The International Parliamentary Assembly on Population and Development held in Mexico City

The International Parliamentary Assmebly on Population and Development took place on August 15-16, 1984, with the participation of more than 300 parliamentarians from 60 countries. The aim was to promote an exchange of views on population programs and policies among parliamentarians, and to support the recommendations adopted by the UN International Conference on Population. The assembly held discussion in 3 subcommittees on the subjects of 1) policies of population and development; 2) the legal and social status of women; and 3) the improvement of family planning service. On population policy, parliamentarians generally agreed that policy formulation is the prerogative of each sovereign country, stressing that such policies and programs should be integrated with social and economic development. The developing countries stronly demanded that a new international economic order be established and international aid increased to help them in solving the popultion problem. Concerning the status of women, the assembly unanimously agreed that both men and women should not only be legally equal, but should also have de facto equality for employment, education and social life. Attention should be given particularly to the rights and status of rural women. Examples of how the status of Chinese women has improved were offered by Chinese representative and were appreciated by the assembly. On improving family planning services, participants urged provision of information about birth control to people of marriageable age and of access to contraceptives to eligible couples; moreover, they advocated the strengthening of medical care for women and children and the lowering of infant and maternal mortality rates. Dr. Qian Xinzhong described the priorities and goals of family planning programs in China. Finally, the assembly unanimously adopted the "Action Plan," whose contents embody independence, respect for national sovereignty, and the spirit of cooperation and conformity to the interest of the international community, particularly the developing nations.     

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.     

Agricultural production responsibility system and the work of family planning in the rural area]

With the establishment of the agricultural production responsibility system, the entire agricultural management and economic system has undergone great changes, and family planning in rural areas has met with many difficulties. Because of this responsibility system, households with more manpower seem to become wealthy more rapidly than others. An existing belief among the rural population is that more children will provide a larger labor force and thus more income. Birth control and family planning are therefore becoming more difficult. In order to change existing beliefs, a comprehensive ideological education for peasants is needed so that they may understand the question of birth control from the viewpoints of national interests. Economic rewards and administrative restrictions may be used as necessary birth control measures. Agricultural production and family planning can be managed well if there is close contact and cooperation between the cadres and the masses. Extra care and benefits should be given to women of childbearing age who undergo birth control operations and agree to a single child in each household. Welfare programs for the masses, such as kindergartens and nursing homes must be established in order to reduce their worries. In addition, efforts are needed to study the new situation and solve new problems. The goal of controlling the rural population growth should be achiefed through practical work and experience.     

Why the silence on population?

The tripling of the world’s population growth since 1960 has received little public attention the past decade. Six reasons for the silence around this subject constitute a “perfect storm”. The first five are: visibility of actual fertility decline in the developed countries as well as a number of the developing ones; well justified attention to the impact of high levels of consumption on the environment; an implicit welcome by conservative political and religious forces to reduced needs for family planning; the tragedy of AIDS dominating international health concerns; and the 1994 Cairo conference’s focus on examples of coercive family planning while nearly ignoring the coercion of women forced into unwanted childbearing. These five relatively new developments have been supported by standard demographic theory containing an assumption that couples naturally want many children, making it difficult to see the many barriers blocking women’s options to manage their own childbearing.     

Asia's population and development in retrospect and prospect

By 1989 Asia's population will reach 3 billion. That Asia's countries can change the course of population development has been shown by China, whose population growth rate has decreased to 1.2%. 58% of the world's population in 1985 was Asian, and 53% of it was concentrated in 11 Asian countries, of which 37.6% was accounted for by India and China. Asia's population density is 3 times the world average, and the number of persons sustained by a square kilometer of land in Asia is 2.5 times the world average. Asia's population is young (median age 20.3), which means a high dependency burden, a large number of women of childbearing age, and low quality of life, as measured by infant mortality, life expectancy, and literacy. Rapid population growth ensures a low rate of development. Asia's goals are to achieve a 1% growth rate by year 2000, zero population growth and replacement level by 2015 for East Asia and 2020 for South Asia. The World Bank estimates that Asia's population will not stabilize until the end of the 21st century, by which time it will have reached 6 billion. Asia must find a way of achieving both population control and economic development. 5 recommendations are made to the Asian Forum of Parliamentarians on Population and Development (AFPPD): 1) that the AFPPD sponsor the activities of "the Day of 3 billion"; 2) that seminars and conferences on population be held among Asian nations; 3) that high-fertility countries adopt late marriages, few births, and programs for maternal and child health; 4) that organizations for family planning be strengthened and given the resources to upgrade the status of women; and 5) that international cooperation in the area of population be intensified.     

