The child survival hypothesis

Summary Because of current interest in the child survival hypothesis, we have reviewed available evidence bearing upon the relationships of infant and child mortality to fertility and contraceptive behaviour. The evidence is drawn from time series data for local and national vital events, from special in-depth studies of the infant mortality-fertility relationships in family formation, and from service statistics from health and family planning programmes. As a result of this review, we suggest five clarifications which should be made in redefining the child survival hypothesis and assessing its potential programme implications. The child survival hypothesis states that improved child survival will contribute to increased family planning motivation and consequent fertility decline. The evidence presented here suggests that the effect is not automatic and probably not a necessary pre-condition for fertility decline. There is certainly not a reflexive one-to-one replacement, but a partial effect may still be important. In the clearly demonstrated reduction in inter-pregnancy intervals after a child death, the major component is undoubtedly the removal of the biological protection of lactational amenorrhoea. A separate but somewhat smaller effect has been demonstrated in situations where lactation did not seem to have been the explanation. It is expected that increased child survival will contribute to fertility decline mainly in countries experiencing rapid mortality decline and population growth. The replacement of children who die is probably not so much 'volitional' as a result of alterations in sub-conscious expectations. It is apparent that in traditional agrarian populations, few direct and manipulable means of influencing motivation for fertility limitation are available, and, therefore, it must be stressed that integrated health and family planning programmes do provide opportunities for immediate programme development. By making parents aware of improved changes of survival through health services in which they develop confidence, the spontaneous linkages between mortality and fertility can presumably be reinforced. Family planning services must be provided as an essential initial step in programme development, but they can be made more effective, as well as politically more acceptable if appropriately integrated with maternal and child health and nutrition services.     

Fertility in botswana: The recent decline and future prospects

Recent estimates of fertility in Botswana suggest a rapid decline of more than two births per woman between 1981 and 1988. This paper proposes that the baseline fertility was overestimated but that nonetheless fertility declined by about one birth per woman during the 1980s. The decline in fertility was linked to a deterioration in social and economic conditions caused by a major drought in the early 1980s and to the increased availability of family planning services in the same period. Fertility apparently began to rebound in the late 1980s in response to improved conditions, which came about as a result of a successful drought relief program. Future declines in fertility depend on the continued success of the family planning program, particularly in rural areas.     

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.     

How Do Education and Family Planning Accelerate Fertility Decline?

Education and family planning can both be influenced by policy and are thought to accelerate fertility decline. However, questions remain about the nature of these effects. Does the effect of education operate through increasing educational attainment of women or educational enrollment of children? At which educational level is the effect strongest? Does the effect of family planning operate through increasing contraceptive prevalence or reducing unmet need? Is education or family planning more important? We assessed the quantitative impact of education and family planning in high-fertility settings using a regression framework inspired by Granger causality. We found that women's attainment of lower secondary education is key to accelerating fertility decline and found an accelerating effect of contraceptive prevalence for modern methods. We found the impact of contraceptive prevalence to be substantially larger than that of education. These accelerating effects hold in sub-Saharan Africa, but with smaller effect sizes there than elsewhere.     

Status of National Family Planning Programmes of Developing Countries in relation to demographic targets

Abstract Having arisen within the context of social and economic development plans, demographic targets associated with family planning programmes in developing countries stipulate levels deemed desirable or necessary to implement economic goals. Since an optimum fertility path for economic development is open to conjecture, targets tend to be vague or arbitrary, and generally imply a fertility decline that goes beyond family limitation based on health considerations. While on the one hand, programme administrators have assumed responsibility for these targets, on the other hand they have structured their programmes toward health, not demographic, goals. As a result, they have minimized rather tham maximized the contribution of the programmes to the targets. of the 24 countries with programmes designed to reduce birth rates, the demographic variable is on target in seven; in six, review is premature; five cannot be evaluated because targets are non-quantifiable or vital data are too uncertain; and in six, including India and Pakistan, progress has been poor, at least in relation to targets. The demographic target is only one of many models and techniques for programme evaluation, although many require data not often available in developing countries. An estimate of births averted based directly on programme activities is not only complex but speculative. However, in contrast to the target criterion, cost benefit analyses involving the estimated return for an averted birth indicate that the programmes are a highly profitable investment.     

Family planning in Taiwan, Republic of China: Progress and prospects

Abstract The family planning programme in Taiwan is considered to have been most successful and has been systematically evaluated. In the light of some expressed scepticism, however, its impact on fertility will have to be carefully reviewed. The present article discusses six specific problems : How many women have accepted the Lippes loops or pills offered in the programme ? How long will the loop stay in utero ? What proportion of married women is currently wearing the loops ? What changes have occurred in the knowledge-attitude-practice (KAP) of family planning among the target population ? How many births have been prevented by the IUD programme ? And finally, How much has fertility declined ? The fertility decline in Taiwan has been accelerating since the programme started in 1964. Approximately 40% of the decline in the birth rate, from 36.3 in 1963 to 27.7 in 1969, or 8.5 points per 1,000 in six years, however, was due to changes in age structure and delayed marriage. An increasing proportion of girls of marriageable age and a possible increase in the fecundability of the population will work against the programme's objective. Concerted efforts and heavier investment are essential for the final success of the programme.     

