After the demographic transition: policy responses to low fertility in four Asian countries

In the low fertility countries of South Korea, Taiwan, Singapore, and Thailand, policy-makers are concerned about the consequences of low growth. In South Korea, a family planning (FP) program was instituted in the early 1960s, and fertility declined to 1.6 by 1987. Rural fertility is still higher at 1.96, and abortion rates are high. 32.2% of fertility reduction is accomplished through abortion. South Korean population will not stabilize until 2021, at 50.6 million people. The elderly are expected to increase and strain housing, energy, and land resources. Government support for FP is being reduced, while private sector services are being enhanced. Government sterilization programs have been reduced significantly, and revisions in the Medical Insurance Law will cover part of contraceptive cost. Integrated services are being established. Many argue for an emphasis on birth spacing, child and family development, sex education, and care of the elderly. In Taiwan, replacement level fertility was reached in 1983. Policy in 1992 recommended increasing fertility from 1.6 to 2.1. The aim was to stabilize population without pronatalist interventions. Regardless of policy decisions, population growth will continue over the next 40 years, and the extent of aging will increase. In Singapore since the 1960s, the national government focused on encouraging small families through fertility incentives, mass media campaigns, and easy access to FP services. Fertility declined to 1.4 in 1988. Since 1983, government has established a variety of pronatalist incentives. In 1989, fertility increased to 1.8. The pronatalist shift is viewed as not likely to succeed in dealing with the concern for an adequate work force to support the elderly and economic development. In Thailand, fertility declined the fastest to 2.4 in 1993. The key factors were rapid economic and social development, a supportive cultural setting, strong demand for fertility control, and a successful FP program. The goal is to reduce fertility to 1.2 by 1996. Replacement level may be reached in 2000 or 2005. Future trends are not clear.     

Eastern Europe: pronatalist policies and private behavior

Fertility trends in the 9 Eastern European socialist countries (Albania, Bulgaria, Czechoslovakia, German Democratic Republic, Hungary, Poland, Romania, USSR, Yugoslavia) are reviewed. Official policy in all these countries but Yugoslavia is explicitly pronatalist to varying degrees. Attention is directed to the following areas: similarities and differences; fertility trends (historical trends, post World War 2 trends, and family size); abortion trends (abortion legislation history, current legislation, abortion data, impact on birth rates, abortion seekers, health risks, and psychological aftereffects); contraceptive availability and practice; pronatal economic incentives (impact on fertility); women's position; and marriage, divorce, and sexual attitudes. The fact that fertility was generally higher in the Eastern European socialist countries than in Western Europe in the mid-1970s is credited to pronatalist measures undertaken when fertility fell or threatened to fall below replacement level (2.1 births/woman) after abortion was liberalized in all countries but Albania, following the lead of the USSR in 1955. Fertility increased where access to abortion was again restricted (mildly in Bulgaria, Czechoslovakia, and Hungary at various times, and severely in Romania in 1966) and/or economic incentives such as birth grants, paid maternity leave, family and child care allowances, and low interest loans to newlyweds were substantially increased (Bulgaria, Czechoslovakia, Hungary, and Poland to some extent, in the late 1960s and early 1970s, and the German Democratic Republic in 1976). Subsequent declines in Bulgaria, Czechoslovakia, Hungary, and Romania suggest that policy induced increases in fertility are short-lived. Couples respond to abortion restrictions by practicing more efficient contraception or resorting to illegal abortion. It is evident that the region's low birth rate is realized mainly with abortion, for withdrawal remains the primary contraceptive method in all countries but Hungary and the German Democratic Republic. It seems that cash incentives have advanced the timing of 1st and 2nd births without substantially increasing the 3rd births required to keep national fertility above replacement level. Demographic factors alone will most likely keep birth rates low in several Eastern European countries during the 1980s and the 1990s. Due to the low birth rates in the 1960s, there will be fewer women in the prime childbearing ages of 20-29 in at least Poland, Czechoslovakia, Bulgaria, and Hungary. It becomes clear that policy efforts to influence private reproductive behavior can only be moderately successful if the living conditions are such that women are determined not to have more than 1 or 2 children.     

