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.     

Toward a U.S. population policy

The gratifying media results from a concerted national and local publicity effort when Zero Population Growth (ZPG) released its recommendations for a national population policy are reported. Support was received from 10 members of Congress and local leaders. 8 ZPG chapters and the Washington office held press conferences casting the meaning of increased population growth in regional terms. In Cincinnati, ZPG focused on the shortage of landfill space, in San Francisco the water shortage, and in Massachusetts the rapid urbanization of prime farmland. The Congressmen emphasized that the U.S. must have a comprehensive population policy before it can tell other countries they must. Among the ZPG policies recommended are: zero population growth by 2008, increased funding for family planning services and education, special programs for teenagers, greater public education on population dynamics, increased funding for contraceptive research, enforcement of existing immigration laws, comprehensive review of immigration policy, equal rights for women, and more equitable income tax policy.     

Why population matters

Population growth around the world affects Americans through its impact on the economy, the environment, and the world our children will inherit. This explains why population growth is important and why the U.S. government provides assistance (roughly $500 million annually, or $2 per American) for population programs in developing countries. These programs help couples to use family planning when they want to, thereby reducing birthrates, protecting the health of women, and strengthening families.     

Guestworker programs: Evidence from Europe and the United States and some implications for U.S. policy

Mounting concern in the United States over increased illegal migration from Mexico during the past decade has generated a heated policy debate and led to a number of proposals as to how the U.S. government should deal with the problem. Among these has been a call for a temporary worker program similar to the U.S.-sponsored Bracero Program (1942–1964) in which over 4 million Mexican workers were recruited to perform temporary agricultural labor in the southwestern United States. This article considers the implications of such a program by examining the social and economic effects of previous guestworker programs in the United States and western Europe from the perspective of both sending and receiving societies. Particular attention is paid to the efficacy of these programs in promoting temporary as opposed to long-term immigration of foreign workers as well as their developmental impact on sending countries.Now at 2405 Rayburn House Office Building, U.S. House of Representatives, Washington DC 20515.     

Determinants of national family planning effort

In light of recent research demonstrating a substantial impact of family planning programs on fertility, we develop and estimate a multivariate model of the determinants of national differences in family planning program effort (FPPE). The framework that guides the specification of this model identifies three broad classes of factors—those that create demand for family planning, those that facilitate the initiation and expansion of family planning programs, and finally those that encourage or inhibit program development. The results from multiple regression using 84 less developed countries indicate that demand for family planning, facilitating infrastructure, and certain demographic and geographic factors are important determinants of program effort. These results suggest that popular demand for family planning is helpful, but that policy makers must perceive the adverse consequences of high fertility and have the infrastructure necessary to develop an effective organized family planning program. Current U.S. policies relevant to reducing birth rates are discussed and found to reflect quite well research on determinants of fertility declines among LDCs. U.S. policy also balances the often competing claims of family planners and their opponents by encouraging support to both developmental projects as well as direct aid to family planning program activities.     

The population debate: A survey of opinions of a professional organization's membership

In analyzing results of a survey concerning population issues taken among members of an organization devoted to the scientific study of population, namely, the Population Association of America, we found high agreement that: (1) world population growth was much too high, (2) many of today's serious problems are caused by overpopulation, and (3) the U.S. should help any requesting country establish programs to curtail growth. There was no consensus, however, on issues such as: (1) ideal population size, (2) family planning as the most reasonable means of reducing population growth, (3) the need to initiate coercive birth control immediately, (4) redistribution of resources as a long-term solution to overpopulation, (5) how to solve population problems in time to avoid widespread catastrophe, and (6) whether the U.S. should exert pressure on other countries to establish a family planning program as a prerequisite to economic aid. These findings apply with few exceptions to four subcategories of members defined on the basis of extent of demographic training and employment.     

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.     

