The determinants of fertility in rural Peru: Program effects in the early years of the national family planning program

Using data from the 1991 Peru Demographic Health Survey, a linked Situation Analysis, and a unique region-level data set, this paper examines the determinants of fertility in rural Peru before and after the 1985 enactment of its National Policy on Population. The empirical framework combines a model of the timing and spacing of conceptions with a model of the timing of the placement of family planning services in communities in order to control for non-random placement of services. Results show the program helped reduce fertility post 1985. The magnitude of the effects is quantified with simulations. All correspondence to David Guilkey.We thank the editor and two referees for detailed comments on an earlier draft of this paper. Funding support for this project was provided by the MEASURE Evaluation Project under a Cooperative Agreement between the U.S. Agency for International Development and the Carolina Population Center (Number HRN-A-00-97-0018-00). The views expressed herein are those of the authors and not the sponsoring agency. Responsible editor: Junsen Zhang.     

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.     

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.     

Five levels of family planning progress: lessons from Thailand

The U.S. Agency for International Development (USAID) has developed terms to categorize nations on the basis of their level of modern contraceptive prevalence. Categorization reveals national family planning elements and circumstances common to each level, aiding policymakers in policy projection and appropriate program formulation. At the lowest prevalence level, emergent countries demonstrate less than 8% modern contraceptive prevalence. Launch countries are from 8-15%, growth countries from 16-34%, consolidation countries from 35-49%, while mature countries range from 50% and higher. Related country characteristics according to respective stages are explored in the paper. Thailand's successful progression through these stages is provided as a model example. For developing countries at a more broad level, launch stage countries should emphasize consensus building for family planning, and consider adopting a national family planning policy. Growth stage countries require effective communication programs, while countries in the consolidation phase need to attract groups from outside of the mainstream. Finally, countries in the mature stage should progressively realize greater responsibility in the private sector for service provision.     

The long-run labour market consequences of teenage motherhood in Britain

Common wisdom states that teenage childbearing reduces schooling, labour market experience and adult wages. However, the decisions to be a teenage mother, to quit school, and be less attached to the labour market might all stem from some personal or family characteristics.  Using the National Child Development Study (NCDS), we find that in Britain teenage childbearing decreases the probability of post-16 schooling by 12–24%. Employment experience is reduced by up to three years, and the adult pay differential ranges from 5% to 22%. The negative impact of teen motherhood on various adult outcomes is not only due to some pre-motherhood characteristics; hence policies aiming to encourage return to school and participation in the labour market may be an efficient way to reduce the long-term consequences of teenage pregnancy. Received: 10 October 2000/Accepted: 3 April 2002 All correspondence to Arnaud Chevalier. We are indebted to Martyn Andrews, Colm Harmon, Gauthier Lanot, Ian Walker and to the participants at the EEEG annual meeting (Southampton, 2000) and seminars at Keele University, LSE and Warwick University for their comments that greatly improved earlier versions of this paper. We also thank two anonymous referees and Christoph Schmidt for their insightful comments. All remaining errors are ours. The data was supplied by the Economic and Research Council's Data Archive at the University of Essex and are used with permission of the Controller of Her Majesty's Stationery Office. Responsible editor: Christoph M. Schmidt.     

Sustainability of family planning and health projects

USAID has assisted the Ghanian Ministry of Health since 1991 to boost family planning services under the Ghana Family Planning and Health Project by providing supplies and information and increasing the effectiveness of HIV/AIDS prevention and control. The sustainability of the health system is endangered by favoring capital expenditures in lieu of continuous expenditures; the lack of linkage between project activities and regular activities; the centralization of resource flow; and too ambitious targeting. Capital outlays provided by USAID featured in the construction of four public health laboratories, but their operation also requires continuous financing amounting to about 10% of the whole investment. The latter is the responsibility of the government, although the details of these recurrent costs were not detailed at the outset and providing these funds for continuous operation may impair the operation of other systems. The resource constraints could be alleviated by an effective cost-recovery system or by the general improvement of the economy. The lack of linkage between project and regular activities is serious at regional and district levels. The centralization of resource flow means that most resources are kept for headquarter level activities, thus other activities suffer and the health sector becomes excessively reliant on donor support. Too ambitious planning stems from pressure on donors and hastily implemented projects result in duplication and waste. Closer consultation with the parties involved would improve the situation. The rivalry of technical and policy groups has contributed to past deficiencies. Double funding for the same activity has also occurred further increasing the dependence on donor funding. By concentration on people and systems sustainability would be enhanced, while cost recovery would help the operation of the laboratories. The Health Education Unit (HEU) recognized the importance of IEC and obtained financing for such activities.     