Motivations for the use of birth control: Evidence from West Africa

A conventional assumption in the family planning literature is that birth control in developing countries is first adopted by high parity women who wish to cease childbearing. The empirical support for this belief has mainly been drawn from interview surveys on the motivations for, and the timing of, the inception of birth control among married women in areas where there is no cultural precedent for birth spacing by traditional means. This study, on the other hand, is based on data drawn from an area sample of 6,606 women, married or single, aged 15–59, in Ibadan, Nigeria, where there is a tradition for the practice of abstinence after a birth for the purpose of birth spacing. The Nigerian pattern revealed in the data presented here is indeed distinctive in many respects: (a) although premarital sex is prevalent, levels of premarital contraception are high; and (b) within marriage, spacing is the most prominent motivation for contraceptive practice, more important than the limitation of family size.     

Childbearing and Women's Survival: New Evidence from Rural Bangladesh

Effects of childbearing on women's mortality and the implications of family planning programs in reducing these effects are examined in a 20‐year prospective study of more than 2,000 women in Matlab, Bangladesh. Maternal mortality is defined as a death occurring in the six weeks after childbirth. But childbearing may affect women's survival beyond this brief period. Additional hypotheses considered relate to 1) cumulative exposure to childbearing, whether measured by parity or pace of childbearing, 2) age at first birth, and 3) effects beyond the reproductive ages. The results offer no support to cumulative exposure hypotheses, showing no link between parity or pace of childbearing and mortality risk. Instead, we identify an extended period of heightened mortality risk associated with each birth—the year of the birth and the two subsequent years. Family planning programs, by reducing the number of children and therefore a woman's exposure to extended maternal mortality risk, potentially increase survival. Research is needed to identify and address the specific causes of extended maternal mortality risk so that appropriate ameliorative programs may be developed.     

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.     

Adolescent fertility: worldwide concerns

There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.     

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.     

A survey of China's birth control among women of child-bearing age

To further implement China's family planning policy of "prevention first, birth control first," a study of the current family planning situation was conducted. A survey of the birth control methods employed by women of childbearing age and by men was based on a nationwide randomized sampling of 1/1000. In the different age groups, ranging from 15-49 years old, IUD users accounted for over 50%, tubal sterilization 25%, and vasectomy 10%. The main IUD users were women in the 20-24 age group. Tubal sterilization was more prevalent among the women in the 35-39 age group. The use of oral contraceptives (OCs) was more common among younger women but accounted for less than 10% of the total. The survey was based on the replies to questionnaires from 172,788 married women of childbearing age; 120,022 of them practiced contraceptive methods for a birth control rate of 69.46%. The breakdown was as follows: IUD, 34.84%; tubal sterilization, 17.63%; vasectomy, 6.94%; OCs, 5.86%; condom users, 1.39%; and other methods (including chemical suppositories, rhythm, or safe period method and withdrawal before ejaculation), 2.78%. There was a higher percentage of OC users in urban areas, and a marked preference for IUDs in the rural communities. The rural birth control rate was 68.58%; the urban rate was 74.17%. The use of the IUD has priority in all the areas; its percentage approaches the national average level. The use of vasectomy as a birth control method varies considerably according to area as does the use of OCs, condom, and tubal sterilization. Rural minority groups prefer the IUD and OCs; tubal sterilization, the condom, and vasectomy are preferred by the Han nationality. The birth control rate differed according to the different occoupation groups: 77.85%, workers; 76.01%, farmers; 85.15%, cadres; 59.52%, housewives; and 66.67%, others. The birth control rate was higher among those who received a college education than the illiterates, but statistics did not show a significant difference in the rate of those with a high school education and the illiterates. Mothers of 0-1 children generally preferred OCs; tubal sterilization was preferred by mothers with 2-3 children. The nonusers of contraception accounted for 30.54% among married women of childbearing age. A breakdown gives the following figures: menopause and infertility, 6.17%; divorced and widowed, 1.64%; planned parenthood, 10.51%; nonusers who should have practiced contraception, 12.22%. On a national level, the estimated number of nonusers of contraception among those who should be practicing contraception comes to about 20,000,000 women.     

