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.     

计划生育政策的人口效应

文章试图估计计划生育政策使我国少生了多少人。利用1980~2008年世界140多个国家的数据来模拟在没有计划生育政策影响下经济社会变量与人口变量的相关关系,并据此对中国无计划生育条件下的总和生育率进行测算。将测算出来的无计划生育条件下的总和生育率和中国实际总和生育率分别代入模型进行人口模拟,比较无计划生育条件下和现实条件下人口增长的不同过程和结果。研究表明:无计划生育条件下,我国2008年生育率水平的预测值大概在2.5左右。1972~2008年间,排除经济社会发展的影响,单纯由于计划生育的作用,中国少生了4.58亿人。     

计划生育家庭福利政策改革思路研究

随着经济体制变革、社会结构变动、利益格局调整等不断深化,传统家庭功能面临严峻挑战,计划生育家庭问题尤为突出。家庭是国外为数不多的福利扩张领域,也应是我国福利"增长"的优先领域。计划生育家庭福利改革框架包括三个层面:一是针对因执行计划生育国策而产生的确定性风险或不足,在养老保障个人账户下建立计生子账户,实现国家补贴直接送达家庭;二是针对因特有概率事件而形成的不确定性风险建立政策性生育保险,并覆盖农村育龄群体;三是明确计划生育/生殖健康服务作为国家基本公共服务的属性。     

Use of maternal health services in rural China

We use data from the nationally representative 1997 Demographic and Reproductive Health Survey to examine use of maternity services in rural China. The data indicate that roughly 60 per cent of women had at least one prenatal visit, while 40 per cent had a professionally assisted birth over the period 1988-97. Despite China's shift from a more socialist to a more privatized health care system, use of maternity services increased over this period. These increases are consistent with the push toward integration of reproductive health into family planning that emerged after the 1994 International Conference on Population and Development and the 1995 Fourth World Women's Conference held in Beijing. At the same time, we find indirect evidence that the target-based population policy may well have exerted downward pressure on use of maternity services; differences by parity are marked and multilevel models predicting use of maternity services indicate underdispersion at the individual level.     

The elimination of contraceptive acceptor targets and the evolution of population policy in India

In 1966 the government of India announced a new national population policy that eliminated numerical targets for new contraceptive acceptors. This paper examines the history of target setting in India and factors that led to the elimination of targets. The analysis is based on published and unpublished reports on India's population policy and the family planning programme and interviews with senior Indian and foreign officials and population specialists. Five factors are identified as playing a role in the evolution from target setting to a target-free policy:(1) the research of India's academics; (2) the work of women's health advocates; (3) the support of officials in the state bureaucracy who approved the target-free approach; (4) the influence of the donors to India's family planning programme, especially the World Bank; and (5) the International Conference on Population and Development.     

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.     

Demographic Research in Britain 1936–1986

We use data from the nationally representative 1997 Demographic and Reproductive Health Survey to examine use of maternity services in rural China. The data indicate that roughly 60 per cent of women had at least one prenatal visit, while 40 per cent had a professionally assisted birth over the period 1988–97. Despite China's shift from a more socialist to a more privatized health care system, use of maternity services increased over this period. These increases are consistent with the push toward integration of reproductive health into family planning that emerged after the 1994 International Conference on Population and Development and the 1995 Fourth World Women's Conference held in Beijing. At the same time, we find indirect evidence that the target-based population policy may well have exerted downward pressure on use of maternity services; differences by parity are marked and multilevel models predicting use of maternity services indicate underdispersion at the individual level.     

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.     

The elimination of contraceptive acceptor targets and the evolution of population policy in India

In 1996 the government of India announced a new national population policy that eliminated numerical targets for new contraceptive acceptors. This paper examines the history of target setting in India and factors that led to the elimination of targets. The analysis is based on published and unpublished reports on India's population policy and the family planning programme and interviews with senior Indian and foreign officials and population specialists. Five factors are identified as playing a role in the evolution from target setting to a target-free policy: (1) the research of India's academics; (2) the work of women's health advocates; (3) the support of officials in the state bureaucracy who approved the target-free approach; (4) the influence of the donors to India's family planning programme, especially the World Bank; and (5) the International Conference on Population and Development.     

Socialist spiritual civilization enhances consciousness in family planning

Since 1985, there have been no cases of coercion in the practice of family planning and yet also no unplanned births among the over 1200 members of the Chinese Communist Party in Hunan Province's Fuxing Township. Ideological work is aimed at demonstrating that fertility control is in the interest of both individuals and the state. All township cadres are asked by the government to take the lead in practicing family planning, publicizing population policies, and assisting in solving the difficulties of the masses. They are further expected to take the lead in the provision of 5 services: 1) publicity about population theory and family planning policy; 2) birth control training and provision; 3) management and distribution of contraceptives; 4) maternal-child health services, including free health check-ups for the 870 children in the township and follow-up visits to the 2100 women who have undergone tubal ligation; and 5) development of social welfare and assistance to 1-child households.     

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.     

