A model to estimate births averted due to IUCDs and sterilizations

The computation of births averted due to a specific family planning programme requires special treatment instead of application of the usual population projection technique using conventional fertility rates. The reason for this is that adopters of a family planning method are a selective group from the general population with respect to a number of demographic and biological characteristics, including the initial susceptibility status at the time of adoption. In the present paper a matrix of annual birth probabilities specific to age at adoption of a method and duration since adoption is obtained. One matrix is presented for adopters of IUCD, another for salpingectomy, and a third for vasectomy. These matrices are used to obtain estimates of births averted for India due to IUCDs and sterilizations performed during 1956–69. The results are compared with those that could have been obtained by using the usual age-specific marital fertility rates under identical conditions, except for initial susceptibility. The entire work is programmed on a high speed electronic computer.     

Some problems in determining the number of acceptors needed in a family planning programme to achieve a specified reduction in the birth rate

Abstract The paper attempts to revive professional interest in a problem originally considered by Lee and Isbister and which has assumed added importance recently because of the increasing number of national family planning programmes that are being instituted, which require the determination of the number of acceptors needed in a family planning programme in order to achieve a specified reduction in the birth rate. The publication of subsequent papers on births averted by programmes, notably by Potter and Wolfers, each of whom had made some criticisms of the paper by Lee and Isbister, has tended to obscure the differences in the nature between the problem raised by Lee and Isbister, and that discussedby Potter or Wolfers. The paper tries to bring out these differences and points out one of the limitations of the estimates of births averted obtained by using either Potter's or Wolfers's methods, viz. the inability to determine the time period to which the birth reduction refers, thereby further complicating the issues involved in assessing the social and economic implications of births averted by a family planning programme. The paper also points out some of the unrecognizedtechnical considerations which arise in dealingwith the 'target-setting' problem raised by Lee and Isbister and suggeststhat stochasticmodel studies might offera clue for evolving practical methods for tackling this problem.     

The time response in averted births

Abstract A calculation of the timing of births that are averted may seem a curious exercise, when not only do the births in question not occur, but the corresponding conceptions may never have existed. However, such a calculation may have considerable use. In order to assess the likely direct impact of a contraceptive programme on birth rates it is useful to estimate the number of births that would, in the absence of the programme, have occurred among the couples who accept it. Moreover, some time would necessarily elapse before a new 'steady state' in fertility could be reached, even if the programme and the potentially fertile population did not change in any way; and it is worth while to seek to find the times (for a few years after the start of a programme) when the (averted) births would have occurred in its absence, and to examine any inherent oscillations produced in birth rates by it. This question is considered below only for groups of women aged 20 at marriage (a state which is taken to be the start of regular exposure to the risk of conception), but the same methods are applicable to other ages, (possibly allowing for mortality) and appropriate combinations of age groups and cohorts in the fertile range may be used to estimate changes in fertility and reproduction rates expected from a programme, subject to given conditions, for several years after its start. The methods can also be generalised, by means of convolution, to contraceptive programmes that change with time, but these are not considered further.     

Gender inequalities and demographic behavior

A summary was provided of the central findings about gender inequalities in Egypt, India, Ghana, and Kenya published by the Population Council in 1994. These countries exhibited gender inequalities in different ways: the legal, economic, and educational systems; family planning and reproductive health services; and the health care system. All countries had in common a high incidence of widowhood. Widowhood was linked with high levels of insecurity, which were linked with high fertility. Children thus became insurance in old age. In Ghana, women's insecurity was threatened through high levels of marital instability and polygyny. In Egypt, insecurity was translated into economic vulnerability because of legal discrimination against women when family systems were disrupted. In India and all four countries, insecurity was reflective of limited access to education, an impediment to economic autonomy. In all four countries, women's status was inferior due to limited control over reproductive decision making about childbearing limits and contraception. In India, the cultural devaluation of girls contributed to higher fertility to satisfy the desire for sons. In India and Egypt, family planning programs were dominated by male-run organizations that were more concerned about demographic objectives than reproductive health. The universal inequality was the burden women carry for contraception. Family planning programs have ignored the local realities of reproductive behavior, family structures, and gender relations. The assumption that husbands and wives have similar fertility goals or that fathers fully share the costs of children is mistaken in countries such as Ghana. Consequently, fertility has declined less than 13% in Ghana, but fertility has declined by over 30% in Kenya. Family planning programs must be aware of gender issues.     