Initially analyzing the characteristics and evaluated indexes in rural areas and making relative policies]

20% of rural family planning (FP) programs in China have an unsatisfactory performance. A study was conducted in four townships with poor FP program performance in Pengxi County, Sichuan Province. Some common characteristics of these townships are as follows. Lack of concern about the FP program on the part of the local leadership. 2) Resistance of local people to FP communication and education; 96% of 426 families interviewed wanted to have 2 children, and only 3.7% wanted 1 child. 3) Lack of enforcement of the incentives and disincentives stipulated in the FP policy. 4) Lack of service delivery back-up in FP programs with a shortage of trained professional staff to provide clinical services and a shortage of the necessary medical facilities or equipment to meet the needs of FP service delivery. 5) The large number of early marriages, early child-births, extra-marital child-births without quota. At the present time, there is not specific quantitative standard to evaluate the FP program performance in a particular district. 3 indicators are appropriate for comparison of program performance. 1) Has the annual birth control target for the district been met? 2) The percentage of births with in the FP quota. Under 60% of births within the quota should be considered poor performance. 3) Over 20% of unplanned pregnancies reflect poor performance in the areas of birth control education, and contraceptive service delivery. The following are suggestions for solving the problems of poor program performance. 1) Community leaders should be evaluated on a per capita production output value rather than on total value. Their achievements should also be linked with their salary increases, promotions and bonuses. 2) One-child families should have a priority in receiving financial aids for development. 3) Governmental and non-government organizations should work together to promote the implementation of FP policies. 4) Service delivery systems should be strengthened by promoting population and FP education to families and in schools. Funding should be made available to increase the capability of birth control service delivery in terms of staff training, provision of equipment and housing and improvement in the quality of services. 5. Full use should be made of the potential of village leaders to take personal responsibility for every aspect of the FP.     

Implementing the birth policy to village as the grass-roots unit]

At the present time, the emphasis of the birth control program in China is in the rural areas where it is harder to implement a birth control policy. A new initiative taken in Liaoning Province to certify rural villages in family planning (FP) practice has proved to be successful. 6 criteria have to be met by a rural village to be qualified for certification: 1) an adequate FP organizational network, 2) comprehensive coverage of publicity and education program activities, 3) satisfactory FP program implementation, 4) extensive usage of contraceptive methods, 5) good quality service delivery, and 6) efficient program management. Specific regulations on organizational structure, educational activities, policy implementation, contraceptive supply, data collection and reporting, and management of finances have also been formulated to promote the certification process. Packages of incentives and disincentives have been established to integrate FP program implementation with the responsibilities, decision-making powers, and personal benefits of the leaders and the village community. The sense of birth control practice as a communal endeavor in villages has also been created under these regulations. Over 80% of villages in Liaoning province have now been certified. Various birth control model villages have been set up to promote the FP program elsewhere.     

Determinants of fertility and the unmet need for family planning in Indonesia

Indonesia's fertility has declined to an average of slightly more than 3 children/woman. The islands of Java and Bali have the lowest birth rates. Indonesia's family planning program has been a model of innovation, flexibility, and community involvement, and has been effective in reducing fertility, changing family preferences, and increasing contraceptive use. Fertility decline is also determined by factors other than contraceptive use, as provinces in Jakarta and East Java has low fertility and low contraceptive use. Recent research by Suyono and Palmore found that among cohorts of women in Jakarta lowest fertility rates were explained by greater nonexposure to pregnancy in an unmarried state or by a divorced or widowed status, and by infecundity. In East Java, fertility determinants were the same with the possible addition of lower coital frequency. The study estimated nonexposure due to marriage, infecundity, and contraceptive use. Policy considerations, however, are concerned with the exposed state of the percentage of time women are currently married, fecund, not using contraceptive, and sexually active. Suyono and Palmore also calculated the percentage of time spent in the exposed state by province. The estimates ranged from 12% in Yogyakarta to 25% in West Java and the Outer Islands. Exposed was further divided into groups with a manifest, latent, and no current need. Women with a manifest need for family planning are those who are aware of their contraceptive needs to stop or postpone childbearing and not using. Manifest need was highest in high fertility areas: 12% in Central Java, 13% in West Java, and 12% in the Outer Islands. Programs targeting these women should focus on wider availability of information and services. Women with latent needs are unaware of their need for family planning and are not using contraception. These women were also concentrated in high fertility areas. The percentage of years spent in the latent unmet need state was estimated at 23-24% in West Java and the Outer Islands. Program emphasis should be on education and motivation to show how family size can be controlled. Women with current need can be educated toward future acceptance.     

