospered, the fertility rate remained stable and high; as China suffered severe economic losses, the fertility rate dropped. A steady decline was evident beginning in 1970 as the government began to propagandize the merits of smaller families. Between 1971-83 the average yearly rate of growth was 1.6%. The number of years a woman was fertile was similar for both urban and rural women in 1964 and 1981; moreover, in 1981 both groups showed a sharp drop in fertility between the ages of 27-35. The 1 child rate for urban women rose from 21.9% in 1964 to 86.6% in 1981. Urban women tend to be more receptive to late marriage, late births, and fewer children. This change in the 1 child rate contributed to the drop in the birth rate of 31.1/1000 in 1964 to 20.9/1000 in 1981.     

How female literacy affects fertility: the case of India

Recent studies indicate that there is a direct correlation between increased literacy and decreased fertility. This link was demonstrated in study that covered 90% of India's population. Studies in other developing countries have confirmed this finding. In addition, high literacy rates have been found to correspond to high infant survival rates. Researchers also found that there was little change in the relationship between literacy and fertility when they were both controlled for different levels of urbanization. The problem is that only 1 in 4 Indian women are literate. However, India's government has a program in place the goal of which is to have universal literacy. In Kerala, female literacy is the highest (65%). And at 3.4 children/women, it has 1 of the lowest fertility rates. For the 14 states studied, the total fertility rate was 5.0 children/woman, the child mortality rate was 126/1000, and the female literacy rate was 22%. In contrast in Rajasthan where female literacy is 11% (the lowest of the 14 states studied) fertility is the highest at 6.0 children/woman. No state with higher than average fertility had higher than average female literacy rates. Literate women are likely to have more surviving children because they are more aware of good health practices, and they tend to live in better circumstances. As a result, couples need fewer births to reach their desired family size.     

An analysis of the fertility transition in developing countries]

Most developing countries are in the demographic stage of early mortality, high birth rates and high rates of natural population increase. A characteristic of developing countries is that after World War ii, particularly since the 1960s fertility rates are on the decline, even though they still remain high. The fertility rate of developed countries fell from a 1950 rate of 22.9/1000 to 15/1000 in 1982, a decrease of 34.5%, whereas the fertility rate of developing countries hovered around 43/1000 between 1930-1950, 40.6/1000 during the 1960s and 33/1000 in 1982. Between 1950 and 1982 there was a decrease of 24.8%. But the main reason for this decrease is the decline in the last 20 years of the fertility rates of China and India, whose rates fell 34.9% from 1960-1980. Changes in fertility rates are influenced by the age structure of a country, as seen in the changing age structure of developing countries from 1960-80. For example, an increase in fertility rates was 1 consequence of an increase in the number of fertile women aged 15-45 from 42.6% in 1960 to 44.4% in 1980. Nevertheless, there exists some sort of birth control, whether conscious or subconscious, because the number of births per fertile woman is 3-4 fewer than the 14-15 children a woman can theoretically bear. The reason for changes in fertility rates in developing countries can be traced to marriage and family customs, and even more important, to social and economic factors. For example, Asian, African and Latin American cultures tend to support early marriages. When the fertility rates of developed and developing countries are looked at for a comparable period, then the rate of decrease for developing countries is slower than developed countries. But, if the comparison is made for a transitional period (i.e., industrialization), then the rate of decrease for developing countries is faster than for developed countries. Currently there are 25 developing countries that have attained a fertility rate of 25/1000 or lower, and 52 developing countries with a rate of 35/1000.     

Change of marital fertility in China from 1964 to 1981]

In 1982 the Chinese National Family Planning Commission conducted a nationwide (excepting Taiwan and Tibet) .001 random sampling of the total population to gather data on the fertility and age structures of married women. In comparing general marital fertility and standardized fertility, findings show that from 1964 to 1970 both rates averaged 225.1/1000. When family planning work began on a wide scale in 1971, the rates steadily declined, reaching 116.7/1000 in 1980. However, in 1967-68 the standard fertility rate rose by 21.34% due to the chaos of the Cultural Revolution, and in 1980-81 the rate increased by 13.2%, indicating that problems still remain in family planning. The total marital fertility rate dropped 2.84/1000 from 1964 to 1981. The rate of decline in rural areas was greater than in the cities, but the cities had a larger percentage decline than the countryside. In the 5-year periods of 1965, 1970, 1975, and 1980, marital fertility rates tended to decline in 1970 and 1975 among women aged 30-40 years because during those periods greater control was placed on women having multiple children. For 1980 and 1975, combined total rates for 15-19 year olds dropped 17.1%, but the combined total rates of 30-49 year olds dropped by 61.2%, indicating that in recent years the drop in marital fertility is mostly among those over 30 years of age.     