The contraceptive prevalence survey project: content and status

The United States Agency for International Development (USAID) selected Westinghouse Health Systems to carry out contraceptive surveys. The primary objectives of the Contraceptive Prevalence Surveys (CPS) are to determine periodically the levels of contraceptive use in the country; to examine the correlates of and differentials in these levels in order to assess the impact of various types of governmental and nongovernmental programs; to identify factors that will facilitate an increase in contraceptive use, particularly factors involved in program planning activities; and to institutionalize in each country the capability to design and implement studies of contraceptive prevalence, to be undertaken at regular intervals by an in-country agency. Each CPS generally collects data on the basic demographic background of the country concerned, knowledge of contraceptive methods, prior contraceptive experience and current method used, past fertility behavior and future fertility intentions, present utilization of various types of service delivery systems, perceived accessibility of contraceptives, and reasons for nonacceptance of contraception. In the CPS project, data collection and field operations have been strongly stressed. Efforts have recently been made to expand the extent and sophistication of CPS data analysis. For example, 2 countries are currently using a series of mathematical techniques called synthetic estimators to estimate subnational levels of contraceptive use by merging CPS and census data. Westinghouse, in cooperation with the University of Michigan, is currently working to develop community characteristics module for inclusion in future CPS projects.     

SHORT REVIEWS

Books reviewed in this article: Neil J. Diamant, Revolutionizing the Family: Politics, Love, and Divorce in Urban and Rural China, 1949–1968 International Federation of Red Cross and Red Crescent Societies, World Disasters Report 2000: Focus on Public Health Christian Joppke, Immigration and the Nation‐State: The United States, Germany, and Great Britain Peng Xizhe with Guo Zhigang (eds.), The Changing Population of China Sebastiao Salgado, Migrations: Humanity in Transition United Nations Development Programme, Human Development Report 2000 United Nations Population Division, The World at Six Billion United Nations Population Division, World Population Monitoring 1998. Health and Mortality: Selected Aspects World Bank, Can Africa Claim the 21st Century?     

How do marital status,work effort,and wage rates interact?

How marital status interacts with men's earnings is an important analytic and policy issue, especially in the context of debates in the United States over programs that encourage healthy marriage. This paper generates new findings about the earnings-marriage relationship by estimating the linkages among flows into and out of marriage, work effort, and wage rates. The estimates are based on National Longitudinal Survey of Youth panel data, covering 23 years of marital and labor market outcomes, and control for unobserved heterogeneity. We estimate marriage effects on hours worked (our proxy for work effort) and on wage rates for all men and for black and low-skilled men separately. The estimates reveal that entering marriage raises hours worked quickly and substantially but that marriage's effect on wage rates takes place more slowly while men continue in marriage. Together; the stimulus to hours worked and wage rates generates an 18%-19% increase in earnings, with about one-third to one-half of the marriage earnings premium attributable to higher work effort. At the same time, higher wage rates and hours worked encourage men to marry and to stay married. Thus, being married and having high earnings reinforce each other over time.     

Employment after childbearing and women's subsequent labour force participation: evidence from the British 1958 birth cohort

Data on women from the British 1958 Cohort Study is used as evidence on the determinants of their labour force participation at age 33. A conventional cross-sectional model of full or part-time employment makes use of some longitudinal material not normally included in such models. Whether the woman made the hitherto customary break from. employment at the time of the first maternity is included in recognition that this cohort was among the first generation to be offered Statutory Maternity Leave. Results suggest that the presence of children (still) inhibits full-time employment and raises the probability of part-time employment; that income effects on participation have continued to weaken while wage elasticity for full-time employment is high. Continuity of employment straight after childbearing raises the chances of subsequent full-time employment, but by no means guarantees it. Gains from maternity leave and other family friendly employment policies have been far from uniform.All correspondence to Heather Joshi. Our research was supported by the ESRC Grant R000234600. Helpful comments by John F. Ermisch, Siv Gustafsson and two anonymous referees are gratefully acknowledged. Responsible editors: Siv S. Gustafsson, John F. Ermisch.     