Falling fertility in Indonesia: success in national family planning

This publication summarizes the findings of the National Indonesia Contraceptive Prevalence Survey (NICPS), which revealed a rapid decline in Indonesia's fertility rate. This article also describes how the successful Indonesia family planning program is designed and maintained. Since 1975, fertility rates have dropped from 5.5 to 3.3 children per woman. Those practicing contraception during the same period has risen from 400,000 couples to 17 million. Contraceptive education is high (e.g. 95% of all married Indonesian woman are familiar with a modern contraceptive method). The Indonesia family planning program cooperates with other government activities designed to improve people's health and welfare. It emphasizes access to contraceptive methods and promoting the idea small family. The program was structured to us extensive community involvement, and cultural beliefs were incorporated into program policy; Islamic leaders were consulted before program implementation. The program is flexible so that the differing needs of each region can be effectively met by the family planning program. The future main goal will be to contain a potential population boom when the 40% of the present population which is under 15 years of age becomes reproductively mature.     

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.     

Estimating unmet need for contraception by district within Ghana: an application of small-area estimation techniques

The importance of meeting the unmet need for contraception is nowhere more urgent than in the countries of sub-Saharan Africa, where the fertility decline is stalling and total unmet need exceeds 30 per cent among married women. In Ghana, where fertility levels vary considerably, demographic information at sub-national level is essential for building effective family planning programmes. We used small-area estimation techniques, linking data from the 2003 Ghana Demographic and Health Survey to the 2000 Ghana Population and Housing Census, to derive district-level estimates of contraceptive use and unmet need for contraception. The results show considerable variation between districts in contraceptive use and unmet need. The prevalence of contraceptive use varies from 4.1 to 41.7 per cent, while that of the use of modern methods varies from 4.0 to 34.8 per cent. The findings identify districts where family planning programmes need to be strengthened.     

Papua New Guinea launches its population policy

On October 15, 1976, at special ceremonies Papua-New Guinea announced the Population Research Programme and a national population policy. At the program Stephen Tago, Minister of Environment and Conservation, the agency in charge of the population policy, traced the history of abstinence and acceptance of abortion and infanticide which had traditionally limited population. With the breakdown of these traditional methods many families now have 10-15 children and the population is expected to double within 25 years. This is putting stress on the goal of universal education,economic opportunity, and agricultural resources. Data must be collected on the effects of population to help the government and the people make proper population decisions. Charles Lepani, Director of the Central Planning Office, emphasized the importance of statistics to population policy and development strategy. This office predicts that the current population of 2,750,000 will double in less than 25 years. Nearly 40,000 people reach working age every year. The labor force currently totals 1,250,000. A more gradual increase in population would make priorities of the research program were described by Governor of the Bank of Papua-New Guinea, Henry To Robert. The government needs to know more about the physical characteristics of population growth, especially about regional variations. The social and economic reasons for high fertility need to be examined as does the relationship between population and resources. Information also needs to be gathered on attitudes toward policy change.     