Effects of education on reproductive behavior: lessons from Pakistan

Evidence from the Pakistan Demographic and Health Survey 1990/91 (PDHS) and a 1987 study by Zeba A. Sathar and Karen Oppenheim on women's fertility in Karachi and the impact of educational status, corroborates the correlation between improved education for women and fertility decline. PDHS revealed that current fertility is 5.4 children/ever married woman by the end of the reproductive period. 12% currently use a contraceptive method compared to 49% in India, 40% in Bangladesh, and 62% in Sri Lanka. The social environment of high illiteracy, low educational attainment, poverty, high infant and child and maternal mortality, son preference, and low status of women leads to high fertility. Fertility rates vary by educational status; i.e., women with no formal education have 2 more children than women with at least some secondary education. Education also affects infant and child mortality and morbidity. Literacy is 31% for women and 43% for men. 30% of all males and 20% of all females have attended primary school. Although most women know at least 1 contraceptive method, it is the urban educated woman who is twice as likely to know a source of supply and 5 times more likely to be a user. The Karachi study found that lower fertility among better educated urban women is an unintended consequence of women's schooling and deliberate effort to limit the number of children they have. Education-related fertility differentials could not be explained by the length of time women are at risk of becoming pregnant (late marriage age). Fertility limitation may be motivated by the predominant involvement in the formal work force and higher income. The policy implications are the increasing female schooling is a good investment in lowering fertility; broader improvements also need to be made in economic opportunities for women, particularly in the formal sector. Other needs are for increasing availability and accessibility of contraceptive and family planning services and increasing availability and accessibility of contraceptive and family planning services and increasing knowledge of contraception. The investment will impact development and demography and is an adjunct to child health an survival.     

A tentative discussion on family planning problems in Xinjiang's minorities]

The Uighur Autonomous region in Xinjiang includes a number of minority groups such as the Uighur, Kazakh and Hui. The question of how to implement family planning in minority areas if of utmost importance. In February 1982, the State Council decreed that family planning policy for minority groups could justifiably be more lax than for the Han people, who comprise a majority of Chinese population. Instead of advocating 1 child per couple, as is the current national policy, urban minority groups are permitted 2 (with exceptions, 3) children per couple and rural villagers are permitted 3 (with exceptions, 4) children. The 1982 National Census showed that the natural rate of growth for Xinjiang was 13.63/1000 (compared to the national rate of 11.45/1000) with individual minority growth rates as high as 20.11/1000. The area's gross output value cannot keep up with this population increase. Over half of Xinjiang's minorities are of the Islamic faith, which teaches that births are not self-willed. It is crucial to inculcate in them that births can indeed be planned. Also, their custom of early marriage (age 15 for girls and 16 for boys) which leads to a high fertility rate, must be changed. Although Xinjiang's land mass is great, only 38.4% is arable, so the common belief that its population can grow without limit is fallacious. When family planning was being implemented nationwide, for minorities it was only propagandistic. After the population growth for the majority Han was under control, the minority groups declared family planning programs would also benefit them. Symposiums were held contraceptive use became voluntary among many women. The birth rate fell from 22.5/1000 in 1981 to 14.09/1000 in 1985. Family planning also received approval from religious leaders. But because population distribution and growth are uneven in Xinjiang, family planning policy must reflect these differences.     