From Bucharest to Mexico: a decade of changing perceptions

The 2nd International Conference on Population held in Mexico City in 1984 had 3 main objectives: 1) to adopt the plan to changing demographic situations, 2) to enlarge the plan's scope so it can consider new views that have emerged since Bucharest, and 3) to reinforce the plan's operational aspects so that the plan can be applied more effectively. The Mexico conference had significant differences with the Bucharest gathering: 1) greater participation of developing countries, 2) clarification of the role of population and family planning in development, and 3) recognition of the status of women in development. Governments of many developing countries argue that they cannot wait for their countries to modernize sufficiently enough to stabilize their population levels. Participants in the Mexico conference agreed that family planning programs have been successful in reducing fertility at relatively low cost. The goal of a development-oriented population policy is to improve the people's standard of living by lowering fertility rates, improving health conditions and life expectancy, improving population distribution, and adopting sound economic policies. The overall objective of population policy should not be confined only to growth, distribution, and other demographic aspects; it is imperative that human life and human dignity be upheld.     

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.     

An analysis of the fertility transition in developing countries]

Most developing countries are in the demographic stage of early mortality, high birth rates and high rates of natural population increase. A characteristic of developing countries is that after World War ii, particularly since the 1960s fertility rates are on the decline, even though they still remain high. The fertility rate of developed countries fell from a 1950 rate of 22.9/1000 to 15/1000 in 1982, a decrease of 34.5%, whereas the fertility rate of developing countries hovered around 43/1000 between 1930-1950, 40.6/1000 during the 1960s and 33/1000 in 1982. Between 1950 and 1982 there was a decrease of 24.8%. But the main reason for this decrease is the decline in the last 20 years of the fertility rates of China and India, whose rates fell 34.9% from 1960-1980. Changes in fertility rates are influenced by the age structure of a country, as seen in the changing age structure of developing countries from 1960-80. For example, an increase in fertility rates was 1 consequence of an increase in the number of fertile women aged 15-45 from 42.6% in 1960 to 44.4% in 1980. Nevertheless, there exists some sort of birth control, whether conscious or subconscious, because the number of births per fertile woman is 3-4 fewer than the 14-15 children a woman can theoretically bear. The reason for changes in fertility rates in developing countries can be traced to marriage and family customs, and even more important, to social and economic factors. For example, Asian, African and Latin American cultures tend to support early marriages. When the fertility rates of developed and developing countries are looked at for a comparable period, then the rate of decrease for developing countries is slower than developed countries. But, if the comparison is made for a transitional period (i.e., industrialization), then the rate of decrease for developing countries is faster than for developed countries. Currently there are 25 developing countries that have attained a fertility rate of 25/1000 or lower, and 52 developing countries with a rate of 35/1000.     

计划生育政策的人口效应

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

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.     

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).     

Adolescent fertility: worldwide concerns

There is growing concern over the adverse health, social, economic, and demographic effects of adolescent fertility. Morbidity and mortality rates ar significantly higher for teenage mothers and their infants, and early initiation of childbearing generally means truncated education, lower future family income, and larger completed family size. Adolescent fertility rates, which largely reflect marriage patterns, range from 4/1000 in Mauritania; in sub-Saharan Africa, virtually all rates are over 100. In most countries, adolescent fertility rates are declining due to rising age at marriage, increased educational and economic opportunities for young women, changes in social customs, increased use of contraception, and access to abortion. However, even if fertility rates were to decline dramatically among adolescent women in developing countries, their sheer numbers imply that their fertility will have a major impact on world population growth in the years ahead. The number of women in the world ages 15-19 years is expected to increase from 245 million in 1985 to over 320 million in the years 2020; 82% of these women live in developing countries. As a result of more and earlier premarital sexual activity, fostered by the lengthening gap between puberty and marriage, diminished parental and social controls, and increasing peer and media pressure to be sexually active, abortion and out-of-wedlock childbearing are increasing among teenagers in many developed and rapidly urbanizing developing countries. Laws and policies regarding sex education in the schools and access to family planning services by adolescents can either inhibit or support efforts to reduce adolescent fertility. Since contraceptive use is often sporadic and ineffective among adolescents, family planning services are crucial. Such programs should aim to reduce adolescents' dependence on abortion through preventive measures and increase awareness of the benefits of delayed sexual activity. Similarly, sex education should seek to provide a basis for intelligent, informed decision making. Programs tailored to reach teenagers in schools, recreational centers, and the workplace have particular potential.     