The international family planning movement

Over the past 3 decades, the number of women using family planning has increased 6-fold to over 400 million married women of childbearing age. The evolution of behavior and attitudes toward using birth control among third world couples reflects the goals and hard work of an international network of individuals, governments and organizations. This article follows the progression of this movement, from early opposition in developed as well as developing countries, to the present day, when birth control is practiced by a slight majority of the world's women of childbearing age. Among world regions, contraceptive use ranges from about 17% in Africa to 75% in Asia. In some African countries, however, family planning is still a foreign concept, and fewer than 5% of women use any birth control. International organizations played a crucial role in spread of family planning by providing training for developing country professionals, funding actual family planning programs and helping to evaluate programs. But the success of a country's family planning program also was dependent upon a national commitment, and often on a strong socioeconomic setting. The private sector has had a limited role except in some countries, notably in Latin America, but its involvement is likely to expand in the future. Also, as financial support from the US and international organizations wanes, national governments will cover a larger share of the cost. The worldwide increase in the practice of family planning has led to fertility declines in many third world countries, slowing rapid population growth rates. For individuals, family planning has been a liberating influence, allowing them to participate more fully in the shift from traditional to modern society.     

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.     

Safeguards proposed for subsidized sterilizations

In December the U.S. Department of Health, Education, and Welfare (HEW) proposed new regulations to prevent the abuse of sterilization while not making it unnecessarily difficult to obtain for those who sincerely want the operation. Included in the proposal are: 1) continuation of existing court-ordered bans on federal funding for sterilization of persons under 21 and mental incompetents, 2) prohibition of funding for hysterectomies to sterilize women, and 3) expansion of the current 72-hour waiting period to a 30-day period between the dates of consent and the operation. In the past year 2 sterilization trends have become apparent. The 1st is the growing acceptance of sterilization as a preferred form of contraception and the 2nd is the growing concern that sterilization is being forced upon poor and minority women. A recent HEW survey revealed that nearly 1/4 of all married couples now rely on sterilization of 1 partner for contraception; this is double the number of 1965. Despite this popularity, there is widespread evidence of different forms of abuse, and reports of abuse have motivated citizens and organizations to seek tighter control of local, state, and federal monies used for sterilization.     

Major studies on population authorized by United States Congress

The Office of Technology Assessment, acting on a request from the U.S. Congress, will undertake 2 major population studies in the near future. The goal of the studies will be to facilitate U.S. policy formulation over the next couple of decades. The 1st study will attempt 1) to assess the impact of efforts make by national government to alter birth rates between 1960-1980; 2) to predict the effects of population growth utilizing different assumptions concerning family planning; 3) to identify the types of population issues which will emerge in the period 1980-2000; and 4) identify research priorities aimed at clarifying these issues. The 2nd study will 1) investigate current contraceptive technology; 2) attempt to define a perfect contraceptive; and 3) examine the prospects of contraceptive technology between 1980-2000.     

Why women who don't want to get pregnant don't use contraception

In the developing world about 120 million women have an unmet need for contraception. They want to postpone childbearing, yet they do not use contraception, often because of the unavailability of services and supplies. However, according to a recent article by John Bongaarts, the primary factors are lack of knowledge about a contraceptive method, concern about side effects, and the disapproval of the male partner in developing countries. Lack of knowledge means inability to describe the uses of a contraceptive, its side effects, and the locale of its availability. An approximate knowledge index was calculated for such women, which showed that knowledge level positively correlated with contraceptive prevalence. Countries where the index was below 50% had a contraceptive prevalence of 8% only. The determinant reasons why women were reluctant to use the pill, IUD, and sterilization had to do with health and the fear of side effects, such as nausea and increased bleeding. The contraceptive prevalence among these women was reduced by 71% for the pill, 86% for the IUD, and 52% for sterilization. In Sub-Saharan countries nearly 70% of women cited partner disapproval of contraception, although they had never discussed family planning with their partners. The central concept for reducing unmet need is access with quality, which means that services are voluntary, safe, and appropriate in delivery. Some of the recommendations to reduce the unmet need for contraception include: one-on-one same-sex discussions to increase contraceptive knowledge and acceptability; sensitive responses by programs to their client's health concerns; support by service providers to women negotiating with male partners in order to mitigate male disapproval; and sex education and family planning services to reduce unwanted and early sexual contact and pregnancy while girls develop identities apart from mothering roles.     