The achievements in family planning work in Rudong County as suggested by the data of the Fertility Survey]

A 15% random sampling from Rudong County was recently taken to survey fertility rates. 1153 primary units were chosen, which included 160,832 people. Among this group were 57,050 women aged 15-67 years. Topics surveyed included: marriage, birth, contraception, and population structure. Rudong County, among the earliest counties in China to begin the work of birth control, started in the 1960s with birth control education. The natural rate of population increase by the early 1970s had already fallen. From 1974 to 1982 the average rate of natural population growth was 3.8/1000. Reproduction has gone from a rising trend to a stabilized trend. The base of the population structure pyramid has shrunk; the number of youths aged from birth to 14 years has fallen from 35.05% in 1964 to 21.77% in 1982. The number of people who must be supported (the old and the young) has decreased, lessening society's responsibility for them. 29.45% of the total population are over 65 years or under 14. Society's coefficient factor of support has fallen from 66.31% in 1964 to 41.75%. There is a decrease in the number of people marrying at a young age; the trend is toward marriage at a later age. The average age at marriage had risen from 23.81 years in 1980 to 23.89 years in 1981. The fertility rate has decreased, as has the number of offspring per woman. 1 child family is on the rise and multiple children family is on the decline. In 1981 the 1 child rate reached 92.98%, the 2 children rate was 6.63% and the multiple children rate was 0.49%. Prior to 1979 the 1 child rate was under 10%. The fertility rate fell from 136/1000 in the 1960s to 41.5/1000 in 1981.     

The demographic transition in southern Africa: Another look at the evidence from Botswana and Zimbabwe

Botswana and Zimbabwe have been acclaimed as being on the vanguard of the demographic transition in sub-Saharan Africa. This paper examines the comparability of the CPS and the DHS data for each country and finds that part of the observed decline in aggregate fertility rates in both countries can be attributed to differences in sample composition. Women of the same cohort tend to be better educated in the second survey relative to the first. This fact explains part—but not all—of the observed fertility decline; for example, it appears to account for up to half the observed decline among women age 25–34 in 1984 in Zimbabwe.     

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.     

Birth and death in cities in the developing world

City dwellers in Sub-Saharan Africa have increased roughly 600% in the last 35 years. Throughout the developing world, cities have expanded at a rate that has far outpaced rural population growth. Extensive data document lower fertility and mortality rates in cities than in rural regions. But slums, shantytowns, and squatters' settlements proliferate in many large cities. Martin Brockerhoff studies the reproductive and health consequences of urban growth, with an emphasis on maternal and child health. Brockerhoff reports that child mortality rates in large cities are highest among children born to mothers who recently migrated from rural areas or who live in low-quality housing. Children born in large cities have about a 30% higher risk of dying before they reach the age of 5 than those born in smaller cities. Despite this, children born to migrant mothers who have lived in a city for about a year have much better survival chances than children born in rural areas to nonmigrant mothers and children born to migrant mothers before or shortly after migration. Migration in developing countries as a whole has saved millions of children's lives. The apparent benefits experienced in the 1980s may not occur in the future, as cities continue to grow and municipal governments confront an overwhelming need for housing, jobs, and services. Another benefit is that fertility rates in African cities fell by about 1 birth per woman as a result of female migration from villages to towns in the 1980s and early 1990s. There will be an increasing need for donors and governments to concentrate family planning, reproductive health, child survival, and social services in cities, particularly in Sub-Saharan Africa, because there child mortality decline has been unexpectedly slow, overall fertility decline is not yet apparent in most countries, and levels of migration to cities are anticipated to remain high.     

Fertility survey in the rural area of Henan province]

The population of Henan Province is 72,850,000, 92% of whom live in villages. From July 12 to August 11, 1981, a fertility survey was taken of 20 communes and 31 work brigades in the counties of Fugou, Shancai, and Dengfeng, in which 38,168 people and 5700 fertility registration forms were studied. In 1980, 15% of the 3 counties' population were women aged 18-49, 80% of whom were married. The birth rate was 134.56/1000, of which the rate for married women was 172.36/1000. A random sampling from Shancai of 18-49 year old women showed an average of 2.3 children per couple. The factors influencing rural fertility are economic, social, ideological, and cultural. The economic system of distribution according to work has actually encouraged population growth because in rural areas where the standard of living is low larger families with more workers have greater incomes than smaller families with fewer workers. Early marriage and early births are encouraged under this system, as evidenced by findings in Fugou County. The survey also found that in the 3 counties, virtually everyone marries, women who work tend to work in the village close to home, high illiteracy is prevalent, and traditional attitudes of favoring males over females were all factors contributing to early and frequent births. In order to lower rural birth rates, rural economy should be developed, old attitudes and habits should be changed, and literacy should be increased.     