A sound population program

A sound population program must respond to real human needs, must be rooted in values, must generate results, must be administered in an integrated manner, must be based on the ethic and goal of self reliance and on the belief that it must operate and grow on its own steam, and must release human resources for productive economic endeavors. To make any sense at all, population must be linked to the gut level needs of the individual. People should not be viewed as demographic statistics, and the word human should be used in the basic sense of hunger and poverty. If the goal is to bring about lasting change in the way that Filipinos manage their lives and their living, it is necessary to probe their values. If social change is the goal, tradition must be challenged. In the area of family planning, persons who can communicate the fact that the program seeks to enrich life more than prevent birth must be chosen. There has been some criticism that the population/family planning program is "too contraceptive oriented" and too mechanistic in the approach to population. Contraception is behavior, a good measure of acceptance and an effective measure of commitment. The delivery of welfare must be horizontally integrated. Thus it is necessary to learn to work in teams, teams of development workers. The value of self determination and the conscious practice of planning and shaping one's life is the very logic of family planning. The program needs to implant the values of family planning firmly in the community, or, more accurately, in the small face to face primary groups where social norms are set and where change must take place if it is to last. The answer to how to achieve a sound population program lies less in what is done than how it is done.     

World population beyond six billion

This world report reviews population growth pre-1900, population change during 1900-50 and 1950-2000, causes and effects of population change and projections to 2050. World population grew from 2 billion in 1900 to almost 6 billion in 2000. Population showed more rapid growth in the 17th and 18th centuries. Better hygiene and public sanitation in the 19th century led to expanded life expectancies and quicker growth, primarily in developed countries. Demographic transition in the 19th and 20th centuries was the result of shifts from high to low mortality and fertility. The pace of change varies with culture, level of economic development, and other factors. Not all countries follow the same path of change. The reproductive revolution in the mid-20th century and modern contraception led to greater individual control of fertility and the potential for rapid fertility decline. Political and cultural barriers that limit access affect the pace of decline. Population change is also affected by migration. Migration has the largest effect on the distribution of population. Bongaarts explains differences in fertility by the proportion in unions, contraceptive prevalence, infertility, and abortion. Educational status has a strong impact on adoption of family planning. Poverty is associated with multiple risks. In 2050, population could reach 10.7 billion or remain low at 7.3 billion.     

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

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

Sweden faces zero population growth

In this discussion of Sweden as it approaches zero population growth, focus is on the following: population growth in perspective, fertility trends (childbearing concentrated and cohort versus period fertility), marital status (non-marital cohabitation, out-of-wedlock births, and divorce), women's changing status (increasing education and increasing employment), constraints and supports for women's dual role (family allowances and housing), birth control (contraceptive methods and practice and abortion), mortality trends, changing age structure and the elderly (average population age and proportion of elderly and cost of elderly support), international migration (from emigration to immigration and demographic impact of immigration), immigration policy, recent population debate (immigration issues and facing zero population growth). Since 1900 the primary features of Sweden's demographic history are a continuing decline in the birth rate to very low levels -- relieved by some upward movement in the 1940s and 1960s -- and a marked shift in the migration balance from emigration to immigration. It is almost entirely because of immigration that Sweden's population growth rate has not yet turned negative. If Swedish women were to continue to bear children at the rate that all women in the reproductive ages actually did in 1978, each women would end up with an average well below the level necessary to exactly replace each adult in the population leaving migration out, an annual total fertility rate of 2.1 children per woman would have to be sustained for births and deaths to be in balance under the low mortality conditions prevaling in Sweden.     

Population goal set for China's new five-year plan

China's 7th Five-Year Plan recommends that China's total mainland population be held within the limit of 1.113 billion, with an annual average natural growth rate of about 12.4/1000. As a large number of youths will reach marriage and childbearing age during the course of the 7th Five-Year Plan, the Plan affords a high priority to the family planning program and to the control of population growth. The plan proposes 5 policies and measures to realize its goal: continuous efforts need to be made to give family planning a high priority; late marriage, late childbearing, and the 1-child family should be advocated; ideological and political education should be strengthened; scientific and technological research devoted to family planning should be intensified; and family planning communication and service centers at the county level should be consolidated and strengthened, and the family planning program should be conducted systematically and be ongoing.     