The relationship of the crude birth rate and its components to social and economic development

Using well-known techniques of regression analysis, we decompose the crude birth rate into six analytical components, indicating illegitimacy, the marriage rate, legitimate fertility, and sex and age composition. All the components except sex structure are important in determining differences in crude birth rates across countries of the world. The model is elaborated by showing how economic development affects the crude birth rate through its basic demographic components.     

Population planning in Asia in the 1970s

Summary To what extent is family planning integrated with broader population planning in the countries of East Asia and South Asia? To what degree do these countries combine population planning with economic and social planning in their development plans? An attempt to answer these questions suggests that, despite variability from country to country in development goals and policy implementation, family planning has been largely separated from economic planning, and birth control programmes have often been substituted for intermediate and long-range population planning. Demographic factors have been treated as exogenous variables rather than as integral parts of social-economic-demographic plans. Such comprehensive planning is difficult for both technical and political reasons, but in any case is unlikely to be achieved so long as family planning and population planning continue to be confused.     

Cheaper by the dozen? The marginal time costs of children in the Philippines

The important relationship between fertility rates and economic development has prompted many researchers to try and better understand the determinants of family size. It has repeatedly been shown that the costs of children, both direct and indirect, are one of the most important determinants of fertility, exerting a significantly negative effect on birth rates in both developed and developing countries. Many studies which investigate the relationship between the costs of children and family size have assumed that these costs do not vary with parity. However, there is substantial evidence that the marginal costs of children are not constant but decrease with birth order in developed countries. In this paper, the hypothesis that there are diminishing marginal time costs of children is tested using household data from the developing country setting of the Philippines. By examining the determinants of additional time spent in childcare before and after the birth of a child, it is found that the marginal time costs are not the same across households of various sizes. Firstborn children cost significantly more in terms of additional mother's time than children of higher birth orders. In addition, the time costs of the second child are found to be significantly greater than those of the third child. However, these economies of scale in childcare are limited and do not extend beyond three children. The effect of birth spacing on the marginal time costs of children is also found to be significant.     

Unintended effects of poverty programmes on childbearing in less developed countries: experimental evidence from Latin America

Because conditional cash transfer (CCT) programmes (which make payments to poor households, conditional on their behaviour) potentially affect both household resource levels and parental preferences for quality vs. quantity of children, they may have unintended consequences for fertility. We use panel data from experimental CCT programmes in three Latin American countries to assess the unintended impact of these programmes on childbearing. Our findings, based on difference-in-difference models, show that the programme in Honduras, which inadvertently created large incentives for childbearing, may have raised fertility by between 2 and 4 percentage points. The CCT programmes in the two other countries, Mexico and Nicaragua, did not have the same unintended incentives for childbearing, and in these countries we found no net impact on fertility. Subsequent analysis examined several potential mechanisms by which fertility in Honduras may have been raised but was not able to identify a primary mechanism with the available data.     

Unintended effects of poverty programmes on childbearing in less developed countries: Experimental evidence from Latin America

Because conditional cash transfer (CCT) programmes (which make payments to poor households, conditional on their behaviour) potentially affect both household resource levels and parental preferences for quality vs. quantity of children, they may have unintended consequences for fertility. We use panel data from experimental CCT programmes in three Latin American countries to assess the unintended impact of these programmes on childbearing. Our findings, based on difference-in-difference models, show that the programme in Honduras, which inadvertently created large incentives for childbearing, may have raised fertility by between 2 and 4 percentage points. The CCT programmes in the two other countries, Mexico and Nicaragua, did not have the same unintended incentives for childbearing, and in these countries we found no net impact on fertility. Subsequent analysis examined several potential mechanisms by which fertility in Honduras may have been raised but was not able to identify a primary mechanism with the available data.     