Fertility Timing of Unmarried and Married Mothers: Evidence on Variation Across U.S. Cities from the Fragile Families and Child Wellbeing Study

In this paper, we examine the determinants of fertility timing of unmarried and married mothers using a rich new birth cohort study, the Fragile Families and Child Wellbeing Study, drawn from 20 medium and large U.S. cities. We find considerable variation in the time to next birth among comparable mothers who live in different cities. Some of this variation is explained by variation in labor markets, housing costs and availability, and welfare policies. City variation is particularly important for unmarried women who already have two or more children, whose fertility is more sensitive to these contextual variables than is the fertility of married women, or unmarried women with just one child.     

Impact of educational attainments on women's fertility]

The fertility rates of Chinese women of different educational backgrounds and ages were studied. The results indicate that women with higher educational backgrounds are likely to marry later in life, and have fewer children. The converse is also true; women with little or no education marry very young and have significantly more offspring. It is noted that many of the poory educated are traditionally conservative; they strongly desire at least 1 male offspring, and generally understand the least about matters related to family planning. In terms of economics and human investment, intellectuals are less likely to want more than 1 child. 2 of the most effective ways in which fertility rates may be lowered are to reduce early fertility and to improve the educational levels of women.     

From Privilege to Prevalence: Contextual Effects of Women’s Schooling on African Marital Timing

In Africa and elsewhere, educated women tend to marry later than their less-educated peers. Beyond being an attribute of individual women, education is also an aggregate phenomenon: the social meaning of a woman’s educational attainment depends on the educational attainments of her age-mates. Using data from 30 countries and 246 birth cohorts across sub-Saharan Africa, we investigate the impact of educational context (the percentage of women in a country cohort who ever attended school) on the relationship between a woman’s educational attainment and her marital timing. In contexts where access to education is prevalent, the marital timing of uneducated and highly educated women is more similar than in contexts where attending school is limited to a privileged minority. This across-country convergence is driven by uneducated women marrying later in high-education contexts, especially through lower rates of very early marriages. However, within countries over time, the marital ages of women from different educational groups tend to diverge as educational access expands. This within-country divergence is most often driven by later marriage among highly educated women, although divergence in some countries is driven by earlier marriage among women who never attended school.     

The lasting low fertility and ageing in Shanghai

This brief article discusses fertility decline and increased proportions of elderly in Shanghai, China. By 1996, Shanghai had 14.19 million permanent population and 13.05 million resident population. The natural population growth rate was 1.4/1000. The birth rate was 5.6/1000 and the death rate was 7/1000. 5.6084 million were engaged in urban employment by the end of 1996, which was 0.5% fewer employed people than in the preceding year. 3.8 million worked in state-owned or collectively owned enterprises. Unemployment was 2.8%. The gross domestic product per capita was 22,086 yuan (US$2661). The average annual wage was 10,572 yuan/year among urban workers. Rural and suburban households earned an average of 4846 yuan/year. The proportion of women of childbearing age continues to decline, while the proportion of elderly increases. 17.1% of total population were children aged 0-14 years in 1995 compared to 18.2% in 1990. The proportion of elderly increased from 9.4% in 1990 to 11.4% in 1995. The median age of population was 37.3 years. Life expectancy was 74.07 years for men and 78.21 years for women.     

Communique of the State Family Planning Commission on a nationwide fertility sampling survey of every person per thousand

In 1982, the Chinese State Family Planning Commission conducted a nationwide fertility survey of 1 person/1000 in 28 provinces, municipalities, and autonomous regions. 815 sample units were selected and 310,462 women aged 15-67 were interviewed, 99.9% of those identified. 252,094 (24.77%) were of childbearing age (15-49) with 24.76% 15-19 years old. Among women of fertile age, 31.46% were unmarried, 64.53% were married to their 1st husbands, 2.89% were remarried, .19% were divorced, and .94% were widowed. Average age of 1st marriage increased from 18.4 in the 1940s to 22.8 in 1981. Total fertility rate dropped from 5.44 in the 1940s to 2.63 in 1981. In 1981, the birth rate was 85/1000 women of fertile age. Fertility was much higher among minority nationalities. 118 million of China's 170 million married couples of reproductive age (69.46%) use birth control at present; 50.2% use the IUD, 25.4% tubal ligation, 10.0% vasectomy, 8.2% oral contraceptives, and 2.0% condoms. About 21 million married women should have begun using contraception but have not. 14 million or 42.3% of 33 million 1 child couples have pledged to have only 1 child. If the fertility level of 1981 is maintained and the average woman continues to have 2.63 children, 2.91 in rural areas, China's population will reach 1.2 billion by 1993 and will exceed 1.3 billion by 2000. The Central Committee has a target population of 1.2 billion by 2000.     