Comparison and fairness in family planning]

There are two kinds of comparison in family planning (FP) practice. First, people compare the number of children they have with their desired family size. Second, people compare their number of children with other's. The extent of their satisfaction from the comparison often depends on their expectation. And people's expectation about their family size may have an impact on the level of fertility. One task in a FP program is to regulate people's objects for comparison and to reduce the number of children they expect to have. But, changes in people's desired number of children are largely dependent upon the socio economic charges which can not be achieved in short time. Therefore, it would be more advisable to direct people to compare their fertility behavior with those of couples who have only one child, rather than those who have 3 or 4. Satisfaction with family size also comes from a feeling of fairness. People not only look at what they get, but also at what others get. Fairness and justice in FP program implementation is important. If those who violate local birth control policies and regulations are not properly punished, other people would feel that the situation is unfair and they would regret that they did not do the same. The pressure brought by over-population to socio-economic development has been gradually felt by most people. But, it is still difficult to have them strictly observe the present fertility regulation policy. If restrictions of various kinds are enforced and education and publicity are used, people will feel that they are being treated fairly. This will facilitate the promotion of the FP program.     

Seven measures for population control announced in Guangzhou

On 7 October 1988, the Municipal Government of Guangzhou, China, announced the following Decision: "First, great efforts should be made to strengthen education on the situation and tasks of the family planning programme. Second, family planning work is included in the target responsibility system of leaders at all levels during their terms of office and whether it is good or bad for the fulfillment of their family planning tasks will be considered as one of the criteria for the assessment of cadres in their work to link up with rewards and punishments. Third, the current family planning policies must be resolutely and unswervingly carried out. For those units where family planning policies have not been well carried out and where family planning work has long been stagnant, competent authorities should send capable cadres to help them improve their work within a definite period of time. Fourth, the principle of 'three priorities' (i.e., priority of publicity and education to economic restriction, priority of contraceptive measures to induced abortions, and priority of day-to-day work to shock work) must be adhered to while technical service and work of transforming the backward situation in some places should be done. Fifth, the family planning organizations at all levels must be perfected and ranks of family planning workers be strengthened with the stress on those at the township, town, and street neighbourhood levels. Moreover, the family planning offices should be set up or full-time family planning workers be staffed for enterprises and undertakings in the cities. Sixth, funds for the family planning work must be guaranteed. Seventh, the management of family planning for [the] floating population must be strengthened and a management group for [the] floating population, which consists of representatives from the Municipal Government and departments concerned, must be established."     

Pakistan's population growth: the need for action

Despite the existence of a national family planning program that dates to 1965 Pakistan has not seen a reduction in the fertility rate. One of the poorest countries in the world, Pakistan has 1 of the highest population growth rates in the world at about 3.0% annually. For over 2 decades, the average woman in Pakistan has given birth to more than 6 children. At the current fertility rate, the country's current population of 120 million will increase to over 150 million by the year 2000, and it will increase to 280 million by 2020. And even if today every woman were to begin having only 2 children, the population would still reach 160 million before leveling off. But reducing fertility in Pakistan will prove difficult. One of the leading obstacles is the low status of women. Few women in Pakistan have advanced education or professional jobs. Only 1/4 of those women without education or who are not working have any knowledge concerning contraception. Family size and composition also fuel the high rate of fertility. On the average, women desire 5 children (the fact that women average more than 5 suggests an unmet need for contraception). And due to social, cultural, and economic conditions, Pakistanis generally prefer male offsprings. Islamic opposition to family planning has also contributed to the continued high rates of fertility. Finally, administrative and management weaknesses have hindered Pakistan's family planning program. In order to overcome these obstacles, Pakistan will have to enlist the commitment of political, religious, and community leaders. The status of women will have to be improved, and the attitudes of people will need to change.     

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.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

A method for calculating rates of induced abortion

Accurate measurement of induced abortion is necessary for understanding the fertility dynamics of a population and for making projections about the future. Changes in abortion rates can amplify or dampen the impact of changes in contraception. This paper presents a methodology for calculating marital induced abortion rates from observed marital fertility and contraceptive prevalence and for modeling the impact of substituting contraception for abortion on future fertility. The methodology is validated against observed abortion complications in three populations, and the impact of substituting contraception for abortion on expected fertility is demonstrated.