Publicity and education on family planning information in Keshan County

In 1984 the Keshan (Northeast China) County Government and the Family Planning Committee initiated an education campaign to disseminate family planning information to farmers. The team of propagandists consisted primarily of full-time family planning workers. Village cadres, school teachers, and rural physicians, who are properly educated and positive about family planning work, enjoy high prestige among the workers. They were invited to be team members after training and are supported by the villagers because they come from among the local people. All the childbearing women aged 15-49 in each village were classified by the propagandist into 5 groups according to their marital and childbearing status, i.e., women at the age of puberty, women of new marriage, pregnant and lying-in women, women with children to be reared, and middle-age and old women. The women were organized into groups to attend lectures on different subjects such as population policy, relationship between population growth and socioeconomic development on the 1 hand and individuals and environment on the other. Also included were physiology, the health birth and rearing of children, and health care for women and the aged. The publicity effort included broadcasting, films, video aids, and slide shows. Increased classs were during the slack seasons, and lectures were given once a week. By 1986, about 80% of the population at childbearing age in Keshan County had attended the family planning lectures.     

A cohort analysis of the fertility of the July 1 People's Commune in Shanghai, County]

The survey was conducted in February-March 1981. The population of this commune at the end of 1980 was 18,608. The cultural and educational levels, economic condition, and work in family planning of this commune form a typical example among numerous similar communes in Shanghai County. The birthrate, natural growth rate, and average fertility rate began to decline in the later half of 1950s and reached the lowest level in 1974. The survey shows a delay in the marriage age. The fertility rate also dropped by 21.31% from 1963 to 1980. The average fertility rate dropped by 162.73% from 1963 to 1980. Among the women of childbearing age, 99% of them have a knowledge of birth control measures, 95% of them have used them before, and 78% are currently using them. All these figures show that the work in family planning in the commune has reached a high level by world standards. 3 factors which have a strong impact on fertility are: the economic and educational level, formation of population elements, and family planning work. A rise in the standard of living and improvement in education normally leads to late marriage and a decline in fertility. An increase in the number of women of childbearing age causes a rise in fertility. The population growth after 1974 is a reflection of this situation. The survey shows that the decline in fertility before 1973 was caused mainly by family planning work.     

Population activities of the United States government

The editor's comment in this issue of the journal cites 5 overlapping phases in the evolution of population and family planning programs in the United States. The phases are 1) collecting census data and vital statistics, 1790-, 2) family planning assistance to developing nations, 1963, 3) family planning assistance to the U.S. "disadvantaged," 1964-, 4) overpopulation as a national concern, 1969-, and 5) the multiple action phase, 197? (phase including diverse steps to limit population growth and occurring after basic attitudes toward human reproduction have changed). The issue of the journal focuses on total population size and rates of population increase rather than on the distribution of population, and on federal action rather than on the activities of state and local governments. The editor's comment is followed by an extensive discussion of population activities of the United States government, especially since 1963. Topics discussed include demographic data, international programs, research, federally subsidized family planning services, medical care programs, educational and international programs, national growth policy, and the roles of the legislative and executive branches of government. A directory listing federal agencies with substantial and identifiable programs concerned with population and family planning is appended.     

Meeting health and family planning needs in Latin America and the Caribbean

The operations research and technical assistance (OR/TA) project in The Population Council has concentrated on fertility and infant mortality issues in Latin American and the Caribbean for more than a decade through INOPAL. INOPAL is an acronym for Investigacion Operacional en Planificacion Familiar y Atencion Materno-Infantil para America Latina y el Caribe (Operations Research in Family Planning and Maternal-Child Health in Latin America and the Caribbean). In March 1995, the project entered its third phase, INOPAL III, with the renewal of its contract from the United States Agency for International Development (USAID). To facilitate communication between INOPAL, collaborating agencies, and USAID, INOPAL Director James Foreit moved from Peru to a Council office in Washington, D.C. INOPAL has six objectives: 1) to test the integration of family planning and reproductive health services; 2) to increase access to family planning; 3) to develop strategies to reach special populations; 4) to improve the sustainability of family planning programs; 5) to improve service quality; and 6) to institutionalize operations research capability in the region. INOPAL II conducted 61 subprojects in 12 countries in collaboration with 24 USAID cooperating agencies and other international organizations. The project established new services for postpartum women, adolescents, and rural women; improved program quality and financial sustainability; increased vasectomy promotion and the range of available contraceptives; and developed new modes of service delivery. A key finding of INOPAL II operations research was the importance of increasing cost-effectiveness to ensure program sustainability. INOPAL III will work toward all six objectives, with an emphasis on integrating reproductive health and family planning services. Operations research and technical assistance (OR/TA) subprojects will focus on the prevention and treatment of sexually transmitted diseases, perinatal and postpartum care, and postabortion care.     