An operational research programme for monitoring and evaluation

5.1. As indicated above, UNICEF in Sudan at present is really left with no option but to develop their own monitoring programmes to realistically assess the rewards, and possible problems of child survival strategies. Yet, as stated before, monitoring is the only manner in which the field efficiency and effectiveness of programmes can be assessed. Simple demographic surveys are one of the principal information sources on health statistics in developing countries. These surveys are conveniently organised to collect information on special groups at greatest health risks, such as mothers and children, and to gather valuable explanatory data on the economic and social factors affecting the health of the household members. Household surveys have an important role to play in monitoring and evaluating primary health care, since they sample directly the intended beneficiaries and thus can be used to judge the extent to which programmes are meeting their expected goals. Reporting forms currently in use in PHCP programmes need drastic simplification and revision to make them more relevant to policy and programme priorities. Attempts might also be made at micro-level participatory planning and monitoring with the participation of additional technical personnel. By closely monitoring the progress of projects and their effect on the situation of children and women in the project areas, it is hoped that the most effective and efficient models for integration of interventions for child survival and development will be developed. This paper has drawn attention to some future directions in making the best use of household surveys and health care utilization that can be collected through these surveys to periodically monitor programme implementation with the specific purpose of reducing costs, improving efficiency and accelerating implementation. Simultaneously with the surveys, there is a great need to develop comprehensive case studies to determine whether the programmes are achieving what they claim. Past experience has to be studied very carefully and thoroughly at all stages of the programming process to avoid duplication of activities and wrong decisions. One last comment: it is necessary to give more attention to observational feedback based on the situation of the areas and not to get too scientific. Sporadic trends and changes happening in the right direction are the first signs of behavioral changes, and these need to be vigorously pushed, promoted and disseminated. Otherwise there is no room for social marketing and scaling up.     

Causes of fertility decline in Eastern Europe and the Soviet Union

Abstract This is the first part of a wider study which attempts to throw iight on the demographic, economic and social factors that have led to dramatic declines in fertility levels in most socialist countries of Eastern Europe during the last fifteen years or so. The present part is concerned with the purely demographic influences, that is mainly with the impact of changes in the age and sex structure of the populations under study, and in nuptiality. The statistical evidence adduced indicates that the observed downward trends in the annual number of births and in crude birth rates are a reflection of genuine changes in attitudes towards family size.     

Effects of child mortality on subsequent fertility of women in some rural and semi-urban areas of certain Latin American countries

Abstract With the rapid decline in child mortality in developing countries there is considerable interest in understanding its effects on fertility. According to the theory of demographic transition, mortality declines are accompanied by fertility declines after a time lag, as countries go through the process of economic development. However, the immediate effects of a mortality decline on fertility have not been uniform as in many countries fertility has actually increased. For example, in many Latin American countries where mortality declines have been very rapid there have not been any appreciable changes in fertility. Only in recent years has there been a noticeable decline in the urban areas of some nations. While it is possible to examine the effects of various socio-economic factors on mortality and fertility at the macro-level, any real understanding of how mortality itself influences fertility would require information at the micro-level on couples who have experienced child mortality and who are also exposed to the risk of childbearing.     

Economic development and fertility decline: lessons from Asia's newly industrialized countries

The general thesis that economic development and fertility decline are interrelated is substantiated in literature that discusses the successes of the newly industrialized countries of Hong Kong, Korea, Singapore, and Taiwan. When countries are developing rapidly, family planning accelerates the rate of fertility change, particularly among the poor uneducated rural population. Relying on economic and social development is not enough. National policy in Hong Kong, Singapore, Korea, and Taiwan recognized that population growth drains resources and the family planning programs operating since the 1960s contributed to a drop from 5 children/woman to 2 by 1988, and 70% of married couples used contraception. Coupled with this, age at marriage rose, contraception became more available, and educational and employment opportunities increased. Economically, the growth rate in the 1980's was 6-10% annually, with growth in the manufacturing and service sectors and export trade. Close economic ties evolved between governments and private sectors. Social development programs had been fully funded and gains evident in education, living standards, health care and nutrition, and life expectancy. The success of family planning is attributed to encouraging contraceptive awareness and use. Fertility reduction may occur with social and economic development, but no developing countries have reduced fertility without family planning. The relative importance of family planning may change over time, and reducing the cost through government sponsored family planning programs and encouraging the acceptability of contraceptive usage.