A review of the studies on fertility transition in China]

This article is a summary of papers and analysis in recent years on fertility transition and the association between fertility decline and socioeconomic development in China. These papers discuss the causes of fertility decline and the role of family planning programs in demographic transition. The major points are: 1. The demographic transition in China has the same characteristics as in the countries that have completed the transition. The transition had already started in the more developed areas or completed in a few large cities before family planning programs were implemented. 2. The role of family planning programs is to lead and to accelerate the demographic transition, which is the key idea of the "induced fertility transition". 3. The socioeconomic development and family planning programs worked together to affect the fertility decline, however socioeconomic development is the fundamental factor. Without the existence of the socioeconomic development, which included the changes in the function of family, traditional ideas on fertility, increased level of education, the status of women and social security system; the family planning program is not likely to make an impact.     

Social and economic factors in Hong Kong's fertility decline

Abstract In both developed and underdeveloped areas, many attempts have been made to alter the course of fertility through family planning intervention. Doubtless the availability of such services facilitates birth control for those who already desire to use it. Whether or not such exogenous interventions have any independent effect upon the operation of endogenous forces in the economy and society is, however, more problematical. Where fertility declines have been observed, family planning services have often been made widely available only after the decline in fertility had already set in. Nonetheless, observers have often attempted to attribute some fraction of the continuing decline in fertility to the operation of family planning activities. One especially notable case is that of Hong Kong, which provides some of the more persuasive evidence about the independent effects of family planning intervention.     

中国农村居民家庭的生育决策模型与实证分析

根据"五普"和"六普"资料,人口总和生育率显著低于世代更替水平,这表明中国人口进入了低生育水平发展阶段。关于这一问题的合理解释是除了计划生育政策影响外,农村家庭生育决策的变化可能是内生的重要影响因素。基于生育决策模型及实证分析,得出这样的结论:在土地量保持不变的条件下,农村居民家庭的生育决策主要取决于收入水平和抚养子女的成本。农村居民家庭可能会依据"量质权衡"减少生育子女,这可能是导致中国人口生育水平下降的根本原因。     

An analysis of major proximate determinants of our fertility]

The sample survey of fertility, in Shanghai city and Shanxi and Hebei provinces of China in 1985, provided plentiful data about fertility, marriage, contraceptive usage and breastfeeding in terms of The World Fertility Survey Model. The data, along with Bongaarts' model, was utilized to analyze the relation between several proximate determinants and fertility changes. When comparing these three geographic areas, the largest difference was breastfeeding and the smallest one was non- contraceptive usage. It was very different from the results of The World Fertility Survey in developing countries in 1977. The difference of marriage indexes among three areas was close to that of breastfeeding; but for the effects on induction of fertility, marriage index surpassed breastfeeding. There were two models showing effective efficacy on fertility decline. One was the Shanghai model, in which much more effect came from marriage delay, accounting for 71%; another was the Hebei model, induction of fertility was caused by contraceptive usage, about 53%. Both indicated that the major factor affecting fertility decline was the family planning program. Otherwise, it seemed to indicate that different factors such as social, economic development indirectly decreased fertility through family planning programs.     

Risk, uncertainty and family formation: The social context of poverty groups

Abstract Despite the assumptions of many demographers that the net returns from children for non-elite groups in underdeveloped areas are likely to be negative, high fertility persists in most of these societies. Both cultural and institutional explanations have been proposed to account for this. We attempt to provide some mediation between these competing models, by introducing the elements of risk and uncertainty as factors likely to induce poverty and lead works to opt for the 'high fertility, low quality' pattern of investment of time and money in family formation. Drawing upon the work of Wharton in subsistence agriculture practices, several alternative decision-making models are proposed to account for both the persistence of high fertility, and the declines that have been registered in selected areas, such as Taiwan and perhaps China. The empirical work of Mueller on Taiwanese expectations of returns on children and the concomitant variation in family-size preferences is consistent with the models proposed. Some implications for uncertainty and risk-reduction strategies in family planning and other social welfare programmes are drawn.     

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.     

Marriage at an earlier than ideal age in six Latin American capital cities

Abstract The study of nuptiality has taken on urgency, for demographers as well as for sociologists, with the increased world concern over sustained high fertility and the evident contribution of early marriage to that high fertility. Moreover, along with despair over the efficacy of conventional family planning programmes has come an expectation that more basic institutional changes, such as changes in marriage patterns, will be necessary in order finally to achieve a tolerably low world population growth rate. Yet our understanding of the determinants of such primary nuptiality dimensions as age at first marriage is very imperfect and unlikely to give much guidance in policy formation.     