Social change,population policies,and fertility decline in Colombia and Venezuela

This paper takes a comparative case-study approach to examine the social and policy correlates of fertility decline. The analysis compares fertility behavior across a mature and young cohort of women in Colombia and Venezuela, two countries that experienced rapid demographic change under dissimilar socioeconomic and population policy conditions. Based on the distinction between birth-spacing and birth-stopping behavior the analysis tests several propositions derived from the adaptation and innovation explanations of fertility decline. Results show that fertility regulation at low parities was largely absent among mature women in both countries, representing an innovative behavior among younger women. The introduction of fertility control, however, was highly dependent on women's socioeconomic position, particularly their educational and occupational characteristics. The strong family planning programs in Colombia resulted in a more rapid extension of contraceptive use, particularly female sterilization, and stopping behavior after two children relative to Venezuela. Results highlight the diversity of conditions under which fertility can decline in developing countries and the importance of family planning and other policy initiatives to understanding the different pathways towards lower fertility.     

Pakistan: re-organization at the top

New measures for population program planning have been introduced in Pakistan. 3 wings were added in the Population Planning Council: administration, coordination, and planning; operation; and technical. New elements in the program include: 1) setting up of new directorates; 2) opening of more family welfare clinics, model clinics, and sterilization centers; and 3) expansion of training facilities for medical and paramedical personnel. 2 national training institutions have been established: the Population Training Centre at Lahore, and the National Institute of Advanced Training at Hyderabad. 16 centers have training courses for doctors performing sterilization. There has been a restructuring of the information, education, and communication aspects of the program. The commercial distribution of contraceptives has become an important element. There are efforts to relate the program to other development programs.     

New perspective in population assistance

The United States Agency for International Development (AID), in a proposal to Congress, has suggested that before assistance is extended to developing countries, its impact on the country's population growth should be considered and development projects accepted that contribute directly to fertility declines. Foreign development projects will be examined for their direct and indirect impact on population growth. Some projects related to education, employment and economic development may be found, by their very nature, to encourage fertility decline and emphasized as a result of the impact examinations. Other projects may be changed to stress the features that are conducive to slowing population growth. The population impact examination proposal has been included in this year's legislation to authorize the continuation of United States development assistance programs for the fiscal year 1978.     

Unmet Need for Family Planning in Developing Countries and Implications for Population Policy

Unmet need for family planning has been a core concept in international population discourse for several decades. This article reviews the history of unmet need and the development of increasingly refined methods of its empirical measurement and delineates the main questions that have been raised about unmet need during the past decade, some of which concern the validity of the concept and others its role in policy debates. The discussion draws heavily on empirical research conducted during the 1990s, much of it localized, in‐depth studies combining quantitative and qualitative methodologies. Of the causes of unmet need other than those related to access to services, three emerge as especially salient: lack of necessary knowledge about contraceptive methods, social opposition to their use, and health concerns about possible side effects. The article argues that the concept of unmet need for family planning, by joining together contraceptive behavior and fertility preferences, encourages an integration of family planning programs and broader development approaches to population policy. By focusing on the fulfillment of individual aspirations, unmet need remains a defensible rationale for the formulation of population policy and a sensible guide to the design of family planning programs.     

Family Planning and Child Health Care: Effect of the Peruvian Programa de Salud Reproductiva y Planificación Familiar, 1996–2000

Our study estimates the effects of exposure to a family planning program which promoted surgical contraception for the first time in Peru on women's use of birth control methods and their children's health. While a broad program, the Programa de Salud Reproductiva y Planificación Familiar forced many indigenous women to undergo sterilization. We compare provinces affected by the program earlier with provinces affected later, before and after the policy. Overall, the results indicate that women in treated areas were more likely to use both temporary and permanent contraceptive methods and their children were less likely to die within their first year of life, partly due to longer breastfeeding. However, we observe heterogeneity by ethnicity. In treated provinces, nonindigenous children benefited from the policy regardless of their mothers’ choice of contraceptive method, while there were few positive impacts for indigenous children whose mothers underwent sterilization. This suggests that coercive or aggressively implemented family planning programs may not confer health benefits on children.     

Infant mortality trends in rural East Pakistan

Infant mortality trends in a rural area of East Pakistan are analyzed utilizing the Bogue pregnancy history technique. The findings indicate that infant mortality has declined slightly over 20 percent between 1958 and 1967. The existence of development programs in women’s education and family planning since 1961 are proposed as possible reasons for this finding. A convergence in infant mortality rates to mothers in the age range 15–39 years was found in the final year under analysis, while the standard U shaped pattern of infant mortality with age structure was exhibited in the previous years. One possible explanation for the convergence is that the development programs are reaching women within this age range more equally than in the past. An alternative explanation relating to the problems of recall of mortality events was discussed.