A brief introduction to China's family planning programme

China's family planning program is described in reference to its goals, approaches, and achievements. Between 1949-83, China's population increased from 541 million to 1,024,950,000. The population has a young age structure, and the median age is 22.9 years. 80% of the population is rural, and 90% of the population lives in the southeastern region of the country. In view of this demographic situation, the government recognizes the need to control population growth. China's goals for the year 2000 are to increase industrial and agricultural input by 400% and to keep population size below 1.2 billion in order to ensure that per capita income increases. In accordance with these goals, the government, in 1979, began advocating a 1-child policy. To ensure the survival of single children, the government also launched a program to upgrade maternal and child health (MCH). In some rural areas and among certain minority groups, the 1-child restriction is not applied. Family size goals will vary with time. These variations will reflect the need to maintain a balance between economic growth and population growth. A variety of incentives are used to promote the 1-child family. For example, single children receive medical and educational benefits, and in some rural areas, the parents of single children can obtain additional land contracts. Economic disincentives are also used. The government seeks to obtain compliance with the policy primarily through educating the public about the consequences of uncontrolled population growth. All channels of the mass media are used to deliver the messages, and the publicity campaign is especially intensive in rural areas. A comprehensive plan to provided family planning and population education for middle school students is currently being implemented. Each local area develops its own fertility control plan. This plan is then incorporated into the nation's overall plan and the overall plan is implemented from above. Family planning workers bring free contraceptives directly to the people, and family planning motivators are found in almost all villages, neighborhood committees, factories, and military units. As a result of these efforts, China made great strides in controlling population growth and improving MCH during the last decade. The birth rate declined from 27.93 to 18.62, and the total fertility rate declined from 4.01 to 2.48. 124 million couples were practicing contraception by the end of 1983. 41% used IUDs, 37.4% relied on tubal ligation, 12.9% relied on vasectomy, 5.1% on oral contraceptives, and 1% on other methods. The quality of maternal and child care also improved. 92.7% of all deliveries are now performed by trained midwifes. Infant and maternal mortality rates declined considerablely in recent years. Currently the respective rates are 35.68/1000 live births and 0.5/1000 live births. In 1983 alone, the gross national agricultural and industrial output increased by 46.1%. Since 1979 per capita income increased annually by 18.3% among rural residents and by 10.7% among urban workers. China controls and operates its own population program, but in recent years, it increased its cooperation with UN Fund for Population Activities, other UN agencies, and nongovernment agencies. China recently completed its 3rd national census, and demographic research institutes have been established in 10 universities.     

On China's family planning policy

The birthrate in China in 1985, according to Li Honggui, Deputy Director of the General Office, the State Family Planning Commission, was 17.8/1000 with a death rate of 6.57/1000 and a natural growth rate of 11.23/1000. The number of births in 1985 was 18,520,000; 59.1% of these births were 1st births, 24% 2nd births, and 16.9% 3rd or more births. Women of childbearing age who pledged to have only 1 child accounted for 15.6% but only for 10% in rural areas. The peak fertility age of Chinese women was 24. Due to the age structure, a birth boom will begin in 1986 and will last for a decade. It is projected that the natural population growth rate will rise to 12.4/1000 in the 1986-96 period. The Chinese government has advocated a "1 child for 1 couple" policy since 1979. Couples who have difficulties can have a 2nd child with approval. Minority nationalities are permitted to have 3 children. The strategy of China's family planning program is to combine the guidance of the government with the motivation of the population. Consequently, communication and education have been emphasized. The situation is reported to be improving. At this time, women are advised to terminate unplanned pregnancies as early as possible. Individuals who refuse to consider the advice will be taxed.