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.     

A cost benefit analysis of the barbados family planning programme

Abstract Of the Caribbean islands, Barbados has the lowest fertility level. The crude birth rate in 1970 was only 20·5 per 1,000, which is one of the lowest found in any country of similar economic development anywhere in the world. In 1960 the crude birth rate was much higher, at about 33·6 and for almost 40 years before that had fluctuated around a value of 33. Thus, a decline of about 40% has been achieved within the comparatively short period of a decade. The reasons for this rapid decline are of particular interest to all those concerned with population growth and economic development in the less developed areas. In Barbados, the importance of population control and the role of family planning was recognised early by the government and other civic agencies, and the Barbados Family Planning Association (BFPA), an autonomous national family planning agency, was established. Since its modest beginning in 1955 the BFPA has grown to be a major social institution, comprising 14 clinics situated in various localities throughout the island. In 1970, a full-time staff of 28 were providing services to an estimated 10,000 clients, about 20% of all women of reproductive age. Funds for the BFPA have come from local government with considerable assistance from international agencies.     

Socialist system creates favourable social environment for fertility decline in China

The Chinese experience suggests that the socialist system can create more favorable conditions for a decline in fertility than the capitalist system. This is related to 5 factors: 1) changes in the traditional functions of the nuclear family; 2) popularization of education and the transmission of culture; 3) improvements in the status of women; 4) rapid decreases in mortality, especially infant mortality; and 5) social security for the aged. In addition, the structure of social organizations and the widespread dissemination of information about birth control methods have facilitated family planning practice. The impact of theswe structural factors has been intensfied by the Chinese social environment, which has changed individual attitudes toward family size. Overall, the social environment has created attitudinal change while implementaton of the national family planning policy has made the fertility decline in China possible.     

The right to have a second birth given up

The Government of the Wendeng County, Shandong Province has taken measures to carry out the family planning program in a down-to-earth way. For the past few years, there are 2141 couples who have given up, of their own accord, the right to have a 2nd birth, though they are entitled to have. During the practice of family planning, the Wendeng Government started with the publicity of family planning policies. More than 30,000 copies of publicity pamphlets were distributed and about 220 shows of videotapes, films and slides were played in the countryside. The county's Family Planning Committee and the Maternal and Child Health Care Station, together with other departments concerned gave 120 lectures on birth control in the rural areas and sent contraceptives to every village with guidance to households. For the past 3 years, the proportion of women at childbearing age using contraceptives has increased by 62%.     

More choices of birth control approaches

In rural Zhejiang Province, China, family planning intermediaries are appointed for each village to introduce comprehensive measures of birth control to the people. With an education level of junior middle school at least, they are mostly working women of high prestige in their villages. After appointment as intermediaries, these women are trained for 1-2 weeks in health stations or maternal and child health care stations in towns. Back in the villages, they take over responsibility for distributing monthly contraceptives as needed by women of childbearing age. The intermediaries also explain the advantages and disadvantages of different kinds of contraceptives to newly wedded women and give them guidance and recommendations. Intermediaries also can provide simple treatment for complaints caused by contraceptive use. For example, if women complain of nausea while 1st taking oral contraceptives (OCs), the intermediaries will give them vitamin B6. When intermediairies encounter difficulties, such as women who cannot use OCs for a long time because of a liver ailment, they refer the people to health stations or send for a doctor. The number of induced abortions has declined because of the fact that a vast number of women of childbearing age in rural areas now obtain appropriate contraceptives in time. Generally, each intermediary is assigned to be in charge of 15-20 households, making a regular monthly visit to each of these families. The contraceptives they distribute are from town governments, which give them a certain amount of annual subsidies.