Corporate clinics take on a new role

The Philippines Department of Labor, in conjunction with the U.N. Fund for Population Activities, is sponsoring a pilot family planning program. The industrial program, supervised by the Labor Management Coordinating Council, aims at integrating family planning services into the health services or clinics of 1000 corporations with at least 200 employees within the 2-year period ending June 1977. Family planning seminars are conducted at 3 levels within the corporations and include training sessions for medical personnel. Companies have found that provision of family planning services is more economical in the long run than provision of family welfare services for employees and families.     

The population policy of China

Summary China has a consistent and well-defined policy to regulate the growth of her population. Population policy is considered as an integral part of overall social and economic development policy. It promotes the reduction of the growth rate in densely populated areas but encourages the increase of population in sparsely populated areas and among national minorities. A series of planned internal migration policies has regulated the spatial distribution of population. Main factors affecting the implementation of China's population policy are the establishment of an effective organization and communication system, the participation of the masses in the work, the socialist transformation of the national economy, the changes in the structure and functions of the Chinese family, the changing status of Chinese women, the development of public health services and the campaign for late marriage and family planning.     

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.     

Interplay of rights,technology, and services explored

Recent developments in the field of reproductive health and family planning have featured key intersections among technology, services, and rights. In May 1999, the Population Council hosted a two-day meeting on rights, technology, and services in reproductive health to examine more deeply the philosophical underpinnings of the council's work. In many countries, planning pregnancies and exercising reproductive rights have been central tenets of feminist thinking and activism for decades. In other settings, fertility-regulation technologies were introduced primarily for the purpose of controlling population growth rather than facilitating the exercise of individual rights. Much of the critique of population programs has centered on violations of rights and the need to protect women in the process of testing and delivering reproductive technologies. Despite a diversity of opinions on the ethics and appropriateness of specific technologies, there is a growing consensus that women and men have a basic right to control their bodies, reproduction, and sexuality. In many places, however, people have faced barriers as they attempt to exercise these rights. Some obstacles are primarily economic, while others are physical or institutional in nature. During the meeting, participants raised many additional questions, and their exploration of these questions highlighted the ways that rights, technology, and service influence each other.     

Family planning and fertility decline: a global overview

Family planning and development policy concerns are not incompatible. The emphasis on development policies at the 1974 World Population Conference at Bucharest did not mean that world governments had lost interest in the population and family planning issue. Although worldwide attitudes toward family planning have become more and more favorable, this has not yet meant great impact on world demographic trends. The "inertia factor," i.e., the effects of high birthrates in the previous generation, will camouflage declining birthrates for some time to come. The trend of fertility reduction which was perceptible only among small populations a few years ago is also becoming manifest in larger Third World countries. Mortality rate declines have slowed down but there is no rising mortality due to starvation in any country. At present, food demand exceeds availability for 80% of the Third World population. It is predicted that the food deficit will increase 70% by the year 2000.     

Does low fertility call for new policies in some Asian countries?

Over the past 2 decades, Japan, China, Singapore, Hong Kong, and South Korea have completed a demographic transition from high birth and death rates and runaway population growth to reduced fertility and mortality and population growth approaching replacement levels. Among the outcomes of fertility decline, 3 have particularly far reaching effects: 1) Changes in family types and structures. Marriage and family formation are postponed, childbearing is compressed into a narrow reproductive span that begins later and ends earlier, and higher-order births become rare. Large families are replaced by small ones, and joint and extended families tend to be replaced by nuclear families. 2) Shifts in the proportions of young and old. Declining fertility means that the population as a whole becomes older. Decreases in the proportion of children provides an opportunity to increase the coverage of education. Increases in the proportion of the elderly means higher medical costs and social and economic problems about care of the aged. 3) Changes in the work force. There is concern that low fertility and shortages of workers will cause investment labor-intensive industries to shift to countries with labor surpluses. Another outcome may be an increase in female participation in the work force. The potential consequences of rapid fertility decline have sparked debate among population experts and policy makers throughout Asia. Current family planning programs will emphasize: 1) offering a choice of methods to fit individual preferences; 2) strengthening programs for sexually active unmarried people; 3) encouraging child spacing and reproductive choice rather than simply limiting the number of births; 4) making information available on the side effects of various family planning methods; 5) providing special information and services to introduce new methods; and 6) promoting the maternal and child health benefits of breast feeding and birth spacing.     

Socioeconomic determinants of China's urban fertility

This paper examines socioeconomic forces other than population policies and family planning programs that have affected the fertility transition in urban China. The authors argue that before and since the intensification of population planning activities, the government influenced fertility directly and indirectly through socialization of the economy, the transformation of the Chinese family, and the provision of education, employment, health, medical, welfare, cultural, and related services in urban areas. The various social institutions and subsystems of society have greatly weakened the motivation for large families. The byproducts of the slow urbanization process in urban China including housing shortages, unemployment, rising living standards, changes in the cost of raising a child, and urban-rural downward mobility have affected the social and economic costs of childbearing, which in turn have affected the postponement of childbearing. Thus, our considerations of urban China's fertility transition must be broadened to include the issues of social development strategy in Chinese urban experience.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

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.