Breastfeeding as a means of contraception

The University of the Philippines Institute of Public Health (UPIPH) and the Family Health International (FHI) brought together health professionals, nutritionists, and family planning experts from different parts of the world to share and gain insights into the issue of breastfeeding and contraception. The participants met in Manila in 1983 and analyzed research findings on breastfeeding and discussed their implications relevant to nutrition and family planning policies and programs. Studies conducted in several countries show a general decline of breastfeeding practice in both urban and rural areas. The issue appears to be not whether women in developing countries breastfeed their infants but for how long. Popkin cites a study in Thailand, which showed very little change in the proportion of babies ever breastfed but large declines in the duration of breastfeeding from 1969-79. In the Philippines, national surveys since 1973 indicate that mothers throughout the country practice breastfeeding but do so for a relatively short period. Scientific data supporting the folk belief that breastfeeding delays the return of fertility after childbirth is growing. The phenomenon is believed to be governed by a sophisticated control mechanism in the female reproductive system. Some researchers suggest that prolactin may be responsible for the delay of fertility in breastfeeding mothers. In a series of studies done in the Philippines and Australia, researchers Barbara Gross and C.J. Eastman found that high prolactin levels were almost always associated with proloned amenorrhea during lactation. A decline in prolactin concentrations accompanied the resumption of menstruation. Gross and Eastman found evidence of ovulation before the 1st menses in only 1 out of 54 fully breastfeeding mothers, or less than 2%. This implies that at least the first few menses of most fully breastfeeding mothers are not accompanied by ovulation, suggesting that breastfeeding continues to affect fertility even after the resumption of breastfeeding. Zablan's study in the Philippine analyzed the various factors contributing to fertility reduction. Breastfeeding appeared to have the greatest impact on the Filipino woman's level of fertility. Zablan points out that, while breastfeeding is a major factor influencing fertility in the Philippines, it "can be relied upon only to postpone childbearing (and then only at the aggregate level), but not to prevent childbearing altogether." Much work needs to be done to help people realize the value of breastfeeding, to encourage mothers to practice it, and to do so for as long as possible.     

World fertility and the women's situation]

In 1981, total number of childbearing women in the world reached 9.8 hundred million. Their socioeconomic status and fertility level are very important data for the study of women's liberation and population control. Facing limited natural resources and a constant growing demand, many nations are studying how to control the population growth and achieve a "zero population growth." In nations with a high GNP, such as Switzerland, West Germany, and France, fertility is low. On the contrary, countries in central and south Asia and most parts of Africa are the poorest economically, and their fertility rate has remained very high. Another factor which is related to the fertility level is the degree of women's participation in the labor market. In Europe and North America, the percentage of women's participation in economic activities is high, and fertility is low. In Latin America and Africa, fertility is high, and the percentage of women's participation in economic labor is low. From the above, we may conclude that promotion of women's participation in the labor market and better employment conditions will reduce fertility. Another 2 factors related to fertility are marriage age and birth control rate. Late marriage and the extensive use of birth control measures are effective methods for reducing fertility. All the above mentioned factors are closely related to the woman's educational background. If women receive a better education and find better employment opportunities, delay their marriage age, and take birth control measures, fertility will be reduced and the population growth will be under control.     

Skill premium effects on fertility and female labor force supply

In the last twenty years the United States has seen a positive relationship between female labor supply and total fertility rates, which differs from the pattern observed over the preceding years. We construct a general equilibrium overlapping generations model capable of generating this changing relationship between fertility and female labor supply. We argue that skilled biased technological change in recent decades has increased the skill premium and has therefore decreased the relative cost of (unskilled) child care services. The positive effect of the increase in female mean wages on fertility rates, and the inducement for labor force participation provided by the reduction in the relative cost of child care services, generated the positive relationship between fertility rates and female labor force participation in the last two decades.All correspondence to Amaia Iza. This paper has benefited particularly from comments by Juan Carlos Conesa, Pedro Mira and Sara de la Rica. We also acknowledge countless conversations with María Paz Espinosa and useful comments from Jaime Alonso, Jose María Da-Rocha, Tim Kehoe, José Victor Rios-Rull, when the paper was presented at the IV Workshop of Dynamic Macroeconomics held in Vigo (Spain, July 1999) and in Universidade de Vigo (October, 2000). We also thank an anonymous referee whose comments enabled us to improve the paper considerably. Financial support from Universidad del País Vasco 9UPV 00035.321-13511/2001, Ministerio de Educación y Ciencia PB097-0620, MCYT BEC2000/1394 and Instituto de la mujer (Ministerio de Trabajo y Asuntos Sociales) MTAS 33/00 is gratefully acknowledged. Any remaining errors are the authors responsibility. Responsible editor: Junsen Zhang.     

The pattern of birth spacing during Taiwan's demographic transition

This paper considers the impact of an extended family structure on the fertility behavior of married women in Taiwan. A sequential duration model is applied to identify the differences in fertility behavior during the early and latter stages of a woman's reproductive period. Heterogeneity adjustments which correct the respondent-specific characteristics are also implemented. It is found that living with the husband's parents has an impact on the wife's fertility only at the early stage of her childbearing period, and that the subjective son preferences together with the objective fact of no son in the previous 2 births do force a wife to expedite her third birth. These results are robust across different cohorts during the demographic transition and under different specifications of hazard functions. We thank an anonymous referee for his or her valuable comments and suggestions. Responsible editor: Junsen Zhang.     