Some problems in the use of open birth intervals as indicators of fertility change

Abstract To measure changes in fertility brought about by specific family planning programmes has been one of the problems faced by demographers as well as policy-makers. This problem is particularly difficult in developing countries where the basic data are poor. Hence, there is a need to find indices of fertility that are easy to obtain, sensitive to changes in fertility and either not grossly affected by errors in data, or alternatively amenable to correction of data errors. Among many possible indices, the open live birth interval has attracted attention of many researchers and experts.(1).     

Socialist system creates favourable social environment for fertility decline in China

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

Kenya's record population growth: a dilemma of development

The causes and implications of Kenya's 4% rate of natural increase and fertility rate of 8.1 births per woman were examined. Attention was directed to the following: pronatalist pressures; inadvertent pronatalist impact of development; women's education and employment and fertility; population growth and pressures; mortality decline and population growth; fertility levels and differentials; fertility desires; the family planning program; and family planning knowledge, attitudes, and practice. Kenya's development success has worked to push up the population growth rate. Improved health care and nutrition halved infant mortality from 160 to 87 deaths/1000 live births between 1958 and 1977 and a marked increase in primary school enrollment may be factors in the birthrate increase to 53/1000 population. At this time fertility is highest among women with 1-4 years of education. The 1977-1978 Kenya Fertility Survey showed that only 5.8% of married women were using modern contraception, indicating that the national family planning program, established in 1967, has made little progress. Program difficulties have included shortages of staff, supplies and easily accessible clinic as well as an almost universal desire on the part of Kenyans for families of at least 7 children. Children are viewed as essential to survival and status to the rural population.     

Land,Fertility, and the Population Establishment

Attempts to demonstrate the dependence of fertility decline in the Third World on radical change have often depended on simplistic statistical analyses. Here some of the data used to explore the relationship between fertility, and land size and ownership, are re-examined. It is concluded that the land-fertility hypotheses of Stokes and Schutjer are not supported by the evidence, but that such analyses are inherently inconclusive and ambiguous. Instead, an understanding of the wider institutional context is called for. The Population Establishment – foreign and international donors supporting population programmes and research – recruits an intelligentsia to validate its activities. The philosophy of this intelligentsia is examined and rejected through an analysis of ideas it derives from the World Fertility Survey and the Matlab family planning project. It is concluded that the Establishment perpetuates rapid population growth by legitimizing unpopular and elitist governments, and by misleading them to believe that fertility decline can, indeed, occur in a political economy of inequality and injustice.     

"发展-计划生育-生育率"的动态关系:中国省级数据再考察

顾宝昌在1987年利用省级数据考察了中国的生育率,通过路径分析得出社会经济发展和计划生育对中国生育率都有重要的直接影响的结论.李建民在2004年分析了我国低生育率的经济环境,提出1990年代我国生育率的下降应该主要是社会和经济发展的结果.基于这些结论或假设,本文利用中国省级数据,再次考察"发展-计划生育-生育率"关系,结果表明在过去30年里,计划生育的作用在下降,而社会经济发展的作用在增强.1970年代计划生育的作用是主导,1980年代计划生育与社会经济发展二者的作用基本达到了平衡,而1990年代社会经济发展的作用成为主导."发展-计划生育-生育率"关系呈献出一种动态平衡.     

Declining world fertility: trends,causes, implications

This Bulletin examines the evidence that the world's fertility has declined in recent years, the factors that appear to have accounted for the decline, and the implications for fertility and population growth rates to the end of the century. On the basis of a compilation of estimates available for all nations of the world, the authors derive estimates which indicate that the world's total fertility rate dropped from 4.6 to 4.1 births per woman between 1968 and 1975, thanks largely to an earlier and more rapid and universal decline in the fertility of less developed countries (LDCs) than had been anticipated. Statistical analysis of available data suggests that the socioeconomic progress made by LDCs in this period was not great enough to account for more than a proportion of the fertility decline and that organized family planning programs were a major contributing factor. The authors' projections, which are compared to similar projections from the World Bank, the United Nations, and the U.S. Bureau of the Census, indicate that, by the year 2000, less than 1/5 of the world's population will be in the "red danger" circle of explosive population growth (2.1% or more annually); most LDCs will be in a phase of fertility decline; and many of them -- along with most now developed countries -- will be at or near replacement level of fertility. The authors warn that "our optimistic prediction is premised upon a big IF -- if (organized) family planning (in LDCs) continues. It remains imperative that all of the developed nations of the world continue their contribution to this program undiminished."     

A note on measuring the independent impact of family planning programs on fertility Declines

This note critically evaluates recent cross-national studies that estimate the independent effect of family planning programs on the fertility of the developing world. The evaluation demonstrates that past research is biased to produce overestimates of net program impact. A new estimate is derived to account more completely for the effects of the social context and socioeconomic development on fertility. This estimate indicates that 5 percent of the variation in crude birth rate decline for 89 developing countries is due to family planning programs. This is substantially less than past estimates.