Fertility and eugenics: Singapore's population policies

Singapore, after serving for two decades as a model for Third World birth control and economic development programs, is now abandoning its earlier population policies in favor of encouraging dramatic population growth. The initial eugenics-based program introduced in 1984 sought increased fertility for university-educated women and provided major subsidies for the voluntary sterilization of poor and uneducated parents. These much publicized and internationally discussed programs have now been abandoned in favor of new population programs seeking to encourage fertility in lower as well as better educated groups. A forty percent population increase is being set as a goal. To accomplish this the effective Singapore Family Planning and Population Board has been abolished and Housing Development Board policies are in the process of being reversed to encourage rather than discourage fertility.The research reported here was partially funded by the Rockefeller Foundation and by a grant from the Population Council's International Research Awards Program on the Determinants of Fertility in Developing Countries, a program funded by the U.S. Agency for International Development.     

The Consequences of Caregiving: Effects on Women’s Employment and Earnings

Caregiving to family members comprises a major part of familial obligations in the United States. Informal caregiving is unevenly distributed in society, with women performing most of the work and bearing the burden of its costs. This paper addresses the cost dimension of informal caregiving to family members by examining whether and how it penalizes women’s employment. Drawing data from the 1987 and 1992 National Survey of Families and Households, we examine whether and how caregiving transitions affect changes in women’s labor force participation and the implications of this caregiving transitions for their earnings. We calculate how these effects vary for demographically different groups of women: those older and younger, with and without high levels of education, and married and not married. Our findings reveal that for most women, the initiation of caregiving led to a substantial reduction in their weekly hours worked and annual earnings. However, the effects were different for various subgroups of women: those older, with fewer skills, and more competing roles paid substantial costs if they began caregiving between 1987 and 1992.     

Reinstatement of the US “Mexico City Policy”

On 22 January 2001, the third day of the new US administration (the day that also marked the twenty‐eighth anniversary of Roe v. Wade, the US Supreme Court decision that liberalized abortion). President Bush issued an executive order, taking the form of a memorandum addressed to the Administrator of the Agency for International Development on the subject of “Restoration of the Mexico City Policy.” The executive order reinstates the US policy promulgated at the International Conference on Population held in Mexico City in 1984 (see “Documents” in the September 1984 issue of this journal). The Mexico City policy was rescinded on 22 January 1993 when President Clinton took office (see “Documents” in the March 1993 issue of this journal). The full text of President Bush's memorandum as released by the White House is reproduced below.     

On the Origins of the United States Government's International Population Policy

Based on documents obtained from the archives of the Agency for International Development and on the author's interviews with participants in the field, this article describes the evolution of America's international population policy. The analysis highlights the perceived negative view of the consequences of rapid population growth that were popular among American policy makers during the 1960s. Also discussed are organizational and policy changes that took place within the Agency for International Development's population programme during its early years. The article concludes that the origins of America's international population programme were fundamentally conservative, and based on the assumption that a certain demographic balance was an essential feature of a properly ordered social life.     

Evolution of recent economic-demographic modeling: A synthesis

This paper develops a flexible framework for modeling population's role in economic growth by assessing and extending a rendering suggested by several Harvard economists. Our framework includes a ``productivity' model explaining output-per-worker growth and a ``translation' model translating that growth into per-capita terms. We specify a core economic model and several ``enriched' demographic variants that include dependency, size, and density. Regressions using a cross-country panel spanning the period 1960-1995 reveal that combined impacts of demographic change have accounted for approximately 20% of per capita output growth impacts, with larger shares in Asia and Europe. An earlier draft of this paper was presented at a conference on ``Population Change, Labor Market Transition and Economic Development in Asia,' Institute of Economics, Academia Sinica, Taipei, Taiwan, 6–9 December 2002. A pre-publication version of this paper will be presented at a joint conference (by COE/JEPA) entitled ``Towards a new economic paradigm: Declining population growth, labor market transition and economic development under globalization,' held at the Awaji Yumebutai International Conference Center, Kobe, Japan, 17–19 December 2005. We have benefited from comments by Michelle Connolly, Andrew Mason, Pietro Peretto, Warren Sanderson, Alessandro Tarozzi, Jeffrey Williamson, and two anonymous referees. Responsible editor: Junsen Zhang.